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

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

Childmind.org – 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

MEET THE EXPERT


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.


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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.

Menopause

Cause

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.

Symptoms

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.

Treatment

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.

MEET THE EXPERT


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.


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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.

Diet

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.


References

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.

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 www.danielshertherapy.com


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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.

Pioglitazone

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.


References

  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

MEET THE EXPERT


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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DSA News Spring 2022

– DSA Western Cape News –

Onyinye receives award by Nigerian community


Onyinye Nwokeji, a nurse and who has been running a Diabetes Wellness Group in Brooklyn/Milnerton in Western Cape for a number of years was given an award in June by the Nigerian community in the area and all the Igbo Nigerian Pastors in the Western Cape. Well done.


Mitchells Plain Wellness Workshop Week

From 22 till 30 July, a Wellness Workshop Week was held at Strand chalets in conjunction with the Mitchells Plain DSA support group.

Blood pressure and blood glucose testing took place every morning and a walking and light exercise programme combined with a fancy dress competition took place.

– DSA Port Elizabeth News –

World Diabetes Day Walk for Diabetes

The Port Elizabeth branch of Diabetes SA held annual Global Walks for Diabetes from 2010 till 2016. Sadly, we have not had Diabetes Walks since 2018 due to the lack of sponsorship and the arrival of COVID. So, we are most excited to announce that on 19 November 2022, the first Saturday after World Diabetes Day, we shall have a Walk for Diabetes in Port Elizabeth.

Our fundraiser manager, Megan Soanes, will be organising this in conjunction with Michael Zoetmulder from Zsports. Michael has done amazing work organising all our previous walks. Young and old are welcome to join this fun walk and to invite their friends and family to also participate. 

The start of our first Diabetes Walk in 2010.
The start of our first Diabetes Walk in 2010.
The start of our last Diabetes Walk in 2016.
The start of our last Diabetes Walk in 2016.

Camp Diabetable

This December, the second Camp Diabetable (Eastern Province) will be held from 15 to 17 December 2022 at Hobbiton-on-Hogsback. Ernest Groenewald, our Camp Director, will be organising this fun-filled and educational event. More information will be available closer to the time.

Gravity Jump for Diabetes

On 2 October 2022, our branch will again be having a Gravity Jump for Diabetes. Our first one was held in November 2017. Paula Thom and Darren Badenhuizen, the DSA Young Guns leaders, will be organising this fun event.

Youngsters attending our first event in 2017.
Youngsters attending our first event in 2017.

– DSA Pretoria News –

Passing of Mariaan Marias

Mariaan Marais served DSA for many years and was an active volunteer. Louise Pywell, a member of DSA Pretoria Wellness Support Group, attended the funeral service on 30 June and wrote, Mariaan Marais’ memorial service on Thursday, 30/6/22 at the Oosterlig NG church in Waterkloof Glen was a beautiful farewell to our dear friend! Her niece Dominee Nadia Marais gave a very touching and heartfelt service which was absolutely befitting of such a special lady! There were photographs and messages from friends screened above the pulpit, which were so personal and emotional! It truly was amazing! A tribute of note! May she RIP …she will forever be in our hearts.

Dealing with interrupted sleep patterns for parents of kids with T1D

Diabetes nurse educator, Christine Manga, offers valuable advice for parents of children with T1D experiencing interrupted sleep patterns.


A diagnosis of Type 1 diabetes in a child comes with many physical, mental and emotional challenges for both the child and parent. As parents assume most of the responsibility for managing the diabetes, it’s no surprise that parental burnout is real.

Of the plethora of feelings parents experience, fear and guilt appear to be common threads in literature. Chronically disrupted sleep resulting in chronic sleep deprivation is another standout topic. Parents who are sleep deprived have an increased risk for depression, anxiety and potential weight gain. It can have a detrimental impact on relationships, work and day-to-day functioning.

How to deal with 2AM testing

2AM testing of blood glucose is a part of the deal. If the glucose level is in range, that is great. If not, it probably means not much sleep for the rest of the night. How do you deal with this?

Good overall blood glucose management is key to a better night’s sleep. If there are regular night-time hypos, the treatment regimen that the child is on will need reviewing. Reassessing the basal doses, carb ratio as well as correction factor and carb counting skills will aid in achieving good stable glucose levels. A pre-bedtime low-GI snack may be recommended. Even with all of these parameters met there is still a chance of night time hypos. Remember, diabetes does not sleep.

Rotation basis

If there is more than one parent at home, working on a rotation basis for testing will allow for better sleep. This could be split up for day to day, week to week or even half evening shifts.

If you are a night owl, staying up until 1am and then your partner being responsible from then until the morning will guarantee a few hours of quality sleep.

If you are a single parent, ask for help. You could teach a relative or friend how to test and what to do depending on the outcome. A solid night of sleep once a week will do wonders.

Minimise the fuss

Be prepared for evening testing and treating, the less fuss involved, the quicker you can get back to sleep. Have the tester and strips out, have a sweet or juice on hand in case of a hypo. Use dim lighting and make sure the passage and room is free of obstacles. Don’t engage in conversation unless necessary.

Good sleep hygiene

Good sleep hygiene will make falling asleep easier for you when initially going to bed or after testing. This includes no use of electronics an hour before bed; a cool, quiet environment if possible, and avoid caffeinated drinks. Try sticking to a routine. Same bedtime every evening, make it early even if it means missing out on some adult time. The extra sleep will help you.

CGM

Using continuous glucose monitoring (CGM) technology to track blood glucose levels that give predictive warnings of an impending high or low reading will provide peace of mind and negate the need to physically get up and test your child. Sensor augmented insulin pump therapy plays a huge role in reducing overnight hypos.

Unfortunately, this technology is expensive and not financially feasible for most of the population. If you are fortunate enough to use any of these, do not do sensor changes or infusion site changes before bed. Calibrations may be required or there may be a site failure that goes unnoticed until intervention is required that will take extra time.

Be kind to yourself

When there has been a rough sleepless night, be kind to yourself. If you are unable to complete all the home chores, park some for the next day. Try to get in a 10-minute power nap. Type 1 diabetes stretches the boundaries of what we believe is possible and what we are capable of.

It is important to know that if blood glucose levels are stable then there is no need to test at 2AM every night. Once or twice a week is sufficient.

Seek counselling for you and your child

Children with T1DM can experience feelings of guilt and believe they are a burden. They may also show anger or resentment towards the parent or caregiver who does their testing. An over-tired parent may struggle to show compassion thereby aggravating the child’s ability to accept their condition. Seek counselling for both you and your child if necessary, reach out to your diabetes team, join support groups and learn how other families cope. Sharing your experience and insight may just be what another parent needs to survive.

Remember, this 2AM testing ritual will not be forever.

eating time budget

MEET THE EXPERT


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


Header image by Adobe Stock

DSA News – Winter 2022

– DSA Western Cape News –

Life Child staff get tested

Ntsiki Nkomo, one of the nurses who volunteers at DSA Western Cape did a wellness talk in Xhosa for the staff at Life Child in Philippi on 25th March.

There were 15 staff members who had their blood pressure and blood glucose checked after talk. Two of the ladies had high blood pressure, unknown to them.

– DSA Port Elizabeth News –

Provincial Hospital Pharmacy’s Demin for Diabetes Day

Our Denim for Diabetes project is managed by Megan Soanes. The Pharmacy Staff at our Provincial Hospital held a Denim for Diabetes Day on Valentine’s day. They had fun and helped our branch to raise some much needed funds. It’s so encouraging to have support from various places for Denim for Diabetes and not just from the schools. Thank you Provincial Hospital Pharmacy.


Teddy Jack

A giant teddy was so kindly donated to the DSA Young Guns before lockdown and has been kept safely till activities could be resumed. They have named him Jack and he has his own DSA Young Guns t-shirt. Jack visits the various Young Guns and he stays with them till the next Young Gun outing. Young Rudi, our youngest member, was the first one to have the privilege of taking Jack home with him. Paula Thom and Darren Badenhuizen are the ‘guardians’ of Teddy Jack.

– DSA Pietermaritzburg News –

Diabetes wellness week

Pranisha Deonarain, dietitian and  chairperson of DSA PMB branch, empowered the community at local practice of Dr Kumeshnee Naicker’s diabetes wellness week. Gift packs were given to all who attended.


Eye health awareness

Mr Vikash Srikewal gave a talk to DSA PMB members regarding their eye health and diabetes. Free eye pressure testing was done.


World Health Day

 On 7th April (World Health Day), DSA PMB branch hosted a health at St Mary’s Care Centre. Various activities including meditation and Zumba sessions were held and healthy foods stalls were on display.

Mental illness and diabetes

Daniel Sher discusses the common forms of mental illness that people with diabetes may encounter, why diabetes and mental illness are linked, and pointers for getting help.


As people with diabetes, we’re well aware that we risk running into medical complications later down the line, if we don’t get the right support for our condition. We’ve all heard about retinopathy, foot damage, kidney issues and so on. Why then, are we not talking about the impact that this condition can have on the brain?

Common culprits

As people with diabetes (Type 1 or Type 2), we are more likely to develop certain forms of mental illness. Why is this the case? Well, quite simply, diabetes is a hugely challenging condition to live with. If we don’t have the right support, we can become overwhelmed by the burden of this condition.

At the same time, though, we are vulnerable to mental illness because of the way in which blood glucose fluctuations affect the parts of our brain that are responsible for mood and cognition. As a result, many people with diabetes will encounter struggles with the following:

Clinical Depression (or Major Depressive Disorder)

Depression involves a deep and unrelenting fog of sadness. Other symptoms include a loss of pleasure in previously enjoyable activities, concentration difficulties, fatigue, low sex drive, insomnia, shifts in appetite and significant changes in body weight. Research suggests that people with diabetes are two to three times more likely to develop depression.

Anxiety Disorders

We’ve all felt stressed out from time-to-time. But if your stress levels are extreme and you are feeling this way all or most of the time, you may have an anxiety disorder. People with anxiety struggle immensely to stop themselves from worrying. In some cases, they may experience panic attacks: brief episodes of intense fear and physical reactions that seem to come out of nowhere.

How common are anxiety disorders in people with diabetes? Research suggests that 14% of us have a diagnosed anxiety disorder. Anxiety has a negative impact on glucose control due to the release of stress hormones and the fact that anxiety stops us from engaging in healthy behaviours.

Eating Disorders

Given how much emphasis is placed on our dietary intake, it’s no surprise that we risk developing disordered relationships to food and eating. We are constantly exposed to reminders that we need to watch what we eat, which leads some to feel that their value as a person is linked to their diet and blood glucose levels.

We also encounter so much stigma, blame and judgment when it comes to our dietary choices, which results in huge doses of shame – an emotion which often drives eating disorders. People with diabetes, therefore, are at risk of developing conditions, such as anorexia, diabulimia (intentional insulin restriction for weight loss) and binge-eating disorder.

What about sugar addiction?

Is food addiction real? Although this has not yet been recognised as a formal psychiatric disorder (more research is needed), there is a good body of evidence to suggest that certain foods release dopamine in a way that can hijack the brain’s reward centres, mirroring the effect that drugs and alcohol have on our brain.

For people with diabetes, an unhealthy relationship with food can set you up to experience some serious difficulties, both in terms of your mental health and your diabetes management.

Signs of sugar addiction include intense cravings, binge-eating, emotional eating, feelings of withdrawal and a sense of being completely out of control with regards to your diet.

In particular, foods that are high in sugar are more likely to affect the brain in this way, because of the rush that they provide. Remember, high sugar foods do not always taste sweet: starchy complex carbs, such as white rice, bread, pap, potatoes and pasta are all culprits here.

Is diabetes burnout a mental illness?

No: diabetes burnout is a natural response to living with a hugely challenging condition. People with diabetes burnout tend to feel overwhelmed and powerless when it comes to their diabetes management and lifestyle. They may find themselves skipping doctor’s appointments or intentionally avoiding glucose monitoring.

Although diabetes burnout is not a psychological disorder, it can cause massive blood glucose fluctuations which render a person’s brain that much more vulnerable to depression and anxiety.

Can mental illness cause diabetes?

The answer is yes: having a psychiatric disorder puts you at risk for Type 2 diabetes. Why? Medications which people take for certain conditions (like bipolar or psychosis) can trigger the development of diabetes.

At the same time, people who are struggling with a mental illness may find it harder to engage in behaviours that reduce the risk of developing Type 2 diabetes, such as frequent exercise, abstaining from drugs, cigarettes and alcohol, and making healthy food choices.

Finally, having a psychiatric disorder can change the way that your body and brain metabolise food for energy. This can make a diabetes diagnosis more likely.

How to get help

Do you feel like your emotional difficulties are stopping you from looking after your physical health? Do you often feel alone and overwhelmed? Are you mentally uncomfortable, despite your efforts at changing your lifestyle and mindset? Have you ever contemplated suicide?

If you answered yes to any of these questions, it’s advisable to get some support. Start by reaching out to your general practitioner or diabetes specialist, so that you can ask for a referral to a clinical psychologist and, if needed, a psychiatrist.

How can psychology sessions help?

If you have diabetes and an additional psychological disorder, there are various ways in which talk therapy can help. In my own practice, I use Diabetes Focused Psychotherapy,which is an individualised treatment plan designed around the specific diabetes and mental health needs of each client that I work with.

Diabetes Focused Psychotherapy draws on several other therapy approaches, including:

Motivational Interviewing helps people to change their behaviour by resolving their ambivalence and generating motivation.

Cognitive-Behavioural Therapy empowers you to take control of unhelpful thinking patterns which lead to unpleasant emotions (like hopelessness or frustration) and unhelpful behaviours (like binge-eating and avoiding testing).

Mindfulness-Based Stress Reduction involves using mindfulness meditation techniques to help improve psychological resilience.

Psychoanalytic Psychotherapy helps you to understand how past experiences and unconscious dynamics impact your life in the present. This involves helping a person to understand and take ownership of diabetes in relation to their identity, while also addressing patterns of unhelpful behaviour, such as self-sabotage and denial.  

Play Therapy and Family Therapy are useful approaches for helping children or adolescents to cope with diabetes.

Dialectical Behaviour Therapy is an approach which helps people to regulate their emotions and overcome eating disorders and/or other forms of self-harm.

Summing up

As people with diabetes, we have a higher risk for developing certain forms of mental illness. Managing a psychological disorder in addition to diabetes is never easy. Furthermore, suffering through such a condition can take a serious toll on your diabetes management and physical health. For these reasons, we need to keep an eye out for the signs of psychological distress; and we need to reach out for support when necessary. Know this: all of the disorders discussed in this article can be treated. With the right support, you can find a way to thrive 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 www.danielshertherapy.com


References

  • Ali, S., Stone, M. A., Peters, J. L., Davies, M. J., & Khunti, K. (2006). The prevalence of co‐morbid depression in adults with Type 2 diabetes: a systematic review and meta‐analysis. Diabetic medicine, 23(11), 1165-1173.
  • Gearhardt, A. N., Yokum, S., Orr, P. T., Stice, E., Corbin, W. R & Brownell, K. D. (2011). Neural correlates of food addiction. Archives of general psychiatry, 68(8), 808-816.
  • Grigsby, A. B., Anderson, R. J., Freedland, K. E., Clouse, R. E., & Lustman, P. J. (2002). Prevalence of anxiety in adults with diabetes: a systematic review. Journal of psychosomatic research, 53(6), 1053-1060.
  • McIntyre, R. S., Kenna, H. A., Nguyen, H. T., Law, C. W., Sultan, F., Woldeyohannes, H. O., … & Rasgon, N. L. (2010). Brain volume abnormalities and neurocognitive deficits in diabetes mellitus: points of pathophysiological commonality with mood disorders? Advances in therapy, 27(2), 63-80.
  • Polonsky, W. H., Fisher, L., Earles, J., Dudl, R. J., Lees, J., Mullan, J., & Jackson, R. A. (2005). Assessing psychosocial distress in diabetes: development of the diabetes distress scale. Diabetes care, 28(3), 626-631.
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Cannabis for treatment of peripheral neuropathy

Lynette Lacock explains how cannabis has been used as medication in the past and the use of it for treatment of peripheral neuropathy today.


Brief history of cannabis as a medication

As far back as I can remember, cannabis was something to avoid if you were a law abiding citizen. It was illegal for most of my lifetime and considered a gateway drug, leading to all sorts of problems for those that used it.

Now all you read about these days is how cannabis helps this and that. So, how did it go from zero to hero in what seems like a relatively short period of time? Believe it or not, throughout history cannabis was more often the hero. The first documented use of cannabis for medicinal purposes was in Asia in 2800 BC by Emperor Shen Nung, the patriarch of Chinese medicine.

From that period onward it was also used for medicinal purposes by the Greeks, Romans, Indians and the British, just to name a few.  The Khoisan people were using it long before Europeans landed on the shores of Africa. It was even rumoured to have been used by Queen Victoria for menstrual cramps.

Labelled a dangerous drug

Eventually in the early 1900s it was labelled a dangerous drug and became heavily taxed, regulated and eventually outlawed in some Western countries.

In 1921, it was outlawed in South Africa under the Customs and Excise Duty Act. Some of the many reasons for this were due to an increase in recreational use, its link to crime and pressure from political and religious groups to have it banned.

Continued research

After the introduction of stronger pain medication, such as aspirin and opioids, cannabis was deemed no longer useful as a medicine and it was removed from most pharmacopeia.

Scientists still continued their research into the possible uses for cannabis. They isolated the compound cannabidiol (CBD) in the 1940s and tetrahydrocannabinol (THC) in 1964. It wasn’t until the 1980s that they discovered receptors for both of these in the human body. Finally, they were able to start to determine some of the effects these two substances had on humans.

Various Acts passed

In 1996 the Compassionate Use Act was passed in California (US) permitting medicinal use of cannabis for epilepsy unresponsive to other medications. Since that time the list of conditions it can be used for has grown along with the number of States that conceded to the Act.

In 2016 the Adult Use of Marijuana Act was passed in California.  Again other States followed suite. Many other countries around the world have also decriminalised it or legalised the use of cannabis for medicinal purposes.

It wasn’t until 2018 that South Africa legalised the private cultivation, possession and personal use of cannabis under the Cannabis for Private Use bill. Parliament’s Justice and Constitutional Development committee are tasked with amending the act to legalise and regulate the cultivation of medicinal cannabis with consideration of legalising it for recreational use by the end of 2022. This is a potential R28 billion a year industry for the country, not to mention the much-needed jobs this could create.

Unfortunately, at this point in time you can only get a license to cultivate cannabis for medicinal purposes and require special permission to obtain it for medical use.

Research continues to shows that CBD and THC can have a therapeutic effect on many different ailments, such as how it can help reduce symptoms associated with peripheral neuropathies.

Peripheral neuropathy in people with diabetes

A neuropathy is a damaged nerve or group of nerves causing numbness, weakness and/or pain. Peripheral means something on the periphery, such as your feet, legs, hands and arms. Unfortunately, 60-70% of people with diabetes will develop some form of peripheral neuropathy.

Neuropathy symptoms can vary from a burning sensation, numbness, weakness, sensitivity to touch, decreased ability to feel temperature or shooting pain. Annoyingly, symptoms can become worse at night when you’re trying to sleep.

This nerve damage can happen after a prolonged period of time with high and uncontrolled blood glucose levels. The damage can be made worse if a person also has high cholesterol and high blood pressure because this can further compromise blood flow to the nerves.

The best way to avoid peripheral neuropathies is to monitor your chronic conditions and maintain a normal blood glucose level. Once a nerve is damaged it can’t be repaired and you’re only able to treat your present symptoms while trying to prevent them from getting worse.

Finding the right cannabis for your neuropathy pain

There have been multiple studies conducted that have shown cannabis can be effective in reducing the symptoms of peripheral neuropathies. Most studies were done with combination of prescription strength (Schedule 6) CBD and THC.

The general conclusions have been that it helps with pain relief and inflammation while the THC can decrease anxiety and alter the perception of pain. This is good news for those neuropathy sufferers that haven’t had relief with conventional medication.

At this time, over-the-counter products containing maximum 600 mg CBD with maximum 20 mg daily dose per pack and 10 parts per million or <0.001% of THC are available to the general public in South Africa.

You can find these products at pharmacies or health shops and you won’t need a prescription to buy them. They come in different forms such as creams, drops or sprays. You can approach your pharmacist for assistance in finding which one would work best for you. This is regulated by the South African Health Products Regulatory Authority (SAHPRA).

Obtaining prescription strength cannabis

However, if you find these products are not effective enough you can get your doctor to apply to SAHPRA requesting permission to obtain prescription strength cannabis.

With a Section 21 application, your doctor can request unregistered medication if you qualify. Medicinal cannabis approval is usually granted by SAHPRA for the following four diagnoses: HIV/AIDS, anxiety, cancer and chronic pain.

Once you receive approval under Section 21, you’re issued with a medical card and are able to fill your prescription.

Since all of these laws and regulations are fairly new, not all doctors are aware of how to go about this process. It was only in September 2021 that the first person in the country received approval for medicinal strength cannabis.

You can go into the following link to find a doctor near you that is aware of how to apply for a Section 21 application for you and then prescribe Schedule 6 cannabis once your application is approved.

If this seems like too much trouble, you may want to wait and see what happens later this year. Hopefully in the not-too-distant future, you will be able to go to your local GP for a prescription then have it filled at your local pharmacy.


References

Sr Lynette Lacock

MEET THE EXPERT


Sr Lynette Lacock received her Bachelor’s Degree in Nursing and Biofeedback Certification in Neurofeedback in the US. She has over 30 years’ experience in healthcare which has enabled her to work in the US, UK and South Africa. Initially specialising in Cardiothoracic and Neurological ICU, she now works as an Occupational Health Sister. She is passionate about teaching people how to obtain optimum health while living with chronic conditions.


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Prediabetes: what you need to know

Dr Angela Murphy goes into detail about prediabetes and highlights that healthcare providers need to provide specific, useful information to stop the progression.


Mrs T, a 65-year-old lady, has just been told she has prediabetes. She relays this information to her daughter describing it as ‘a touch’ of diabetes. She has been told that she must just avoid sugar and she will be fine. Her daughter, however, wants to know more and asks the following questions:

What is prediabetes?

Prediabetes includes the conditions: impaired fasting glucose and impaired glucose tolerance. These describe levels of blood glucose that are higher than normal but not yet in the diabetic range. These higher glucose levels are associated with a significantly higher risk of developing cardiovascular disease as well as progression to diabetes.

How is prediabetes diagnosed?

There are international guidelines set out to diagnose diabetes and prediabetes. Over the last decades, the goal posts have been moved several times in the diagnosis of prediabetes.

Blood glucose levels are measured fasting after eight hours of no food or drink, or two hours after a glucose challenge. This is given as a drink containing 75g of glucose. Your healthcare provider will ask the laboratory to do an oral glucose tolerance test (OGTT). This is the only test that can diagnose impaired glucose tolerance and is considered a sensitive test to diagnose prediabetes.

To definitively diagnose prediabetes, two tests should be done on separate days.

Table 1 shows the glucose levels for normal, prediabetes and diabetes.

TABLE 1: DIAGNOSIS OF PREDIABETES

NORMAL PREDIABETES DIABETES
FASTING GLUCOSE (mmol/L) ≤ 6,0 6,1-6,9 ≥ 7,0
2-HOUR GLUCOSE*(mmol/L) <7,8 7,8-11,0 ≥ 11,1
HBA1C % ** ≥ 6,5

*2-hour glucose level after a 75g glucose challenge

**HbA1c is not used in the categorization of prediabetes

Where: Fasting is defined as no caloric intake for 8 hours

2-hour glucose is measured after a 75g glucose load given in 250ml of water over five minutes.

What are the symptoms of prediabetes?

It’s unlikely that a person will have any specific symptoms of prediabetes. As glucose rises, thirst and loss of weight may occur. It’s concerning that in many instances prediabetes is detected when tests are done to investigate another complaint, particularly ones that may be a complication of diabetes such as the following:

 Peripheral neuropathy – damage to the small nerves of the feet cause pain and discomfort which may be described as burning, pins and needles, or sensitive. This may eventually lead to complete loss of sensation.

Cardiovascular disease – cardiac disease such as angina, heart attack or heart failure; peripheral vascular disease resulting in decreased blood flow in the legs causing pain on walking; stroke or transient ischaemic attack.

Kidney disease – this would be detected with blood and/or urine tests.

Other described complications of diabetes may be a presenting feature of prediabetes, but these are infrequent, e.g. retinopathy, autonomic nervous dysfunction (including impotence in men) and poor wound healing or recurrent infections.

Who should be tested for prediabetes?

Increased body weight is the greatest risk for developing prediabetes. It’s also more frequent in older populations and those with a family history of diabetes. Certain ethnicities have a higher incidence and in South Africa, our Indian community has a particular increased risk. Women with a history of gestational diabetes (diabetes developed during pregnancy) and polycystic ovarian syndrome may develop prediabetes or diabetes as well.

When should people be tested for prediabetes?

The US Preventative Task Force recommends screening for prediabetes every three years in adults with normal blood glucose, especially if they have risk factors.

Our South African guidelines suggest that all adults be screened for high glucose from the age of 45 years but an adult who is overweight can be screened at any age. The frequency of repeat screening will depend on the presence of the risk factors mentioned above.

Can prediabetes be treated?

Several large studies have shown conclusively that it’s possible to prevent the progression of prediabetes to diabetes. In the Finnish Diabetes Prevention Study (DPS) and the Chinese Da Qing Study, weight loss and physical exercise showed significant benefit.

The DPS demonstrated a 58% relative risk reduction in the progression to Type 2 diabetes in participants with impaired glucose tolerance who were treated with intensive lifestyle modification. The Da Qing study showed a similar 51% lower incidence of progression to Type 2 diabetes in a similar population of prediabetes.

Most importantly, there was still a 43% lower incidence seen over a 20-year follow-up period and this was associated with overall lower mortality. It’s incredible to think that a six-year lifestyle intervention showed such long-term benefits.

Other trials have shown benefit with pharmacological treatment. The most quoted of these is the Diabetes Prevention Programme undertaken in the US. Lifestyle intervention alone was compared to metformin, a medication that is the cornerstone of Type 2 diabetes management. The group following lifestyle alone showed a 58% decrease in the incidence of Type 2 diabetes compared with 31% in the metformin group.

The Diabetes Prevention Programme Outcomes Study followed up these subjects for a mean of 15 years offering twice yearly lifestyle reinforcement to the lifestyle group and ongoing metformin to the second group. Type 2 diabetes incidence was further reduced by 27%.

Other studies have looked at the role of diabetic medications to treat prediabetes and, thus, prevent progression to diabetes, e.g. pioglitazone, acarbose (no longer available in SA) and orlistat (a weight loss agent).

Should medications be used to treat prediabetes?

There is a role for medications, but several factors must be considered. All of these medications, including metformin, can have side effects. In addition, medical funders don’t recognise any prediabetes condition as a primary medical benefit so the medications can’t be put on to chronic reimbursement.

For there to be ongoing benefit from the medications, they do need to be continued. It’s recommended that medications be considered in people who haven’t reversed their prediabetes diagnosis with lifestyle alone or in individuals who are considered very high risk of progressing to diabetes.

According to our local South African guidelines these would include people with the following:

  • Age < 60 years old
  • A history of gestational diabetes
  • A BMI > 35 kg/m2
  • Presence of both impaired fasting glucose and impaired glucose tolerance
  • The metabolic syndrome (hypertension, high cholesterol, obesity)

The treatment of choice is metformin starting at a dose of 500mg twice daily, but this can be adjusted if glucose levels don’t improve.  Repeat blood tests can be done every three to six months. The person will need to be advised that this medication is being used off-label.

Orlistat is an option for those people struggling to lose weight as it has shown benefit for both weight reduction and glucose lowering.  However, it has significant gastrointestinal side effects requiring an almost fat-free diet which is not suitable for everyone.

What lifestyle intervention is best for prediabetes?

Weight loss

The key elements of lifestyle intervention are a reduction in body weight and an improvement in physical activity. Data from the DPP showed that for every 1kg of weight lost, there was a 16% decrease in the risk of developing Type 2 diabetes. Referring patients to a registered dietitian to embark on this journey is best. Weight loss requires significant calorie reduction, and it’s essential for a balance of nutrients to be included in the diet.

For patients who struggle to achieve significant weight loss, it’s reasonable to discuss weight loss medications, such as orlistat mentioned above, or liraglutide, now available in SA.As a rule of thumb there should be 5% weight loss in three months. If that isn’t attained, then the method of weight loss has to be discussed with the dietitian or the doctor.

Exercise

Physical activity needs to be of a moderate intensity, such as brisk walking, and it needs to be regular. A daily 30-minute session five days a week is ideal. The aim is usually to be active for 150 minutes per week which burns around 700 kilocalories.

Where possible, it’s best to have a mixed exercise programme that includes resistance training, stretching and cardiovascular. Light weight training improves insulin resistance and, thus, blood glucose levels.

It’s important to be active during the day, choose the stairs and not the lift, park far from the shop entrance but these types of activities can’t be counted as part of the 150 minutes.

Support system

If it was easy, we would all be losing weight and exercising regularly.  The reality is that for many people, achieving these goals is a struggle so a support system must be in place. It can be difficult to motivate yourself to go for a walk at the end of a busy workday, but if you have a friend or family member to motivate you and get you walking, it will help.

It’s encouraged to follow some structured programme, preferable with supervision. The COVID pandemic has presented a huge challenge with the closing of exercise classes, gyms and even the popular parkrun. Now that we are able to return to these activities, try and have a specific programme.

Seeing the dietitian regularly helps keep up the motivation to follow the eating plan. It’s important to set goals and to troubleshoot when the goals aren’t being met.

Conclusion

The importance of identifying prediabetes isn’t to diagnosis a stand-alone condition but rather to highlight the continuum of risk of increasing blood glucose levels to cardiovascular diseases and diabetes itself.

At the point of prediabetes, there is a definite window of opportunity to change lifestyle and improve blood glucose, to reverse the prediabetes and prevent the development of Type 2 diabetes.

Healthcare providers should provide specific, useful information for people to be able to make these changes and guidelines on the follow-up of blood glucose testing.


References

  1. US Preventive Services Task Force. Screening for Prediabetes and Type 2 Diabetes: US Preventive Services Task Force Recommendation Statement. 2021;326(8):736–743. doi:10.1001/jama.2021.1253
  2. Guideline Committee. The 2017 SEMDSA Guideline for the Management of Type 2 Diabetes. JEMSDA 2017; 22:1(Supplementary pgS1-S192)
  3. The Diabetes Prevention Program. Design and methods for a clinical trial in the prevention of type 2 diabetes. Diabetes Care. 1999 Apr; 22(4):623-34.
  4. Table Adapted from The 2017 SEMDSA Guideline for the Management of Type 2 Diabetes. JEMSDA 2017; 22:1(Supplementary pgS1-S192)

MEET THE EXPERT


Dr Angela Murphy is a specialist physician working in the field of Diabetes and Endocrinology in Boksburg. She has a busy diabetes practice.


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