Nourish your skin more in winter

Kate Bristow, a diabetes nurse educator, shares easy and practical tips to nourish and care for your skin during the colder months.


Listen to this article below or wherever you get your podcasts or visit our playlist.

Skin 101

Did you know that your skin is an organ? In fact, it’s the largest organ of the body, packed with blood vessels and nerves and is the centre for your senses (touch and pressure, pain and temperature).

The skin sheds about 40 000 skin cells every day and is a protective barrier that is capable of continually replenishing itself. Its primary role is temperature regulation, but it’s also a shield from disease, infection and the sun.

When we talk about the effects of diabetes on all organs in the body, this includes our skin. Your skin is a very good indicator of general health. If you notice skin changes have them checked out. Early diagnosis and treatment are essential in preventing complications from skin problems caused by diabetes.

How does winter affect your skin?

As we go into winter, the changes in temperature and humidity may change your skin’s texture and it will need a bit more care. Winter can make your skin drier and more irritated, and heaters will further dry out your skin.

If you suffer from eczema, rosacea or psoriasis, these conditions can flare in the winter. Note, these conditions are common conditions of the skin, not isolated to persons with diabetes.

Tips to take good care of your skin in the cold weather

  1. Go easy on cleansing of the skin – A daily wash/cleanse is important, but don’t wash multiple times in a day. Moisturising cleansers instead of foaming face wash will strip less of the natural oil off the skin. Also using a thicker moisturiser may help prevent dryness.
  2. Don’t forget the sunscreen – Shorter days and a weaker sun may make you slacker with using sunscreen. Although the UV rays are less, they are still there, and sunscreen remains an essential part of skincare management. Remember to re-apply it every two hours and pick shade where possible.
Did you know that sunscreen loses its properties of protection when it is expired? So, check the expiry date. A sun protection factor (SPF) of 30 or higher is recommended.
  1. Use a humidifier with heaters – If you are using a heating device, such as a gas heater or an air conditioner on heat, have a humidifier going in the same room to keep the skin more comfortable. Remember this rule applies for an open fire too.
  2. Avoid soaking in the tub – Long hot showers and baths which are so divine in winter can actually dry the skin out. So, try keep soaking in the tub to a minimum and keep the water lukewarm and not piping hot. Try to use your moisturiser while your skin is still damp to seal the hydration in. If you have a dry skin, this is important all year round.
  3. Switch to fragrance-free products – Certain products may be more irritable to your skin. Know how you react and if you have an irritable skin, avoid products, such as laundry detergent with fragrances.
  4. Take care of your nails – Often, we don’t look at our nails until it’s time to wear sandals but things like fungal infections can start developing in winter. Foot care and nail care is important; if you notice brittle, yellowing or nails lifting check in with a doctor.
  5. Wear gloves and keep your skin warm – It’s also a good idea to wear gloves for doing dishes or with use of any cleaning products.
  6. Remember your lips – Use a gentle lip balm on a regular basis. Try not to use products that sting or make your lips tingle.  Suggested ingredients include glycerine, shea butter, beeswax, olive oil, castor oil and coconut oil.
  7. Be patient with dry, cracked skin – If your skin is already irritated, please be patient; badly cracked and dry skin or broken skin barrier may take months to heal properly. If you suffer from any diagnosed skin conditions (rosacea, eczema, or psoriasis), it’s important to get specialised treatment from a dermatologist.
  8. Stop smoking – Smoking makes you look older and contributes to wrinkles. It also narrows the tiny blood vessels in the skin, decreasing blood flow and increases the risk of squamous cell skin cancer. In the words of the Mayo clinic, “The best way to protect your skin is to quit!”
  9. Manage your stress levels – This may be the hardest one, but stress can increase your skin’s sensitivity and trigger acne and other skin conditions. Try to get a balance: enough sleep, exercise and time to do the things you enjoy.
  10. Follow a healthy eating plan – Plenty of vegetables, whole grains, lean protein and some fruit. Drink enough water to keep your skin hydrated.

References:

Sister Kate Bristow is a qualified nursing sister and certified diabetes educator.

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Sister Kate Bristow is a qualified nursing sister and certified diabetes educator.


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Jo-Anne Campbell – My weight loss transformation

Jo-Anne Campbell shares how a major weight loss transformation has given her new-found confidence, motivation and a love for running.


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Jo-Anne Campbell (46) lives in Grassy Park, Cape Town with her husband, Wayne. They have four children, aged 29, 21, 16 and nine years old.

For most of my life, I have struggled with my weight, but the weight really started piling on during my teenage years. Nonetheless, I lived my life, got married and had children.

It was only after a health scare in January 2011 that it finally dawned on me that I needed to somehow lose weight. Severe pain in my abdomen led me to the hospital and after several tests, forty-three adenomas (non-cancerous tumours) were found on my liver. Each tumour had a three percent chance of becoming cancerous while one tumour had bled and became hard, measuring 5 x 7cm in size.

During all the tests, it was also found that I had Type 2 diabetes, high blood pressure and high cholesterol.

To treat these tumours, surgery was needed. However, before surgery could take place, the doctor gave me a month to lose at least 7kg and to lower my glucose levels. Thankfully, I achieved this but not in the healthiest of ways: I was too afraid to eat so didn’t and took high doses of metformin.

I underwent surgery though only four tumours could be surgically removed; the rest were inoperable as they were meshed in my liver. It was discovered that my hormones were the cause of the tumours hence why a liver transplant wasn’t viable as my body would only make more tumours. I was told I had to follow a healthier diet and exercise to improve the condition of my liver.

The surgery was successful, and I managed to lose 20kg straight afterwards but a year later, the weight once again piled back on.

During this time, a span of five years, I was prescribed various diabetic medication and was then lastly prescribed insulin. Every time I consulted with my diabetes nurse educator, she advised me to increase my insulin dose. Eventually, I was injecting myself with 120 units of insulin per day at the age of 38.

Choosing the gastric bypass route

At this stage, my diabetes was out of control and I realised that I was not going to live until the age of 50; my youngest child was only three years old at the time.

I told my endocrinologist that I feel like I am dying and so he gave me my last option and recommended I undergo a gastric bypass, a type of weight loss surgery. For eight months, I was seen by a panel of doctors, dietitians and psychologists who monitored my health and mental state until I could lose at least 6kg and was fit enough to go through with the operation.

The dietitian recommended a meal replacement shake at least once a day or have it for supper. I only managed to lose 4kg before the surgery but could still go ahead with the planned surgery. A check-up of my liver was needed before the surgery and thankfully no tumours were seen anymore.

“I have regained my humanness through this transformation.”

No quick fix

The surgery was a success and a complete life saver: my diabetes is non-existent, and my blood pressure and cholesterol all came down to normal levels. The recovery period of the surgery went very well, and the doctors were constantly monitoring me during this time.

I started taking LIFEGAIN® Advanced Nutritional Supplement, after the dietitian discovered that the meal replacement she suggested contained milk and I was lactose intolerant. Hence, I wasn’t losing any weight. So, she opted for this nutritional supplement rather.

As soon as I started using LIFEGAIN, having it in between meals, I began to lose the weight. Every day since my gastric bypass, I drink LIFEGAIN, especially for its extra vitamins as my body now struggles to absorb vitamins from the small portions of food I eat.

Life as I knew it changed drastically for me, especially after losing 35kg in 10 months. But, it’s no quick fix. In order to keep my weight constant, which has been for four years now, I have to eat clean (foods with no preservatives) and exercise. I never in my life thought I would become a runner but now I am; I’m loving it. I do weight-lifting and many other physical activities I never thought I would attempt.

The fruits of weight loss transformation

Before the weight loss, I was extremely self-conscience and insecure about my body and that had placed a huge strain on my marriage. Now, with all the new-found confidence, my husband and I have a better understanding between us and even communication with each other has improved. Though, the only negative aspect is because of being so confident I have much more responsibilities at work and personal projects, which has impacted on family time.

This weight loss transformation had a major impact on how I see myself as a person; from bordering on depression, zero confidence, self-loathing and totally demotivated, I’m the total opposite of these traits now. I have regained my humanness through this transformation.

Memoirs of a diabetic survivor

After going through this whole experience, my husband, Wayne, who supported me during my journey, inspired me to write a book, Memoirs of a diabetic survivor, about my transformation and how it has totally changed my life. I would like to share my journey with others to let them know determination and the will to live is very strong in all of us, and we should make the decision to move forward in spite of what is happening in our lives or with our health and have no regrets after.

The book will be available on E-books Amazon and on other platforms by the end of July 2024.


This article is sponsored by LIFEGAIN® Advanced Nutritional Supplement in the interest of education, awareness and support. The content and opinions expressed are entirely the patient’s own work and not influenced by LIFEGAIN in any way.


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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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 [email protected]


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Futurelife® diabetes-friendly peanut butter flapjacks

These Futurelife® diabetes-friendly peanut butter flapjacks are ideal for a nourishing snack. If you prefer muffins, this recipe can be made into muffins too.  


Servings: 18 – 20 flapjacks

Recommended serving size for a snack: 3 flapjacks

WET INGREDIENTS

  • 2 eggs
  • 1 cup low-fat or skimmed milk
  • 1 cup low-fat plain yoghurt
  • 5ml vanilla essence
  • 20g sugar-free, salt-free peanut butter

DRY INGREDIENTS

  • 10ml (2 teaspoon) baking powder
  • 25ml (1/4 teaspoon) salt
  • 1 cup FUTURELIFE® Smart food™ Peanut Butter Flavour
  • 1 cup wheat bran
  • 1 serving of a non-nutritive sweetener, optional

METHOD

  1. Place all the wet ingredients into a blender. Blend all wet ingredients for 30 seconds or until the peanut butter is properly mixed into the ingredients.
  2. In a bowl place all the dry ingredients.
  3. Add the wet ingredients into the dry ingredients and mix with a spatula.
  4. Heat up a non-stick pan. Place flapjack-sized portions of the mixture in the pan. Let it cook for a few seconds before flipping. Tip: they may take slightly longer to cook than other flapjacks.
  5. Serve as is or enjoy with some melted sugar-free, salt-free peanut butter and diabetes-friendly jam.

MUFFIN VARIATION

They can be made as muffins too.

Servings: 12 muffins

Recommended serving size for a snack: 1 muffin

  1. Preheat the oven at 180°C.
  2. Grease a muffin tin and evenly distribute the mixture in the tin.
  3. Bake for 12 – 15 minutes.
  4. Enjoy as is or with some sugar-free, salt-free peanut butter and diabetic-friendly jam.

For more information on the product used in this recipe visit: futurelife.co.za


NUTRITION INFO

Energy Protein Carbohydrates Fibre
Flapjack
(per 1 flapjack)
47kcal/ 196kJ
 3.1g  5.2g  1.5g
Muffin
(per 1 muffin)
78kcal/ 32kJ
 5.2g  8.7g  2.5g
Header image by Taetim Smith

Vaginal yeast infections: all you need to know

Gynaecologist, Sumayya Ebrahim, educates us on vaginal candidiasis, also known as vaginal yeast infections, and its link to diabetes.


Listen to this article below or wherever you get your podcasts or visit our playlist.

Research has consistently shown that vaginal yeast infections are common in patients with both Type 1 and Type 2 diabetes. This is especially so if glucose control is not optimised.

Candida 101

Candida (or yeast) is a type of fungus that lives naturally in the body. We find it usually in the mouth, throat, gut and vagina. It also lives on the skin surfaces. Occasionally, when certain conditions exist in the body, this organism will multiply and cause an infection. This infection goes by the common name of thrush or candida.

What conditions favour the development of vaginal candida?

  • Pregnancy – due to the hormonal changes
  • Users of hormonal contraceptives
  • Diabetes – especially if control is poor
  • Recent antibiotic usage
  • Weak immune system – from HIV, chemotherapy or any immune-related illness

Lifestyle factors

Candida loves a warm moist environment. Below are some lifestyle factors to get candida:

  • Staying in a wet swimming costume
  • Not changing sweaty gym clothes like lycra
  • Using scented tampons
  • Using a vaginal deodorant
  • Unhealthy diet that consists of refined and processed foods and deficient in fresh fruits and vegetables

What are the symptoms?

Please note, vaginal candidiasis is not a sexually transmitted disease.

Symptoms can range from very mild to severe. In some instances, if the underlying problem is ongoing, the infection can recur frequently.

  • Vaginal or vulva itching and irritation
  • Sensation of burning during urination or intercourse
  • Vaginal rash, tiny blisters or even cuts
  • Redness and swelling of the vulva
  • Vaginal or vulva pain
  • Thick white vaginal discharge that resembles cottage cheese; this often has no odour

How is vaginal candida treated?

Treatment of vaginal candida involves either topical antifungal treatment like a cream to the skin or an ovule into the vagina. These are available over the counter.

Treatment usually lasts up to five days and resolves the problem. Oral antifungals are also available on script from your doctor. These can be used as an alternative for an early infection or be reserved for when candida recurs.

Prevention of vaginal candida

The best way to prevent vaginal candida infection is to avoid all the lifestyle factors that can act as triggers. In sufferers with ongoing diabetic challenges, the key strategy is good glucose control. Without good glucose control, candida overgrowth and symptomatic infection are never really kept in check.

Oral probiotics in the form of capsules or regular dietary unsweetened yoghurt with lactobacillus also prevents candida overgrowth.

Gynaecologists may also recommend vaginal probiotics inserted as a pessary directly into the vagina once or twice per week. This restores the good bacteria in the vagina called lactobacilli and allows the vagina to regulate its own pH. Thus, keeping it healthy. This in turn, helps to prevent ongoing or recurrent infection. A recurrent infection is said to occur if it happens more than four times per year.

Special considerations with diabetes

  1. New research shows that a new group of drugs to treat Type 2 diabetes, called sodium glucose cotransporter 2 (SGLT2) inhibitors, makes users more prone to develop recurrent candida infections. These include dapagliflozin and empagliflozin.
  2. Recent studies show that people with diabetes are more prone to having candida caused by strains different to the general population. In the general population, candida albicans is the most common yeast identified. In people with diabetes, the most common strain is candida glabrata; this strain has also been shown to be more resistant to successful treatment.
Dr Sumayya Ebrahim is a gynaecologist in private practice in Johannesburg. She is also a blogger. Check out her blog Vaginations by Dr E on vaginations.co.za

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Dr Sumayya Ebrahim is a gynaecologist in private practice in Johannesburg. She is also a blogger. Check out her blog Vaginations by Dr E on vaginations.co.za


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Learning about glucagon

Estée van Lingen tells you everything that you need to know about glucagon, the hormone that raises blood glucose to treat a low in diabetes.


Listen to this article below or wherever you get your podcasts or visit our playlist.

Most of you have heard about insulin and know what its function is in the body. But how many know what glucagon is and what it does?

What is glucagon?

Your body normally has a complex system to make sure your blood glucose is at optimum levels. If you have too much or too little glucose in the blood, it can cause certain symptoms and complications and in cases of people with diabetes, it can also be life-threatening.

Glucagon is a natural hormone that your pancreas makes that works with other hormones (like insulin) and bodily functions to help regulate your blood glucose levels.

Why is this important and how does it work?

Hormones are chemicals that co-ordinate different functions in your body by carrying messages through your blood to your organs, skin, muscles and other tissues. These signals tell your body what to do and when to do it.

Your pancreas is a glandular organ in your abdomen that secretes several enzymes to help with digestion and several hormones, including glucagon and insulin. It’s surrounded by your stomach, intestines and other organs.

Glucose is the main sugar found in the blood. You get glucose from carbohydrates in the food you eat. This sugar is an important source of energy and provides nutrients to your body’s organs, muscles and nervous system. Glucose is essential because it’s the primary source of energy for the brain.

Glucagon increases your blood glucose to prevent it from dropping too low (hypoglycaemia), whereas insulin, another hormone produced by the pancreas, decreases blood glucose levels. The alpha cells in your pancreas make glucagon and release it in response to a drop-in blood glucose, prolonged fasting, exercise and protein-rich meals.

How does it do this?

Glucagon helps blood glucose levels rise back up in multiple ways, including:

  • Glucagon triggers the liver to convert stored glucose (glycogen) into a usable form and then release it into the bloodstream. This process is called glycogenolysis
  • Glucagon can also prevent your liver from taking in and storing glucose so that more glucose stays in the blood.
  • Glucagon helps your body make glucose from other sources, such as amino acids (protein building blocks).

If your blood glucose levels trend higher, your pancreas releases insulin to bring it back into range.

What is the difference between glucagon and insulin?

Glucagon and insulin are both important hormones that play essential roles in regulating your blood glucose. Both hormones come from your pancreas: alpha cells in your pancreas make and release glucagon and beta cells in your pancreas make and release insulin.

The difference is in how these hormones contribute to blood glucose regulation. Glucagon increases blood glucose levels, whereas insulin decreases blood glucose levels. If your pancreas doesn’t make enough insulin or your body doesn’t use it properly, you can have high blood glucose (hyperglycaemia) which can then lead to diabetes, if left untreated.

What tests check glucagon levels and what are normal levels?

Healthcare providers don’t typically order glucagon level tests for people with diabetes, but they may order tests to help diagnose some rare endocrine conditions.

Your healthcare provider may order glucagon blood tests to measure your glucagon levels if you’re having certain symptoms. During the test, a provider will draw a blood sample and send it to the lab for testing.

Normal value ranges can vary from lab to lab and depending on the duration of fasting and blood glucose levels. Always compare your results to the reference given on your blood lab report and talk to your healthcare provider if you have questions.

What conditions are related to glucagon function?

People with diabetes can develop an inability to release enough glucagon in response to decreasing blood glucose levels. Because of this, they’re more likely to develop frequently low or severely low blood glucose if they take medication that could cause low blood glucose, especially synthetic insulin and certain medications.

People with Type 2 diabetes may have glucagon levels that are relatively higher than what would be considered normal, based on blood glucose levels. This can contribute to higher blood glucose.

What are the symptoms of glucagon-related conditions?

Depending on the situation and condition, you can experience low and/or high blood glucose from abnormal glucagon levels.

Symptoms of low blood glucose (hypoglycaemia)

  • Shaking or trembling
  • Sweating or chills
  • Dizziness and light-headedness
  • Faster heart rate
  • Hunger
  • Confusion or trouble concentrating
  • Nervousness or irritability
  • Pale skin
  • Weakness
  • Tingling or numbness in your face/ mouth

If you experience these symptoms, it’s important to eat food with carbohydrates/sugar to treat it and bring your glucose levels up, and after that make sure you consume a healthy balanced meal. If this happens often, contact your healthcare provider.

Symptoms of high blood glucose (hyperglycaemia)

Not necessarily always caused by glucagon problems but more by not enough insulin or the body not being sensitive to insulin.

  • Increased thirst and/or hunger
  • Blurred vision
  • Frequent urination
  • Headaches
  • Fatigue (feeling weak and tired)
  • Unexplained weight loss
  • Slow healing cuts and wounds

If you experience these symptoms, it’s important to see your healthcare provider.

When should you see your healthcare provider about glucagon levels?

If you have diabetes and are experiencing frequent episodes of low or high blood glucose, it’s important to contact your healthcare provider. Glucagon levels are not normally tested in people living with diabetes, but your provider might need to adjust medications.

While other glucagon issues are rare, if you are having symptoms, its essential to figure out the cause by talking to your healthcare provider.

Estée van Lingen is a registered dietitian practicing in Randburg and Fourways, Gauteng. She has been in private practice since 2014 and is registered with the HPCSA as well as ADSA and served on the ADSA Gauteng South Committee for 2020 – 2022.

MEET THE EXPERT


Estée van Lingen is a registered dietitian practicing in Randburg and Fourways, Gauteng. She has been in private practice since 2014 and is registered with the HPCSA as well as ADSA and served on the ADSA Gauteng South Committee for 2020 – 2022.


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Seven ways to get the most out of apple cider vinegar

Apple cider vinegar is a kitchen staple that has several benefits including health, beauty, household, and cooking uses. Estée van Lingen tells us how to get the most out of it.


Listen to this article below or wherever you get your podcasts or visit our playlist.

What is apple cider vinegar?

It’s a vinegar made from cider; it’s made by crushing apples, then squeezing out the juice. The apple juice is then fermented to yield apple cider vinegar. Acetic acid and malic acid combine to give this vinegar its sour taste.

Note: Organic, raw and unfiltered apple cider vinegar is usually the best choice. It may be cloudy and will be higher in beneficial bacteria.

Seven ways to get the most out of apple cider vinegar

Did you know that you can wash your hair with apple cider vinegar and even use it as a skin toner? Yes, you can. 


However, let’s focus on the different ways to use apple cider vinegar with food and to benefit your health.

1. Preserve food

Just like other types of vinegar, apple cider vinegar is an effective preservative. People have used vinegar as a pickling agent to preserve foods for thousands of years.

Apple cider vinegar deactivates the enzymes and creates an acidic environment that inhibits the growth of harmful bacteria, yeast, and mould. You can pickle various vegetables like cucumbers, onions, and olives; the tangy flavour of apple cider vinegar adds a delightful twist to pickled veggies.

It can also be used to preserve sauces, marinades, and chutneys. Its acidity helps extend the shelf life of these flavourful condiments.

There are many recipes online to preserve or pickle food using apple cider vinegar. Just make sure that you follow the instructions and that you use the correct cookware. Most importantly, don’t dilute the vinegar as the acidity will be lowered and might not be enough to kill harmful bacteria.

2. Make salad dressings, vinaigrette or marinades

Homemade dressings can be much less processed than store-bought and are often tastier too. They also don’t contain added sugars which is ideal for people living with diabetes.

Apple cider vinegar is a very popular ingredient in steak marinades because it gives a nice sweet-and-sour flavour. This can then be combined with olive oil, garlic, soya sauce, onion, cayenne pepper and fresh or dried herbs to give your meat a delicious flavour.

3. Add a burst of flavour to your food

If you are looking for a tangy sauce for your food, try adding apple cider vinegar to tomato-based sauces to give a fuller flavour.

You can also add to your favourite soup at the end if it tastes bland. Add it gradually and taste as you go, until you reach a flavour you enjoy.

4. Wash fruits and vegetables

Pesticide residue on fruits and vegetables can be a concern for many people. That’s why some people like to wash theirs in apple cider vinegar before consuming.

Although it’s not entirely clear whether it will remove more pesticides than simply washing with water, it may help kill any dangerous bacteria.

5. Ease a sore throat

Gargling with apple cider vinegar diluted in water is a popular home remedy for sore throats. The thought is that its antibacterial properties could help kill off the bacteria that is causing the sore throat. However, there is no evidence to support its use in this way.

If you try this at home, make sure you mix the vinegar with water before gargling (about 1-2 Tbsp. per half a glass of water). This is because of the acidity which can cause throat burns when consumed undiluted.

6. Increase satiety

Obesity is a significant risk factor for Type 2 diabetes, and maintaining a healthy weight is essential for managing the condition. It has been suggested that apple cider vinegar helps with appetite suppression and increased feelings of fullness. This may help you consume less kilojoules and achieve weight loss goals since it only has 12,6 kilojoules per tablespoon which is way less than standard salad dressings or marinades.

7. Regulating blood glucose levels

Apple cider vinegar has been shown to improve insulin sensitivity and lower blood glucose levels after meals, especially if you have insulin resistance or Type 2 diabetes.

This is due to its effect of reducing a glucose spike after a meal through acetic acid that helps to inhibit the digestion of refined carbohydrates, slowing down the conversion of starches into sugars.

Insulin resistance is a key factor in Type 2 diabetes, where the body’s cells become less responsive to insulin’s action. Studies suggest that apple cider vinegar may help enhance insulin sensitivity, allowing cells to better utilise glucose from the bloodstream. This can lead to improved glycaemic control and reduced reliance on insulin.

Estée van Lingen is a registered dietitian practicing in Randburg and Fourways, Gauteng. She has been in private practice since 2014 and is registered with the HPCSA as well as ADSA and served on the ADSA Gauteng South Committee for 2020 – 2022.

MEET THE EXPERT


Estée van Lingen is a registered dietitian practicing in Randburg and Fourways, Gauteng. She has been in private practice since 2014 and is registered with the HPCSA as well as ADSA and served on the ADSA Gauteng South Committee for 2020 – 2022.


This article is sponsored by Safari Vinegar in the interest of education, awareness and support. The content and opinions expressed are entirely the contributor’s own work and not influenced by Safari Vinegar in any way.

Header image by Adobe Generated AI Image

Nathan Hendricks – Hard work pays off

Nathan Hendricks will be competing in the Paris 2024 Paralympic Games. We catch up with the young swimmer to find out what this great achievement means to him.


Listen to this article below or wherever you get your podcasts or visit our playlist.

Nathan Hendricks (18) lives in Middelburg, Mpumalanga with his parents, Darryl and Jennifer. He has five siblings.

Despite not having the easiest start to life – being diagnosed with diabetes as a baby and then diagnosed with Stargardt disease – macular dystrophy at the age of 12 – Nathan depicts joy. He answers every question with the most mature mindset and is very humble. A playful relationship with his father is evident while admiring respect is given to his mother.

“I never had self-pity, I grew up with diabetes and made the decision that I wouldn’t allow it to limit me. Then when I lost my eye sight, I never saw it as a bad thing, it actually helped me get closer to my family as my mother had to read for me and my dad had to help me with a lot of other things. I also believe God gave it to me for a reason so I’m going to find that reason,” Nathan says.

Type 1 diagnosis

At just eight months old, Nathan was diagnosed with Type 1 diabetes. This came after he was urinating a lot; a GP treated him with antibiotics for a bladder infection. Though, it didn’t help so his mother, Jennifer, took him to a hospital where a paediatrician diagnosed him with diabetes. He was treated with insulin and his parents took him to Johannesburg for a consultation with a paediatric endocrinologist.

“For the first six months, we injected him mainly in the buttocks but then the endocrinologist suggested that he start insulin pump therapy. Nathan was actually one of the first babies to be on an insulin pump. Up until the age of 16 or 17, he was using the insulin pump,” Jennifer explains.

Nathan stopped using the pump due to swimming. “Because I was in the water for a long periods of time (two and a half hours) without the pump, I wasn’t getting a good flow of insulin. So, I started injecting long-acting insulin to sustain me while swimming but now I inject both long- and short-acting insulin as I find it’s the best way for me to have good management,” Nathan says.

Stargardt disease – macular dystrophy

Then at the age of 12, Nathan was diagnosed Stargardt disease – macular dystrophy, a genetic eye disorder that causes progressive vision loss, mainly affecting central vision loss.

“We discovered that I was struggling to see when we sat at the dinner table. Instead of looking straight at a person, I would either look just above their head or to the side, so I could picture their face better. I went to an optometrist and was given the strongest lenses but still couldn’t see. We then consulted an ophthalmologist and he then diagnosed me with Stargardt disease – macular dystrophy,” Nathan says.

“Stargardt has nothing to do with my diabetes, it’s genetic. However, uncontrolled glucose levels can cause further damage but I’m proud to say that my ophthalmologist says there is no sign of diabetic damage.”

Unfortunately, there is no cure or current treatment for Stargardt disease. However, various gene and drug research trials are underway. To slow the vision loss down, Nathan reduces his vitamin A intake.

“There is a possibility that as I get older, I may become completely blind but it’s not a definite,” Nathan says.

Education

Nathan attended primary school and his parents would explain his diabetes to every new teacher he got, educating them on highs and lows and what to do in those instances. “At first the teachers were scared of the responsibility but as the years went by, it became a non-issue,” Darryl says.

Nathan then started high school but in Grade 9, his parents made the decision that home-schooling would be better for him due to him struggling to see the white board. It has been a good move as Nathan is doing extremely well academically and hopes to further his studies in particle physics.

A love for swimming

When asked when his skill for swimming was discovered, Nathan humbly says that he doesn’t see himself as being talented but rather that he has a love for swimming.

“When I joined my swimming club, I would lose to girls who were three years younger than me. But I kept on training, putting in the work in for my stroke correction and eventually I became good at it and was invited to Senior Nationals and competitions overseas,” Nathan says.

Darryl adds that when Nathan was in primary school he encouraged his son to keep on practising and eventually he would win races. “And that happened, even though his first swimming teacher said he would never be a swimmer. Nathan is disciplined; he doesn’t miss any training and as the years went by, the more races he won. In 2020, Nathan qualified to swim in a Level 2 competition, but it was cancelled due to COVID.”

Darryl continues, “When Nathan joined the swimming club, I told his coach that our goal is for him to compete in the Paralympics as he qualifies as a S13 swimmer due to having Stargardt disease. The coach looked at me incredulously but a few months later, Nathan was invited to swim in a Level 3 competition and he made the final of the 100m backstroke and from then, he just kept on going, and now he is one of the top swimmers in the club.”

Nathan is an all-rounder and is good at all four strokes but his top two strokes are 400m freestyle and 100m backstroke. “Surprisingly, I have an African record for breaststroke, which is my least favourite.”

Breathing techniques to regulate emotions

If Nathan has low blood glucose levels while training, he can feel it as he gets very tired; he then immediately gets out of the pool. Though, he says if his levels are high, he can continue to swim for a while.

He admits that emotions during galas play a huge factor in his management and extreme highs and lows. “We noticed my glucose levels were very high before a race. No matter if we increased the insulin dosage, it stayed high. Then after a race, I would go into an extreme low and had to pull out of races that were straight after. After consulting with my endocrinologist, he confirmed that adrenalin was the cause of these rollercoaster glucose levels,” Nathan explains.

Nathan consulted a sports psychologist who taught him breathing techniques to do before a race which helps him stay more calm. He also follows a daily six-meal plan to help curb these highs and lows during races and has to take a certain amount of carbs just before races and thereafter.

Keeping colds and flu at bay

With preparations for the upcoming Paralympics underway, Nathan’s schedule is jammed-pack with 10 training sessions a week, which includes two gym sessions and a total of four hours in the pool a day and 60km+ of swimming a week, as well as home-schooling.

To keep the colds and flu at bay in winter, Nathan’s coach keeps him in his own swimming lane during training. Jennifer adds that their family become hermits in winter and stay indoors to keep all the germs away.

Nathan adds that he does test more during winter to just keep an eye on his glucose levels; this is to ensure his body isn’t put through unnecessary strain.

Road to Paralympics

Nathan says he is very excited to take part in the 2024 Paris Paralympic Games as it has always been one of his goals. “I’m so honoured to represent my country and it’s a beautiful flag to hold up. There are many people that are looking up to me now, especially in my province, so I’m going to do well not only for myself but for everyone who is supporting me.”

We wish Nathan all best and look forward to seeing him make more of his goals come true.

Nathan Hendricks
Nathan Hendricks

I also believe God gave it to me for a reason so I’m going to find that reason.”

Nathan Hendricks
Nathan Hendricks
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

MEET THE 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 [email protected]


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Are moods and blood glucose in children related?

Daniel Sher explores the mechanisms behind the relationship of moods and blood glucose and offers practical advice for parents and caregivers to better support their children.


Listen to this article below or wherever you get your podcasts or visit our playlist.

The interplay between mood and blood glucose in children with diabetes involves a complex relationship where physical health significantly influences emotional well-being and vice versa. This connection reminds us that we need to focus on more than just blood glucose management when it comes to diabetes, we also need to pay attention to the emotional side of this condition. 

Understanding blood glucose dynamics

Blood glucose is essential for the body’s cells and critical for brain function. In children with diabetes, the body’s inability to effectively regulate blood glucose can lead to significant mood and behavioural effects. Hyperglycaemia (high blood glucose) and hypoglycaemia (low blood glucose) can manifest various psychological symptoms that impact a child’s daily life.

For example, hyperglycaemia can cause symptoms such as fatigue, irritability, and difficulty concentrating. These can disrupt a child’s ability to engage in academic and social activities, potentially leading to frustration and lowered self-esteem.

Hypoglycaemia on the other hand, can lead to symptoms such as confusion, dizziness, irritability, and even severe outcomes like seizures. The acute nature of hypoglycaemia can induce significant anxiety and mood swings, affecting not only the child but also those around them.

Psychological impacts

Managing diabetes demands ongoing attention and adjustment, which can put a substantial mental burden on a child. The stress of constant monitoring and treatment can lead to psychological issues such as anxiety and depression, which can further complicate mood regulation. Diabetes distress, or burnout, can also hold a child and their family back when it comes to living a happy and healthy life with this condition.

Social challenges may also become evident. The visible aspects of diabetes management (such as technology, testing and taking insulin) can make children feel self-conscious and different, which can impact their social interactions and emotional well-being.

The bidirectional relationship

Mood and blood glucose levels influence each other in a bidirectional manner. Stress and emotional distress can lead to hormonal imbalances that may disrupt diabetes management, while unstable blood glucose levels can cause mood swings. Understanding this reciprocal relationship is crucial for effective management of diabetes in children.

How can we help kids cope?

Educational and supportive strategies

Education is crucial. Parents and children need to understand how diabetes can affect emotional health. Recognising the signs of blood glucose fluctuations and their emotional effects is the first step toward effective management. 

Holistic care approach

Management strategies should incorporate both medical and psychological support. Regular consultations with healthcare providers who understand the dual nature of diabetes care are essential. 

Establishing routine

Consistency in daily routines helps stabilise blood glucose and mood. Regular monitoring and timely adjustments in diet and medication are key to maintaining balance.

Open communication

Encouraging children to express their feelings about diabetes and its challenges is so important. Support from counsellors or participation in support groups can provide children with coping mechanisms and a sense of community. 

Inclusive and active lifestyle

Activities that integrate children with diabetes into wider social groups can enhance their self-esteem and emotional health. Physical activity not only helps in regulating blood glucose but also boosts mood through the release of endorphins.

Family engagement

Involving the entire family in diabetes care helps normalise the condition and reduces the emotional burden on the child. Shared meal planning and group activities can foster a supportive environment.

Comprehensive care

The relationship between mood and blood glucose in children with diabetes is central to overall health. By addressing both the emotional and physical aspects, caregivers can provide more effective support, enhancing both the child’s quality of life and their diabetes management.

Understanding and intervening in this bidirectional relationship is key to helping children manage their condition while maintaining a positive outlook on life. Comprehensive care not only stabilises blood glucose but also significantly improves mental health, offering a brighter and healthier future for children with diabetes.

MEET THE EXPERT


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


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Navigating the post-meal rollercoaster

Dr Paula Diab shares valuable tips for keeping blood glucose spikes in-check to avoid the post-meal rollercoaster.


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Over nearly 20 years of assisting people managing their diabetes, I’m always humbled by how much there is to know about the disease. Not too long ago, I thought that if you could master the art of counting carbohydrates, then dosing insulin would be simple. 1 unit of insulin for every 15g of carbohydrates. 1 slice of toast = 15g of carbohydrates. What could be easier?

But if practicing medicine has taught me nothing else, it is that medicine is an art as much as it is a science. Seemingly simple maths does not always add up.

In listening to patients, I began to realise that they too were finding that this simple maths didn’t always work and that eating a burger with a side salad as a starter would sometimes work out better than eating just the burger alone. And then I had the opportunity to attend an international conference where I attended a lecture on macro-sequencing and the puzzle pieces slowly started to fit together.

One of the latest buzzwords or phrases in diabetes management is Time in Range (TIR). This refers to the overall time during the day that you spend within a particular target range. This range can depend upon your circumstances but is generally between 3.9 – 10.0mmol/L (70-180mg/dL).

If you are able to spend 70% or more of your time within this range, your risk of complications and overall prognosis in diabetes will be greatly improved. Studies have shown that kidney and eye disease are accelerated with greater post-meal peaks as well as these rises being an independent risk factor for developing cardiovascular disease.

Matching the action of insulin

Short-term glucose control is also negatively affected by these post-meal peaks which manifests in a decrease of energy, cognition (thinking) difficulties, mood swings and other physical and emotional abilities are affected.

As we then struggle to get the readings back into range, a common problem is that of overcompensating and causing what clinicians refer to as a rebound-low. A key component of remaining in range is therefore being able to manage your glucose levels after meal times and not just monitoring your fasting glucose levels early in the morning.

Keeping your glucose levels to remain in the target range with as little fluctuation as possible. In fact, if you are trying to get your glucose levels closer to that magic number of an HbA1c of 7%, managing your after-meal peaks is going to be all the more important.

It is normal to have fluctuations in glucose levels throughout the day even for people who don’t have diabetes. However, if the peak of the rise is too high or lasts too long, this may have adverse effects on your health. The idea in diabetes is to match the action of insulin with the consumption and digestion of carbohydrates.

Measuring and targets

Medicine is an art as well as a science. So, whilst most people will experience a peak about 60 – 90 minutes after starting their meal, this may vary from person to person and depending upon the meal eaten.

The next conundrum occurs when looking at what your targets should be. General guidelines suggest a post-meal peak of <10mmol/L (180mg/dL); however, this may also vary. Elderly patients or those with multiple co-morbidities may be encouraged to set their targets slightly higher to avoid the disastrous consequences of hypoglycaemia whilst pregnant women will be encouraged to have a much tighter range and not allow their post-meal peak to rise above 7.8mmol/L (140mg/dL) in order to prevent unnecessary damage to the foetus.

Peak management

  1. Selecting the correct insulin

Very often people think that all rapid-acting insulins are the same. The reality is that whilst most people (particularly with Type 2 diabetes) don’t notice a significant difference between insulin aspart or glulisine, for example, other people do react very differently.

There are also newer ultra-rapid insulins that will act even quicker as well as different formulations of insulin (inhaled insulin, not yet available in South Africa) that also work much quicker.

  1. Injection technique

The manner in which you inject insulin can also affect the way it’s absorbed and how quickly and efficiently it acts. Injected insulin works much faster when the injection site is warmed. This can be done by rubbing the site before injecting, exercising the muscle near the site or immersing the site in warm water.

In practical terms, your insulin may be absorbed quicker after a warm bath, after a run or on a warm summer’s day. Injecting directly into the muscle (anterior thigh or arm) is not usually indicated but if you are wanting insulin to work very quickly in the case of diabetic ketoacidosis (DKA) or treating a very high glucose level, this will certainly make a difference.

Remember that working quicker or faster doesn’t mean working for a longer time which will be discussed later.

  1. Pre-bolusing

Some people may have heard about the concept of pre-bolusing or injecting insulin prior to a meal. This can have a significant impact on squashing the peak that occurs after a meal, but you do need to be careful.

The aim is to get the insulin into your body and working at its maximum at the same time as your meal peaks. The exact timing of this will depend on multiple factors as medicine is an art, as well as a science.

High glycaemic index (GI) foods will peak quicker and therefore may require a bolus 15 – 30 minutes before the meal whilst lower GI foods may digest better when the insulin is given at the start of the meal. Higher pre-meal glucose values may respond better when mealtime boluses are more pronounced whereas lower glucose levels may benefit from insulin taken during or even after the meal.

  1. Other medications

The effect of insulin may be enhanced by other hormones, such as GLP-1 receptor agonists. These delay gastric emptying and keep carbohydrates from raising the blood glucose levels too quickly after meals.

Another drug, pramlintide (not available in South Africa) also helps to reduce appetite and squash the post-meal secretion of anti-insulin hormones in the body. Both of these medications will result in much more stable glucose levels and smaller peaks.

These are the pharmaceutical ways in which you can squash that post-meal peak but there are also quite smart manoeuvres you can try with simple lifestyle adjustments that will also have a significant impact.

Lifestyle adjustments

  1. Glycaemic index

As mentioned previously, lower-GI foods (pasta, beans, legumes) will digest slower and therefore have a flatter peak if you measure the glucose response.

Higher-GI foods (bread, cereal, potatoes, rice) are converted into glucose more quickly and therefore will tend to give a higher and more pronounced peak.

In addition to balancing the timing of your insulin, try to balance your meals with a combination of carbohydrates so that you do not only get a quick peak and then feel hungry again soon afterwards.

  1. Acidity

The addition of acidity to food has also been shown to reduce the post-meal spike. In practical terms, this can be in the form of sourdough bread as opposed to regular flour bread; adding vinegar or even tomato sauce as a condiment.

  1. Food sequencing

The order in which you eat your food has also been shown to be important in maintaining stable glucose levels. Having a salad or vegetables prior to your main meal will allow time for your digestive enzymes to be secreted so that when you eat your carbohydrates, your body is optimally-primed to digest these foods.

Fats will slow down the absorption of carbohydrates in the body. The most typical example is that of a cheesy pizza – very often insulin is given in split doses in this case to match the peak of the carbohydrate as well as the delayed peak of the fat in the cheese.

Proteins will also slow down the absorption of food in the body and contribute to satiety (fullness) therefore reducing the overall glucose load.

As always, a healthy balanced meal is recommended so experiment with your favourite meals and see what the impact can be on your post-meal peaks.

  1. Splitting meals

Other suggestions are to split the meal and have a portion of the meal 30 – 60 minutes after the initial meal. This is particularly useful if you are to embark on a large gourmet feast. The longer you take to eat the food, the more time your body has to digest it.

Even smaller meals can be broken down in this way by having a cup of coffee prior to breakfast and then eating the bowl of cereal and milk a while later.

Those who like to have a mid-morning or mid-afternoon snack may consider removing a serving of fruit from breakfast or lunch and having it between meals. In this way, the body is presented with smaller loads of carbohydrates more consistently which will certainly assist in more regular blood glucose levels. Please speak to your clinician about how to dose insulin if you are going to split your meals in this way.

  1. Exercise

If ever there was a solution to almost all problems, it is that of physical activity. Being active after eating will reduce post-meal peaks by slowing down absorption of glucose into the bloodstream. The body also uses the glucose consumed and actually becomes more sensitive to insulin as well. Ten to twenty minutes of mild activity (walk, household chores, etc.) is usually adequate.  

  1. Prevent hypoglycaemia

We’ve spoken often about the dangers of hypoglycaemia but one of the most overlooked problems is the vicious cycle that it creates. The body responds to low glucose levels by doing everything it can to counteract this potentially lethal situation. It empties the stomach quicker, food is digested quicker and blood glucose levels rise more rapidly. In addition, counter-regulatory hormones are released that stimulate glucose production in the liver. The end result – blood glucose levels peak and it becomes difficult to lower them again.

Take-home lessons

Its highly possible that by now your blood glucose levels have dropped, due to all the mental agility, or sky-rocketed, due to the stress response elicited by the body by reading all this information. Perhaps, they’re perfectly stable with no change at all.

If you take away one thing, remember that medicine is an art as well as a science. Sometimes, what looks like simple maths is actually a complex interplay of numerous different factors with even more unexpected outcomes.

Another good point to remember is to be alert to new ideas and thinking and constantly try to improve your knowledge and understanding of diabetes. What worked for the last 20 years, may not be the most ideal way to manage your diabetes and sometimes change is necessary and even helpful.

Experiment with your medication and food and find out what works best for you. Read through this article slowly and carefully and try one strategy at a time and get a good idea of the impact it has on your diabetes.

Obviously, all these strategies are much easier when using a continuous glucose monitor but you can get a very good idea by testing before and two hours after each meal and then discussing your findings with your diabetes educator or diabetologist.

Treat it as an interesting puzzle and try to solve the conundrums. Even experienced clinicians are sometimes forced to go back to the drawing board and ask for assistance. Managing the post-meal rollercoaster very often requires time, lots of trials and testing and a great team-effort.

Dr Paula Diab

MEET THE EXPERT


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


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The ‘Can you eat that’ shame

Monique Marais addresses the shame that people with diabetes can experience when loved ones question or misunderstand their food choices.


Listen to this article below or wherever you get your podcasts or visit our playlist.

There are several common misconceptions regarding what a person with diabetes should eat and what needs to be avoided at all costs. It is, however, important to note that dietary needs can differ among individuals, and people with diabetes should work closely with health professionals who understand the condition and can give relevant and practical guidance to create a meal plan that is appropriate for them.

It’s also recommended to approach conversations about dietary choices with sensitivity and empathy, especially when discussing restrictions. It may be counterproductive to point out what people are allowed to eat and what not and can affect the person living with diabetes on an emotional level. People living with diabetes often face enough challenges in managing their conditions without the added stress of feeling ashamed about their food choices.

It’s therefore more constructive to focus on positive and supportive communication and understanding their dietary needs. Encourage them to make healthier choices, provide information on balanced nutrition and highlight a variety of foods that are beneficial for their well-being. Educating yourself as a family member is vital to effectively support them in their journey, and this means eliminating inaccuracies.

Common misconceptions

  • Sugar must be avoided completely

While it’s true that managing sugar intake is crucial for people with diabetes, it doesn’t’ mean they must eliminate sugar completely. The focus should be on monitoring carbohydrate intake, as carbohydrates directly impact blood glucose levels. The type and amount of carbohydrates, along with proper portion control, are important considerations.

  • People with diabetes can only eat diabetic foods

Specialised diabetic foods are helpful, however, are not a must or an only and can be expensive. These products often still contain carbohydrates and kilojoules, and they may have sugar alcohols or artificial sweeteners that can have laxative effects if consumed in excess. A balanced and varied diet is more beneficial.

  • Starchy foods are off-limits

Starchy foods like bread, rice and pasta can affect blood glucose levels, but when they are part of a balanced diet and consumed in moderation, the effect on the blood glucose levels is reduced. Whole grains are also a better option to include in your meal plan.

  • Fruit is forbidden

Fruits contain natural sugars, but they also provide essential nutrients and fibre. Moderation is key, and it’s advisable for people with diabetes to choose fresh, whole fruits over fruit juices or dried fruits, which can be more concentrated in sugars.

  • Skipping meals controls blood glucose

Skipping meals can lead to irregular blood glucose levels and overeating later. Regular, well-balanced meals and snacks are essential for managing stable glucose levels.

A family disease

Diabetes is known as a family disease, as it can affect many people within one family in various ways. It’s important for people with diabetes – and their family members and support system – to understand how different foods affect an individua’s body.

By understanding the condition, and specific red flags, you can avoid spikes in blood glucose levels, and will be able to have a more consistent average.

Approaching conversations with empathy and understanding can help create a supportive environment for people with diabetes to make informed and positive choices regarding their diet and overall health. This is important for family members and friends, but also for healthcare professionals. Have patience with your patients, work from where they are and support them in their journey. Take the time to understand where they are in the process and how you, as the healthcare professional, can support them to make effective and sustainable lifestyle changes.

As a loved one, you can support your family member by:

  1. Understanding the impact that a chronic illness has on their emotional well-being. This is a long-term condition, and some days may be easier to deal with than other days.
  2. Avoid blaming. Do not constantly nag your loved one about what they are eating and add more pressure, as it often leads to conflict in the relationship.
  3. Ask your loved one what they need from you; support them in their journey.
  4. Attend appointments with your loved one. This way you also get the feedback from the doctor and will be able to support them more effectively.

Learn to identify symptoms of high or low blood glucose levels so that you can intervene quickly and effectively.

How best to support someone with diabetes
Monique Marais is a registered social worker at Care@Midstream sub-acute, specialising in physical rehabilitation for the past 11 years. She has a passion for the medical field and assisting people to understand and manage their diagnoses and the impact on their bio-psychosocial well-being.

MEET THE EXPERT


Monique Marais is a registered social worker at Care@Midstream sub-acute, specialising in physical rehabilitation for the past 11 years. She has a passion for the medical field and assisting people to understand and manage their diagnoses and the impact on their bio-psychosocial well-being.


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