Calming the hyperactive

Veronica Tift elaborates why reflexology has a place in working with hyperactive children or adults on medication or not.

As kids we used to have to entertain my hyperactive brother. My mom would insist on my sister and I being outside and making sure we ran around all day with him. Looking back, I think she was trying to tire my ADHD brother out so that he would be able to sit at the dinner table. This strategy seldom worked.

When we were kids, we never realised that there was ever anything wrong with my brother. It was only when he struggled in school, attended extra lessons and went for test after test, did we become aware that he had a problem. To us he was our excited little brother who kept us on our toes always coming up with the best games.

I then married a man with ADHD and he couldn’t even sit still long enough to read this article to the end (he did try to his credit). I guess that’s why when I read the overview for ADHD, I felt a little sad, referring to it as a condition that can’t be cured.

The condition includes difficulty with hyperactivity and impulsiveness. These can contribute to low self-esteem, troubled relationships and difficulty at school or work. While these things might all be true, it’s a simplistic way of describing a condition that is extremely complicated and unique to each individual and their circumstances.

To medicate or not?

The pressure to fit into this society and education institutes makes medication not only necessary but also a blessing for many children or adults. The many friends and family that have taken medication for ADHD have had different reason for taking it, different side effects and experiences about how it affects them.

The decision to put your child on medication if diagnosed with ADHD is deeply personal and dependent on your circumstances, the environment of the child and the child themselves.

As a reflexologist working in holistic healing, I always encourage clients to try the natural route first. As an aunt, cousin, sister and wife of family struggling with ADHD I would say, do what works for you and your family.

ADHD presents its self, differently for many people, so what works for one might not work for everyone. Don’t be afraid to try a combination of different therapy’s until you find the one that works for your child and yourself.


Stimulants are the most common types of prescribed medication for ADHD (methylphenidate or amphetamine). These are equally effective and also seem to carry the same risk. There is either short-acting formulation or a longer-acting, depending on your needs and the child.

The most common side effect according to The Child Mind Institute, is loss of appetite. This can be a scary side effect for parents, especially if your child starts to lose weight and used to be a good eater. Sleeping problems like difficulty falling asleep seems to effect younger children more. Depression can be another worrying side effect.

Working with a reflexologist

Important points that a reflexologist will work on to assist the body with ADHD medication and even symptoms of ADHD will be the solar plexus, digestive reflexes, pineal glands, the endocrine system, the brain and spinal reflexes.

By working on the digestive reflex, it helps stimulate the digestive system, which can possibly assist with the lack of appetite. The solar plexus is a calming and relaxing reflex point helping with insomnia and stress.

The reason we focus on the endocrine system is to help coordinate the body functions like growth, development and general wellness of the body.

Working the brain reflex and spinal reflexes, reflexology can encourage the body to deal with stress, encouraging the release of endorphins among other benefits.

Parents are sometimes worried that their child won’t be able to sit still during a treatment, chat to a therapist beforehand if this concerns you. A light gentle treatment is recommended for children and treatments should be adjusted according to the child.

The amazing thing about reflexology is how quickly most kids responds to regular treatments. The parent or guardian is always in the room and conformed consent is mandatory. Often, I give parents a few techniques to do at home; it’s always special how a child responds to a loving parents touch.

There definitely isn’t a cure for ADHD and while reflexology doesn’t claim to be the answer, it can absolutely be considered as a tool and has a place in working with hyperactive children or adults on medication or not.

References – complete guide to ADHD medication

The complete guide to reflexology – 2nd edition Ruth Hull

The complete idiots guide to Reflexology – Frankie Avalon Wolfe, Ph.D, Alpha books


Veronica Tift is a therapeutic reflexologist, registered with the AHPCSA, based in Benoni. She continues to grow her knowledge through attending international and local courses on various subjects related to reflexology. Veronica has a special interest in working with couples struggling with infertility.

Header image by Adobe Stock

Keep an eye on your diabetes

Dr Paula Diab advocates the need to move away from a curative, rehabilitative model of treating diabetes and invest time and money into preventing the complications, such as eye disease, by early detection, timeous treatment where necessary and appropriate follow-up.

It’s probably fairly common knowledge that diabetes can affect your eyes and, in some cases, even cause people to lose their sight completely. It’s estimated that over 7 million people over the age of 40 have some degree of diabetic retinopathy and that this number will increase to 11 million by 2030. The good news though is that it’s estimated that 95% of severe visual loss from diabetic retinopathy can be prevented.

Who is at risk?

All people with diabetes, be it Type 1 or Type 2 diabetes, are at risk. Complications are more common in those people who have had diabetes for longer or whose diabetes has been uncontrolled, but that doesn’t mean that everyone else is safe.

Anyone who already has another form of vascular disease is already at high-risk of developing eye disease. The blood vessels in the eyes are obviously much smaller than those in the heart, brain and limbs so we can often pick up early vascular disease much earlier by shining a light in the eye than we can on an angiogram. Anyone who already has heart disease, suffered from a stroke or heart attack or poor limb perfusion is most certainly already at high-risk.

Because the eyes also have multiple vessels that supply them, the clinical signs of poor vision don’t always correlate with the pathological decline. In other words, it’s not reliable to wait until you experience visual loss or a deterioration in your vision before getting your eyes examined.

How is it detected?

The only way of detecting diabetic eye disease is by regular screening by an optometrist or ophthalmologist. This is not the same as your annual update of your glasses or contact lenses. This is a comprehensive examination where the optometrist or ophthalmologist is specifically looking for complications related to diabetes.

When we renew our script for glasses or contact lenses, we are concentrating mainly on the lenses, the windows of the eye through which we see. In diabetes, we need to assess the blood supply and the potential damage to the retina of the eye which often requires a more sophisticated examination and photographs to be taken. Current South African guidelines recommend that every person with diabetes has their eyes screened at least annually from the time of diagnosis of diabetes, even in childhood.

As mentioned above, please don’t wait for deterioration in your vision before you seek help; at this stage it’s often too late. Regular monitoring and documentation of declining eye function often encourages a diabetologist to enhance medical therapy and prevent the decline in vision before it becomes noticeable. This is why comprehensive care and good communication amongst the various specialists is vital.

How can eye disease be treated?

Firstly, and most importantly, addressing any additional risk factors is very important.

  • Stop smoking.
  • Ensure that your blood glucose levels, blood pressure and cholesterol levels are well within target and that you’re taking all the correct medication.
  • Maintaining a healthy diet and regular physical exercise will also go a long way to ensuring good cardiovascular health.

Some eye conditions can be treated with eye drops and topical medications whilst others may need surgical intervention. Eye surgery and treatment has progressed at a rapid rate over the last few years and many procedures are extremely safe, quick and have remarkable outcomes. However, the longer that these diseases are left before treatment is commenced, the more difficult it becomes and the more the prognosis deteriorates.

What type of damage can occur?

Diabetic retinopathy is a general term for all disorders that affect the retina caused by diabetes. The retina is the back surface of the eye where all the blood vessels are found and where the images we see are imprinted onto the retinal cells. It stands to reason that if these blood vessels are blocked or leaking in any way, that the images we see may not be correct.

Proliferative retinopathy refers to the new vessels that are formed when older vessels become damaged or obstructed. These new vessels are often fragile or weak and can leak into the vitreous humour (jelly-like substance at the back of the eyeball) causing haemorrhages, scar tissue and even retinal detachment.

Non-proliferative retinopathy refers to the phenomenon where capillaries in the back of the eye balloon and form pouches. As the condition worsens, more blood vessels become blocked depriving areas of the retina from their blood supply. This results in new but weaker vessel formation.

Maculopathy is when fluid leaks into the centre of the macula, causing the macula to swell and blur the vision. The macula is the central area of the retina where colour vision is perceived and where the image is the most focussed.

Cataracts may also be found as a result of diabetes although they may also occur independently of blood glucose levels. These cause cloudy vision and difficulty with night vision.

Glaucoma (damage to the optic nerve) caused by an increased pressure build-up within the eye can also be a consequence of diabetes and may occur quickly or over a longer period of time but can also have a severe impact on vision.

What should you do? 

Talk to your doctor today and ask for a referral to get your eyes tested as soon as possible. South African guidelines recommend that you get your eyes checked annually regardless of what visual symptoms you may have.

Trials have shown that good glycaemic control, managing other risk factors and regular eye screening can prevent or delay many complications related to diabetic eye disease. Test your glucose levels regularly and understand the fluctuations that occur on a daily basis. Ask your doctor to explain how you can manage your diabetes more effectively and look for complications. Don’t wait for the symptoms before you act.

Finally, please don’t put off these tests because you can see okay or just got new glasses last month. Diabetic eye disease is preventable and treatable if detected early. It’s also an excellent sign of other vascular damage in the body and a skilled clinician will be able to adjust your chronic medication to address these changes and prevent any further damage taking place. There is no need to lose your vision due to diabetes.

Dr Paula Diab


Dr Paula Diab is a diabetologist at Atrium Lifestyle Centre and is an extra-ordinary lecturer, Dept of Family Medicine, University of Pretoria.

Header image by Adobe Stock

Make Froggie your choice of shoes this Spring

So many of us experience foot health issues; could it be, that we are not meant to wear shoes, such as high heels or shoes with pointed toes, that do not accommodate the natural structure of our feet? 

Sarah Gedye, Froggie Brand Manager

Sarah Gedye, Froggie Brand Manager, founder and absolute shoe fundi tells us more.

At Froggie, we have always considered how to make great-looking footwear comfortable. Recently, we focused on what we could do to make shoes for customers with exceptional needs. Specifically, a customer needing a shoe that can accommodate an insert; a common requirement for people living with diabetes and associated footwear implications.

To offer that extra bit of comfort, the team developed a footwear solution that provides extra cushioning underfoot with a fully removable padded footbed. The result: a shoe range with custom comfort that still looks fabulous.

For your choice of wear this season


Three styles: a closed back, two-strap sandal slingback sandal and three-strap slip-on.

  • The closed back sandal holds onto the foot securely at the back for increased stability while still providing airy, cool all-day wear.
  • The two-strap sandal, with velcro straps, is totally adjustable to the width of your feet and comes with extender straps should you require a little more length.
  • The three-strap is a comfy slip-on style with adjustable velcro straps, perfect for the South African heat and associated foot swelling.
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Sneakers, loafers and boots

Comfort and ease are key, especially for women on the go. Froggie sneakers, loafers and boots sport a classic leather look while the added padded footbed (removable) offers unparalleled comfort and convenience.

  • Classic leather Froggie sneakers with a refresh. These are elasticated and super easy to slip-on. Wear them with skinny jeans, summer shorts or even sweats.
  • Slip-on sneakers are chic and incredibly comfy. Wear them with skinny jeans, flares or pair them with shorts and skirts.
  • Mid-calf boots are a Froggie fav! This slightly boxy style, sits out from your leg, giving your calves a bit of breathing room. The gentle gathering on the leg gives this must-have genuine leather mild-weather staple, a stylishly slouchy yet feminine look.

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Our latest – Neo Sole Wedges

Aptly named “Neo” because this new style of wedge gives you that extra lift, yet also the stable comfort you look for in a wedge. This unique design was developed to include the Froggie comfort features, as well as echo the latest fashion trends from work to weekend-wear.

  • The Pump: New look with classic shape offering a lift with comfy stability. (Back Wedge Height: 6cm)
  • Are sporty trends your thing? This sneaker wedge with a cute lace-up is a winner: game-set-match!
  • This Slipper Cut Wedge offers a little more coverage and holds beautifully onto your foot while walking, or even running – if you’re in a rush.

We won’t deny, there was a lot of back and forth at the development stage plus the odd roadblock but, what we’ve found with anything challenging, when you’re backed by a passionate, cohesive team – nothing is impossible.


Come walk with Froggie Shoes – your step, our shoes.


The benefits of Cupping therapy for people living with diabetes

Farhana Cassim, a Cupping therapist, explains the benefits of Cupping therapy, highlighting the good it does for people living with diabetes.

What is Cupping therapy?

Cupping is a safe, non-invasive and inexpensive technique that has been practiced since ancient times. It’s used to alleviate the pain and discomfort arising from disorders of internal organs, and muscle spasms, joint pains, diabetic neuropathy and numerous other conditions. There are three types of Cupping: Dry-, Wet- and Massage Cupping.

After a long period of neglect, Cupping was revived in the Islamic age. Strict adherence to rules of application was demanded, with close attention to timing and patient condition. Traditional healers in many parts of the world use Cupping or versions of it in their healing repertoire. The technique has historically been used by practitioners of conventional medicine for many centuries to treat a range of diseases. It’s also an important aspect of traditional Chinese medicine.

How does it work?

Cupping causes the tissues beneath the cup to be drawn up and swell. This increases blood flow to the affected area. This enhanced blood flow under the cup draws impurities and toxins away from the nearby tissues and organs to the skin.

The release of the vacuum redirects toxic blood that had pooled at the site and redirects it to other areas of the body, thus allowing fresh blood to replace it. This facilitates the healing process. Localised and deep-tissue healing takes place.

Cupping diverts toxins and impurities from important organs, such as the liver or kidney, to the upper surface of the body.
In Dry Cupping, the toxins are brought to the underlying skin. In Wet Cupping, the toxins are brought out of the body, onto the surface of the skin. This process strengthens the immune system, so encouraging the optimum functioning of the body.

The benefits

Cupping assists the liver by increasing blood perfusion, so removing the metabolic load imposed by the disease and perhaps any drugs used to treat the disease. It also supports the immune system, by acting on the reticuloendothelial system to help it in opposing the actions of invading microbes. In addition, Cupping supports the nervous system, by helping to reverse ischaemia (reduced blood flow), which can lead to conditions characterised by cerebral metabolic insufficiency, such as memory disturbances, epilepsy and emotional conditions.

It supports the renal system, by helping to reverse the ischaemia which underlies many disorders. Cupping is also involved in the release of cortisol and serotonin, important mediators in pain and stress. Added to that, it also stimulates meridians, and releases biological opioids called endorphins.

Clinical value

The benefits have been extensively researched and documented. Cupping is recommended for people with recurring, refractory headaches, skin disorders, stomach pain, boils; disorders of the heart and circulation, such as varicose veins and hypertension; joint and neck pains, for example, arthritis and rheumatism; diarrhoea and vomiting; menstrual cramps; bronchitis; colds; asthma; infertility; impotence; and haemorrhoids, amongst other ailments.

The clinical benefits of Cupping continue for several days after the procedure. These are for most ailments that effect a large number of diabetic patients.

The use of whichever form of Cupping is at the discretion of the practitioner.

Studies in people with diabetes

Diabetic patients (Type 2) that were treated with Cupping therapy, the results showed that blood glucose levels were lowered consistently in almost all experimental patients subjected to Cupping, when comparing blood glucose levels before (mean 11.98 ± 10.11SD) and after (9.86 ± 8.93 SD).

On quality of life issues, people with diabetes showed substantial improvement in patient health parameters when the final cupping session was compared to the initial one. The majority of patients showed an increase in energy levels and improvement in sleeping habits.

Although Cupping is not a cure for diabetes, it can assist by detoxing the body and blood by reducing the toxic accumulated waste in the body and improving blood circulation. Cupping also assists in cleansing the blood and cells, resolving stagnation and blood stasis in the body.

Diabetes can make it difficult to control your blood pressure and cholesterol, which can lead to heart attacks, stroke and other serious conditions. Cupping increases blood flow in the body and improves circulation; it also reduces blood pressure and cholesterol when performed regularly.

Farhana Cassim is a Hijama Cupping therapist certified via Hijama Association South Africa. She is passionate about bringing benefit to mankind, your health is your wealth. Cupping 4 Cure


Farhana Cassim is a Hijama Cupping therapist certified via Hijama Association South Africa. She is passionate about bringing benefit to mankind, your health is your wealth. Cupping 4 Cure

Header image by Adobe Stock

The benefits of a plant-based diet for people with diabetes

Dietitian, Meagan Atcheson, explains the advantages of adopting a plant-based diet if you have diabetes.

A plant-based lifestyle is any diet that focuses on eating more foods derived from plant sources. This includes consuming more fruit, vegetables, wholegrains, pulses, legumes, nuts and seeds as well as meat substitutes, such as soya and tofu. This type of diet emphasises minimising the intake of animal products as well as limiting processed foods.   

Types of plant-based diets

There are a variety of diets that may fall under the broad term plant-based:

  1. Lacto-ovo-vegetarian: Lacto refers to milk and ovo refers to eggs. This typeof vegetarian consumes eggs and dairy products but no other animal products.
  2. Flexitarian:This style of eating encourages mostly plant-basedfoods while allowing meat and other animal products in moderation.
  3. Pescatarian: Pescatarians don’t consume any meat or poultry but occasionally consume fish as part of their diet.
  4. Vegan:A vegan diet excludes:
  • Meat and poultry: Beef, lamb, pork,veal, horse, organ meat, wild meat, chicken, turkey, goose, duck, quail, etc.
  • Fish and seafood: All types of fish, anchovies, shrimp, squid, scallops, calamari, mussels, crab, lobster, etc.
  • Dairy: Milk, yoghurt, cheese, butter, cream, ice cream, etc.
  • Eggs: From chickens, quails, ostriches, fish, etc.
  • Bee products: Honey, bee pollen, etc.
  • Animal-based ingredients: Whey, casein, lactose, egg white albumen, gelatine, L-cysteine, animal-derived vitamin Dand fish-derived omega-3s.

There are numerous health benefits to following a carefully planned out whole-food plant-based diet which includes a wide variety of plant foods, such as fruits, vegetables, wholegrains, legumes, nuts and seeds.

Benefits of a plant-based diet 

It’s always best to seek advice from a registered dietitian who will provide an individualised meal plan to ensure that the diet is healthy and includes a variety of plant proteins as well as other nutrients to prevent nutritional deficiencies.

  1. Lower BMI

Research shows that individuals who follow a healthy plant-based diet tend to have a lower body mass index (BMI).

  1. Weight loss

Several studies show that healthy plant-based diets are effective for weight loss. This may be due to a lower calorie intake as plant-based diets tend to be higher in fibre which leads to feelings of fullness and satiety.

  1. Improved glycaemic control in people with Type 2 diabetes

Various studies show that following a low-fat plant-based diet improves glucose control in Type 2 diabetes. Some studies show that individuals on a plant-based diet have a 78% lower risk of developing Type 2 diabetes.

  1. Cardiovascular health

Plant-based diets may also improve heart health and reduce the risk for heart disease as they are effective in reducing blood pressure, cholesterol and blood glucose levels.

  1. Other pros

These diets may also be beneficial in reducing symptoms of arthritis, reducing the risk for developing Alzheimer’s and improving kidney function in diabetic patients. However, more research is still needed in these areas.

  1. Soya foods and diabetes

Eating whole soya bean products, like tofu, tempeh, edamame and soya milk, have been show to lower cholesterol, decrease blood glucose levels and improve glucose tolerance in people with diabetes.

  1. Reducing consumptionof red meat

Particularly reducing processed meats (smoked, cured, had salt or chemical preservatives added) has been linked to a reduced risk of colorectal cancer.

What does the evidence say?

Studies strongly support the role of plant-based diets in reducing the risk of Type 2 diabetes. Evidence demonstrates the benefits of plant-based diets in treating Type 2 diabetes and reducing key diabetes-related complications.

The evidence suggests that the type and source of carbohydrate (unrefined versus refined), fats (monounsaturated and polyunsaturated versus saturated and trans), and protein (plant versus animal) play a major role in the prevention and management of Type 2 diabetes.

Overall plant-based diets improve insulin resistance and improves overall health in people living with diabetes as it promotes an increases in fibre and phytonutrients and decreases the intake of saturated and trans fats.

If a predominantly plant-based lifestyle sounds daunting start with one day in the week (start by adding brown lentils to a mince dish, chickpeas to a curry or beans to a soup). Whatever you decide to do, please speak to a registered dietitian before embarking on a new diet to assist in meeting your individual needs.


Meagan Atcheson is a registered dietitian who focuses specifically in oncology. She is a plant-centric foodie who promotes a nourishing approach to health and wellness using evidence-based research and guidelines only.

Header image by Adobe Stock

Ostrich, vegetable & cashew stir-fry

Makes 4 servings
Preparation time: 10 – 15 minutes 
Cooking time: 30 – 35 minutes


  • 400g SPAR *Ostrich Prime Steaks/SPAR Ostrich Strips can also be used (which will then not need to be sliced in step 9)
  • 2 Tbs SPAR Extra Virgin olive oil
  • 2 Tbs Vital Soy sauce (or any other low sodium alternative)
  • 1 Tbs Raw Honey
  • 1 Tbs SPAR Freshline Ginger, grated
  • 1 Tbs SPAR Apple Cider Vinegar/Lemon Juice
  • 1 tsp Ina Paarman Garlic & Herb Spices
  • ¾ cup quinoa
  • 1 ½ cups water
  • ½ SPAR Freshline Onion, diced
  • 2 SPAR Freshline Garlic Cloves, minced
  • ¼ punnet (65-70g) SPAR Freshline Mushrooms, sliced
  • ½ SPAR Freshline Yellow Pepper, diced
  • ½ SPAR Freshline Red Pepper, diced
  • 6 SPAR Freshline Spring Onions, chopped (and extra for garnish)
  • 2 cups SPAR Freshline Broccoli, cut into smaller florets
  • 2 handfuls of SPAR Freshline Baby Spinach
  • 50g *cashew nuts (can be roasted but limit the addition of salt)
  • Sea Salt and Black Pepper (to taste)


  1. For the marinade: Mix together the olive oil, soy sauce, honey, ginger, apple cider vinegar/lemon juice and spices in a small bowl.
  2. Put the *Ostrich steaks in the marinade. Cover completely with the marinade and marinade for 20 min or longer.
  3. Meanwhile, add the quinoa and water to a medium sized pot. Heat on high until it reaches a boil. Once boiling, cover and reduce to simmer for 12-15 minutes. Once all liquid is absorbed, remove the cooked quinoa from heat, fluff with a fork and set aside.
  4. While waiting for the meat to marinade and the quinoa to cook, steam broccoli until bright green (5 min). Do not overcook as this reduces the nutritional value
  5. Once the steaks have finished marinading, heat a wok or large frying pan. Put the steaks in the hot pan and quickly cook on both sides till brown but not cooked through (2 minutes per side). Now add a little of the marinade to the meat in the pan, cover with a lid and cook for 5 min. Remove the steaks from the pan and let rest on a plate while leaving the rest of the juices from the steaks in the pan.
  6. Add the onions and garlic to the pan with meat juices in. Stir-fry till just brown and then add the mushrooms. Stir-fry for another 1-2 minutes then add the peppers and stir-fry till browned. Top with the spring onions. Little bit of water can be added to the pan if the vegetables start to burn.
  7. Next add the steamed broccoli florets and cook till broccoli IS crisped (1-2 minutes).
  8. Meanwhile, slice the steak into thin strips and add to the stir-fried vegetables together with any juices that is left on the plate that it rested in and was sliced in.
  9. Add the baby spinach and the remaining marinade and put the lid on for 2-3 minutes so the dish is heated through, but the meat is not over-cooked. Remove from the heat
  10. Divide the quinoa in 4 serving bowls and top with the stir-fry mixture.
  11. Lastly garnish with the spring onions and the *cashew nuts.
  12. Flavour with salt and pepper and serve.

Additional notes:

*Chicken breast can also be used as an alternative to the ostrich meat. The chicken breasts should be sliced into strips at the beginning before marinading and extra lemon juice can be added to the marinade

*Allergic to nuts, replace the cashew nuts with sesame seeds.

This recipe is brought to you by:

Menopause and managing blood glucose levels

For many women menopause can herald a rather turbulent time. For women living with diabetes, the turbulence can be tumultuous. In other words, managing menopause and blood glucose presents significant challenges but is possible.

Let’s first make sense of all the terms that get used during this period.

Menopause is officially the time when the ovaries have stopped working and reproductive life is at an end. A woman is said to be in menopause when she has not had a period for a year. The average age range of menopause is 45 – 55 years.

Peri-menopause is the time before menopause when oestrogen levels start to decline and some symptoms of this may occur, for example: sleep disturbances, night sweats, hot flashes and mood changes. This can start eight to 10 years before menopause.

Post-menopause is the time after menopause and is life-long.

Early menopause is when menopause occurs before age 45 years and often there is no other cause.

Premature menopause occurs before age 40 years. It can be due to surgical removal of or damage to the ovaries from radiation or infection. In many instances this is genetic or autoimmune.



Natural menopause occurs due to aging of the ovaries and a decrease in the production of oestrogen. Surgical menopause occurs if both ovaries are removed.


Menopausal symptoms are traditionally divided into:

Vasomotor – This includes hot flashes (sudden sensation of heat in body) and night sweats (these can be in the day as well).

Mood changes – New onset or worsening anxiety and depression; insomnia.

However, there is a long list of other symptoms which women may experience, such as local vaginal dryness and urinary problems; headaches; decreased libido; decreased concentration; hair thinning or falling out, and the one concern almost all women have, weight gain.

Changes in a women’s body at menopause

Oestrogen decreases during peri-menopause and will eventually be undetectable in the female body. Studies have shown that this hormonal change was the reason for decreased energy expenditure. If there is no simultaneous decrease in energy intake, that is daily calories remain the same, then weight gain begins. This weight being gained is all fat. In fact, menopause itself is associated with muscle loss, a condition called sarcopenia. This affects the distribution of weight and hence, the despised middle-aged spread. This increase in fat around the middle of the body as well as the reduction in lean muscle mass is what can cause insulin resistance.

At this time of a woman’s life, she is often less physically active, and the cycles of work stress, family responsibilities and having to deal with unpleasant menopausal symptoms often triggers unhealthy eating. This worsens weight gain and insulin resistance, and of course diabetes control.

Is diabetes more common after menopause?

There is a definite relationship between oestrogen levels and blood glucose levels. The European Prospective Investigation into Cancer Study showed that women with premature menopause had a 32% higher risk for developing Type 2 Diabetes. This data has been replicated in several studies. If a woman has other risks, such as a family history of diabetes or increased body weight, it’s a good idea to be screened for diabetes. Interestingly, women who experience hot flashes and other vasomotor symptoms have an increased risk of developing Type 2 diabetes.

Is diabetes harder to control after menopause?

As mentioned, insulin resistance is a feature of menopause, so this will make diabetes management more challenging. It is possible that there will be a deterioration in HbA1c, requiring an increase in medication, particularly insulin doses. However, key to improving glucose levels is a healthy lifestyle and maintaining a normal body weight.


For many years menopausal women with Type 2 diabetes were not offered menopausal hormone therapy (MHT) due to the concern that this would increase the risk of cardiovascular disease. In fact, research has shown benefit rather than risk. MHT can reduce insulin resistance, abdominal fat and improve glucose metabolism, as well as other cardiovascular risk factors, such as blood pressure and cholesterol levels. This is largely due to MHT acting directly on the liver and pancreas.

MHT comes in various combinations:

Oestrogen only – Oestrogen is the hormone that gives most relief to symptoms and overall benefit. Only women who have had their womb removed can use this.

Oestrogen plus progesterone – Women who still have their womb have to take progesterone to stop unopposed oestrogen effect on the lining of the womb which could cause cancer.

MHT can be given either as a pill or patch. Oestrogen alone is also available as a gel. The advantage of giving MHT through the skin (transdermally) is that it does not get metabolised through the liver and this reduces its overall side effect profile.

Side effects

For women concerned only about vaginal dryness, oestrogen is available as vaginal creams or pessaries. As this is only absorbed locally, side effects are much lower.

Overall side effects of MHT are low, especially if used at the time of menopause, the lowest effective dose, shortest time necessary and transdermally. There is always concern about the risk of:

Breast cancer – Risk is seen with more than five years of continuous use of combination MHT and increases in the over 60 years age group. In most instances, women who have had breast cancer or have a first-degree relative (mother or sister) with breast cancer are not given MHT.

Blood clots – All MHT can increase the risk of deep vein thrombosis and lung embolism but this is rare in the 50 – 59-year age group. If a woman has had a blood clot or has a strong family history of blood clots, then she should not use MHT.

Most effective therapy

MHT is the most effective therapy for controlling the symptoms of menopause. Additionally, it prevents osteoporosis and given at the time of menopause provides cardiovascular protection. These latter two are significant advantages in the women with Type 2 diabetes.

Each woman should discuss these pros and cons with her doctor. MHT should improve overall glucose control, but again there can be a variable response. Home glucose testing is important during this time.

Many women will navigate menopause without any treatment or choose herbal or natural remedies. Women with diabetes need to be aware of the risk of deteriorating glucose control. As always, the most effective protection and management of this is a healthy lifestyle which aims to maintain a normal (or as close to as possible) body weight.

Dr Angela Murphy qualified as a specialist physician in 2000 and joined the Department of Endocrinology and Metabolism at Charlotte Maxeke Johannesburg Academic Hospital. Currently she sees patients at Sunward Park Medical Centre. She retains a special interest in endocrinology and a large part of her practice is diabetes and obesity. She is a member of the Society of Endocrinology and Metabolism of South Africa and the National Osteoporosis Foundation and is actively involved in diabetes patient education. Living with diabetes in the family for 17 years has shown her that knowledge is power. Basic principles in diabetes must always be applied but people living with diabetes should also be introduced to innovations in treatment and technology which may help their diabetes journey.


Dr Angela Murphy qualified as a specialist physician in 2000 and joined the Department of Endocrinology and Metabolism at Charlotte Maxeke Johannesburg Academic Hospital. Currently she sees patients at Sunward Park Medical Centre and retains a special interest in endocrinology and a large part of her practice is diabetes and obesity.

Header image by Adobe Stock

How to use an app to help manage your diabetes

We learn how an app can make the road of managing your diabetes smoother and hump-free.

If you’re reading this, you already know how much goes on behind the scenes to manage your diabetes. You have to think about what happened recently, what’s happening right now and what you expect to happen in the coming hours. You’ve probably gotten so good that you don’t even consciously think about most of it, you just do it.

Then there’s the big-picture stuff: how you’re doing over a longer period of time. If you’re like many people, you don’t think about this until there’s a doctor’s appointment right around the corner.

Where does an app come in?

Keeping so much information in your brain doesn’t make sense. You can feel overwhelmed and unsure of your next move, second guess your decisions or get frustrated. That’s completely normal, and a good reason to outsource.

For certain parts of diabetes management, computers do better than humans: recording information and remembering it when requested, monitoring something over and over again, performing a task around the clock or spotting patterns and trends. Computers, especially smartphones, are perfect for a lot of diabetes-related work. They’re powerful and portable, they’re almost always with you, they’re connected to the world and they’re packed with sensors.

Being able to outsource diabetes work to an app on your smartphone means you have that much more brainpower for more important things in life.

How to use an app for your diabetes management

The future of diabetes data management is automated. With the mySugr app, the Accu-Chek Instant® will log your blood glucose measurements automatically. With a tap of your finger, you can quickly add details about your meals, your meds and any other information you think is important. You can even customise the logging screen, so you don’t waste time dealing with things that aren’t important for you.

The mySugr app can automatically pull in activity data from your phone so you can see exercise information alongside your blood glucose levels. Location services make it possible to search for past experiences, like eating at a restaurant. With two taps, you can see everything you’ve tried at that restaurant and how your blood glucose responded. Having this type of information at your fingertips helps you make more informed decisions. That’s powerful!

You add the context

To give your story even more detail, you can add context:

  • Meal photos – Quick manual entry to help you manage your post-meal questions.
  • Notes – Add a quick note when something is out of the ordinary or if it helps explain a decision you made. You’ll even be able to search them later.
  • Tags – By far, it’s the easiest way to add useful information to your entry. You can select a tag for many common situations.

How many times has your doctor asked, “What happened here?” while looking over your reports? Now, you can just pull up the mySugr app on your smartphone and explain everything. It’s a great way to get the most out of an appointment.

So much is automated now, thanks to apps like mySugr and connected meters. Don’t feel like you have to do everything for your diabetes management. You have lots of help around!

How to connect?

Connecting your Accu-Chek Instant with mySugr is a snap. First things first, have your smartphone and your Accu-Chek meter handy. *

Once you have downloaded the mySugr app to your smartphone, follow the four easy steps below:

  1. Turn on your phone’s Bluetooth and select Connections from the menu.
  2. Select your Accu-Chek Instant from the list shown and tap Connect Now.
  3. Follow the instructions on your smartphone screen.
  4. Find the matching PIN on the back of your meter just below the battery and enter it into your phone.

Voilà! Your device is now connected. From here on out, the mySugr app will act as chief communication officer between you and your Accu-Chek Instant. That means any settings adjusted within the mySugr app will be transferred to your Accu-Chek Instant meter once synchronisation is complete.

*Some users find it easier to have the PIN from the back of their Accu-Chek Instant written down ahead of time for easier visibility before starting the pairing process.

To check if your mobile device is compatible with the mySugr app, please contact our customer support team. For more information, contact your healthcare professional.


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The link between diabetes and ADHD

With October being ADHD Awareness Month, Daniel Sher educates us on the links between ADHD and diabetes, and how to manage both.

Defining ADHD

Attention-Deficit Hyperactivity Disorder (ADHD) is a common childhood developmental condition, affecting about 7.2% of all children. People with ADHD experience a hijacking of the brain’s executive system, which is responsible for focus, planning, organisation and impulse control. For those affected, ADHD can cause problems with school or work performance. In addition, ADHD symptoms can have a serious spill-over effect for diabetes management.

Is there a link between Type 1 diabetes and ADHD?

While some studies say that there is no clear link between Type 1 and ADHD, some research has found that as many as 12% of Type 1 adolescents have ADHD. But why would this be the case?

Research has found that people with Type 1 diabetes frequently have changes in the brain’s grey and white matter areas. These changes, which are linked to poorer blood glucose control, are thought to underlie and worsen some of the cognitive difficulties that people with ADHD experience. For children who develop Type 1 diabetes early in life, therefore, the brain may be changed in a way that makes them vulnerable to ADHD.

Is there a link between Type 2 diabetes and ADHD?

People who grow up with untreated ADHD are more likely to develop Type 2 diabetes, as well as obesity and hypertension, as they get older. How does this happen? A part of the theory is that ADHD impacts planning and organisation, making it harder to regularly engage in healthy physical activity and nutritious meal preparation. Furthermore, ADHD brains tend to crave dopamine rewards and for many, this causes overeating and sugar addiction. 

Diabetes management

There’s no doubt about it: having ADHD makes the already challenging job of managing diabetes that much tougher. How? Anyone with diabetes will know just how complicated it can be to manage this condition. To thrive with diabetes, some of the skills that we need include:

  • Knowing how to plan properly and set achievable goals;
  • Having good strategies to manage our impulses;
  • Finding ways to sustain motivation and avoid burnout;
  • Establishing a schedule that makes it easy to remember all of our testing and medications; and
  • Knowing how to multi-task and find balance in life.

The common thread between all of these skills is that they are based on the brain’s executive control networks: the very functions that people with ADHD struggle with. For this reason, people with diabetes and ADHD often struggle to plan, set realistic goals, motivate themselves, manage impulses and remember to take their medications on time.


People with ADHD have reported that they struggle with their diet, which makes diabetes management extremely challenging. This happens because ADHD is an impulse control disorder, meaning that people who have it struggle to stop themselves from engaging in a certain behaviour. This helps to explain why, for example, many people who have ADHD also have binge-eating disorder and related eating difficulties, such as snacking frequently between meals and night-eating.

Additionally, the brain of people with ADHD tends to crave dopamine hits, which often leads a person to snack on foods that are high in refined carbs or sugars. This can lead to insulin resistance and fluctuating blood glucose, which in turn makes the ADHD even harder to manage.

It should come as no surprise, then, that research shows youngsters with diabetes and ADHD often have higher A1c (average blood-glucose) readings. They also tend to have more hospital admissions, longer times spent in hospitals and, consequently, doubled healthcare costs.

How is ADHD diagnosed and treated?

The diagnosis should be made by a medical specialist (paediatrician or psychiatrist) or a clinical psychologist. At times, a psychologist may perform neuropsychological testing to help the doctor make the diagnosis. This helps the parents and doctors understand the exact cognitive strengths and weaknesses that a person presents with, which can help with getting the right support.

If you suspect that you or your little one may have ADHD, it’s important to get a diagnosis from a clinician who has a detailed understanding of how diabetes can change your behaviour and brain. For some children, their behaviour will look like ADHD when in fact it’s being caused by other factors, such as stress, diabetes burnout or fluctuating blood glucose levels.

Is it all bad news?

There’s no doubt about it: having ADHD makes the already tough job of managing diabetes even harder. With the right support, though, people can learn to thrive with diabetes and ADHD. There are many effective treatment options out there, ranging from medication to therapy and lifestyle change. Speak to your doctor or psychologist about getting the right help, to assist you or your little one in learning to establish harmony between the brain, body and behaviour.


Akaltun, I., Tayfun, K. A. R. A., Cayir, A., & Ayaydin, H. (2019). Is There a Relation between type 1 diabetes mellitus and ADHD and severity of ADHD in children and adolescents? A case-control study. Osmangazi Tıp Dergisi.

Hilgard, D., Konrad, K., Meusers, M., Bartus, B., Otto, K. P., Lepler, R., … & German/Austrian DPV Study Group, the Working Group on Psychiatric, Psychotherapeutic Psychological Aspects of Paediatric Diabetology (PPAG eV) and the BMBF Competence Network Diabetes, Germany. (2017). Comorbidity of attention deficit hyperactivity disorder and type 1 diabetes in children and adolescents: Analysis based on the multicentre DPV registry. Pediatric diabetes, 18(8), 706-713.

Macek, J., Battelino, T., Bizjak, M., Zupanc, C., Bograf, A. K., Vesnic, S., … & Bratina, N. (2019). Impact of attention deficit hyperactivity disorder on metabolic control in adolescents with type1 diabetes. Journal of psychosomatic research, 126, 109816.

Thomas, R., Sanders, S., Doust, J., Beller, E., & Glasziou, P. (2015). Prevalence of attention-deficit/hyperactivity disorder: a systematic review and meta-analysis. Pediatrics, 135(4), e994-e1001.

Volkow, N. D., Wang, G. J., Kollins, S. H., Wigal, T. L., Newcorn, J. H., Telang, F., … & Swanson, J. M. (2009). Evaluating dopamine reward pathway in ADHD: clinical implications. Jama, 302(10), 1084-1091.


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

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Alzheimer’s, dementia and diabetes

Alzheimer’s disease and diabetes are both increasing in numbers. Dr Louise Johnson explains why the associations are getting stronger with better data.

Alzheimer’s disease

Alzheimer’s disease was diagnosed by German psychiatrist, Professor Alois Alzheimer, in 1906. Alzheimer’s disease is the most prevalent form of dementia in the aging population. Recently declared as the sixth major cause of death in the world.

Patients affected with Alzheimer’s suffer a gradual decline of cognitive abilities and memory functions till the disease renders them incapable of performing normal daily activities, such as eating, dressing and bathing.

Over 30 million people suffer from Alzheimer’s disease in the world. And this number is estimated to double to 60 million by 2030.2

Clinically Alzheimer’s disease (AD) can be classified into two sub-types: Late-onset or sporadic AD and early-onset or familial AD.

Late onset AD

This type affects about 95% of the Alzheimer population. These people are older than 65 years of age. Other than ageing, other risk factors for late onset AD are:

  • Stroke
  • Family history of diabetes
  • Hypertension
  • Obesity
  • ApoE4 gene

Studies revealed that the apolipoprotein E (ApoE4) gene is a significant risk factor for the development of the disease.

Early onset AD

It affects 5% of the Alzheimer population. This disease is diagnosed in thirties, forties or fifties. It’s due to the mutation of three genes: amyloid precursor protein, presenilin-1 and presinilin -2.1

Type 2 diabetes

Diabetes mellitus is a chronic metabolic disorder that is increasing worldwide. In 2019, there were 415 million people with diabetes worldwide. Of this number, 95% are Type 2 diabetes. There is another approximate 50% (220 million) walking around undiagnosed. Currently, one in every 11 people worldwide has diabetes according to the International Diabetes Federation 2019.

The salient features of Type 2 diabetes are:

  • High levels of blood glucose
  • High insulin levels
  • Insulin resistance

Insulin resistance arises due to decrease insulin sensitivity in the muscle, fat tissue and liver.

What evidence proves there is link between diabetes and Alzheimer disease?

Epidemiology studies show that Type 2 diabetes increases the risk for AD by two-fold. Type 2 diabetes is strongly associated with late onset Alzheimer’s disease. This association is partially due to cerebrovascular disease (stroke and TIA). But that isn’t the only reason. The reason that the connection between these two major diseases can be made are:

  • Insulin resistance
  • Inflammation and blood vessel damage
  • Blocked nerve communication
  • Tangled tau proteins

Insulin resistance

When cells don’t utilise insulin the proper way, this can affect the brains mechanics. When your brain cells aren’t fuelled properly, the brain can’t function correctly, resulting in blood glucose to rise. Over time this can result in harmful fatty deposits in the blood vessels.

Having too much insulin can upset the chemical balance in the brain. The impact on the brain is so strong that Alzheimer’s disease related to insulin resistance should be referred to as Type 3 diabetes.

Inflammation and blood vessel damage

Those who have diabetes are at higher risk for heart attack and stroke. High blood glucose levels can cause bouts of inflammation, which puts stress on the blood vessels. Those damaged vessels can then result in Alzheimer’s disease. Inflammation can also make cells more insulin resistant. This is worse in obese people.

Blocked nerve communication

High blood glucose relates to high levels of beta amyloid, which is a protein that, when clumped together, can become stuck between the nerve cells in the brain and caused blocked signals. Nerve cells that fail to communicate are a big trait associated with Alzheimer’s disease.

Tangled tau protein

Your cells are always moving food and other supplies along pathways, akin to railroad tracks. A protein, referred to as tau, helps these tracks run in straight rows. In brains of Alzheimer patients, however, tau gets all tangled up, leading to falling apart tracks and dead cells. Some studies say those with diabetes have more tangles of tau protein in their brains, resulting in more dying cells in the brain, which as we know can lead to dementia.

How to reduce your risk?

  1. Prevent diabetes or manage it effectively with the correct medication with the help of your doctor.
  2. If you already have metabolic syndrome, weight loss and diet and exercise will help. Address your risk factor of high blood pressure and abnormal blood cholesterol with the correct prescribed tablets.
  3. Eat healthy foods including vegetables, fruit, lean meats, whole grains and low-fat milk and cheese.
  4. If you’re overweight, start a healthy diet and exercise to lose weight.
  5. Exercise for at least 30 minutes five times a week.

Metabolic syndrome raises the risk of dementia in people under 60

Metabolic syndrome is defined by the presence of three of these risk factors:

  • Impaired fasting glucose
  • Waist circumference in a female more than 80cm and in a male more than 94cm
  • High blood pressure above 130/85 mmHg
  • Increased triglyceride cholesterol
  • Low HDL cholesterol

In a recent study running over 20 years, the Whitehall II cohort showed that the risk of dementia is increased by 13% in people with metabolic syndrome younger than 60 years of age. In the age group between 60 and 70 years, the risk increase with 8%. The Whitehall II cohort consisted of UK civil servants: 10 000 in London (1991 to 2016).

The study concluded that the dementia risk was significantly high in study participant under age 60 years who had at least one metabolic syndrome component even when they didn’t have cardiovascular disease (heart attack or stroke)

Type 1 diabetes and Alzheimer’s disease

Most data have focused on Type 2 diabetes. It has been found that impaired learning, memory, problem solving, and mental flexibility have been found to be more common in patients with Type 1 diabetes than in the general population.

Treatment of Alzheimer’s disease

There is currently no treatment for Alzheimer’s, only drugs to slow down symptoms.


The diabetic drug, pioglitazone, improves insulin resistance and promotes cholesterol management by the liver. In 12 small studies of Type 2 diabetes with mild cognitive impairment, pioglitazone was promising in three studies. There was cognitive improvement.3

Intranasal insulin

Intranasal insulin enters the brain direct via the olfactory pathway. Participants who were treated with intranasal insulin showed greater improvement in memory and attention 21 days after start of treatment.

Alzheimer’s disease and diabetes are both increasing in numbers. The associations are getting stronger with better data. The best treatment currently is to manage glucose and other risk factors optimally.


  1. Dorszewska J, Prendecki M et. al. (2016) Molecular basis of familial and sporadic Alzheimers disease. Curr Alzheimer Res, 13, 952-963
  2. James BD, Leurgans SE, Hebert l et. al.(2014) Contribution of Alzheimers disease to mortality in the United States. Neuroloy 82,1045-1050
  3. Watson GS, Craft S.” The role of insulin resistance in the pathogenesis of Alzheimer’s disease: implications for treatment” CNS Drugs 2003;17:27-45

Dr Louise Johnson


Dr Louise Johnson is a specialist physician passionate about diabetes and endocrinology. She enjoys helping people with diabetes live a full life with optimal quality. She is based in Pretoria in private practice.

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