Category: 2021 Winter – Diabetes Focus eMag

Seiso Motlhale

Seiso Motlhale – diagnosed with diabetes after COVID

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After testing positive for COVID, Seiso Motlhale was also diagnosed with Type 2 diabetes. He tells us more.

Seiso Motlhale (39) lives in Bloemfontein, Free State with his wife and two children. 

In August 2020 after testing positive for COVID and being treated with vitamin B, C, and zinc, Seiso suffered with headaches and dizziness so he went back to his doctor. After more tests, Seiso was diagnosed with Type 2 diabetes.

“I was shocked because I’m active person and train almost three times a week. Luckily, I knew a bit about diabetes, but I felt I needed more support and information, so I contacted Diabetes SA,” Seiso says.

Seiso was prescribed atorvastatin (20mg), gliclazide (60mg), and metformin hydrochloride  (1000mg). He also changed his diet and cut down alcohol, but he adds it’s not easy. Luckily his wife and kids have been very supportive by changing 60% of their diet to accommodate him.

“I am slowly getting there. Plus, for the sake of my health I have to compromise. I only drink gin or dry wine; I don’t drink beer or sweet things anymore.”

The father of two still exercises three times a week, running 5km, and hopes to change the negative mindset people have about diabetes. “I never thought someone at my age will have diabetes, but it goes to show, anyone can get it and the public needs to know this and look out for the symptoms,” Seiso says.

Can COVID cause diabetes?

Information published in Diabetes, Obesity and Metabolism, a medical journal, looked at the proportion of newly diagnosed diabetes in people with COVID-19 infection.

“This is commonly observed, occurring in as many as 14,4% of those admitted to hospital with COVID. Again, a number of factors may be responsible. Undiagnosed Type 2 diabetes is common and may have been present before contracting COVID-19. The severe inflammatory response induced by the virus and the resultant need for corticosteroid treatment may precipitate diabetes in prone individuals. However, there is also evidence to suggest that the virus itself may directly destroy the insulin-producing beta cells of the pancreas.”

It was also reported in Medical News Today, that an international group of diabetes experts believes that some people may develop diabetes for the first time due to severe COVID-19, the respiratory illness caused by the SARS-CoV-2 virus. They have set up a registry to investigate the possible link and inform future treatment.

 

MEET OUR EDITOR

Laurelle Williams is the Editor at Word for Word Media. She graduated from AFDA with a Bachelor of Arts Honours degree in Live Performance. She has a love for storytelling and sharing emotions through the power of words. Her aim is to educate, encourage and most of all show there is always hope. Feel free to email Laurelle on editor@diabetesfocus.co.za

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eyes

Diabetes and the eyes – prevention is better than cure

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Diabetes nurse educator, Kate Bristow, educates us on the normal function of the eyes and how uncontrolled diabetes can damage this.

Before we can identify what is abnormal in the eyes, we need to know what is normal. This is why screening is so important. In eye care, this is a cardinal rule.

The prevalence of diabetes is increasing, especially in working age adults. Fifty percent of people with diabetes don’t know they have diabetes and out of that 50% will not receive treatment or inadequate treatment. Fifty percent of people with diabetes will develop diabetic retinopathy (DR).

What is diabetic retinopathy (DR) and how can we prevent it?

Retinopathy is a complication of diabetes that affects the eyes. DR is caused by damage to the blood vessels in nerve tissue at the back of the eye. If blood pressure and blood glucose levels are consistently high, it can cause serious damage to blood vessels. Blood vessels in your eyes supply blood to the seeing part of the eye which is called the retina.

Damage to blood vessels can cause blockage, leaking or unusual growth of random blood vessels. This means that the retina does not get sufficient blood.

Retinopathy usually develops in stages. Early stages have no symptoms but as the condition progresses you may develop:

  • Floaters or spots in your visual field
  • Blurred vision
  • Dark or empty areas in your vision
  • Loss of vision and difficulty perceiving colours
  • Blindness can occur

What causes diabetic eye disease?

Too much glucose in the bloodstream over time can lead to damage of the very small blood vessels which take oxygen to the eye. This means no blood supply or reduced blood supply to the eye. The eye tries to compensate by growing new blood vessels, which don’t develop properly and leak or bleed into the retina or into the vitreous (gel-like fluid that fills your eye)  that leads to further damage of the retina.

Retinopathy can be early or advanced

Early diabetic retinopathy is called non-proliferative diabetic retinopathy (NDPR). This means new blood vessels are not yet growing in the eye but the walls of the retina weaken and can bulge and leak fluid or blood into the retina. Larger vessels can also dilate and swell. NPDR can progress from mild to severe as more and more blood vessels are damaged.

Sometimes damage to the retinal blood vessels leads to a build-up of fluid causing swelling in the centre of the retina, the macular. This is called macular oedema and if it affects vision, treatment is required to prevent permanent visual loss.

Advanced diabetic retinopathy is also known as proliferative retinopathy where damaged blood vessels lead to starvation of the retina of oxygen, causing growth of abnormal new vessels in the retina. The vessels are fragile and prone to leaking or bleeding into the vitreous.

Scar tissue from the growth of the new blood vessels can cause the retina to detach from the back of the eye. This is called tractional retinal detachment because the retina is pulled off the eye by scar tissue.

New blood vessels (neovascular) can also interfere with the normal function of the eye and pressure can build up in the eye. Raised intraocular pressure damages the main nerve in the eye (the optic nerve) which carries messages from the eye to the brain, resulting in a condition called glaucoma.

What are the risk factors for diabetic retinopathy?

It can be a complication for anyone who has diabetes especially if you have:

  • Diabetes over a longer period
  • Poor blood glucose control and bouncing blood glucose levels
  • High blood pressure
  • High cholesterol in pregnancy
  • Smoking
  • If you are of African descent or Hispanic, the risk is higher.

Complications associated with diabetic retinopathy include

  • Vitreous haemorrhage is when the new abnormal blood vessels bleed into the vitreous of the eye causing floaters or visual disturbances. This is often not permanent and if the retina is not damaged, sight can return to normal after a few weeks or months. Laser treatment is required to regress the abnormal blood vessels and if laser is not possible, surgery to remove the gel (vitrectomy) is done and then laser performed.
  • Retinal detachment happens when the scar tissue associated with abnormal blood vessel growth can pull the retina away from the back of the eye. This causes spots, flashes of light or severe loss of vision.
  • Glaucoma is when new blood vessels grow on the iris of the eye which interfere with normal flow of fluid out of the eye and increased pressure in the eye. This causes damage to the optic nerve.
  • Blindness occurs when diabetic retinopathy, macular oedema, glaucoma individually or in combination leads to complete loss of vision, especially if left untreated.

Prevention is better than cure

Although it is not always possible to prevent diabetic retinopathy, regular eye exams, good blood glucose and blood pressure control and early treatment for problems with your sight can go a long way to preventing severe loss of vision.

Patient education is essential, work with a diabetes nurse educator (DNE) to learn how to better manage other aspects of diabetes. Your DNE is your co-ordinator to the team approach to your diabetes care.

So, in short:

  • Manage your diabetes with a healthy eating plan and a regular exercise routine.
  • Take medications as prescribed and work with your doctors diabetes educator to improve/manage/maintain your blood pressure, cholesterol and glucose control
  • Test your blood glucose levels regularly and aim for targets that you have set with your diabetes medical team.
  • Have your HbA1c (glycosylated haemoglobin) tested regularly and aim for a reading of 7% or below. A decrease of 1% in HbA1c can reduce complications of diabetes, including DR by 33% (that’s a 1/3 decrease in risk because of better blood glucose).
  • Manage weight and blood pressure; healthy lifestyle choices go a long way to helping with this.
  • Quit smoking
  • Reduce/stop alcohol use.
  • If you have diabetes before or develop it during a pregnancy, the risk of retinopathy may be increased, and you may need more regular eye exams during this period.
  • Be aware of visual changes and seek help immediately if you are concerned. This includes blurred vision, or spots.
  • See your eye doctor/ophthalmologist for an annual examination even if your vision is fine. Your pupil will be dilated to allow careful examination of the back of your eye.

Diabetes does not always lead to loss of vision and being actively involved in your own diabetes management is the best way to prevent complications. There are team members out there to guide and support you in this. Ask for help from your diabetes team.

The Ophthalmology Society of South Africa (OSSA) developed the Screen For Life programme for early diagnosis of diabetic retinopathy.

The Screen For Life programme helps communicate these important messages, using three red warning flags.
Sister Kate Bristow is a qualified nursing sister and certified diabetes educator.

MEET THE EXPERT

Sister Kate Bristow is a qualified nursing sister and certified diabetes educator. She currently runs a Centre for Diabetes from rooms in Pietermaritzburg, providing the network support required for the patients who are members on the diabetes management programme. She also helps patients who are not affiliated to a diabetes management programme on a private individual consultation basis, providing on-going assistance and education to assist them with their self-management of their diabetes.

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footcare

Meet Sock Doctor

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Have you tried the mohair and bamboo socks from Sock Doctor? This proudly South African company is determined to design socks that aid in the therapeutic support for symptoms of diabetes and want you to try a pair!

Exclusive offer for Diabetes SA

Keen to try a pair of Sock Doctor’s better-for-you socks?

Head to sockdoctor.co.za.

Their Mohair Medi Socks are designed specifically to aid in the therapeutic support for symptoms of diabetes, circulatory problems, Raynaud’s syndrome and sweaty feet. Find them here.

Use the code: GREATSOCKS for 20% off any website purchase.

WHY IS GOOD FOOTCARE IMPORTANT FOR PEOPLE WITH DIABETES? 

Having diabetes can put you at an increased risk of poor circulation, a loss of feeling in the feet and infection. Furthermore, poor blood supply to the feet can result in minor cuts and abrasions taking longer to heal. Good foot care is essential.

HOW CAN QUALITY SOCKS HELP?

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

  1. Your feet will 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.

THE SOCK DOCTOR OPTIONS

Choose between two styles of Mohair Medi Socks (you are also welcome to try the Bamboo and Cotton ranges but the Mohair Medi have been designed with diabetes specifically in mind).

Active Mohair Medi Socks

  • Designed with a high tab on the heel to keep the sock in place.
  • Unique bamboo features offer extra breathability.
  • The fully cushioned mohair foot offers maximum moisture absorption and protection.
  • An anatomical band offers arch support and stability inside the shoe.
  • The flat toe seam prevents friction and blisters.

Long Mohair Medi Socks

  • Designed with a non-restrictive top to prevent ʻelastic biteʼ.
  • The super soft bamboo graduated fit on the leg offers extra stretch so as not to hinder circulation.
  • The fully cushioned mohair foot offers maximum moisture absorption and protection.
  • The low-profile seam is designed to offer added comfort.



Offer valid until 31st December 2021.

ORDER A PAIR!

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

cottage cheese

All you need to know about cottage cheese

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Registered dietitian and diabetes nurse educator, Tammy Jardine, unpacks the benefits of adding cottage cheese to your meal plan.

What is cottage cheese?

Cottage cheese starts out with pasteurised skimmed milk. Cultures are added to start the fermentation process at an increased temperature. This acidification makes some of the proteins in milk clump together and the mixture to solidify, resulting in curd and whey. The curd is then cut into small and medium sized pieces, cooked and the whey liquid is drained off. Water is added to rinse and cool the curd, where after it’s blended with salt and a cream dressing.

It is available in smooth or chunky and in varying fat levels: fat free, low-fat, medium fat and full cream. Creamed (or full cream) cottage cheese contains approximately 13-14% milk fat, medium fat cottage cheese contains approximately 12%, low-fat cottage cheese between 2,0-2,5% milk fat, and fat free cottage cheese no more than 0,5%.

It’s important to understand that even full cream cottage cheese is only 13-14% fat whereas most other cheese contains approximately 30% fat which is why cottage cheese is considered to be a healthier option.

100g of Lancewood smooth or chunky low fat cottage cheese provides 10,2g of protein and only 2g of carbs.

How does it affect blood glucose?

Interestingly, eating cottage cheese may help manage your blood glucose. Over the last four decades, there have been many studies investigating the effects of dietary modifications on blood glucose control. The type, amount, and combination of macronutrients in the diet can influence how much insulin our body secretes and how the body manages glucose.

Since 1984, the effects of milk, yoghurt and cheese have been investigated in Type 2 diabetes. In a ground-breaking study, done in 2004, men who ate 25g of cottage cheese with 50g of glucose had 38% lower blood glucose post eating it, compared to those who consumed glucose alone. The blood glucose-lowering effects of cottage cheese are often attributed to the milk proteins (casein and whey) and amino acids making up its high protein content.

Cottage cheese is a low carbohydrate, low fat, and high protein food. When carbohydrate in a meal is replaced with protein and/or fat, there is an improvement in the post meal (postprandial) blood glucose which is exactly the aim in diabetes management. Lowering carbohydrate from the standard 55% of total energy to 40% with a corresponding increase in protein can reduce HbA1c to a similar decrease seen when using metformin.

Also important in diabetes management is weight loss or a healthy weight maintenance. Protein is satiating and studies have shown that it will keep you fuller for longer and prevent overeating.

What does this mean for your diet?

The data provides evidence that cottage cheese can be a potent insulin stimulator and regulator of glucose control when consumed with or without fat or carbohydrates. These potentially beneficial effects are seen when you replace some or all of the carbohydrate in a meal.

For a lower carb meal and looking at similar calories, instead of having a sandwich with a slice of cheese and a fruit, have 1 slice of bread with sliced cucumber and Lancewood creamed smooth cottage cheese, celery and cashew nuts:

Food Carb Protein Fat kJ
2 slices low-GI bread with 1 tablespoon of margarine, 1 slice processed cheese, and an apple 52g 12g 18g 1806kJ
1 slice low-GI bread, ½ cup of cucumber slices, 2 celery stalks and 125g (½ cup) Lancewood creamed smooth cottage cheese and 15g cashews 22g 19g  26g 1774kJ

References:

  1. Lancewood website
  2. Nuttall FQ, Gannon MC (2004). Metabolic response of people with type 2 diabetes to a high protein diet. Nutrition & Metabolism, 1:6. doi:10.1186/1743-7075-1-6
  3. Bjørnshave A, Hermansen K (2014). Effects of Dairy Protein and Fat on the Metabolic Syndrome and Type 2 Diabetes. Rev Diabet Stud, 11:153-166. doi:10.1900/RDS.2014.11.153
  4. Thorning, TK, Raben A, Tholstrup T, Soedamah-Muthu SS (2016). Milk and dairy products: good or bad for human health? An assessment of the totality of scientific evidence. Food & Nutrition Research, 60:32527. doi:10.3402/fnr.v60.32527
  5. Pasin G, Comerford KB. (2015). Dairy Foods and Dairy Proteins in the Management of Type 2 Diabetes: A Systematic Review of the Clinical Evidence. Adv. Nutr, 6:245–259. doi:10.3945/an.114.007690

MEET THE EXPERT

Tammy Jardine is a qualified diabetes educator and a registered dietitian. Living with diabetes for over 15 years means that she knows first-hand how difficult it can be to achieve and maintain optimal blood glucose control with good lifestyle habits. She believes that diabetes affects every person differently and takes the time to understand how it’s affecting the individual and to help them manage it effectively. With more than 20 years of experience working as a dietitian in the UK and SA, she has a passion for helping people live a better and happier life with good food. Tammy currently works from Wilgeheuwel hospital.

Visit lancewood.co.za

socks

Put your best foot forward with socks

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Podiatrist, Dennis Rehbock, educates us on the history of socks and how they have advanced over the years.

The history of socks

Socks have been worn on the feet of humans since the 8th century BC in Greece. They were made from matted animal hair or leather, called piloi. The earliest known surviving pair of socks, created by nalbinding, dates from 300-500, and these were excavated from Oxyrhynchus on the Nile in Egypt. A thousand years later in the 2nd century AD, the Romans were the first ones to sew woven fabrics together and make fitted socks.

Modern socks

Socks today are vastly different to the early historical models. Modern fabrics, technology and the latest fashion has transformed them into a necessity for humans to wear for protection and as great looking fashion accessories.

The functions of socks are:

  • Protection of the feet
  • To insulate feet from the cold weather
  • To absorb and dissipate sweat from the feet in warm conditions and during sport
  • Odour control
  • To protect the feet by preventing chaffing from shoes
  • Comfort
  • Fashion

Sock materials

Traditionally socks were made from wool or cotton with a little bit of nylon in it for strength.Wool and cotton are still used in socks, but modern materials are far better.

Modern socks contain materials like Drynamix, mohair, bamboo, Merino wool, Coolmax, elastane, polyamide, nylon, spandex and polypropylene. Some socks have silver or copper infused yarns for the antimicrobial function.

Bamboo is one of the softest, if not the softest sock material you can buy. It’s much smoother than cotton, and feels more like a high-quality silk or cashmere, making them extremely comfortable to wear. Bamboo has incredible moisture-wicking capabilities, being able to keep feet dry even if there is excess sweat.

Most technical sports socks contain mostly Drynamix and some nylon for strength.

Diabetic socks contain mixtures of cotton, bamboo, Merino wool, mohair and some nylon for foot protection and sweat control.

Other modern sock technologies

  • Left foot and right foot specific shape
  • Seamless toe design
  • Seamless comfort
  • Full foot cushioning
  • Lightweight construction
  • Soft comfortable feel
  • Extra heel and toe cushioning
  • Deeper heel pockets
  • Ventilation panels
  • Blister resistant materials and construction
  • V-tech arch support system
  • Silver thread for antimicrobial function
  • Non-elastic stay-up. Low compression, non-restrictive top with extra cross stretch to not impede normal blood flow.
  • Bamboo – hypoallergenic yarn
  • Compression socks, specifically for certain vascular conditions and may be calf-length and over-the-knee length.

Thickness and length

Socks also come in different lengths, such as thin volume socks for running, medium volume socks for tennis and squash, and thick volume socks for hiking and maximum protection.

Sock length can also vary: long socks, short socks or ankle socks for running, secret socks (very low-cut socks), and medium length socks.

How does diabetes affect your feet?

Diabetes can damage your feet and toes in the same way as it may affect your eyes, blood vessels, and other parts of the body.

Control of the blood glucose levels is most important on a long-term basis, but over time there may be damage to the blood vessels and the nerves throughout the body

This common complication of the foot in diabetes is known as peripheral neuropathy and peripheral artery (vascular) disease (bad circulation). Experts say that up to 80% of limb loss from diabetes is preventable.

Because the feet are high risk in diabetic patients, the feet must be looked after and protected. This is where the correct socks for people with diabetes is important.

Diabetic socks

Normal and special diabetic socks are important for good foot protection and care in the diabetic community. It’s advisable that all people with diabetes wear good quality, preferable special diabetic socks.

In simple terms, a diabetic sock is designed for keeping your feet dry, absorbing and dissipating the sweat, keeping the feet warm, preventing restriction of blood flow, and protecting from rubbing and trauma.

One of the functions is absorbing sweat. Research shows we produce 0,12L of sweat per day from our feet. Socks help to absorb this sweat and draw it to areas where air can evaporate the perspiration.

Thin socks are most commonly worn in the summer months to keep feet cool.

In cold environments, socks made from cotton, wool, bamboo or Merino wool helps warm up cold feet which, in turn, helps decrease the risk of getting chilblains and other lesions. 

Thicker thermal socks can be used for extreme cold environments.  They are commonly worn for skiing, skating, and other winter sports. They provide not only insulation, but also greater padding due to their thickness.

Diabetic socks are often made in a white colour. This makes it easier to notice any bleeding or oozing wounds on the feet.

Diabetic socks are specially designed to help save your feet from amputation by keeping feet dry, decreasing the risk of foot injury, cuts, blisters, infection, dampness, and enhancing blood circulation. They are a key part of foot care, which is an important aspect of diabetes management due to potential damage to the nervous and circulatory systems caused by high blood glucose levels.

Diabetic socks vs compression stockings

Compression stockings are not the same as diabetic socks. Compression stockings are meant to increase constriction so that blood can return more easily to the heart.

Medical-grade compression socks are not appropriate for people with diabetes because they can decrease blood flow to the feet and accelerate damage.

However, if you have swollen feet, talk to your doctor. Some diabetic socks provide a lighter degree of compression that may ease swelling without inhibiting blood flow. True compression socks need to be prescribed by a healthcare professional and properly measured and fitted for the patients’ requirements.

Smart technology

Some diabetic socks have embedded sensors that track foot temperature, moisture and pressure to alert the wearer via an app if, say, an ulcer is forming. They have a coin-size battery located on the exterior of the sock near the ankle. These socks usually last around six months.

Important things to look for in diabetic socks

  • Look at the Drynamix, cotton, wool, Merino wool, bamboo, mohair content in the mix. The higher percentage of these materials, the better the sock.
  • Choose socks that are soft and thick for the protection and cushioning.
  • Look for seamless socks, especially in the toe area.
  • Read the label of the socks when purchasing. The features of the sock and the material composition will be listed. Look specifically for a diabetic type of sock.
  • Buy new socks regularly and get rid of the old and worn away socks. Socks should be thrown away at the first sign of wear and tear, such as holes or rips.
  • Thermoregulating (keeping your feet warm in winter and cool in summer) resulting in dry, healthy, warm and comfortable feet all day long is important.

 What not to do

  • It’s not necessary to sleep with socks on, unless it’s to keep your feet warm.
  • Do not wear toe socks. These socks encase each toe individually like fingers in a glove. You may get irritation in between the toes that could cause skin breakdown or interdigital corns.

 Important diabetic footcare information

  • Gently wash your feet daily, especially in between the toes.
  • Dry your feet well. Concentrate in between your toes.
  • Keep your feet dry to prevent fungal and bacterial infections, especially in between the toes.
  • Powder the feet with a generic powder like baby powder.
  • Wear clean socks every day. Use the special diabetic socks if necessary. Use very soft and thicker socks if you need them to keep your feet warm.
  • Check your feet daily for any wounds, cuts or damage. If you can’t do this then get someone to help you. Look for any small cuts, blisters, or corns that are starting to look bright red, swollen, bloody, oozing pus, developing a green or brown colour, or producing a strong odour.
  • Do not walk around barefoot, especially if you have peripheral neuropathy. If you have neuropathy in your feet and have lost sensation and feeling in your feet, walking around barefoot (especially outside) means you could step on something sharp, cut your foot, and not know it.
  • Wear shoes. Even a thin shoe or ballet-like slippers are better than nothing. Running shoes or tackies also work well to protect feet.
  • Schedule regular foot checks with your podiatrist to examine your feet and to do any treatment that may be necessary.
  • If you have already experienced a foot ulcer, foot inspections and podiatry visits are critical to treating new cuts or ulcers quickly, preventing your risk of amputation.
  • Improve your blood glucose levels if necessary. See your diabetologist, diabetic educator and dietitian regularly.
  • If you suspect an area on your feet isn’t healing properly or is looking a bit unusual, don’t hesitate to visit your healthcare team immediately and get it checked out.

References

FALKE SOCKS – www.falke.co.za

BALEGA SOCKS – https://balega-socks.implus.com/contact

THE SOCK DOCTOR – www.sockdoctor.co.za

MEDIPOS DIABETIC SOCKS – www.medipod.co.za

READERS: ONE OF THE BENEFITS OF TAKING OUT A DSA MEMBERSHIP IS THAT YOU RECEIVE A FREE PAIR OF MOHAIR AND BAMBOO MEDI-SOCKS.

Go to the Membership tab to sign up.

MEET THE EXPERT

Dennis Rehbock is a podiatrist in private practice in Johannesburg. He has been a part-time lecturer and clinician at the University of Johannesburg Podiatry Department for 37 years. His special interest includes podiatric sports podiatry and the diabetic foot. Visit footdoctor.co.za for more info.

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This article is sponsored by Sock Doctor. The contents and opinions expressed are entirely the medical experts and not influenced by Sock Doctor in any way

Heart attack

Heart attack and stroke – know the symptoms

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Did you know heart disease and strokes are the leading cause of death in people living with diabetes? The good news is that there are many things that you can do to control your diabetes, reduce your risks and stay healthy.

How does diabetes affect your heart?

Heart disease and stroke are the leading cause of death in people living with diabetes. The constant high blood glucose causes damage and narrowing of the blood vessels, increased blood triglycerides (a type of fat), decreased levels of “good” HDL cholesterol, high blood pressure and increased risk of a heart attack or stroke.

People living with diabetes are also more prone to the development of atherosclerosis and blood clots. Diabetes also accelerates the damage done by smoking, high blood pressure and high cholesterol.

Diabetes can even affect the heart muscle itself, making it a less efficient pump. As diabetes can affect the nerves to the heart, symptoms of angina may not be felt in the usual way and may be passed off as indigestion or an upset stomach. This leads to delays and difficulties in diagnosing angina and heart attacks.

As you can see, diabetes increases the risk of stroke and heart disease, especially if other risk factors are already present. The risks multiply!

So, prevention is key. Up to 80% of heart disease and strokes that happen before the age of 70 years can be prevented by simply living a healthy lifestyle and treating conditions, such as high blood pressure, high cholesterol and diabetes.

Knowledge is also vital and the best knowledge you can equip yourself with are the signs and symptoms of a heart attack and stroke so that if ever you are in a situation, you are armed with what to do.

Signs and symptoms of a heart attack

Not all people experience the same symptoms when they suffer a heart attack. Sudden chest pain is the most common symptom of a heart attack. In some cases, mostly women or people with diabetes, a heart attack can happen without any chest pain.

Chest pain can also be caused by several other conditions that affect the stomach, chest wall, muscles or lungs. Ambulance staff or a doctor can do the necessary tests to find out if chest pain is caused by a heart attack.

Below are the common symptoms of a heart attack. You may experience only one or several of these symptoms during a heart attack.

  • Pressure, tightness, pain, or a squeezing or aching sensation in your chest or arms that may spread to your neck, jaw or back.
  • Nausea, indigestion, heartburn or abdominal pain.
  • Shortness of breath.
  • Cold sweat.
  • Lightheadedness or sudden dizziness.

If you are in doubt, get checked out.

Signs and symptoms of a stroke

Because stroke is usually not painful, patients may ignore the signs or symptoms and not seek medical attention, in the hope that they will improve. Acute stroke or TIA should be treated as a medical emergency and should be evaluated as soon as possible.

  • Weakness/numbness or limited movement to the affected side.
  • Memory loss/confusion, impaired thinking the loss of concentration.
  • Speech difficulties, (talking or understanding speech).
  • Visual disturbances.
  • Inability to control bowel or urine activities.
  • Loss of balance and difficulties in walking.

FAST is a simple way to remember the signs of a stroke and to seek medical help urgently.

F – Face drooping

A – Arm weakness

S – Speech difficulty

T – Time to call emergency medical services 

FACE: ask the person to show their teeth or smile and see if one side of the face droops or doesn’t move as well as the other side does.

ARMS: ask the person to lift both arms up and keep them up and see if one arm doesn’t move or drifts downward when extended.

SPEECH: ask the person to repeat a short sentence (e.g., “it is a sunny day in Cape Town”) and see if the person uses the correct words without slurring.

TIME: make a careful note of the time of onset of symptoms and call for help urgently if you spot any one of these signs.

For more information go to www.heartfoundation.co.za or find us on Facebook @HeartStrokeSA or on Twitter @SAHeartStroke

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Rita and Tonie van Wetten

Toine and Rita van Wetten – Living with the glass-is-half-full-attitude

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Rita van Wetten shares how her and her husband, Toine, have persisted the glass-is-half-full-attitude in both of their diabetes journeys.

Tonie (80) and Rita van Wetten (67) live in Ballito, KwaZulu-Natal and have been married for 47 years. They have one daughter and an adopted grandson. Rita has Type 1 diabetes and Toine has Type 2 diabetes.

Rita’s diagnosis

Rita was diagnosed with Type 1 diabetes in 1970 and thinking back she recalls how things have changed, for the better of course. “My first syringe looked like an icing decorator and it was extremely stressful to inject myself. In those years, a person with diabetes couldn’t check his/her blood glucose like we do nowadays. You had to go for blood tests at the lab, or on visiting my physician, he would take my urine sample, put it in a test tube and light a burner, he would then put a tablet in the urine and hold the test tube over the burner. Then he would compare the result with a strip on the tablet’s bottle and most of the time my glucose level would be shockingly high. The urine glucose could be an hour or more out in comparison to a blood test.”

“When we could test our own blood glucose around the 1990s, you had to prick your finger with what looked like a scalpel blade. Scary, and needless to say to get a proper drop of blood for the test was extremely stressful. I think my readings were always high as just battling to prick with that lancet made me perspire, stress and curse every time. It was horrible! Insulin changed over the decades from pig-based insulin to human-culture based insulin.”

Rita admits in the first four years of her diagnosis, she couldn’t accept it. “I was in complete denial and cheated and lied to everybody and myself for those four years. This changed once I got married and the biggest turning point was when I was invited to a diabetes meeting at the old Hillbrow hospital, but unbeknown to me this was a lecture for medical students. The words were one thing, but the graphic and horrific slides showing an ulcerating leg, foot, and vagina, with three quarters ‘eaten away’ jerked any complacency out of me.”

“During the lecture, there was also a discussion about the pregnancy complications for a woman with diabetes, and her unborn child. Toine and I so wanted at least one child so that is when while driving home I decided, no more transgressing!”

Brittle diabetic

In the first years of Rita’s diagnosis, it was a struggle to stabilise her glucose levels, not only by herself but by doctors too. “I remember soon after I was diagnosed, I was admitted to hospital to try and stabilise my glucose, and also during my pregnancy I was in hospital for three months. My gynae eventually said, ‘We will never be able to get your glucose right, go home and try your utmost at home.’ I would be 12 mmol/L and within 30 minutes I could be in a hypoglycaemic coma, and it wouldn’t be because of over-injecting. This happened often and I was then deemed a brittle diabetic.”

Brittle diabetes is a term used to describe Type 1 diabetes that is particularly difficult to control. If you have brittle diabetes, you are likely to experience frequent, dramatic swings in blood glucose levels and are at risk of dangerous periods of hypoglycaemia and hyperglycaemia.

Rita adds, “I have never had a hyperglycaemic coma but about 500 hypo comas (where I was out for the count and needed help, either from family, friends or paramedics or doctors). That is apart from  thousands of lows in my 50-years with diabetes. In the early years of my life with diabetes, I had bad spells of high glucose and very often had ketoacidosis.”

Toine’s diagnosis

Toine was diagnosed with Type 2 diabetes after an armed robbery in 2005. Rita explains, “However, he is also unfortunately genetically predisposed due to a family history going back generations.”  Toine currently takes Jardiance and Galvus Met as well as cholesterol medication and Rita uses Tresiba (long-acting insulin) and Humalog (short-acting insulin) and Glucophage.

Managing their diabetes together

Despite the turbulent road Rita has had with her glucose control, she is happy to say she has no secondary complications caused from diabetes. She attributes this to managing her diabetes as best as she can.

“I have no secondary health problems due to diabetes. This I feel is due to a number of factors: after the wake-up call of the diabetes meeting, Toine and I incorporated a healthy lifestyle with regard to eating habits and keeping fit. Smoking and drinking were out. I detest smoking and I have never taken to drink. Regarding our eating plan, we eat very little white carbohydrates (bread, rice, potatoes). However, that doesn’t mean that we occasionally don’t cheat, but when we do we relish and love it and enjoy it thoroughly and thereafter back to the straight and narrow next meal. I carbo count, our dietitian has helped me to work out to a fine art what to inject for what I am going to eat. This injection depends entirely on what my reading is before we eat.”

A game changer

“Since glucometers came into fashion, my control improved a lot. Before I was on Freestyle Libre, I used to test up to 20 times a day because I’m not able to distinguish between high or low glucose symptoms. However, the Freestyle Libre has made my life a lot easier the past three years, actually it has changed my life completely. And Toine’s life as well. He can check my readings any time, whether I am asleep or busy reading or whatever I am busy with.”

Advice for families

Rita’s advice for family with a newly diagnosed member is, “Cook and serve healthy and nourishing meals to everyone in the family. In other words, as a family, decide how this diabetes disruptor is going to be handled and tackled by the family. It’s not only a problem for the person with diabetes.”

Her reasoning for this is her own experience, “When I was just diagnosed, it was a shock to me and my family. It felt like a death sentence. The admonitions and finger wagging of the doctor, no sugar, no desserts etc, only chicken and salads from now on demolished my savoury and sweet tooth staples. While the rest of the family ate delicious meals, I had to/pretended that my piece of chicken and salad was nice. I felt alienated (A driver of my denialism?). Once the family was asleep, I would creep into the pantry and help myself to tasty leftovers. I became a food thief par excellence.”

Glass half full attitude

Rita also attributes positivity to her and Toine’s good management of diabetes. “We keep friends with a positive outlook on life as we are very positive. I believe that having the glass half full personality is important in life. We laugh a lot, at, with and about ourselves (thankfully nobody has to listen to our warped sense of humour). Furthermore, we have immense respect for one another and we touch and cuddle often and show and tell our immense love for each other.”

“We do a lot of things together but we also give each other room to do our own thing. I’m an extrovert and Toine is an introvert. It works well for us. I have always kept myself busy with hobbies over the years like pottery, sculpting, weaving, painting and dancing (which I still do now) and I belong to a writers club. Toine reads a lot and does woodwork; he makes frames for my art. We do crosswords and quizzes and play games and also card games. Last but not the least we are Christians and our faith is of utmost importance in our lives and it keeps us on our knees and grateful, joyful, thankful, happy and our hearts filled with love.”

When asked if they feel they are aging or upgrading, Rita responds, “Mentally, we feel very young. Physically it gets harder and harder to keep fit and before COVID we used to walk 5 plus kilometres daily on the boardwalk without a problem. With lockdown, it went out the window and down the tube. We are trying to get back but it is hard. The mind is willing and instructs; but the muscles say, who are you talking to?”

MEET OUR EDITOR

Laurelle Williams is the Editor at Word for Word Media. She graduated from AFDA with a Bachelor of Arts Honours degree in Live Performance. She has a love for storytelling and sharing emotions through the power of words. Her aim is to educate, encourage and most of all show there is always hope. Feel free to email Laurelle on editor@diabetesfocus.co.za

Daya

Meet Mr and Mrs Daya

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Surendra and Manjhula Daya, the co-ordinators for the Malabar Diabetes Wellness Group, tell us about both having diabetes and managing it together.

Surendra (71) and Manjhula Daya (71) live in Malabar, Port Elizabeth. They have been married for 46 years and have two adult children and two grandsons. Surendra has Type 2 diabetes and Manjhula has Type 2 diabetes.

Manjhula was diagnosed first, in 2000. She remained positive as she knew diabetes is controllable and in order to live a full life, one needs to accept this. She has used insulin (Basaglar and Humalog) since her diagnosis.

Surendra was diagnosed in 2008. He too accepted the condition, despite having high blood pressure and heart problems. His belief is that one must not be upset with the sickness they have, they just need to be positive that they will overcome and survive. He was prescribed Glucophage XR 500 and still takes it today.

The Dayas became members of DSA in September 2009 and Surendra became the co-ordinator of the Malabar Diabetes Wellness Group, which had been in recess for a while; in 2012 when it was re-launched on Valentine’s Day.

“Throughout our lives, my wife and I knew we had to be positive and support each other no matter what, and this is what we did when we found out we had diabetes. We became aware of what we were eating, especially during the Diwali festival. The wife prepares all the delicious sweetmeats, but we control our eating habits during this time.  Every winter, we get our flu vaccines. and we are waiting to get our COVID vaccines Even though we are aging in years, we feel we are upgrading in life,” Surendra says.

MEET OUR EDITOR

Laurelle Williams is the Editor at Word for Word Media. She graduated from AFDA with a Bachelor of Arts Honours degree in Live Performance. She has a love for storytelling and sharing emotions through the power of words. Her aim is to educate, encourage and most of all show there is always hope. Feel free to email Laurelle on editor@diabetesfocus.co.za

reflexology

No more cold feet – reflexology

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For people with diabetes, winter can bring many battles, such as cold feet, that don’t need to be fought if reflexology is considered. Fiona Hardie tells us more.

Winter is slowly introducing herself through autumn colours and leaves falling from the trees. Heaters are being hauled out of storage and there is a decided increase in tea and coffee consumption, larger meals, as well as a deep need for thick socks and fluffy boots or slippers.

While this conjures up cosy images of comfort food and crackling fires, for people with diabetes this can spell trouble particularly with those who have peripheral neuropathy, the loss of feeling, numbness, or tingling one gets in the extremities due to high blood glucose levels. Burning soles and itchiness are another symptom of diabetic neuropathy caused by cytokines (proteins released by the immune system to regulate the inflammatory process).

Added to this, the cold weather also slows circulation as we tend to be somewhat more sedentary in the winter months. People with diabetes should definitely not resort to sitting too close to heaters or using hot water bottles which not only dries skin out, but can lead to blisters, ulcers and much worse if they have lost some sensation in their feet. Cooler weather also worsens neuropathy because blood vessels constrict when temperatures drop, resulting in less blood flow to the nerves. This can mean more pain and numbness.

Reflexology

Winter can bring many battles, for people with diabetes, that don’t need to be fought if reflexology as a therapeutic treatment is considered.

Reflexology is a blessing for numbness in the extremities because the reflexes are stimulated, which encourages blood flow to the nerves. This stimulation comes as a result of firm pressure exerted on the soles and tops of the feet, energising the corresponding organs in the body thus removing blockages in this flow of energy. Therefore, numbness is decreased, and mobility increased which lessens the chance of injury to the feet, loss of balance and overall feelings of discomfort. Additionally, swelling, pain, and the burning sensation respond favourably to reflexology treatments.

Reflexology can also work wonders in assisting in the maintenance of healthy blood glucose levels. HbA1c levels which are the average blood glucose levels also tend to rise during winter as exercise decreases and food consumption increases. This can weaken the immune system leading not only to colds and flu but also increases the risk of bacterial skin infections, such as Athlete’s foot.

The previously mentioned reflex stimulation can help in this dilemma. This is because the various glands responsible for producing white blood cells and building our immunity, as well as the organs involved in insulin regulation, such as the pancreas and liver, are stimulated, consequently helping to maintain the desired balanced blood glucose levels.1

Emotional and mental well-being

Beyond the physical, reflexology can have a profound impact on the emotional and mental states that are often accompanied by winter. It offers comfort because in the aforementioned stimulations, serotonin and oxytocin (feel good hormones) are increased.  Moreover, the firm confident pressure of the therapist during the treatment also lends a feeling of reassurance. Overall, a sense of relief is found not only in the extremities, thus rendering reflexology an all-encompassing therapy.

Spotting other health issues

Therapeutic reflexology can be a diabetic patient’s best friend during this cold season as the reflexologist does a thorough inspection of the condition of the nails and feet as this is how we can tell what is going on in the body. Each individual clients’ specific health issues and symptoms are taken into consideration allowing the therapy to be more personalised and efficient in its process.

Reflexology is not simply a foot massage but a systematic treatment that is incredibly powerful in assisting the body in healing itself by bringing about a profound feeling of relaxation during the cold months of winter.

References:

  1. Reflexology Association of Connecticut – 2007

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.
sick days

The rules for sick days

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Diabetes nurse educator, Kate Bristow, outlines the rules for sick days and how to manage diabetes when you are sick.

COVID-19 has made the whole world sit up and take note but if you have diabetes, it is useful to know a bit more about handling sick days and the higher blood glucose readings that go with it, no matter what the cause of illness is.

When you are sick, your body will make a hormone called cortisol which is a stress hormone. Cortisol increases resistance to insulin which forces your liver to make more glucose, resulting in higher blood glucose levels. These signs are increased urination and thirst.

In some cases, the cells of your body will keep looking for something to give them energy and they will break down fat. Fat is converted to ketones by your liver. Ketones are toxic or poisonous to our bodies. Some signs of ketones can be tummy aches, nausea, and vomiting.

Which illnesses may affect your diabetes and your glucose levels?

  • Common colds/flu – this now includes COVID-19
  • A sore throat
  • Infections of the urinary tract
  • Chest infections/bronchitis/pneumonia
  • Gastric/stomach upsets
  • Skin infections e.g. abscesses

Be aware that certain medications used to treat infections may also impact the blood glucose levels. Cortisone treatment commonly used will cause the blood glucose levels to increase significantly.

How to deal safely with sick days

  • Know your targets – expect an increased blood glucose level and discuss how to handle this in advance with your healthcare team. Elderly patients with diabetes will have slightly higher targets – targets are individualised with your diabetes nurse educator and your doctor.
  • Understand how to adjust your medication and when to call the healthcare team for help.
  • Test your glucose levels more regularly. It’s recommended every two to four hours, including during the night. This applies to patients taking tablets and those on insulin and/or tablets.
  • If you take insulin you may need to test for ketones as well. Your healthcare team will help with this.
  • There is no need to eat when you are sick, but it is important to stay hydrated. High blood glucose levels will make you thirsty and urinate more often, this can lead to dehydration which is equally bad for your system. So, drink more often, even just small sips.
  • Keep taking your insulin as normal, you may need more not less.
  • Some medications may be stopped in infections, these include metformin and SGLT2 inhibitors. Discuss this with your healthcare professional.
  • Check all over-the-counter medications with your pharmacist but they are generally okay, even if they contain a bit of sugar.
  • If you have ketones, anti-nausea medications may not be effective.
  • If you have extremely high blood glucose levels and are on insulin, know the symptoms of ketone build up: tummy ache, nausea and vomiting.
  • Rapid breathing with no cough or fever as well as vomiting without diarrhoea could indicate an increase in ketones.
  • If you can’t keep fluid down or have anything that makes you worried, call for help. A lot of assistance can be given on the phone.
  • Have the contact details for your healthcare team on the fridge and easily accessible to your family/support system. It is okay to ask for help.

DKA

High ketone levels are called diabetic ketoacidosis or DKA.

High ketone levels are called diabetic ketoacidosis or DKA.

Essential supplies to manage your glucose levels

  • Blood glucose test kit
  • Glucose test strips
  • Basal and rapid-acting or mixed insulins (as prescribed)
  • Oral medications (as prescribed)
  • Quick-acting carbs/sugars to treat a low if necessary
  • Ketone test kit and ketone strips
  • Glucagon
Sister Kate Bristow is a qualified nursing sister and certified diabetes educator.

MEET THE EXPERT

Kate Bristow is a qualified nursing sister and certified diabetes educator. She currently runs two diabetes clinics as well as consults with patients privately, on a one-on-one basis via their medical aids, providing the network support required and on-going assistance and education to assist them with their self-management of their diabetes.

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