Diabetes complications – your screening check list

Diabetes nurse educator, Christine Manga, explains why screening for diabetes complications should form part of your diabetes healthcare plan.

Screening for diabetes complications

Diabetes is a disease that affects and damages the vascular system, large and small blood vessels. It is damage to the vascular system that leads to diabetic complications.

Large blood vessel damage is associated with increased risk of heart attack and strokes. Small blood vessel damage is associated with increased risk of kidney failure, retinopathy (blindness) and peripheral neuropathy.

Maintaining good blood glucose control can help with delaying and possibly preventing complications. But this alone is not enough. Blood pressure and cholesterol levels also need to be managed.

Screening for diabetes complications should form part of your diabetes healthcare plan. Regular screenings allow for early detection of complications before you are aware of the problem.

Most of the complications are ‘silent’ with symptoms developing after damage has occurred. All people with diabetes should undergo screening for complications.

Screening for retinopathy

Eyes should be screened annually. An ophthalmologist usually does the screening, though some optometrists have the training and equipment required to perform the test.

Drops are placed into the eyes to dilate (widen) the pupils so that the examiner can see the retina of the eye. The drops may cause your vision to blur and driving would not be possible for a few hours after the procedure.

Any abnormal blood vessels, scar tissue, new blood vessels, swelling, bleeding or fatty deposits in the retina will be detected. In addition, any damage to the optic nerve and cataract development would be observed.

A separate test will be done to measure the pressure of the eye. Increased eye pressure, a condition called glaucoma, can also cause blindness.

The results of the screening will show:

  1. No signs of the complications.
  2. Early signs of complications.
  3. Follow-up and treatment decision required. Treatment may not improve sight, but it can prevent further deterioration.
  4. More frequent check-ups required.

Early detection and treatment of eye complications is usually successful and can prevent vision loss.

Screening of peripheral neuropathy 

Peripheral neuropathy is pain, weakness or numbness in the feet and, occasionally, hands caused by nerve damage. It can also present as a burning sensation or pins and needles.

Due to damage of the small blood vessels, the nerves can’t receive nourishment. The blood vessel damage will cause ischaemia (poor blood circulation) in the lower legs and feet. This can further cause redness or a blueish tinge, swollen and sore feet. It also increases the risk of developing skin infections and skin ulcers.

Seeing a podiatrist (foot specialist) at least once a year is recommended. A podiatrist will examine your feet for blood flow, temperature, sensation and general condition. They may detect a ‘silent’ loss of sensation.

You will also be educated on good foot care. This will include the teaching of self-foot examination, proper nail cutting technique and the importance of foot moisturisation. Footwear choices as well as the appropriate type of shoes for your feet and how to wear in new shoes will be discussed.

Blood pressure and cholesterol screening

Blood pressure should be checked at least every three months. This can be tested at a routine visit to the doctor, your local chemist or at home on a home device.

Blood pressure targets should be personalised and discussed with your doctor. There are general guidelines that he/she will follow. Blood pressure and cholesterol management go hand in hand.

A lipogram, a full cholesterol test, checks all aspects of the cholesterol and should be performed annually. The reference ranges of results are different for people with diabetes who have more risk factors compared to the general population. Medication and dietary modification will be prescribed to manage these conditions if necessary.

Dental screening 

People with poorly-controlled diabetes are at a greater risk of developing dental problems, such as periodontal disease. Other oral manifestations could include a very dry mouth, a burning sensation in gums, delayed healing of mouth sores as well as an increased frequency and severity of infections.

Poor glucose-control exacerbates dental complications. The reverse is also applicable, periodontal disease worsens blood glucose control.

Dental treatment may need to be delayed until blood glucose levels are under control. A dental screening should be performed at least every six months.

Early detection is key

It is vital that screening is done on a regular basis for all possible complications. As stated earlier and cannot be emphasised enough, early detection is key to early management.

Christine Manga (Post Grad Dip Diabetes and Msc Diabetes) is a professional nurse and a diabetes nurse educator. She has worked with Dr Angela Murphy at CDE Centre, Sunward Park since 2012.


Christine Manga (Post Grad Dip Diabetes and Msc Diabetes) is a professional nurse and a diabetes nurse educator. She has worked with Dr Angela Murphy at CDE Centre, Sunward Park since 2012.

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Social distancing and exercise

Saadia Kirsten Jantjes shares helpful tips to keep you and your family active during this period of social distancing.

With social distancing and self-isolation becoming a part our daily lives due to the outbreak of COVID-19, it is a great chance to optimise on some family time and establish familial bonds. A great way to do so is through exercise.

Managing your diabetes means coming up with exciting ways to keep fit and active, especially since most gyms are either closed or too high-risk.

One of the major benefits of exercise, apart from weight management, is the major and positive effect it has on boosting the immune system, which is imperative at this point.

Get started

If you’re still new to exercise and not sure where to start, there are many online videos and workout programmes which you can download, either on Pintrest or YouTube. A word of advice, make sure the source is reliable and that the content is provided by a registered fitness trainer.

Change it up

If you are working from home and taking care of the kids, doing the same thing each day will become monotonous. Add variation so that you are doing different activities each day ranging from cardio activities, like walking or running, to strength training activities, like weight training or Pilates.

Make it rewarding

Create little challenges and make it competitive, rewarding and fun. Other than getting your Vitality step or workout rewards, make it rewarding to work out as a family. You can do a timed workout or obstacle course. Use incentives, such as chores, to see who gets to choose the next movie or series, or who gets a special treat to keep the morale up at home.

Track your progress

It’s a good idea to do some basic measurements (weight, height, circumference measurements like waist, hip, thigh) and a basic fitness test to track your progress. This can be something simple like seeing how many push-ups and squats you can perform in one minute. Retest and redo your measurements every week to make sure you’re on track and making progress.

Be mindful

It is a stressful time, which could result in increased anxiety for both you and your family. This isn’t helpful when it comes to managing your diabetes. Incorporate activities, such as yoga and meditation, into your exercise plan to find a good balance between physical fitness and mental health.

It is a trying and testing time for everyone. Taking care of your and your family’s health and well-being is of the utmost importance, so make sue you are taking time to stay fit, healthy and mentally active.


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.

Sugar Tax: An update – where are we at currently?

ADSA spokesperson, Mari Pronk, updates us on the current standing of Sugar Tax.

The obesity epidemic

South Africa is facing a severe and growing obesity epidemic.According to the South African Demographic and Health Survey (2016), 68% of women, 31% of men and 13% of children are overweight or obese.1 This makes South Africa the country with the highest overweight and obesity rate in Sub-Saharan Africa.

Sugar and health

Added sugars (added sugars are any sugars added to foods or drinks by a manufacturer, cook or consumer), particularly in beverages, are a major cause of increased weight gain and tooth decay.

The World Health Organisation (WHO) recommends that: the daily consumption of added sugars should be less than 10% of an individual’s daily energy intake. This would be equivalent to about 12 teaspoons of granular sugar per day for adults. For additional health benefits, this amount can further be reduced to 5% of daily energy intake (about six teaspoons of sugar).2

Sugar-sweetened beverages

Sugar-sweetened beverages (SSB) are non-alcoholic beverages, sweetened with added sugars. There is convincing evidence to support a positive link between the intake of SSB and the risk of obesity, diabetes and other conditions, such as stroke and heart disease.3

SSB consumption rates among urban and rural communities in South Africa have increased considerably over the past 20 years. Reports show that the total SSB consumption has risen by 68,9% from 1999 to 2012. This increase is accompanied by an increase in the rate of overweight and obesity, leading to an increased risk of non-communicable diseases, such as diabetes.4

Regular, high-calorie carbonated soft drinks are considered the most frequently consumed of all SSB categories. Several studies indicated that the frequent consumption of these drinks is due to habit, addiction, advertising and the wide availability of inexpensive SSB, as opposed to more expensive fruits, vegetables and wholegrain products.3,4

What is sugar tax?

The Health Promotion Levy (HPL) on sugary beverages is a levy that was introduced, in support of the South African Department of Health’s Strategic Plan for Prevention and Control of Obesity and aims to reduce obesity by 10% by 20205.

South Africa was the first country in Africa to introduce the taxation of SSB, when the tax was introduced in April 2018, with the objective of reducing SSB consumption.

In 2018, sugar tax started at a rate of 2,1 cents per gram of sugar content, which exceeds 4 grams (about one teaspoon of granulated sugar) per 100ml. The first 4 grams per 100ml are levy free.6

The sugar tax results in an average price increase of 11% on SSB, whereas the WHO recommends an increase of 20% or more, to be effective.7

In 2019, sugar tax increased from 2,1 cents to 2, 21 cents, in line with the then inflation rate of 5,2%.8This amount is unchanged for the 2020/2021 financial year.

A can of 300ml (current can size) Original Taste Coke (contains 33g sugar) will not be taxed on the first 12g (4g for each 100ml) of sugar. The remaining 21g of sugar will be taxed at a rate of 2,21 cents per gram. Thus, a 300ml can of Original Taste Coke is taxed by 46,41 cents. A can of 300ml Less Sugar Coke (contains 24g sugar) is taxed by 26,52 cents.

 Locally manufactured SSB are taxed at source, meaning that the tax should be paid by the manufacturer.6

 Effect on consumption

In countries where sugar tax has been implemented, such as Mexico, Portugal, Ireland, Canada and in some states in the USA, the impact on consumption has been greater in poorer households.4 Unfortunately, the same impact is expected in South Africa.

Mexico has so far been the most successful with their sugar tax levy. There was a decrease in the consumption of taxed beverages by an average of 6%, after implementation in 2014.7


Producers of SSB have started to reduce the sugar content of their products to reduce sugar tax. Coca-Cola has reduced the sugar content of its SSB by 26%.8

Another strategy by manufacturers of SSB, was to reduce the volume of the product by 10%.7A 330ml can of SSB now only contains 300ml and a 500ml bottle now contains 440ml.

The reduction in sugar content and container size may possibly contribute to a decrease in sugar intake by consumers.

A recent study found that, since the introduction of sugar tax, there has been a significant price increase in carbonated soft drinks. It was found, however, that the price increase was similar for no sugar and high-sugar beverages, despite the underlying difference in tax liability.9

Effect on the sugar industry

According to the SA Cane Growers Association, the price of sugar cane is at a record low. This is due to the impact of a devastating drought; cheap sugar being imported from other countries; and a substantial drop in the demand for sugar since the implementation of the sugar tax.10

Tax income

During the first year after its introduction, sugar tax has raised almost R3 billion.8 Many public health experts called for this money to be specifically allocated for obesity prevention initiatives. Money generated from the HPL goes into the National Revenue Fund, to be used for general government expenditure, including health expenditure, which also include health promotion interventions.8

The future

Non-profit organisation, the Healthy Living Alliance (Heala), has asked Treasury to increase (to 20%) and expand (to include fruit juices which have high sugar content) South Africa’s sugar tax, as the country deals with growing health issues.11


Studies are currently underway to determine the impact of sugar tax on the consumption of SSB, to determine its reduction of obesity.5

In the meantime, it is important to note that South Africa probably needs to complement sugar tax, with lifestyle and dietary change strategies. These strategies might include increasing physical activity and improving the availability and cost of healthy food choices, such as fruit, vegetables and whole grain products.


  1. South African National Department of Health (2017) ‘South Africa Demographic and Health Survey 2016 – Key Indicators Report’ Available at: https://www.statssa.gov.za/publications/Report%2003-00-09/Report%2003-00-092016.pdf (Accessed: 6 March 2020). 
  2. World Health Organisation (2017) ‘Sugar tax, why do it?’ Available at: https://apps.who.int/iris/bitstream/handle/10665/260253/WHO-NMH-PND-16.5Rev.1-eng.pdf?sequence=1(Accessed: 6 March 2020).
  3. Bosire, E.D., Stacey, N., Mukoma, G., Tugendhaft, A., Hofman, K. and Norris, S.A. (2019) ‘Attitudes and perceptions among urban South Africans towards sugar-sweetened beverages and taxation’, Public Health Nutrition, 23(2), pp. 374-383.
  4. Okop, K.J., Lambert, E.V., Alaba, O. Levitt, N.S., Luke, A., Dugas, L., Dover, R.V.H., Kroff, J., Micklesfield, L.K., Kolbe-Alexander, T.L., Smit Warren, Dugmore, H., Bobrow, K., Odunitan-Wayas, F.A. and Puoane, T. (2019) ‘Sugar-sweetened beverage intake and relative weight gain among South African adults living in resource-poor communities: longitudinal data from the STOP-SA study’, International Journal of Obesity, vol. 43, pp. 603–614. Available at: https://doi.org/10.1038/s41366-018-0216-9 (Accessed: 6 March 2020).
  5. Schneider, F. (2019)‘Health Levy or Sugar Tax: Is the Pain Worth the Gain?’, Taxtalk Magazine. Available at: https://www.thesait.org.za/news/450529/Sugar-Tax.htm (Accessed: 6 March 2020).
  6. South African Revenue Services (2019) ‘Health Promotion Levy on Sugary Beverages’ Available at: https://www.sars.gov.za/ClientSegments/Customs-Excise/Excise/Pages/Health%20Promotion%20Levy%20on%20Sugary%20Beverages.aspx(Accessed: 6 March 2020).
  7. ‘Is sugar tax really a health measure or a tax income stream?’, https://www.bizcommunity.com,18 Feb 2019 [Online] (Accessed: 6 March 2020).
  8. Pilane, P. and Green, A. (2019) ‘Sugary drinks tax turns one — amid opposition’, Health-e news, 1 April [Online]. Available at: https://health-e.org.za/2019/04/01/sugary-drinks-tax-turns-one-amid-opposition/(Accessed: 6 March 2020).
  9. StaceyN., Mudara, C.,WenNg, S., Van Walbeek, C., Hofman, K. and Edoka, I. (2019)Sugar-based beverage taxes and beverage prices: Evidence from South Africa’s Health Promotion Levy’, Social Science and Medicine, vol. 238. Available at: https://doi.org/10.1016/j.socscimed.2019.112465 (Accessed: 12 March 2020).
  10. Stainbank, G. (2019) ‘Sugar Tax: Devastating to an Industry Already on its Knees’,Taxtalk Magazine.Available at: https://www.thesait.org.za/news/450529/Sugar-Tax.htm(Accessed: 6 March 2020).
  11. ‘Push to increase South Africa’s sugar tax’, Businesstech, 12 February 2020 [Online]. Available at: https://businesstech.co.za/news/finance/373280/push-to-increase-south-africas-sugar-tax/(Accessed: 6 March 2020).


Mari Pronk is a registered dietitian and a spokesperson for the Association for Dietetics in South Africa (ADSA). She is currently in private practice in Pretoria. She holds a post-graduate diploma in Diabetes and has a special interest in diabetes, cholesterol, renal disease and IBS.

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Water – the best things in life are free

Lila Bruk advocates that water should be your essential tonic for optimum health.

Over 70% of the body is made up of water, and water has many essential roles within the body. It is necessary for important body processes, such as digestion, excretion and metabolic functioning. It, therefore, should come as no surprise that drinking enough water is essential for optimum health.

Regular plain water is best

There is a huge variety of bottled water available now, including flavoured carbonated waters, as well as those that promise additional health benefits (e.g. slimming water).

However, flavoured waters often contain just as much sugar as regular sugary soft drinks, or else have large quantities of artificial sweeteners.

Similarly, those waters that claim that they boost your metabolism, or give you more energy are usually packed full of substances, which may be detrimental to your health and/or can even adversely affect your body’s response to certain medication.

For example, ginseng is often added to slimming waters and energy drinks, as it allegedly helps to boost energy levels. However, ginseng can, in fact, interact with blood thinning medications and intensify their affects, which in turn can lead to bleeding problems. For this reason, regular plain water is your best bet.

How much water do I need?

For every kilogram you weigh, you need 30ml. Therefore, to work out how much water you need, multiply your weight in kilograms by 30. So, if you weigh 60kg; 60kg x 30ml = 1800ml. You would need a minimum of 1800ml or 1,8l of water.

Then for every 30 minutes of exercise you do, you need at least an additional 250ml of water.

Therefore, if you weigh 60kg and do an hour of exercise on a given day, you need: 1800ml + (2 x 250ml) = 2300ml or 2,3l. This means you need at least 2,3l water per day.

Of course, on very hot days or when you’re doing particularly strenuous exercise, you may need even more fluids.


As mentioned previously, natural uncarbonated water is preferable. However, if you don’t like the taste, you can add lemon juice, a dash of fruit juice, orange slices, or even mint leaves. Some prefer to drink hot fluids, which is also totally acceptable, as water is good for you regardless of the temperature.

Also remember that other liquids can also contribute to your fluid intake, such as rooibos, herbal or fruit teas and vegetable soups.

For the warmer summer months, try making your own iced tea using a fruity, non-caffeinated tea as a refreshing alternative to plain water.

If you find that increasing your fluid intake leaves you taking far too frequent bathroom breaks, don’t despair. Rather, keep up with your water-drinking and before too long, your body will have adapted to the increased fluid intake.

Is it possible to drink too much water?

Yes, it is. More than approximately six litres a day can, in fact, be dangerous. If one drinks too much, it can cause the body’s sodium levels to drop (otherwise known as hyponatremia), which can have many detrimental effects on the body, such as swelling of the brain.

Can water help me lose weight?

Yes, it can aid weight loss in three main ways:

  1. Often one mistakes thirst for hunger, which results in one eating when in fact the body needs fluid. Also, in this situation when one’s body is crying out for fluids, it is usually sweet, starchy foods that one craves. Therefore, by drinking enough, one can minimise the risk of eating unhealthy snacks.
  2. Fruits, vegetables and wholegrain breads, grains and cereals are all rich in fibre and an essential part of a healthy low-fat eating plan. Fibre acts as a sponge in the body, as it absorbs water and makes you feel fuller for longer. Therefore, you’re less likely to snack on unhealthy choices. However, if you don’t drink enough, you won’t get the full ‘filling-up effect’ of fibre.
  3. Even mild dehydration has been found to detrimentally affect athletes’ sporting performance. Therefore, by drinking enough you can be sure that you’ll train at your optimum intensity. Thus, ensuring that you burn the maximum number of calories during your training session, and in this way optimising your weight loss.

So, in conclusion, look at water as your essential tonic for optimum health, rather than a good mixer or a precursor to ice cubes, and prepare to reap the benefits!


Lila Bruk  is a registered dietitian and nutritional consultant in private practice in Johannesburg, Gauteng. She is passionate about promoting health and good nutrition and thus has written in over 350 general and health-related publications. She gives regular lectures on nutrition-related topics, and appears regularly on television and radio. Her areas of interest include nutritional management of lifestyle diseases (including diabetes, insulin resistance and heart disease), digestive disorders (e.g. Crohn’s disease, Irritable Bowel Syndrome), eating disorders, food allergies and sports nutrition.

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How to help children deal with diabetes-related stress

Daniel Sher suggests four psychologically-informed strategies to help children cope with diabetes-related stress.

As a parent of a child with diabetes, it is fair to assume that you are no stranger to stress. We all know how detrimental chronic stress can be for any child’s mental and physical well-being. When it comes to diabetes care, stress can make it that much harder for children to cope.

The signs of stress in children

Stress is a physiological, mental, emotional or behavioural response to a difficult situation.

  • Physiological signs of stress include muscle tension, shallow breathing, restlessness, sweating and an elevated heart rate.
  • Mental manifestations of stress are thoughts which seem overwhelming and disproportionately negative. Examples include “I’ll never get this right”, “I’m losing control” or “My readings are never where I want them to be.”
  • Stress also manifests emotionally, leading to feelings of shame, anxiety, irritation, fear or anger.
  • Finally, stress can manifest behaviourally, in the form of anger outbursts, social withdrawal, forgetting to take one’s insulin or falsifying one’s blood-glucose results.

Stress and diabetes: a vicious cycle

Stress can affect diabetes directly, by increasing the level of cortisol and adrenaline (stress hormones) in the bloodstream. These chemicals make it harder for insulin to work properly, which can cause a spike in blood glucose levels.

Stress also affects diabetes indirectly. A stressed child, for example, may be more susceptible to eating sweet treats, avoiding testing or skipping on insulin doses. Adolescents may engage in denial and avoidance, whereby they choose to take a break and pretend that they don’t have diabetes for a period.

Four ways to help your child fight stress

It is important to tailor these strategies according to your child’s age and temperament.

  1. Empathise and reflect

Humans are biologically hard-wired to seek out social support. While there are many practical tools (such as meditation and exercise) that can be used to manage stress, arguably the best way to help children de-stress is to make them feel heard.

This involves temporarily brushing aside your own, personal concerns about the situation and truly putting yourself in your child’s shoes. Ask yourself what he/she is feeling and why? Try to imagine their actual emotional experience.

Establishing true empathy will make it that much easier to connect with your child in a way that promotes healing, on a neurobiological level.

Once you have a sense of what they are going through, ‘reflect’ this back to them. So, that they have an experience of being heard and supported. Examples of reflective statements include:

  • “It sounds like this is really tough for you.”
  • “I can see how angry you are.”
  • “It’s clear that you’re feeling overwhelmed.”
  1. Help them name their feelings

To support your child, help him/her develop a vocabulary with which to express emotion. Research has demonstrated again and again that translating emotions into language (or namingfeelings) helps people to regulate their emotions.

Start by asking your child to help you understand what they are feeling. If they don’t have the vocabulary to describe their emotions, help them by proposing possible labels, such as:

  • sad
  • scared
  • hurt
  • angry
  • helpless
  • hopeless

If it feels like these concepts are too abstract for your little one, you can start by focussing on where in the body their emotion is felt. Emotions often manifest physiologically. Is the feeling warm or cool? Radiating, pulsating, vibrating or static? Does their emotion have a colour? Have interactive conversations about emotions. Don’t forget to reward them as they learn to develop this vocabulary.

  1. Model healthy behaviours and attitudes

Modelling means leading by example. Sometimes, the best way to help your little ones’ cope is by showing them how we manage our own stressors. How can you model healthy stress management to your child?

Know the difference between healthy and unhealthy coping mechanisms. How do mom and dad manage when things get tough? Do they go get some endorphin-boosting exercise, take a dip in the ocean, or attend a yoga class?

Or are they more inclined to get snappy, binge eat on junk food or turn to alcohol? When mom and dad get stressed, are they able to verbalise and own their experience, or do they withdraw into themselves?

Modelling healthy stress-reduction mechanisms is vital. Not only does this teach your children adaptive skills and techniques for coping, it also helps them to feel more secure in themselves.

Children who believe that their parents know how to cope with stress are better equipped, on an emotional level, to feel competent in doing so themselves.

  1. Treats are okay

Food is a big deal. The dietary restrictions that a diabetes diagnosis brings can feel incredibly limiting. It is important to recognise that as they grow, they will become increasingly independent. This means that before long, you will have no say whatsoever as to whether they choose to cheat.

In her excellent book The Emotions of Children with Diabetes, Rosemary Flynn describes the difference between ‘cheating’ and ‘treating’. Cheating involves deception, while treating is a form of self-care. If your son has an occasional portion of his favourite ice cream for dessert and accommodates by increasing his insulin dose, this is not cheating, but treating. But, if he sneaks a chocolate bar behind your back and doesn’t accommodate for it, that is cheating.

If your child wants the occasional treat, don’t make them feel shamed or shunned. Support them in their choice to treat themselves occasionally, if they are taking appropriate measures to compensate with insulin or exercise.

At the end of the day, it is not our job as parents to dictate our children’s choices to them. But to support them in making safe and informed decisions for themselves.

When to seek professional help?

While stress and anxiety often go hand-in-hand, they are not the same thing. Anxiety disorders are mental health conditions that may be triggered by acute or chronic stress. If you think that your child may be developing an anxiety disorder, it is important to seek help from a licensed mental health professional.

Do your child’s stress levels feel out of control? Are they stressed-out for extended periods of time? Are they unable to cool-off and regulate their emotions? Is their stress significantly impacting on their grades, social lives, relationships or physical health?

If the answer to any of these questions is ‘yes’, your child may benefit from a consultation with a psychologist who can help them set up an anxiety treatment plan.

Taking back control

Stress is inevitable. Everyone experiences it. We know that stress can negatively affect mental and physical health, making it harder for children to effectively manage their diabetes.

However, stress in and of itself is not a bad thing! If we feel equipped to cope, small doses of stress can make us feel energised, focussed and motivated.

The answer, therefore, is not to try to completely eliminate stress from the lives of your kids. This is impossible. Rather, we need to support them in developing the tools and feelings of competency that they will be able to draw on to manage stress effectively.


Baikie, K. A., & Wilhelm, K. (2005). Emotional and physical health benefits of expressive writing. Advances in psychiatric treatment, 11(5), 338-346.

Flynn, R. (2000). The emotions of children with diabetes. Creda Communications: JHB.


Daniel Sher is a registered clinical psychologist who has lived with Type 1 diabetes for over 28 years. He practices from Life Vincent Pallotti Hospital in Cape Town where he works with Type 1 and Type 2 diabetes to help them thrive. Visit danielshertherapy.com

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PCOS and insulin resistance – the link

Dr Carmen James educates us on the often heart-breaking mutually destructive relationship between insulin resistance and polycystic ovary syndrome (PCOS)1.

Understanding insulin resistance

Prediabetes is a condition which occurs when your blood glucose levels are higher than normal but not high enough to be diagnosed with actual diabetes.

Prediabetes usually occurs in people who already have some insulin resistance3. Cells in your body use glucose for energy. Glucose in your body is transported into your cells with the help of the hormone insulin.

Insulin resistance is when cells in your muscles, fat, and liver don’t respond well to insulin and can’t easily take up glucose from your blood3. In response, your pancreas releases more insulin and as a result, both insulin and glucose begin to accumulate in the bloodstream1.

What is PCOS?

Polycystic ovary syndrome (PCOS) is a common reproductive disorder4 that affects as many as 15% of the female population5. It is defined as a hormonal disorder common among women of reproductive age6.According to statistics, 60-80% of women with PCOS suffer from insulin resistance4.

Mutually destructive relationship 

While many of us might know insulin resistance may be a precursor to diabetes1, 3 and that excess weight and lack of physical activity could be at fault3, how many of us are aware of the relationship between insulin resistance and PCOS?

The relationship between insulin resistance and PCOS can be described as mutually destructive in that PCOS worsens insulin resistance and vice versa1.

Not only are high insulin levels a feature of PCOS, they also fuel the disease. The reason for this is because insulin accumulation reduces ovulation and promotes the production of androgens or male hormones. This results in symptoms, such as a male pattern of hair growth (hirsutism), acne and, in some cases, is associated with difficulties with fertility1.

In fact, 60% of women with PCOS suffer from hair loss, acne and unwanted hair growth and 20% have infertility problems4.

Alarmingly, more than 50% of women with PCOS will develop diabetes or pre-diabetes before the age of 407.

With so many women affected by PCOS or insulin resistance, or indeed both4, the effect on fertility can be heart-breaking.

How does having insulin resistance affect fertility? 

Ovulation occurs during a normal menstrual cycle where an egg is released from the ovary and passes through the fallopian tubes and into the uterus. If the egg is not fertilised, the egg, together with the uterine lining, will be shed during menstruation1.

Because an accumulation of insulin in the bloodstream elevates androgen levels, the resulting hormone imbalance will negatively affect ovulation. When women do not ovulate, they may menstruate less frequently, have irregular cycles and, in some instances, they may not menstruate at all. If an egg is not released into the uterus, conception will not occur.

PCOS is the most common cause of irregular menstruation that leads to infertility4.

While it is more likely for overweight and obese women to experience insulin resistance1 and PCOS6, women of a normal weight can be affected too. It is important to remember that weight alone is not an absolute representation of health.

Address the underlying root condition

It is recommended that women with PCOS and/or insulin resistance address the underlying root cause drivers of their condition. While we can’t control our genes, we can aim to live a healthy lifestyle to reduce the negative effects of both PCOS and insulin resistance.

Adopt a healthy diet, rich in plant-based foods and low in refined carbohydrates; enjoy regular physical exercise; add supplements, including myo-inositol; curcumin; powerful antioxidants, such as Alpha-lipoic acid; folate and berberine; manage stress levels and get good quality sleep. These measures will reduce inflammation, improve insulin sensitivity and begin to bring balance to the hormones to support ovulation1.



Dr Carmen James is an integrative medical doctor and holistic health and wellness coach. She has a special interest in women’s hormone health.

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Why you need to see an optometrist if you have diabetes

Geline Mare outlines the importance of annual optometrist consults if you have diabetes.

If you are newly diagnosed with diabetes, welcome. Take a deep breath. Yes, there might be a season of change starting now, but with the support from your loved ones and support groups, formed by veteran diabetes patients, you will get through this.

If you are living with diabetes, you might already know the secondary effects, the pitfalls, you need to watch out for. If this is so, this will be a reminder, a refresher and a motivator to manage your glucose levels and visit all the necessary healthcare professionals annually.

The optometrist consult questions

The following questions should be asked when a diabetic patient visits an optometrist:

  1. What type of diabetes have you been diagnosed with?
  2. When were you diagnosed?
  3. What medication are you currently using? This will be for diabetes, but also includes any other medical conditions.
  4. How often do you check your glucose levels? What is the value on average?
  5. Did you check your glucose level today and what is it?

It is important for an optometrist to understand your glucose level pattern, which will influence the vision and the visual problems that you might experience.

Even though your glucose level might never be considered normal, because of certain factors, having a healthy and stable average helps us determine your vision and visual solutions, should you need anything.

High blood glucose levels

High blood glucose levels have serious effects, but so has fluctuation of your glucose level. A sudden spike can cause unwanted damage and changes in your vision.

Behind the coloured portion of the eye (iris) there is a clear and transparent lens. This lens is responsible for the focusing of images on the nerve layer (retina) so we can see the image clearly.

High glucose levels cause swelling of the lens in the eye, which in effect change the power and curvature of the lens and the image on the nerve layer gets out of focus or blurred.

Optometrists might be able to clear the image by prescribing spectacle correction. But if the glucose level drops, the power of the lens will change again, leading to a different prescription necessary.

Keeping your glucose stable will keep your vision stable. And that will make it possible to accurately determine the power of your visual system.

High and fluctuating glucose levels can ultimately lead to faster changes in the structure of the eye and may cause secondary cataracts, glaucoma and diabetic retinopathy.

Cataracts: hardening of the lens

The lens inside the eye is soft and transparent to let light pass through on to the retina. Think of the white portion of an egg, it is soft and transparent, but as soon as you bake the egg, it becomes white and hard.

Similarly, the lens in the eye becomes white and hard, and that is what we call a cataract, that hardening. But, thankfully it’s a much slower process than with an egg. It becomes more difficult for light to pass through the hardened lens and thus you’ll have blurry vision. Some people compare the vision to a dirty window.

Glaucoma: damage to the nerve layer due to pressure

The eyeball is soft, with no bones, and has fluid inside to keep it in the shape that it should be in. Constantly new fluid is being produced and old fluid is drained out. If the amount of fluid being produced is more than the amount of fluid draining, there will be too much fluid in the eyeball. Unfortunately, the eyeball can’t expand like a water balloon, and the pressure will build up. If that pressure starts damaging the nerve layer (retina) at the back of the eye, we call it glaucoma.

Sadly, the damaged nerve layers can’t be fixed and loss of visual field is permanent. Glaucoma is silent, as there are usually no symptoms to warn you, but thankfully it’s preventable if high pressure is picked up soon enough. If you have high eye pressure, you won’t necessarily get glaucoma (damage). But once you have glaucoma (damage), it cannot be reversed. 


Diabetic retinopathy: damage to the nerve layer due to uncontrolled glucose levels

The nerve layer (retina) at the back of the eye is super important. It is made up of all kinds of nerves, light and colour receptors, and blood vessels. This layer receives the information from our outside world in light form, collects all the data and sends it to the brain for interpretation.

High and fluctuating glucose levels causes changes to the blood vessels that feeds the retina with oxygen and nutrients, which leads to damage to that nerve layer. This damage is called retinopathy.

Applied knowledge is power

All these conditions might not give you initial symptoms and cause for alarm; for this reason, a yearly eye examination is recommended for people living with diabetes.

Remember as Eric Thomas says, “Knowledge isn’t power, applied knowledge is power.” All we can do is give you information and instruction. What you do with it, is the most important aspect. Seek help if you can’t get your glucose levels under control and stable. Don’t give up.


Geline Marè Du Toit got her B.Optom (Hon) degree at University of Johannesburg in 2006 and is now owner and optometrist at EyeLove Optometrist in Roodepoort, Gauteng.

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Why experts recommend urea for the treatment of dry skin

According to medical experts, urea, an organic compound, is the gold standard treatment for dry skin. We learn why this is so.

When it comes to treating patients, and giving advice on special conditions, doctors often turn to trusted medical bodies and their latest research for advice.

Dry skin (or xerosis cutis) is a common skin complaint, caused by internal and external factors disturbing the skin’s moisture balance. This skin condition is highly prevalent among the South African population. Yet, surprisingly, there was no standardised approach on how best to treat the condition until recently.

Medical experts agree on the best way to treat dry skin

In 2018, a group of renowned physicians published a medical paper on the Diagnosis and Treatment of Xerosis cutis. The report summarises the latest research findings in the prevention, diagnosis and treatment of dry skin and gives doctors practical advice on how best to treat the condition.

The medical paper states that dry skin can, in principle, be treated effectively. The decisive factor in the effectiveness of dry skin treatment is choosing the appropriate care product.

Moisturising should involve a combination of hydrating and lipid-replenishing ingredients, formulated to restore the skin’s natural barrier function in the best possible way and prevent skin from drying out further.

Urea – the gold standard treatment    

The paper explains that, “based on the available scientific data, urea is the gold standard for the therapy of xerosis cutis1.”

Urea has the advantage of being effective on two fronts; as a natural moisturising factor, it binds moisture into the outermost layers of skin. Plus, it also supports desquamation which is the natural process by which skin sheds dead skin cells. Healthy desquamation is linked to smooth skin.

The Diagnosis and Treatment of Xerosis cutispaper also explains that when urea is combined with other moisturising ingredients and lipids, the effect is even better: It states, “The combination of urea with ceramides, NMF and glycerol shows a significantly better effect than the effect of urea or the vehicle alone2.”

Eucerin UreaRepair PLUS

Eucerin scientists were the first to effectively include urea in a dermo-cosmetic product, and now have more than 25 years’ experience of maximising the benefits of urea in skincare formulas. Experience that includes more than 30 clinical and dermatological studies, involving 10 000 volunteers.

The lotions and creams in the Eucerin UreaRepair PLUS range offer people with dry skin exactly what the independent expert paper recommends. The formulas include:

  • various concentrations of urea (ranging from 5% to 10%).
  • other natural moisturising factors (NMFs), ceramides and gluco-glycerol.

The range is clinically and dermatologically proven to offer immediate and 48hour dry-skin relief.3

Urea and 17 other natural moisturising factors help the skin to attract and bind in moisture, thereby improving the symptoms of dry skin.

Ceramides repair and strengthen the skin barrier and thus reduce moisture loss.

Urea binds water into the outermost layers of skin and, at the same time, breaks down the connections between dead skin cells. This promotes desquamation and ensures a smoother skin surface.


  1. Augustin M et al., Diagnosis and Treatment of Xerosis Cutis. JDDG, July 2018: Suppl 4, Volume 16.
  2. Weber TM et al., J Clin Aesthet Dermatol 2012, 5:29–39.

3. Beiersdorf. Data on file

For more information please visit www.eucerin.co.za

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