Why footcare and wearing the right socks is important if you have diabetes

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We learn why good footcare and wearing the right socks are a top priority for people with diabetes.


High blood glucose levels experienced by those with diabetes can, over time, damage blood vessels and nerves throughout the body, including those in the feet and toes. Nerve damage can result in pain as well as a loss of feeling, meaning it’s easy for a cut, blister, infection or the like to go unnoticed.

Furthermore, diabetes can see circulation reduced which makes it harder for any wound on the foot to heal. This is the crux of diabetic footcare; it’s important to avoid small cuts or infections as recovery in diabetic patients can be slow and complex.

Essential footcare for people with diabetes


As the feet of people with diabetes are high risk, daily footcare is important.

  1. Wash feet gently every day. When washing, check for any wounds, cuts or damage. If anything is looking a little red or swollen, seek the help of a professional immediately.
  2. Dry well to prevent fungal and bacterial infections, especially in between the toes. Baby powder can also help to make sure feet are dry.
  3. Wear clean socks every day and, preferably, invest in socks that are designed especially for those who suffer with diabetes.
  4. If you have lost sensation in your feet, wear comfortable shoes or slippers (don’t walk around barefoot).
  5. Book regular check-ups with a podiatrist.

Invest in socks made for those with diabetes

Socks designed for those who suffer from diabetes keep feet dry, absorb sweat, keep feet warm, and prevent any restriction of blood flow or chafing. They can also provide greater padding and support.

Recommended socks

The Mohair Medi Socks from Sock Doctor are made with a combination of mohair and bamboo for these brilliant reasons:

  1. Your feet with stay dry

The capillary nature of mohair means that it has natural wickability and absorbs moisture quickly, always keeping your feet dry (one of the best ways to look after your feet).

  1. Your feet won’t chafe

The smooth fibres and quick drying properties of mohair help to reduce chafing and prevent blisters.

  1. Your feet will never be too hot or cold

The breathability and insulating properties of both mohair and bamboo keep your feet cool in summer and warm in winter.

  1. Your feet won’t smell

The natural breathability and smooth fibres of mohair and bamboo prevent the build-up of bacteria and keep your feet fresh and odour-free.

  1. Your feet will be at less risk of fungal infection

Bamboo has an inherent antibacterial agent, called bamboo kun, that helps prevent fungal infections and is completely hypoallergenic.

  1. You’ll be wearing the softest socks

Bamboo is naturally silky soft on the skin and incredibly comfortable to wear. These are socks you’ll never want to take off. They also have flat toe seams and are non-restrictive to prevent any elastic bite.

What do the experts say about these socks?

“Many sock brands claim to have the best diabetic socks, but having tried various other brands, I have found that the Mohair Sock Doctor socks truly do what they claim to do –keeping the feet dry, fungus-free with a non-restrictive top band. Thank you for a great product.” – Neil van der Merwe, Orthotist Prosthetist, Mobility Assist.

“We assist numerous patients with problematic feet, these patients need special attention and care when it comes to their feet. We have received excellent feedback from our patients. These socks are comfortable, suitable for our diabetic patients and it doesn’t hurt that these socks come in a variety of prints and colours.” – OP Active



Offer valid until 31st December 2021.

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Interested? Browse the full range at sockdoctor.co.za

The kidneys and the kidney meridian

Fiona Hardie explains that there is a direct link between the kidneys and their associated kidney meridian hence reflexology can have a healing impact on the kidneys.


Did you know that the season that the kidneys are related to and during which their energy is most active is winter. And spring is that time of the year when we should be energised and have, well, a spring in our step. While winter may well be behind us, taking care of our kidney health all-year-round ensures decreased vulnerability to colds and flu, as well as an easy transition to spring without hay fever or the inevitable summer cold that often ensues.

When looking at any organ in the body, there are two perspectives that must be referenced. The Western perspective is one we are all mostly familiar with. Yet the Traditional Chinese perspective has a very different, yet effective approach from which reflexology draws a lot of inspiration .

Western perspective

From the Western perspective, the kidneys are involved in filtering toxins from the body and having them expelled through the urine.  The functions of the kidneys are remarkable:

  • These organs are tasked with recognising and separating waste materials from useful substances and determining how much of that specific substance the body needs.
  • Excess hormones, vitamins, minerals and any foreign matter, such as additives from food or drugs, are sorted and sent for elimination by the bladder.
  • Our electrolyte balance is maintained ensuring that sodium, potassium, hydrogen, magnesium, calcium and other mineral levels are in check.
  • Vitamin D is converted into a usable state while the acid-alkaline balance of the body is also modulated.
  • Not only mineral levels, but the body’s overall fluid requirements are constantly being monitored by these two bean-shaped organs.
  • Red blood cell production is stimulated by a hormone, called erythropoietin, which is produced by the kidneys.
  • On top of all that, the kidneys also have a double filtration system to filter the blood.

Traditional Chinese perspective

Looking at the above, it’s an impressive list of tasks that the kidneys perform and is clear to see why in Chinese medicine the kidneys are considered the storehouses of our “essence.” Essence is that life force which keeps us healthy, vital and youthful.

As a result, the Chinese associate weak kidney energy with premature ageing, early greying of hair, balding, loss of libido, impotence, irregular menstruation and poor willpower to name but a few symptoms of having a sluggish internal system.

Kidney meridian

Let’s face it, if our blood is stagnant and toxic, how can our organs have the energy to perform their duties? How can we have the energy to enjoy our life or produce life?

The kidneys also rule the teeth, bones and produce marrow. A close relationship exists between the kidney and the ears as is evidenced when we get a cold and our ears become blocked or infected.

The kidneys almost always feel tender when a respiratory infection is setting in. We get that achy feeling in our lower backs. In fact, many back problems are often associated with a congested kidney meridian or its partner the bladder meridian which runs up along the spine.

This brings me to kidney meridian congestions and how they present in the body from a reflexology perspective. Burning, sweating and painful soles and fungal infections are often signs of a kidney imbalance. Weak ankles, puffiness and swelling of the foot are indications of weaknesses in the kidneys and bladder. The kidney meridian runs along the inner aspect of the calf and thigh, and pains, varicose veins, knee problems in these areas often point to imbalances in these organs.

The kidney meridian then continues through the diaphragm, and the lungs and of course any lung congestions, diaphragmatic dysfunctions and breast disorders will be considered symptoms of weaknesses here.

Traditional Chinese medicine also associates emotions with the organs and where the kidneys are concerned fear and anxiety are the related emotions. Hence panic attacks, phobias, and constant anxiety are related to the kidneys. When we work on healing these emotions, the kidneys will also heal, and vice versa.

In summary

There is a direct link between the kidneys and their associated kidney meridian. Therefore with the direct focus on the meridians for which reflexology is known, it becomes clear that reflexology can have a direct impact on the kidneys.

With knowledge of kidney imbalances above, it is quite useful to know about the incredible healing effects of reflexology, as it can have a direct and immediate impact. The sense of relaxation brought about by reflexology will also assist in reducing anxiety and fear and coax the body holistically to heal.

Reflexology is best enjoyed over a series of eight to 10 treatments during which time the congestions in the meridians and their organs are cleared, bringing the body to a state of balance. And it is when in balanced harmony that the body is able to perform its functions and heal.


References

Reflexology – The 5 Elements and their 12 Meridians by Inge Dougans.

World Medicine – The east west guide to healing your body by Tom Mont

Images from The International School of Reflexology and Meridian Therapy and Oriental Medicine.

MEET THE EXPERT


Fiona Hardie has owned her own Pilates studio for 18 years in Bryanston, Gauteng where she also does Bowen Therapy, Therapeutic Reflexology, Acudetox, and Bach Flower Remedies. She treats each client holistically taking into consideration their posture and physical state as well as their mental and emotional well-being. She has a special interest in natural pain management, particularly for diabetes and cancer related issues.


Header image by Adobe Stock

Strategies for dining out or ordering meals at restaurants

For a person with diabetes, the thought of dining out or ordering meals can be challenging and quite daunting when trying to control blood glucose levels. Annica Rust shares strategies to follow when deciding what to order.


What to drink

When dining out, the first confrontation is what to drink. Sparkling water, flavoured water and sugar-free soft drinks would be the preferred choices.

If it is a special occasion, moderate amounts (one or two drinks/units not more than twice a week) of alcohol may be consumed, only in combination with a well-balanced meal to prevent delayed hypoglycaemia.2 This happens because drinking alcohol on an empty stomach can interfere with the ability of the liver to release stored glucose. A low kilojoule white wine with lots of ice is an example of a smart choice.

What to eat

Plate method

When deciding what to eat, it may be helpful to take the plate example in consideration. (See Figure 1.) The plate example will in most cases have a low glycaemic load (GL), even though some of the individual items have a high glycaemic index (GI). Choose a meal as close to the example or construct a meal to achieve a well-balanced meal. Try sharing, if possible, to be able to construct a more balanced meal.

Figure 1: Plate method1

Let’s look at a few examples when ordering:

  1. Pizza


2. Burger



3. Chicken

Take note of the carbohydrates

It is crucial for people with diabetes to control their carbohydrate intake. Carbohydrate containing items used in recipes can sometimes be hidden and may add to the total carbohydrate count for the meal. It is therefore important to be on the lookout for them whilst ordering.

Items that contain carbohydrates1

  • Grains: bread, baked goods, cereal, crackers, pancakes, rice, tortillas and pasta
  • Starchy vegetables and legumes (beans): white potatoes, sweet potatoes, corn, peas and lentils
  • Fruit and fruit juice
  • Milk, milk substitutes and yoghurt
  • Some condiments: jelly, braai sauce, tomato sauce and many salads dressings
  • Sweeteners: sugar, honey, concentrated fruit juice, maple syrup and corn syrup
  • Sweets: ice cream, cake and candy

Dessert is not a must

Lastly, remember that dessert is not a must. If you are satisfied with your meal, rather drink a coffee. Always remember that a flat white, cappuccino or a latte has a large milk basis which makes them high in carbohydrates.

Honour hunger and know when to stop

Lastly never forget about your intuition. Unfortunately, a person with diabetes cannot solely rely on intuitive eating, but a nutritional approach that combines key diabetic dietary strategies in combination with intuitive eating can only reap good results. Honour hunger but know when to stop when you are satisfied and rather ask for a “doggie bag.”

Try not to label certain food items as forbidden but try to incorporate them into your meal plan. Remember with portion control there is a time and place for all food items. Always try to see the bigger picture. For example, if dining out is part of your daily routine, stricter portion control is necessary, however, if you rarely dine out, you can be more lenient whilst still staying within boundaries.

There is no one size fits all approach. Please contact a registered dietitian for individualised advice on strategies for dining out at restaurants.


References:

  1. https://www.nutritionletter.tufts.edu/general-nutrition/diabetes-diet-what-to-eat/
  2. Mahan, L.K. & Raymond, J.L. (eds).2017. Krause’s food and the nutrition care process. 14th ed. St Louis. MO: Elsevier Saunders.

MEET THE EXPERT


Annica Rust is a registered dietitian practicing at the Breast Care Unit in Netcare Milpark Hospital as well as in Bryanston. She assists with medical nutritional therapy for cancer prevention, treatment, survivorship and palliation. She gives individualised nutritional care to prevent or reverse nutrient deficiencies, nutrition-related side effects and malnutrition to maximise quality of life.


Header image by FreePik

Doug Ellish – living life 4Shaw

Doug Ellish, founder of 4Shaw, tells us more about his diabetes journey and why he started the wellness and educational website.


I was 15-months-old when I was diagnosed with Type 1 diabetes. My diagnosis was a result of increasingly difficult behaviour (caused by constant high blood glucose) and I went into a diabetic coma.

I remember my mom always giving me my human insulin (rDNA) injections, with the vial and the old orange top hypodermic needles. I don’t recall the name of the basal insulin I was using back then, but I do recall the delivery injector was closer to a double barrel shotgun, than an insulin pen. My dad quite enjoyed delivering my basal to me.

For the past 20 years, I have been using insulin lispro, and insulin glargine. However sometimes I get generic, if they don’t have the original in stock. I have never used an insulin pump. As my doctor said, “Don’t fix what isn’t broken.” I did start using the Freestyle Libre but am currently unable to afford the co-payment my medical aid requires so have gone back to old strips and calloused finger tips until I’m able to afford it again.

Bad management during youth

My management regime has up until recently been a secondary in my life. During my youth all the way up until my early teens my control was not very good. I lost both my folks to cancer before I turned 20 and I think that, after a brief spiral out, kind of set me on a path to change my health and even my mental state. It made me realise my mortality and that if I didn’t start taking care of things, it would not be long before things would take care of me!

I will say I do feel I have an advantage over those who get diagnosed later on in life. If a fish is born with a deformed fin (Finding Nemo), it will adjust its actions and movements to feel as if it’s just as normal as the other fish. I feel the same thing with my diabetes. Having never known any different, I never went through the struggle of changing my lifestyle drastically. For those who get diagnosed later, they have known what the “normal” side of life was before their diagnosis and having to adjust lifestyles, eating and managing injections and glucose checks  can come as a massive blow for some.

Friendly diabetes community

Even though I have had diabetes most of my life, I’m very new to the diabetes community. I always felt if I didn’t involve myself in it, I would just be oblivious to the horrors that await me. I regret that now. From what I have experienced thus far, it has been nothing less than amazing support and gratitude for each other. I am thankful to all who put themselves out there for awareness and am hoping 4Shaw can be a contributor to that.

Lessons learnt

I think the biggest lesson is not being too hard on yourself. You have to be able to live a little from time to time or you will end up dying young from stress as opposed to this disease. As much as we have to see the world differently in terms of having to plan in depth even for menial tasks, there needs to be a balance. Living in the moment, for that moment, is a big one for me. Its literally taken 30 years, but I feel I am able to let go more now.

Acceptance is another big one. Knowing there are things you can and can’t control and being conscious of each of those aspects will make life just that little bit sweeter.

Exercise is also a big one. Find some form of activity that makes you smile and challenge yourself with it. That has helped me immensely in my later years.

Family support

As I said I lost both my parents to cancer in my late teens, but up until that point both my mother and father were hyper-involved with all aspects of my life. My dad gave me the confidence from a young age to not be afraid of getting out there no matter what the circumstances were. Where my mom was more in the supportive and loving role, constantly checking in on me, making sure I was eating correctly and at the right times, and always keeping me positive about things.

My sisters have never had the best grasp of what my existence entails, but I would never assume to think that was their role. I also never pushed them to understand or help carry my burden. It was never theirs and they didn’t need it.

My girlfriend is possibly the best family role player of them all. She has gone out of her way to understand what having diabetes entails and has even attended visits to my endocrinologist with me. She’s the balance of why I am better at managing my levels and a person as a whole and I’m forever indebted to her for her contributions to my life.


4Shaw

4Shaw was originally a standard e-commerce website; I was competing with the major players and just didn’t have the backing to continue the fight. I had the brainwave during our first lockdown last year to start converting it into a wellness and educational platform for those like me who perhaps were newly diagnosed, or those who were just looking for information about diabetes. The thought process was basically that I have lived with and dealt with a lot throughout my life with diabetes and have always kind of supported myself, and my hope was to give some support to those like me who didn’t have it and so 4Shaw was reborn.

It’s about education, sharing the burden and knowing you are not alone in this. I also wanted to give people access to things like dieting tips, exercise regimes to suit their needs and sending the message that having a bad day of control doesn’t mean you’re an out-of-control diabetic. It’s about removing the stigma that seems to surround us and educating non-diabetics about what this autoimmune disease means for people who have it.

For more info, visit 4shaw.co.za

Doug Ellish showing his Libre Flash Glucose Monitoring System.

Ryan Pasqualle – overcoming depression

Ryan Pasqualle tells us how having diabetes led to depression and a suicide letter but thankfully with the support of his family he pushes on every day.


My story starts when I was 7 years old. Wherever we went, I needed to use the toilet less than five minutes after leaving the house. My parents we very concerned, because it would happen anywhere, no matter if I drank water or not. I was eating loads and was losing weight!

One Thursday evening, my dad went to our local pharmacy to find out what was wrong. The pharmacist gave him a urine container and told him to bring back a sample of my urine to have it tested. After my father got the urine and returned it to the pharmacist, he told him to take me to the doctor.

We went to the doctor on Friday and the following day the doctor phoned to say that I had diabetes and we had to go immediately to hospital.

Minutes after we got the news, my mom and sister rushed me to the hospital to get treated. The doctors gave me amazing treatment and got my blood glucose levels down to a decent level.

Life turned upside down

Finding out that I had to take insulin every day for the rest of my life was a massive shock. I had no way of knowing how to cope with it. It wasn’t only the fact that I have diabetes, it was the fact that I had no idea what diabetes was. I’d never heard of it before. Thankfully, the doctor was very helpful; he took a lot of his time to explain what diabetes was. After he explained it, I had somewhat of a grasp on my illness.

It took me round about two weeks to be discharged from hospital. I had no idea how I would go through my day-to-day life with my newly found illness, but my family and doctors supported me every step of the way.

It took me years to really get a hang of my diabetes, it was about three to four years to get my blood glucose levels semi under control.

Depression and suicidal thoughts

Having diabetes really took its toll on me; it led to me being depressed and writing a suicide letter. However, my dad found the letter and rushed to fetch me from school and took me to hospital to get help for my depression.

I wasn’t happy about being in a psychiatric ward, it made me feel like I was put in a jail, but I couldn’t be mad at my family because they were only looking out for me.

I stayed in that hospital for more than three months. It was tiring to have your every move watched, you weren’t allowed to do anything, not even have your phone on you. But after I was discharged, I was so happy, because I came home to loving family, and I was extremely happy to see my dog.

We are only trying to survive

Every day is a challenge for a person living with diabetes. We must live our lives watching what we do and eat. There are days where we can’t even eat an ice cream in warm weather, because the heat from the sun pushes our readings up.

It’s tough living like this. Our lives are in constant danger, and it’s our duty to control it, but it’s difficult to control it when all you want is to be like a normal child. All you want to do is eat what other kids eat, drink what they drink, and live how they live. People will call us sick, weird, different, but we’re normal, our lives just have extra tasks to do daily. We aren’t weird, we are only trying to survive.

Ryan with other camp leaders at 2019 Diabetes Children’s Camp in Kommetjie, Western Cape.
Ryan with other camp leaders at 2019 Diabetes Children’s Camp in Kommetjie, Western Cape.
Ryan and family celebrating his sister's graduation.
Ryan and family celebrating his sister's graduation.

The recipe to a successful patient-provider relationship

Jeannie Berg outlines the responsibilities of both the healthcare provider and patient as a way to a successful patient-provider relationship.


Defining healthcare

Every day, 24/7, people who work in the healthcare industry provide care to millions of patients, from newborns to the very ill thus forming a patient-provider relationship. The healthcare industry is one of largest providers of jobs in most countries around the world. Many healthcare jobs are in hospitals. Others are in nursing homes, doctors’ offices, dentists’ offices, outpatient clinics, private practices, and laboratories. There is a vast range of services rendered by professionals to patients today.

These are our healthcare providers. A healthcare provider is a person or company that provides a healthcare service to you. In other words, your healthcare provider takes care of you.

How healthcare has evolved

The world of healthcare has expanded over the last hundred years. Many things have improved; new discoveries have been made and there is major research being done on so many different aspects of healthcare. What was once thought of as impossible and unthinkable may have now even become the new norm.

Until the 20th century, hospitals were places associated with the poor and where people went to die. The wealthy were treated at their homes by doctors who made house calls 100 years ago. Physicians were not paid by hospitals. They volunteered to treat the poor to help build their reputation. Today hospitals are places of hope and innovation.

In this modern age, many more people have access to healthcare providers and with that comes new challenges.

Positive patient-provider relationship

Patient needs have evolved. Patients are not simply looking to visit their doctors to cure a disease. They now also want a positive patient-provider relationship that yields a positive patient experience. Patient-provider relationships have emerged as cornerstones of quality healthcare.

Trust, knowledge, regard, and loyalty are some of the elements that form the doctor-patient relationship, which has an impact on patient outcomes. There also must be empathy, strong communication, and shared decision-making to ensure a positive patient-provider relationship.

Patients are generally looking for a provider who is knowledgeable, listens to patient concerns, explains medical concepts clearly and in layman’s terms, and spends as much time as necessary during care encounters.

Challenges

Here comes the first challenge: there are simply not enough healthcare providers to go around. However, patients still want their “piece of pie” which they have every right to. Though, “I’m paying for this, you know!” could be articulated in a softer approach.

This makes for many challenges and with COVID taking up so much of all providers’ time, the patient must compromise even more on interaction and time with a provider.

How can we solve this challenge?

Firstly, a patient must try to be prepared for his visit to his healthcare provider. This helps that the minimum time is spent with the maximum benefit.

Being prepared for your visit entails that you have jotted a few of your concerns down so that you can address them with your provider, whether you are visiting a doctor or consulting a physiotherapist.

Concerns would be like: What does my treatment entail? What is the prognosis? How long will it be to get well? What must I do?

Things to consider:

  • Most healthcare appointments need to be made at least the day before.
  • Ask for a longer appointment if you think you will need more time.
  • Be on time for your appointment and be patient if the provider is running late. He/she too is only trying their best.
  • Let the healthcare service know of any preferences you have, such as if you would like to see a female doctor.
  • Ask if there is anything you need to bring with you (such as X-rays) or that you should do to prepare (such as fasting).
  • If you are having multiple tests, find out if you need to have them in a particular order, so that you can book them that way.

Providers have duties. What are they?

  • Consult with patients, discuss their healthcare needs, and offer advice.
  • Diagnose illnesses and offer prognoses as required.
  • Provide a medical service or perform a procedure depending on the patient’s needs.
  • Prescribe medication and/or provide the best course of action.

Patients do have rights. What are they?

  • They have the right to be treated with respect, allowed to obtain their medical records (which is their responsibility to keep safe and private if they keep them on their person).
  • Patients are allowed to make a treatment choice and give informed consent.
  • They can also refuse treatment and can make decisions about end-of-life care.

But patients are not without responsibilities as well

  • Take care of his/her health (and that includes being compliant and adherent to correctly using his medication and following advice given by the provider).
  • Care for and protect the environment. Do not throw those syringes and needles into the trash, for example.
  • Respect the rights of other patients and healthcare providers.
  • Utilise the healthcare system properly and do not abuse medical aid/insurances’ available benefits by fraud and allowing other persons access to their benefits.
  • Use your medical aid wisely. Don’t consult your HCP for things that cost your medical aid unnecessary money. For example, like phoning your doctor for a prescription of deworming medication. This is something you can buy over the counter at any pharmacy.
  • Understand the local health services and what they offer and know how their medical aid works. This is not his provider’s responsibility.
  • For optimum results, they must provide healthcare providers with the relevant and accurate information for diagnostic, treatment, rehabilitation, or counselling purposes.
  • A good idea is to advise the healthcare providers on their wishes regarding death.
  • Compliance with the prescribed treatment or rehabilitation procedures is also a huge responsibility.
  • A patient, even if he/she has medical insurance or medical aid, is still responsible for the payment of any health bills and it is not for the provider to fight this battle for the patient.

Communication, respect and boundaries

When both parties commit to honouring their responsibilities, a patient-provider relationship can be successful. A vital element of good patient-provider relationship is communication. Communication is a two-way street and must always be kept open. It is also important to create clear boundaries.

Providers and patients need be polite, considerate, and honest with each other.

Patients should be treated with dignity and as individuals. Respect patients’ privacy and right to confidentiality. Support patients in caring for themselves to improve and maintain their health.

Providers also need to be treated with the necessary respect, and with both sides paying attention to this a health relationship between provider and patient is possible.

Jeannie Berg

MEET THE EXPERT


Jeannie Berg is a pharmacist and accredited diabetes educator. She served as Diabetes Education Society of South Africa (DESSA) chairperson for four years and was a committee member for many years and served on an advisory board for South African diabetes guidelines as well. She also does online tutoring in diabetes management for The University of South Wales.


Header image by FreePik

SPAR Freshline: serving up healthier food choices

SPAR Freshline has got a big appetite for bringing you goodness, this includes healthier food options too. While we know that diabetes is overwhelming, we’re here to let you know that living with diabetes no longer means you need to miss out on all the great food, because we’ve got delicious and healthy choices for you too.


Choose from our wide range of fresh and prepared produce that’s ripe and ready for your picking. From a bounty of leafy greens to a variety of fresh veggies, nutritious fruit and mouth-watering salads, we’ve got you covered.

And if it’s healthy convenience food you’re looking for, our wholesome prepared, ready-to-cook, and ready-to-heat options, from our DELIcious range of deli meals to soups, fresh chopped soup mixes and more, are all sure to satisfy your taste buds.

The SPAR Freshline Natural baked range was created for individuals with special dietary requirements in mind, including those with diabetes. Natural offers you an array of healthy baked goods that include sugar-free options with the same great taste. Try it!

A FRESH APPROACH FOR YOU

Healthy living begins with healthier eating and SPAR Freshline ticks all the boxes to make things easier on you by offering a wide range of healthy options, as well as diabetic-friendly foods to assist you on your journey to great health.

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FRESH AND PREPARED PRODUCE | FRESHLY BAKED GOODS | CONVENIENTLY PREPARED MEALS


No quick fix – bariatric surgery as a treatment option to obesity

Sunette Swart tells about how bariatric surgery is a tool for treating obesity. Though, she highlights it’s not a shortcut to weight loss as the patient will still have to put in effort after surgery.


Defining obesity

Obesity is defined as a chronic (long-term), progressive disease with episodes of remission (improvement in weight) often followed by relapse (regain of weight). It has multiple causes with behavioural, hormonal and neurological elements and can lead to almost 200 different health problems, including diabetes (high blood glucose) and hypertension (high blood pressure). It is a treatable condition, and it has been shown that even a 5% weight loss or more can reduce the risk of complications and improve overall health.

Obesity treatment options include lifestyle changes (healthy eating, increased physical activity, stress management, mental health, and good sleep quality), medication, and bariatric surgery. Behavioural changes or lifestyle changes alone can account for a 5-15% weight loss, whereas bariatric surgery can result in 35-40% up to two years after surgery.

Bariatric surgery

Bariatric surgery is derived from the Greek word “baros”, which means “weight.” The first weight-loss surgery was performed in 1953, and bariatric surgery has since evolved into what is now known as metabolic surgery.

To qualify for bariatric surgery, you must be between the ages of 18 and 65 years, with a body mass index (BMI) of 40kg/m2 or more or a BMI of 35 kg/m2 or more together with at least two co-morbid conditions (like diabetes, high blood pressure or high cholesterol).

Bariatric surgery can be done via a small, keyhole cut (laparoscopic) or with a larger cut, determined by the surgeon.

There are three types of bariatric surgery procedures:

  1. Restrictive procedure – This is a sleeve gastrectomy and gastric banding procedure (less used). After this surgery, the stomach is about 80% smaller (pouch) and this causes earlier satiety and delays gastric emptying.
  2. Malabsorptive procedures – Bilio-Pancreatic Diversion with a Duodenal Switch (BPD-DS) and Single Anastomosis Dueodeno-Ileal with Sleeve Gastrectomy (SADI-S), where fewer nutrients are absorbed.
  3. A combined restrictive and malabsorptive procedure – The Roux-en-Y gastrectomy (RYGBP) procedure.

Sleeve gastrectomy

The sleeve is performed when approximately 80% of the stomach is removed, leaving a small banana-shaped stomach that can hold around 50-150ml in volume. This results in smaller portions of food eaten and the hunger hormone, ghrelin, is reduced by removing a part of the stomach. Food then continues to pass through the small intestine in the same manner as before surgery, as shown in Figure 1.

Figure 1: Sleeve gastrectomy

Sleeve gastrectomy

Biliopancreatic diversion with duodenal switch (BPD-DS)

This procedure combines a sleeve gastrectomy with a much longer Y-shaped intestinal bypass than the RYGBP. The food bypasses about 75% of the small intestine, resulting in a decrease in energy and nutrients. As shown in figure 2, the bile and pancreatic digestive juices only mix with the food at the very end of the small intestine. The hormone changes caused by this procedure is far superior and causes a significant reduction in hunger, increases the feeling of fullness and results in excellent blood glucose control.  This is a highly complex surgery that can cause “dumping” (symptoms such as nausea, vomiting, abdominal cramping, diarrhoea, bloating, sweating, dizziness, and a fast heart rate), malnutrition, and loose stools. Protein intake and life-long vitamins are critical due to malabsorption (especially vitamins A and D).

Figure 2: Biliopancreatic diversion with duodenal switch (BPD-DS)

Biliopancreatic diversion with duodenal switch (BPD-DS)

Single Anastomosis Dueodeno-Ileal bypass with Sleeve Gastrectomy (SADI-S)

The SADI-S procedure is a newer variation of the duodenal switch that is easier to perform, takes less time in the operating room, and requires only one surgical bowel connection. The stomach is reduced in size by removing approximately 85% of it (same as the sleeve gastrectomy). The small intestine is then bypassed about 50% (longer than in the RYGBP).  This results in nutrient malabsorption due to the shorter path that digested food travels through the intestines, but with the benefit of added digestive enzymes, as illustrated in Figure 3. Bowel movements after this procedure are likely to be looser and more frequent.  Life-long vitamin supplementation is compulsory.

Figure 3: Single anastomosis dueodeno-ileal with Sleeve gastrectomy (SADI-S)

Single anastomosis dueodeno-ileal with Sleeve gastrectomy (SADI-S)

Roux-en-Y gastric bypass

The Roux-en-Y gastric bypass is regarded as the gold standard in weight-loss surgery due to its effectiveness and durability.  The name is a French expression that means “in the shape of a Y.” The stomach is divided into a small egg-sized pouch, and the larger part is bypassed. The small intestine is then divided into two sections, and the new stomach pouch is linked to the bottom end of the small intestine, which allows food to pass through. The top portion of the small bowel (where stomach acids and digestive enzymes pass from the “old” stomach) is connected to the small intestine during the final stage of the procedure, forming the Y shape seen in Figure 4.

As a result, the Roux-en-Y gastric bypass combines restrictive and malabsorption procedures. The patient eats less, feels fuller faster, and as the food bypasses contact with the first part of the gastrointestinal tract, there is less absorption. Gastric acid reflux is treated during this procedure. Life-long vitamin supplementation is recommended.

Figure 4: Roux-en-Y gastric bypass

Roux-en-Y gastric bypass

Hormone changes after bariatric surgery

Ghrelin, a hunger hormone produced in the stomach, stimulates the brain, increasing appetite and cravings for fatty foods. Because the stomach is smaller after bariatric surgery, less ghrelin is released, and patients’ appetites decrease. Leptin is another important hormone that regulates satiety, or the sensation of fullness. Following bariatric surgery, leptin levels rise, increasing fullness. Incretins are hormones secreted by the gut that regulate glucose levels via insulin release and affect appetite and gastric emptying. The most common of these incretin hormones, glucagon-like peptide 1 (GLP-1), is increased by bariatric surgery, resulting in improved blood glucose levels, decreased appetite, and slower gastric emptying. One of the reasons we see Type 2 diabetes remission after bariatric surgery is the improved GLP-1 effect on blood glucose.


Bariatric surgery in South Africa

Bariatric centres use a multi-disciplinary team approach, consisting of the surgeon, physician, registered dietitian, biokineticist and psychologist. There are several bariatric centres in the private healthcare sector in South Africa with varying accreditation with medical aids. At this time, a limited number of bariatric surgeries are performed in public hospitals, such as Helen Joseph Hospital in Johannesburg and Tygerberg Hospital in Cape Town.


Closing

Bariatric surgery is a tool for treating obesity. The success should be measured by weight loss and the improvement and/or resolution of co-morbid conditions, such as diabetes and hypertension. Continuous follow-up with your multi-disciplinary team is essential to ensure the long-term success of bariatric surgery with long-term lifestyle changes, for example,  healthy eating. Remember, no matter which procedure is chosen or performed, this is not a shortcut to weight loss. You as the patient will still have to put in the effort after surgery.


References available on request.


Sunette Swart

MEET THE EXPERT


Sunette Swart is a registered dietitian with 16 years’ experience in bariatric surgery. Her focus is on diabetes and obesity. She is an active member of a research team and a participant in international clinical trials. Since 2006, she has been a multi-disciplinary team member at Netcare Sunward Park Bariatric Centre of Excellence. Since 2010, she has been involved at the Sunward Park CDE clinic as consulting dietitian, led by specialist physician Dr A Murphy and a member of The Centre for Diabetes and Endocrinology (CDE). www.sadietician.co.za


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How biokineticists can assist with exercise in Type 1 diabetes

We learn more about the role of biokineticists in exercise and Type 1 diabetes.


What is a biokineticist?

Biokinetics is a profession that focuses on promoting health and well-being by means of scientifically-based exercise prescription.1 It involves many areas, including: orthopaedic and neurological rehabilitation, health promotion, chronic disease management and sporting performance. As biokineticists, we promote an active lifestyle to prevent non-communicable diseases, such as diabetes, by enhancing muscle strength, endurance, cardiorespiratory fitness, and flexibility.  A biokineticist will improve your physical functioning and educate you on how you can live your life through movement.2

Understanding diabetes

Diabetes is characterised by a sustained elevation in blood glucose. Type 1 diabetes specifically is caused by an autoimmune dysfunction which disrupts the pancreas and its ability to produce insulin.3 Insulin is a key hormone which acts as a gatekeeper between your blood vessels and muscles. Insulin is required for muscles to absorb the glucose circulating in your bloodstream.

Without insulin, blood glucose levels elevate beyond normal levels, which has negative effects on our biology, particularly the cardiovascular system. Type 1 diabetics supplement their insulin levels with injections administered at strategic times throughout the day.

Function of exercise in diabetes

The primary reason for exercise in the management of diabetes is to improve glycaemic control. In conjunction with diet and medication, exercise can reduce the risk of diabetes-related health complications.3

A biokineticist will perform a personalised evaluation and assign an exercise prescription that will help improve your glycaemic control, in turn aiding cardiovascular health and increasing life expectancy.3 Your biokineticist will ensure that you are exercising safely and meeting your personal goals.

Principles for exercise

There are various principles that biokineticists use to ensure that exercise is prescribed correctly. These include frequency, intensity, time, and type.1

  1. Frequency: This is how often you exercise during the week. Studies show that 3-7 days of aerobic exercise and 2/3 days of resistance exercise is recommended.
  2. Intensity: This is either how moderately or vigorously you exercise. It is calculated using a rating of perceived exertion (RPE) scale. This scale ranges from 1-20. 1 being no discomfort to 20 being unbearable. Aerobic exercise can be performed moderately (11-12 RPE) to vigorously (14-17 RPE). Resistance exercise can be performed moderately and vigorously using a percentage of your 1 repetition maximum, which your biokineticist will calculate.
  3. Time: This is how long you exercise for. Your biokineticist will recommend at least 150 minutes a week for moderate exercise to 75 minutes of vigorous aerobic exercise. Resistance training uses repetitions and sets. It is encouraged to do 8-10 exercises with 10-15 repetitions and 1-3 sets.
  4. Type: The type of exercise is important. Your biokineticist will give you aerobic exercises, like swimming and cycling, and resistance exercises, such as lifting weights or using resistance bands.

Where to find a biokineticist?

Biokineticists are found in private practice, gyms, or wellness centres. Head over to the BASA website to find a biokineticist near you.


References

1.Biokinetics Association of South Africa. (2021). What is a Biokineticist? Retrieved from Biokinetics SA – Life through Movement : biokineticssa.org.za/public-information/

2.Ellapen, T. J., Strydom, G. L., Swanepoel, M., & Hammill, H. V. (2018). Biokinetics: A South African Health Profession Evolving from Physical Education and Sport. Sport and Exercise Science, 15-27.

3.Riebe, D., Ehrman, J. K., Liguori, G., & Magal, M. (2016). ACSM’s Guidelines for Exercise Testing and Prescription. Tenth Edition. Philadelphia, PA: Wolters Kluwer.


Written by Stephanie Irons (Biokinetics Intern at Rob Evans Biokineticists) on behalf of The Biokinetics Association of South Africa (BASA).

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Five secrets for a good diabetes check-up

Diabetes nurse educator, Christine Manga, shares five ways to make the best of your diabetes check-up.


A man arrives at his local car workshop and asks to speak to the mechanic. He enquires whether the mechanic can help fix his car. “No problem,” replies the friendly mechanic. “Let me take a look.” The man answers quickly, “Oh, I haven’t brought it, but I can tell you what is wrong.”

Sometimes healthcare professionals (HCP) in the field of diabetes feel like that mechanic. We are so often asked, even expected to ‘fix’ the diabetes but we are not given the opportunity to see the glucose control or other health issues (the car). This simple analogy alludes to a diabetes check-up as perceived by an HCP.

On the other hand, the patient may perceive the diabetes check-up totally differently. More like a trip to the principals’ office, a nerve-wracking, dreaded experience.

These situations for both the patient and HCP can be avoided by following these tips.

  1. Bring the “goods”

Bring along a list of all the medications, prescribed and others you are taking, including the dosage. You can bring in the actual medication or a photo of the box or container (anything that will identify the medication). Unfortunately, HCP do not know what all tablets look like and there are at least 100 “little orange tablets” on the market. No treatment changes can be made without this information.

Your glucometer, diabetes diary or CGM are vital for all appointments. These should not be a cause for anxiety. Many patients do not test their blood glucose levels because they fear seeing high readings or are afraid of what the HCP may say. Analysing these readings together, high or not, will allow for better outcomes. An HCP will focus on fasting and post meal readings as well as any hypoglycaemic events (readings below 3,9mmol/L), trends and patterns. It is important to see if your readings are in keeping with your HbA1c.

A food diary is a good accompaniment to a glucometer. It allows you to realise the effects of certain foods on your blood glucose readings. This will enable you and the HCP to work on possible food alternatives or quantity changes. You can discuss any observations you have noted or concerns about these readings.

If your HCP has requested any blood or other tests be done, please ensure that they are done at least three days prior to the diabetes check-up. Bring any recent sonars, X-rays or specialist reports along.

  1. Be prepared

For your first appointment with your HCP, you will be asked about your family’s health history – is there a history of diabetes, strokes or heart attacks? If you have any disabilities of any kind, inform the practice so that steps can be taken to accommodate these. This may sound odd, but I have had a patient with hearing difficulties politely nod at me until we established that they couldn’t hear me. This is particularly important during this pandemic when masks are being worn.

A lot of information will be exchanged during the consultation. Bring along a friend or second set of ears as many things may be forgotten after the appointment. A notebook to write down instructions is also a good idea. Clarify any instructions by repeating them back to the HCP. Most HCP will take notes throughout a consultation.

Many patients, in my experience, are nervous or anxious during appointments. Having a list of questions and concerns you’d like to address with your HCP will prevent you from forgetting anything.

  1. Be honest

It bears repeating that it’s of vital importance that you are honest with your HCP. Remember, these diabetes check-ups are confidential. If you feel that you’re unable to be completely honest with your HCP, it may be worth considering changing your HCP.

Patients often feel, a natural urge, to tell their HCP what the patient thinks their HCP wants to hear. This is not in anyone’s best interest. The best outcomes are based on complete honesty. Don’t be shy about discussing problems with the HCP, there are probably many people with diabetes who have the same problem. Keep an open mind and give input on your treatment plan. Your HCP will be honest with you. This may mean that they are not able to answer 100% of your questions and may need to refer you to someone who can answer a specific question.

This honesty will range from the medication that you are taking and the doses you are omitting, food and exercise as well as your blood glucose readings. There are various reasons that patients omit medication doses, from side effects of the medication, cost, painful injections and genuinely forgetting to take it. These can all be dealt with if the HCP is aware.

Carbohydrates need not be lied about either; they are an important part of a healthy diet and need to be eaten. Let us know what you are eating/drinking and together we can plan the best way to incorporate these foods.

Elevated blood glucose levels do not always indicate a lack of effort or interest in ones’ own diabetes management. Multiple factors affect readings and these need to be discussed honestly and openly. Sometimes that elevated Hba1c may be due to the natural progression of diabetes and not that full slab of chocolate you plundered.

  1. Be consistent

Attending regular follow-up appointments with your HCP is important. It allows for timeous interventions when necessary. It forms the basis of managing a chronic condition, such as diabetes. If any change or intensification of treatment is required, early implementation can delay the onset of diabetes complications. On this note, staying in contact with your HCP between appointments is beneficial and can lead to better outcomes. Confirm what forms of communication the practice uses be it email, phone calls or WhatsApp. Ask about emergency contact details or hotline numbers.

  1. Relax

These appointments are for your benefit. Arriving anxious at your appointment can influence your vital signs, increasing your blood pressure to levels that you would not have in other settings. This is known as white coat syndrome/hypertension. Try to arrive at your appointment a few minutes early to enable you to wind down from any traffic stress. This appointment is yours, embrace it and make it meaningful.

eating time budget

MEET THE EXPERT


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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