Movement disorders associated with diabetes

People living with diabetes may suffer from an array of movement disorders that can cause pain and dysfunction. Physiotherapist, Saadia Jantjes, tells us more.


In the last issue, I discussed the importance of getting active and incorporating more movement into your daily life. But what if you’re experiencing joint or bone pain, discomfort or just have difficulty moving?

One of the barriers preventing people living with diabetes from implementing exercise into their daily routine is movement or musculoskeletal disorders that develop due to diabetes.

Diabetic patients may suffer from an array of musculoskeletal disorders that can cause pain and dysfunction. This could result in a negative effect on the management of their diabetes, stress and a decrease the quality of life.

Common examples of such movement disorders

Frozen shoulder

Frozen shoulder is frequently on both sides in diabetic patients. It’s characterised by severe pain, increased tightening, stiffness, and restricts the range of motions of the shoulder. It has an incidence of 10 – 20% in Type 1 diabetes patients and 7 – 32% in Type 2 diabetes patients. Other risk factors include past shoulder trauma, cardiac-, respiratory- and cerebral diseases. 

Carpal tunnel syndrome

This is a neuropathy that occurs frequently in the wrist and hand. Diabetes is the most common metabolic disease that causes carpal tunnel syndrome, found in 14 – 16% of patients. It is also seen more frequently in women than in men.

Symptoms include paresthesia (abnormal sensation) that worsens in the evenings in the thumb, index, and middle fingers of the hands, which wakes the person up from sleep.

Pain in the wrist and hand can cause clumsiness and poor control of hand movements. It can cause a decrease in work production as well as pain in manual workers, office workers and drivers.

Diabetic peripheral neuropathy (DPN)

Peripheral neuropathy is nerve damage which leads to numbness, loss of sensation, pain or impaired sensation in hands, feet and legs.

The dangers of having neuropathy include loss of balance and poor control of extremities which could result in falls and further injury.

The prevalence of numbness and poor sensation means that bruises, cuts and abrasions are usually gone unnoticed and untreated, leading to ulcers which could result in amputation if infected. It is the most common complication of diabetes; about 60 to 70% of people with diabetes will eventually develop peripheral neuropathy.

However, studies have shown that diabetic patients can reduce their risk of nerve damage by controlling their blood glucose levels through correct nutrition and exercise.

Charcot arthropathy

This is a result of diabetic peripheral neuropathy. It is a progressive and degenerative disease of the foot and ankle joints, which causes damage and deformities of the joint if left untreated. Charcot’s joints are typically seen in patients over the age of 50 who have had diabetes for many years and have existing neuropathic complications.

What to do if one of these sound familiar?

Consult your GP and he/she will point you in the right direction. You may need further tests done to get a proper diagnosis and a consult with a specialist, like a neurologist, orthopaedist, or rheumatologist.

It is important to note that I have only highlighted a few and more common disorders. If you are feeling any pain during exercise or at rest, whether it is constant pain or intermittent pain, the best thing would be to consult your GP and get it checked out. Exercise should not be painful.

I’ve been diagnosed with a diabetes associated movement disorder, now what?

This is where your multi-disciplinary team becomes involved. Not only will you need regular check-ups with your GP, nurse and dietitian, but this is where physiotherapy and occupational therapy become an integral part of your management of your condition as well.

It may all seem incredibly daunting and scary. But keeping yourself informed is one of the best tools when managing your diabetes. The management of your condition is critical in preventing movement complications.

When the control of diabetes is poor, higher levels of diabetic complications result. Pharmacotherapy, diet, and a regular physiotherapy programme should be the cornerstone of diabetes management.

It is imperative to have an appropriate exercise programme, overseen by a GP, as an integral part of diabetes management to reduce the frequency and severity of complications.

MEET OUR EXPERT


Saadia Kirsten Jantjes is a physiotherapist with a passion for health and wellness. With a second degree in Sport Science, exercise is one of her favourite rehabilitation tools, to not only rehab injuries but prevent injuries too. Saadia has her own private practice in Morningside, Johannesburg, while working at a Sub-Acute Clinic and furthering her studies in Pilates.


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Fabulite™ Seafood Cakes

Fish and shellfish are a fantastic source of high-quality protein. They are also low in saturated fat and contain essential omega 3 fatty acids. This recipe also includes macadamia nuts, another source of healthy fats. However, if you’d prefer, you can leave them out.


Ingredients

  • 500g uncooked king prawns
  • 400g boneless fish fillets
  • 100g roasted macadamias, finely chopped
  • ½ small onion, finely chopped
  • 1 tbsp green curry paste
  • 2 tbsp lemon juice
  • 1 tbsp macadamia or olive oil
  • ½ cup Fabulite™ plain yoghurt
  • 1 ½ tbsp chopped mint

Method

  1. Peel and devein the prawns. Chop the prawns and fish roughly. Combine in a food processor and blend until roughly chopped.
  2. Add the macadamia nuts, onion, curry paste, and lemon juice to the fish mixture. Press the mixture together, then divide into eight balls rolled into patties.
  3. Heat the oil in a non-stick frying pan. Add four of the patties and cook on medium heat for a minute on each side or until just cooked through. Repeat with the remaining patties.
  4. Serve with combined Fabulite™ yoghurt and mint.

For more information please visits www.parmalat.co.za


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DSA News Spring 2019

DSA Port Elizabeth news

Health awareness day in Malabar


The Malabar Diabetes Wellness Group held their 4th biennial Health Awareness Day, on 22 June 2019, at the Malabar Community Centre.

Amongst the screenings that were offered free of charge to the community were blood glucose, cholesterol, BMI, TB, HIV/AIDS, vision, hearing, and feet examination. A medical doctor was also in attendance to answer questions and offer advice.

Many healthcare groups manned exhibition tables, namely: Port Elizabeth Branch had a display of old glucometers and syringes as well as a slide show of our history; Springdale concentrated on promoting membership; Malabar had a large variety of pamphlets and were there to advise the people; DSA Young Guns explained what is available for young Type 1s; Nelson Mandela Health District; Parkinson’s Support Group; Heart and Stroke Foundation; Van der Sandt Audiology; Retina SA E.C; Specsavers; CANSA; Podiatrist; St Francis Hospice; ForaCare, Africa; and VitolAire.

A total of 192 people took advantage of the various screenings that were on offer. The youngest was a recently diagnosed two-year-old and the oldest an amazing 95-year-old lady.

Before the doors even opened, members of the community were waiting for the free screening tests.
The Nelson Mandela Health District team, led by Sr. Marina Barnard, were in attendance to assist with the screenings.
Surendra Daya and his hard-working committee ladies helped to keep things running smoothly and to ensure that the service providers had ample tasty refreshments.
Paula Thom and Darren Badenhuizen manned the DSA Young Guns table. They helped, not only to give advice to young Type 1s, but also to help people understand that a person of any age can develop diabetes.

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Getting life insurance when you have diabetes

Did you know that you could qualify for life insurance even if you have diabetes? Janette Rooney tells us more.


If you have a financial advisor, he/she needs to be fully informed about your health and financial status to apply for life insurance for you. Your financial advisor will then conduct a financial needs analysis to ascertain what type of cover you require and how much cover you require under each element.

If you do not have a financial advisor, you, as the client, would deal directly with the insurance company regarding the new business requirements and adverse offers. You don’t have to have a financial advisor, but it’s always better to utilise one as you would be given best advise by an expert who conducts a financial needs analysis. Plus, a financial advisor often negotiates with the insurance companies regarding adverse decisions, as they have the knowledge of the product and the client.

Types of cover

Here are a few examples of the types of cover available:

Life Insurance

Lump sum amount payable in the event of a person’s death. Usually this cover is taken out to cover any financial impact of the person dying:

  • Debt
  • Estate Duty
  • Executors Fees
  • Replace lost income of the person dying for a specific period of time.

Disability

Lump sum amount payable in the event of a client being disabled.

  1. Debt
  2. Revamping of clients lifestyle post disability
  • Apparatus, such as wheelchairs.
  • Modifying vehicle changing to an automatic vehicle.
  • Modifying changes to house, for example, changing a bathroom.

Income Protection

Monthly income replacement in the event of a disability.

Severe Illness

Lump sum amount payable in the event of a server illness, such as cancer.

Life insurance

When it comes to initially applying for life insurance, various initial factors are taken into consideration when generating a life quote, such as age, sex, income, education and smoker status. The initial quote is usually generated with what is called an A1 rating, which is a “healthy life” rating.

The next step is to complete the application form with your financial advisor, where most life insurance companies require full medical history. This is the most important element and it is vital to disclose all health information.

The application form is submitted through to the life insurance companies underwriting team. The application is assessed based on the various risk factors disclosed. The underwriters will then generate a list of requirements. The type of requirements generated would depend on each client’s individual health status.

For people living with diabetes, again depending on the type, the life insurance companies would usually call for glycated haemoglobin (HbA1C) blood test. Depending on the results of this blood test and any other tests required, if the client has any other high-risk health conditions, the life insurance company would then decide on whether to offer the client cover.

Should cover be offered, the offer could be subject to terms and conditions. For example, the premium being loaded, certain ancillary benefits (Disability, Severe Illness and Income Protection) may not be offered, or offered subject to certain exclusions, such as dread disease.

If the life insurance company is not prepared to offer life insurance, some companies are prepared to offer accidental life insurance cover, where you could be covered as the result of accidental death. There are also some life insurance companies who specialise in higher risk clients and it would be best to contact your financial advisor to get guidance in this regard.

Note to remember

All of the insurance companies that I deal with will offer quotes to clients who have diabetes. These include Momentum Life, Discovery Life, Hollard Life, Old Mutual and Brightrock. However, I have had different diabetic clients accepted and other clients declined by the same insurance company. This is because each client is unique and their factors are different compared to the next one. 

Remember, the life insurance company would look at the overall health of the client; what type of diabetes the client has; how controlled the diabetes is. This is determined, for example, by blood tests conducted prior to the company making a decision. Lastly, does the client have any other conditions besides diabetes and how much risk does the other conditions impose? All those factors determine the decision.

Diagnosed after commencement of life insurance

If the client’s health status changes after taking out life insurance, it is always recommended to advise the life insurance company from a disclosure perspective. However, the underwriting was conducted at application stage in accordance with the client’s health status when the cover was taken out. The premiums and conditions cannot be changed due to additional conditions contracted after cover commencement date. The premiums and conditions of cover can be amended when the client adjusts their cover i.e. increases the cover or adds additional cover.

The life insurance companies usually request a health review and depending on the updated health conditions can then underwrite in terms of increasing the premium or exclusions, etc.

Janette-Rooney

MEET OUR EXPERT


Janette Rooney is an independent financial advisor and owns her own brokerage, Le Forge Financial Consultants. She started her career, in 1993, in the medical aid industry, working for Medscheme and then for Discovery. 


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Informing the uninformed – doctors and patients

Lisa Swaine gives us legal insight as to why doctors need to have a record of informed consent, and highlights that good clear communication is key.


1 April 2019 was certainly not a day for fools. The Supreme Court of Appeal gave judgment in the case of Beukes v Smith ((211/2018) [2019] ZASCA 48) for a surgeon whose information to his patient was called into question.

The decision highlights the value of keeping proper written records of explanations, discussions and advice leading to the informed consent to avoid protracted legal proceedings for both doctors and patients.

What is informed consent?

The introduction to the ethical guidelines published by the Health Professions Council of South Africa succinctly describes informed consent in this statement: “Successful relationships between healthcare practitioners and patients depend upon mutual trust. To establish that trust, practitioners must respect patients’ autonomy – their right to decide whether or not to undergo any medical intervention, even where a refusal may result in harm to themselves or in their own death. Patients must be given sufficient information in a way that they can understand, to enable them to exercise their right to make informed decisions about their care. This is what is meant by informed consent.”

Medical treatment cannot be provided in the absence of consent. Our courts have held that, to give proper informed consent, a patient must be informed of all material risks associated with the treatment.

What is material? If a reasonable person in the position of the patient, warned of the risk, would attach significance to the risk, it is material. To give proper informed consent, the patient must know, appreciate and understand the nature and extent of the harm or risk.

The claim in the proverbial nutshell

Dr Smith performed a laparoscopic (using multiple small incisions with ports to perform surgery with specialised instruments) hernia repair on Mrs Beukes. She sued him for damages alleging that he had negligently failed to provide her with sufficient information to enable her to give informed consent for the surgery.

Dr Smith’s alleged failure was to inform her that the hernia repair could have been done by way of a laparotomy procedure (older technique that relies on a single large incision, through which a surgeon uses his or her hands to directly perform the procedure).

His failure caused her to give uninformed consent to the laparoscopy during which her colon was perforated, resulting in her suffering complications and damages.

Mrs Beukes lost in the Gauteng Division of the High Court in Pretoria. The appeal was against that judgment.

Consultation, motivation, operation, complication

Against the backdrop of the surgery lay Mrs Beukes’ medical risk. She was a high-risk patient which meant that because of her health, lifestyle and medical history, the risk of her suffering complications related to surgery was high.

Mrs Beukes was referred to Dr Smith who consulted with her on 21 February 2012. He admitted her to the hospital as surgery was inevitable if she did not respond to conservative treatment. The issue would then be which surgery to perform.

After having consulted the referring doctor’s report and radiological reports, Dr Smith’s recommendation was that the laparoscopy would be the best option for Mrs Beukes in the circumstances.

Dr Smith wrote a detailed motivation for approval for the laparoscopy to Mrs Beukes’ medical aid in which the reason for his recommendation for the laparoscopy was stated and the general and specific advantages of the surgery were listed.

The laparoscopy was performed by Dr Smith on 23 February 2012. Mrs Beukes was discharged from hospital on 28 February 2012.

Three days’ post-discharge, Mrs Beukes was re-admitted to hospital with various complications associated with a perforation of her colon which included sepsis. She underwent three further surgical procedures and remained in hospital until 19 April 2012.

Trial and tribulation

The doctor’s version

According to Dr Smith, Mrs Beukes gave him informed consent orally on 22 February 2012, after he had consulted with her and explained the nature of each of the two options available, being the contemplated laparoscopic surgery and the laparotomy, and the material benefits and risks associated with both.

He had informed her that, in his opinion, the laparoscopy was the better option in the circumstances. He also testified that she had signed a written consent shortly before the operation on 23 February 2012, which formed part of the record and was a confirmation of the oral consent given the previous day following his explanation of both procedures.

The patient’s version

Mrs Beukes, on the other hand, denied that Dr Smith had explained both procedures to her. She insisted that, in her first consultation with Dr Smith on 21 February 2012, he told her that he would first consult with the radiologists on her scans and thereafter perform a “quick 15 to 20-minute operation” to repair her hernia with a mesh and in “two or three days” she would be home.

In her version, Dr Smith made the decision to do the laparoscopic hernia repair during the first consultation on 21 February 2012 before having consulted the radiologists. She also denied having signed the written consent. She testified that had she been informed that the hernia could also have been repaired through a laparotomy, she would have discussed her options with her family and would have opted for the less risky of the two procedures. But, she trusted Dr Smith and believed him when he told her that the laparoscopy was a simple procedure that would take 15 to 20 minutes and that she would be discharged from hospital in three days.

Expert opinions

The specialist surgeons who gave expert testimony on behalf of Mrs Beukes and Dr Smith agreed that Mrs Beukes was a high-risk patient, that under the circumstances, the laparoscopy was the better option; the procedure had been performed by Dr Smith without negligence; and that Dr Smith’s post-operative management of Mrs Beukes was acceptable.

Was informed consent obtained?

The only issue was whether informed consent had been obtained.

At the heart of Mrs Beukes’ contentions was the fact that there was no written record of the details of the informed consent discussion.

It was not disputed that no record had been made of the content of Dr Smith’s explanation to Mrs Beukes.

Mrs Beukes’ version was that, in the absence of evidence on the detail of her consultation with Dr Smith, the court had to conclude that Dr Smith had not given Mrs Beukes the necessary information as he alleged and further, even if he had given her some information, it was not sufficient to enable her to make an informed decision

Dr Smith’s evidence was entirely reliant on his memory of what had transpired over the relevant period. However, as found by the trial court, several aspects supported his version, such as his demeanour and diligence which were more consistent with his version that all had been sufficiently explained.

Added to this were the medical records which also supported his version as opposed to that tendered by Mrs Beukes. Mrs Beukes’ version was inconsistent with Dr Smith’s undisputed caring and diligent nature.

The medical records suggested that there had been a more substantive discussion between her and Dr Smith than she was willing to admit. The written representations made by Dr Smith to Mrs Beukes’ medical aid, after his consultation with her the morning before the laparoscopy, were consistent with his version and revealed that the material risks and benefits of the medical procedures occupied his mind. Nothing in the medical records contradicted Dr Smith’s evidence.

Judgment day

Fortunately for Dr Smith, the Appeal Court found no basis upon which to overturn the factual finding by the trial court that Dr Smith’s version was probable and that of Mrs Beukes was not.

The cost of not recording what is said

Unfortunately for Dr Smith, as it would appear from what was stated in the judgment, he was subjected to lengthy cross-examination from which he might have been spared had there been a written record or other record of his explanation, discussion and advice leading to the informed consent.

That is aside from the cost of the litigation to Dr Smith and by cost, I don’t just mean legal costs. Litigation is stressful and takes one out of one’s day-to-day professional practice. It comes with a high personal and economic price tag.

Keeping record not only protects the patient which is primary. It also protects the practitioner and may well avoid the risk of becoming embroiled in costly and lengthy ‘he said – she said’ debates.

MEET OUR EXPERT


Lisa Swaine is a partner at Webber Wentzel. She is a dispute resolution and litigation specialist.


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Mindful eating vs gulping down food

Dietitian, Retha Harmse, educates us on why we shouldn’t gulp down our food but rather practise mindful eating.


We all have those days when we are strapped for time to sit and savour a meal. Sometimes we eat in the car in traffic. Other times we eat on our laps in front of the television, or while working in front of the computer.

Unfortunately, in our fast-paced lifestyle these scenarios mentioned are often the norm and not the exception. And, unfortunately, gulping down of food and quickly devouring meals come with a cost.

Recent research, from Japan’s Hiroshima University, identified the link between gulping down food and metabolic syndrome.

What is metabolic syndrome?

Metabolic syndrome is a group of metabolic risk factors that exist in one person. Some of the underlying causes of this syndrome that give rise to the metabolic risk factors, include being overweight, having insulin resistance, physical inactivity and genetic factors.

Metabolic syndrome is a serious health condition. The reason why this is an area of concern is that people with this syndrome are also more likely to develop Type 2 diabetes.

What is mindful or intuitive eating…and how does it help?

Eating is a natural, healthy and enjoyable activity to satisfy hunger and fuel the body. But in our diet-obsessed, food abundant culture, many individuals struggle with a love-hate relationship with food.

Eating is too often mindless, overwhelming, and guilt-inducing instead. This troubled relationship with food often lies at the heart of some of the most common health problems in our society. Or, it can be a ‘symptom’ of unmet needs in other areas of one’s life.

Mindful eating is an ancient, mindfulness-based practice with profound implications and applications for resolving problematic eating behaviours and troubled relationship with food. It also fosters the development of self-care practices that support optimal health.

Although the concept has grown in popularity recently, mindful eating is still widely misunderstood and underutilised. So, let’s talk it through.

What exactly is mindful eating?

One very simple and practical way to think about mindful eating is with intention and attention. Eating with the intention of feeling better when you’re finished than you did when you started, and with the attention necessary to notice food and its effects on your body and mind.

Research on mindful eating and mindfulness as it relates to eating behaviours is accumulating quickly, with promising results. The evidence demonstrates a positive impact on a wide variety of food- and well-being related issues, including emotional eating, binge eating, food cravings, nutrient intake, blood glucose regulation, and more.

Often narrowly understood as ‘eating slowly’ or ‘eating without distraction’, mindful eating may also incorporate thoughts, feelings, and behaviours throughout the entire process of eating. The goals of mindful eating can be broadly summarised as follows:

  • Cultivating awareness of physical and emotional cues.
  • Recognising non-hunger triggers for eating.
  • Learning to meet non-hunger needs in more effective ways than eating.
  • Balancing eating for nourishment and enjoyment.
  • Increasing satisfaction from eating.
  • Using the energy you consume to live vibrantly.

Dr. Michelle May states it perfectly, in the book series Eat What You Love, Love What You Eat: “When a craving doesn’t come from hunger, eating will never satisfy it.”

Eating is so much more than what you eat or even in the manner you eat. Mindful eating helps us look beyond the superficial reasons why we eat.

How does mindful eating help improve health and quality of life?

  • Increases consciousness of unrecognised or unexamined triggers.
  • Creates space between triggers and response.
  • Interrupts old, unconscious and ineffective patterns and habits.
  • Empowers decision-making that supports optimal well-being.
  • Develops skills that positively influence other areas of life.

Who benefits from mindful eating?

Mindful eating is a simple concept that can be applied in any setting – home, work, dining out, travelling, and special occasions. It’s a flexible approach that doesn’t depend on a limited list of foods. So, it works well across cultures and socioeconomic conditions. It doesn’t require weighing, measuring, reference lists, logging, or other time-consuming practices, so it fits into even the busiest lifestyle. Unlike dieting which becomes more difficult over time, mindful eating becomes easier and more natural with practice.

In addition, mindful eating is an effective approach for resolving issues related to food and physical activity that diminish well-being and quality of life for people across the health spectrum. Those who have struggled with yo-yo dieting or weight cycling and have tried numerous programs (including weight loss surgery) are especially likely to benefit from this approach because it’s not based on restriction, deprivation and willpower.

People who are at risk for or affected by chronic conditions impacted by nutrition, such as metabolic syndrome or diabetes, benefit greatly by learning sustainable self-management skills through mindful eating.

So, in short, anyone who eats can benefit from bringing greater intention and attention to their decisions.

How to get started with your first mindful eating practice:

  • Start with a favourite: Choose a favourite food or dish you really enjoy and have eaten often.
  • Sense it: Observe the look, touch, texture, and smell. Appreciate the appearance and scent of your food and begin to perceive any sensations happening in your body, particularly stomach and mouth.
  • Observe before you chew: Once you take a bite, observe the sensation of food in your mouth without chewing. Carefully think about the taste of the food.
  • Go slow and think: Chew slowly and pause briefly. Think about the location of the food in your mouth, as well as the taste and texture. Concentrate on how the taste and texture changes as you continue chewing.
  • Pause: Before you swallow, pay attention to the urge to swallow. Do so consciously and notice the sensation of the food travelling down the oesophagus to the stomach. Pay attention to any physical sensation.
  • Be grateful: Take a moment to express gratitude for the food, for those who provided it for you, and for how it was made. The concept of gratitude will help in the overall process of mindful eating.
Retha Harmse is a Registered Dietitian and the ADSA Public relations portfolio holder. She has a passion for informing and equipping the in the field of nutrition. She is currently in private practice in Saxonwold, Houghton and believes that everyone deserves happiness and health and to achieve this she gives practical and individual-specific advice, guidelines and diets.

MEET OUR EXPERT


Retha Harmse (née Booyens) is a registered dietitian and the ADSA Public Relations portfolio holder. She has a passion for informing and equipping in the field of nutrition. She is currently in private practice in Saxonwold, Houghton and believes that everyone deserves happiness and health and to achieve this she gives practical and individual-specific advice, guidelines and diets.


Header image credit by Freepik 

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