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.


Header image by Adobe Stock

Diabetes Centre opened at Groote Schuur Hospital

Groote Schuur Hospital (GSH) launched its Diabetes Centre to promote a culture of excellence in diabetes-related primary healthcare in the Western Cape. This is the first public healthcare centre of its kind in Africa.


Diabetes on the increase

The number of people living with diabetes (PLWD) continues to escalate globally, outpacing all predictions. According to the International Diabetes Federation (IDF):

  • Over the next two decades, the number of PLWD in Africa is projected to increase by 143%, the greatest increase among all continents.
  • In SA, we continue to see a rise in the numbers of PLWD, with current estimates suggesting there are 4,6 million South Africans with diabetes.
  • Roughly 52% of PLWD are undiagnosed. At least 50% of those that are diagnosed don’t have access to adequate care.
  • Approximately 70% of all PLWD remain poorly controlled.

Professor Joel Dave, Head of the Department of Endocrinology at GSH, said,“Overall, diabetes was the second most common cause of mortality in SA, just behind tuberculosis. The vulnerability of PLWD to infectious diseases has been highlighted during the recent COVID-19 pandemic with diabetes being a significant risk factor for hospitalisation and death from COVID-19. Data from the Western Cape shows that 43% of all those with COVID-19 requiring admission to hospital were PLWD and 23% of all deaths from COVID-19 were PLWD.”

About the Diabetes Centre

Since the Diabetes Centre is a tertiary clinic, the more complicated cases of diabetes will be dealt with. The centre will only accept referrals from the Community Healthcare Centres and secondary level hospitals. However, some referrals will be accepted from private doctors. Referrals to the centre are made via the Vula E-Referral App.

Offerings:

This centre will be used as a fulcrum on which an extensive and expanded diabetes service will be built providing the following services:

  1. Diabetes Clinic: Specifically focusing on complicated diabetes, such as Type 1 diabetes, gestational diabetes, diabetes in special situations (patients with organs transplants, cystic fibrosis, steroid-induced, atypical), preoperative optimisation of diabetes. A specialised Diabetes Foot Clinic encompassing a multi-disciplinary team, including a podiatrist, endocrinologist, vascular surgeon, plastic surgeon, will be part of the centre.
  2. Patient Education: A dedicated patient education centre will form part of the GSH Diabetes Centre where patients will be encouraged to attend group sessions and one-on-one education sessions with trained diabetes educators.
  3. Nurse Education: A state-of-the-art Conference Room will form part of the GSH Diabetes Centre and will be used to conduct Basic and Advanced Diabetes Education Courses for all nurses within the public and private sectors.
  4. Doctor Education: The Conference Room will also be used to conduct Masterclasses in diabetes for doctors within the public and private sectors.
  5. Training of endocrinologists/physicians: The expertise and technology in the GSH Diabetes Centre will be used to train the next generation of endocrinologists and physicians for SA and Africa.
  6. Teaching of medical students: The GSH Diabetes Centre will provide an environment in which the next generation of medical students and general practitioners will be empowered to develop a foundation of knowledge for the optimal management of PLWD.
  7. Research: The GSH Diabetes Centre will focus on generating local data that will allow for the optimal management of PLWD in SA and will be used to inform local and national guidelines.
  8. Outreach: The GSH Diabetes Centre will house the expertise and technology to conduct outreach clinics and training regionally, nationally and internationally within Africa.

On the right track

The Provincial Minister of Health, Dr Nomafrench Mbombo, said, “Having worked as a nurse in the public healthcare system, I have seen first-hand how PLWD struggle with their illness. It also places enormous pressure on our healthcare system. However, we must do more in providing affordable and uninterrupted access to diabetes care for everyone. We know that early diagnosis and access to appropriate care for all types of diabetes can avoid or delay complications in people living with the condition. That is why I am so encouraged by the establishment of the Diabetes Centre. It shows that we are on the right track in the fight against diabetes.”

What is the endocrine system?

Sister Lynette Lacock explains what the endocrine system is and how this systems fails when the pancreas malfunctions.


Unless you took biology in high school or work as a health professional, you’re probably not aware of all the different functions in the body that rely on the endocrine system to work properly. So, let’s start off with the basics.

What is the endocrine system?

The endocrine system is a complicated group of glands that produce hormones and regulate different functions in the body. These include:

  • Pancreas – produces insulin that regulates blood glucose levels.
  • Adrenal gland – produces hormones that help regulate metabolism, immune system, blood pressure and response to stress.
  • Thyroid gland – controls metabolism by regulating thyroid hormones.
  • Pituitary gland – referred to as the master gland because it controls other glands in the body and is responsible for well-being.
  • Pineal gland – regulates circadian rhythm by regulating melatonin.
  • Ovaries – regulates hormones responsible for female characteristics and reproduction.
  • Testes – regulates hormones responsible for male characteristics and sperm production.

Pancreas malfunction

Many people are blissfully unaware of how hard their pancreas is working to regulate their blood glucose all the time. Unfortunately, many of us have some form of diabetes and our blood glucose is unregulated, causing us to be symptomatic.

The more stable our blood glucose is, the less likely we’ll experience the negative side effects of diabetes. So, if you’ve diabetes you must be knowledgeable about various treatments and work at keeping your blood glucose in check. 

Types of diabetes

Pre-diabetes and insulin resistance

You may be more prone to getting pre-diabetes if you’re overweight, have a family history of diabetes, lead a sedentary lifestyle, have an elevated cholesterol level or had gestational diabetes.

Be aware of some warning signs, such as constant thirst, frequent urination, urinary tract infections, fatigue, blurry vision and itchy skin. If you’re experiencing any of these symptoms go have your blood glucose checked by a healthcare professional. If you blood glucose is slightly elevated, see your doctor for an evaluation and advice.

Warning bell

You can think of pre-diabetes as a warning bell telling you to change your lifestyle and diet to prevent yourself from getting full-blown diabetes.

When you’re pre-diabetic, your pancreas is still producing insulin but your cells don’t respond normally and glucose builds up in the blood. You’ll have slightly elevated blood glucose levels that aren’t high enough to be diagnosed with diabetes.

Reverse the progression

However, your body will be suffering the negative side effects of elevated blood glucose and you may not even be aware it’s happening. Luckily there are ways to reverse this progression. These following three changes may seem hard at first but if you stick with them you’re on the road to a healthier life.

  • Exercise/walk five days a week
  • Eat less processed, high glycaemic index and fatty foods
  • Drink more water

Start small and progress at your own pace. At first you may just be able to walk short distances but over time you’ll be able to increase that distance. If you’re not the one that cooks at home, speak to whom ever does so you can come up with healthier alternatives that the whole family can enjoy.

Type 1 diabetes

Unfortunately there isn’t anything you can do to prevent Type 1 diabetes. It’s an autoimmune disease thought to be the result of genetics or a viral infection which causes the body to attack and destroy the cells in the pancreas, making them unable to produce insulin.

If you’ve Type 1 diabetes, you’ll need to use insulin to regulate your blood glucose on a daily basis. Your doctor will explain how to control your blood glucose with insulin. You will need to check your blood glucose several times a day to make sure the insulin dose is effective. It’s still very important to exercise and eat healthy foods if you have Type 1 diabetes.

Type 2 diabetes

This type of diabetes occurs when you develop insulin resistance and the pancreas can no longer produce enough insulin to regulate your blood glucose.  If your pancreas is still producing some insulin it may be possible to go on oral medication to regulate you blood glucose. However, if there isn’t enough insulin being produced, you’ll need to go on insulin to regulate your blood glucose.

People living with Type 2 diabetes can help control their blood glucose by losing weight, exercising and following a healthy diet. This will help lower blood sugar glucose levels and possibly prevent you needing insulin in the future.

Why is it important to keep my blood glucose levels normal?

To maintain your health and well-being you must keep your blood glucose levels stable and within the normal range. The best way to do this is to have your blood glucose tested regularly and work closely with your doctor to decide the best course of treatment.

Elevated or uncontrolled blood glucose over a period of time can have negative effects. Though, most of these problems can be prevented. Although you may not feel sick with slightly elevated blood glucose, it may already be affecting your organs.

Uncontrolled diabetes can damage small blood vessels causing problems with your heart, kidneys, eyes, peripheral nerves and capillaries causing neuropathies and delayed wound healing. Remember, prevention is easier than cure.

Keep track of your pancreas

It’s important to get your blood glucose tested regularly, particularly if you have a family history of diabetes, or have been diagnosed as pre-diabetic.

If you’re already on treatment, it’s still important to monitor your blood glucose so you and your doctor can make sure you’re on the best treatment for your type of diabetes. For example, if you’re prescribed tablets, you need to monitor your blood glucose to make sure that they are controlling it. If they are not, you can be suffering from the negative side effects of high blood glucose because the treatment isn’t working.

So, please take charge of your health and learn the best ways to stay healthy and prevent complications. Get your doctor or healthcare professional to explain your medications and anything you don’t understand about your condition. Remember, we only get one body so look after yourself.


References

https://kidshealth.org/en/teens/endocrine.html

https://www.carenewengland.org/blog/endocrine-system-and-diabetes

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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Would you know if you have one of the three silent killers?

Type 2 diabetes, high cholesterol and high blood pressure can be silent killers. How often do you get screened for these chronic conditions?


Many people are unaware that chronic health conditions, such as Type 2 diabetes, high cholesterol and high blood pressure (hypertension), can cause damage to the body, often without the person experiencing noticeable symptoms.Although these conditions can occur individually, these three are often interlinked and can significantly increase the chances of stroke, heart attack and premature death.

NB! Routine health screenings

At the beginning of a new year, many of us think about improving our health through taking up a fitness regimen or eating more healthily. A crucial but often overlooked aspect of taking care of our well-being is having routine health screenings.

Even if you feel healthy and well, be aware that you could be living with one or more of these underlying conditionswithout knowing it. With non-communicable diseases on the rise in SA, it really is advisable for adults to screen for these common health threats each year so that any risks can be detected and managed early to ward off more serious complications from developing in future.

Three silent killers 

Diabetes – chronic high blood glucose

Diabetes is a chronic long-term condition that affects how your body breaks down glucose from the food that you eat. While Type 1 diabetes is usually diagnosed in childhood, Type 2 diabetes develops over time and is more often diagnosed in adulthood.

Insulin is a hormone that helps control your body’s blood glucose levels. If your body doesn’t produce enough insulin or cells stop responding to insulin, too much glucose remains in your bloodstream and this can lead to serious health problems over time, including potentially irreversible damage to the eyes, kidneys and other organ systems. It’s therefore critical to be aware of your blood glucose levels and get tested regularly to know if you are at risk of developing Type 2 diabetes.

With the medicines available these days, along with regular exercise and a healthy diet as advised by your treating doctor, diabetes can be well-controlled with many new oral or injectable medicines to help keep blood glucose levels stable.

Hyperlipidaemia – high cholesterol

High cholesterol, or elevated levels of fat in the bloodstream, is another common non-communicable disease that is all too common in SA. Although people with high cholesterol usually don’t have any symptoms, if it remains undiagnosed and therefore untreated it significantly increases the risk of heart disease, heart attack and stroke.

A simple blood test reveals cholesterol levels, and if these are outside of the healthy range your treating doctor will prescribe the right kind of chronic medicine to help maintain cholesterol at healthier levels. A diet that is low in saturated fat and regular cardio exercise are generally recommended as part of the treatment plan.

Hypertension – high blood pressure

The World Health Organisation estimates that almost half of people living with high blood pressure globally remain undiagnosed and therefore untreated, and only one in five have their hypertension under control.

When hypertension isn’t well-controlled, it places additional pressure on the cardiovascular system, potentially leading to heart attack, heart failure and stroke, as well as kidney damage among other risks.

Unmanaged, these conditions are associated with significantly higher risk of hospitalisation and premature death, but these outcomes can be avoided with the right treatment. Once a person has been tested, they have the power to improve their long-term health and can often avoid complications with the necessary treatment and lifestyle adjustments.

When your doctor has prescribed the right medication specifically for you, this is only the first step to effective treatment, and it’s of critical importance that you continue to take your medicine exactly as prescribed, even when you feel better.

Supporting better health outcomes

Being diagnosed with a chronic condition and starting new medication can be daunting, and to help make it as easy as possible to adhere to prescribed treatment, Medipost Pharmacy offers telephonic assistance from the pharmacy team in all official languages, as well as free delivery of chronic medicines to any address in SA. If you have any questions or concerns about your treatment, reach out to your pharmacist who can give you advice, such as how to overcome potential side effects.

To be effective, chronic medicine must be taken at the right dosage continuously, even when you’re on holiday or out of your usual routine.

As part of its free delivery service for chronic medicines, with advanced notice those registered with the courier pharmacy can have their confidential medicine parcels delivered to another address while they are away from their usual delivery address.

As well as dispensing medicines to individuals privately, the service also includes assistance with registering PMB conditions, including diabetes, hypertension and hyperlipidaemia, to help conserve medical scheme members’ day-to-day benefits.

Medipost Pharmacy aims to improve access to quality and affordable medicines for all South Africans, making it simple and convenient to adhere to chronic treatment and improve your health and quality of life.

MEET THE EXPERT


Joy Steenkamp is pharmacist at Medipost Pharmacy. She completed her Doctor of Pharmacy, in 2005, at the University of Mississippi, USA before gaining experience working as a home-infusion clinical pharmacist. In 2010, she moved to SA where she completed her community service as a pharmacist in SA. Since joining Medipost, in 2015, Joy has been actively involved in training new pharmacists and as a clinical analyst promoting public health awareness initiatives.

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DSA News – Autumn 2022

DSA welcomes new board members

We get to know the two new DSA National Board Members, Salih Hendricks and Wesley Mc Aslin,who were elected at the DSA National AGM held on 14 December 2021.


Salih HendricksSalih Hendricks

Salih Henricks (55) lives in Crawford, Cape Town. He is separated and has five children. He has had Type 1 diabetes for 40 years and been a diabetic amputee for two years.

How do you feel about this appointment?

I’m happy to be part of this organisation and hope to be of value for DSA and the diabetes community.

What do you aim to achieve?

What I want to get into action is raising awareness on the less costly medications that are given to diabetes patients in the public sector. These medications aren’t working for many patients. Treatment needs to be put together as a package deal with extra management and added components to make these meds work.

No matter what type of medication you take, a good mindset and exercise help the medication work better. I want to ensure all people with diabetes don’t give up.

What are your responsibilities?

The community

In your opinion, how does the care for diabetes need to change or improve in SA?

There is no need for improvement but more involvement from communities and sharing their experience. We learn from each other better than from any book.

What does balance mean to you?

Nothing is perfect in this world therefore giving, caring, supporting , mental health and many more positives could help us balance our lives better. Just by trying, we can balance everything.


Wesley Mc Aslin

Wesley Mc Aslin (43) lives in Kempton Park, Gauteng. He is married and has two children. He has Type 1 diabetes.

How do you feel about this appointment?

I’m excited in that I believe I can make a difference to someone’s life by hopefully inspiring people with diabetes to push themselves and their limits and not to let diabetes rule their lives.

What do you aim to achieve?

Enlighten people about diabetes and eliminate any misconceptions

What are your responsibilities?

My responsibilities have not been completely defined as yet but I want people living with diabetes to know that they need to look after their health and they shouldn’t cheat as in the end it only does harm.

In your opinion, how does the care for diabetes need to change or improve in SA?

Better understanding and better education in all sectors about living with diabetes and the emotional toll it takes on people living with diabetes and their immediate family members.

What does balance mean to you?

Healthy living and been able to manage your diabetes efficiently without it encumbering your ambitions and goals in life.


Western Cape Camp Diabetable


With the kind sponsorship of EPT recovery, DSA is holding Camp Diabeteable on 22 to 24 April 2022.

Benefits of diabetes camps

Diabetes South Africa has been holding camps for children with diabetes for well over 40 years. These camps are designed to facilitate a camp experience in a medically safe environment, while fostering opportunities for children to develop basic diabetes self-management skills.

These type of camps also provides opportunities for children with diabetes to forge sustainable relationships, overcome feelings of isolation, and gain self-confidence and a positive attitude to living with a lifelong chronic disease which has to be managed hour by hour.

IMPACT 

According to three years of pre and post surveys, diabetes camps positively impact a wide-range of camper outcomes, including knowledge of diabetes management, management behaviours, and emotional well-being.

Doctors have reported to us that the positive benefits of our camps for children with diabetes are seen in their young patients for many months post camp. Newly diagnosed campers appear to benefit the most from their camp experience.  The encouragement and support the children receive often leads to them giving themselves their first insulin injection on their own. Campers usually ask on leaving the camp when the next one will be.

Some our past campers have joined our DSA Camp Management Team as young adults to pay forward the positive experience they had when attending our camps as children.

The theme of the camp is: The elements – earth, wind, fire, water.

To join the camp email margot@diabetessa.org.za

– DSA Port Elizabeth News –

Springdale Diabetes Wellness Group

What an amazing caring group this is. The convenor of this group is Clive Burke who is a management board member of the DSA PE branch.

This group was previously called Gelvandale Diabetes Wellness group and was started in 2008 by Hester Isaacs, ably supported by her husband, Esau, and daughters, Sadie and Terry.

In April 2018, at the 100th meeting organised by Hester, she handed over the reins to Clive Burke who had been an active and supportive member for many years.

Clive with his wonderful caring and compassionate nature has led this group since then and through the tough lockdown years, has still cared for each member in his own quiet and sincere way. We see this in his written word below:

In 2018, I took over from the late Hester Isaacs, who ably led the group since its inception in 2008. We have members from a wide spectrum in our area. Quite a lot of Muslim support as well. Our aim is to educate and support people living with diabetes. We have become a close group and we encourage each other to introduce other people living with diabetes to our meeting. I have found that they are very caring towards each other.

One of our members lost her husband recently and the group felt we should just lift her spirit a little bit and we decided to give her with a bouquet of flowers. This was handed to her close friend at the February meeting to take to her. This was indeed a WOW moment for her and much appreciated.

We do treasure each other’s company and share our sorrows and joys. May our group make a great impact in our society where we live, as we support and care for each other. We are about 15 to 20 members in regular attendance.


Denim For Diabetes

Megan Soanes, DSA Port Elizabeth’s fundraising co-ordinator, has already organised two Denim for Diabetes days. One at St George’s Prep School and one at the Provincial Hospital Outpatients Pharmacy. Both were held on Valentine’s Day.


Wellness meetings

Our Diabetes Wellness Groups in Newton Park, Malabar and Springdale held their meetings in February. This was an exciting step forward for the Malabar and Springdale groups as this was the first time they met since the start of lockdown.

Each group presented a topic relating to COVID and diabetes. At the Newton Park meeting, Renique Verhoef, dietitian, spoke about Leaving the Weight of COVID Behind. Dr Jeff Govender presented an interesting talk on COVID vs diabete at the Malabar meeting. While Stories of COVID-19 were told and shared by the members at the Springdale meeting.

Join Camp Diabetable 18-20 March 2022!

– DSA Pretoria News –

Wellness Day

As we are well aware, last year (2021) was not the best time in most lives. It was also not a good time for DSA Pretoria. Due to lock down we were unable to meet together for most of the year. We were also unable to do what we need to do and that is to inform people about diabetes, by means of holding wellness days at companies and doing testing, as well as free testing ay shopping malls.

So, we are thrilled to have hosted our first Wellness Day at x on 26 February.


DSA members interviewed on TV show

In December, DSA Pretoria was approached by SABC 2 asking for people with Type 1 and Type 2  diabetes to be interviewed their TV program, Vital Signs.

Frans Steenkamp (Type 1) and Brian Midlane (Type 2) were the two representatives chosen from the Pretoria branch. They shared their experience of living with diabetes. Both men had very interesting stories to tell.

At the end of the broadcast, National Chairman, Martin Prinsloo, was able to publicise the purpose of Diabetes SA. All in all a good experience was had by all and we are hoping that the message went out loud and clear.

The best questions to ask after being diagnosed with diabetes

Receiving the diagnosis of diabetes can be daunting. However, having the correct information and guidance will make the transition and acceptance less intimidating. Diabetes nurse educator, Christine Manga, suggests the best questions to ask to make it a smooth transition.


Asking your healthcare professional the following questions will assist in receiving clarity about what is necessary to manage your diabetes to the best of your ability.

  1. What type of diabetes do I have?

Knowing what type of diabetes you have will determine your treatment plan. There are three main types: Type 1, Type 2 and gestational diabetes.

Type 1 is an auto-immune condition. This is caused by the body destroying its own insulin producing beta cells. The reason isn’t clearly understood but is often preceded by a viral infection. Type 1 makes up 5-10% of people with diabetes.

Type 2 is a progressive condition with ongoing loss of beta cell function. It’s also characterised by insulin resistance which is where the body still has sufficient insulin, but the body is unable to utilise it. Type 2 accounts for 90-95% of diabetes cases.

Gestational diabetes presents and is diagnosed for the first time during pregnancy. It usually develops at about the 24th week of pregnancy. Hormones produced by the placenta cause insulin resistance and an increase in blood glucose levels. These elevated glucose levels pass through the placenta to the foetus. Gestational diabetes tends to resolve after the birth.

  1. What treatment will I have to take?

The type of diabetes you have will determine the treatment that you’re prescribed.

Type 1

Type 1 will be treated solely with insulin, initiated at the get-go. Treatment will be lifelong. This will be administered as multiple daily injections or through a continuous subcutaneous insulin infusion from an insulin pump.

Some patients with Type 1 will also receive metformin if they become insulin resistant. Unfortunately, Type 1 is currently irreversible.

Type 2

People who are diagnosed with Type 2 can go into remission with a drastic change in lifestyle including diet, weight loss and an increase in activity. It’s vital to continue testing your blood glucose levels to ascertain if you’re still in remission.

For most of the population, treatment initiation is usually metformin. As time and condition progress, increased doses of oral medication may be indicated. There is a full plethora of oral medication available to people with Type 2. These medications will be introduced and removed in response to your diabetes progression.

Eventually insulin may be required to manage your blood glucose levels. This is not due to failure on your part but rather the natural progression of Type 2. Adding insulin to your medication regimen doesn’t change your diagnosis. You would be known as having insulin-dependent Type 2 diabetes.

Gestational diabetes

Treatment consists of metformin and/or insulin. Gestational diabetes usually resolves after the birth and medication would be discontinued. Testing your blood glucose levels by means of an oral glucose tolerance test at six to 12 weeks post-delivery is recommended. You should continue to test one to three years thereafter. There is an increased risk of developing Type 2 after having gestational diabetes. 

  1. Will the medication cause side effects?

Enquiring about potential side effects of new medication is useful, as knowing what to expect makes adherence easier, gives you peace of mind as well as knowing when to report a side effect to your healthcare practitioner.

Certain medications have common side effects experienced by many people. Being prepared for these and knowing how to manage them and how long to expect them to persist for will instil confidence in your treatment.

  1. What are the symptoms of uncontrolled blood glucose levels?

People tend to experience similar symptoms to each other when their glucose is either high or low however it’s possible to experience different symptoms. It’s beneficial to learn to recognise these symptoms to afford yourself time to take appropriate corrective action.

Typical symptoms of high glucose readings:

  • Increased thirst
  • Increased urination
  • Blurry vision
  • Nausea and vomiting
  • Fatigue
  • Dry mouth
  • Over a longer time, weight loss and delayed wound healing are also symptoms.

Typical symptoms of low blood glucose levels:

  • Sweating
  • Hunger
  • Shaking
  • Anxiety
  • Palpitations
  • Irritability
  1. Will these symptoms go away?

Once you’re diagnosed, commence medication and improve your lifestyle, your symptoms will almost definitely improve. They may not subside fully until your glucose levels are in target range or much improved. An exacerbation in the control of your diabetes may cause symptoms to recur. This may be a sign that medication needs to be reviewed.

  1. How often should I see my doctor and who else should I see?

Once you’re diagnosed you should see your doctor at least every six months, more regularly if you’re struggling to manage your diabetes. At these visits you should discuss your glucose control as seen on your blood glucose meter, or continuous glucose monitoring (CGM) and Hba1c. Medication should be reviewed and blood pressure and weight checked. Any concerns could be brought to the table here.

Blood tests for cholesterol and kidney functions should be done annually unless more frequent testing is required. Over and above monitoring these parameters, an annual visit to a podiatrist and ophthalmologist are recommended even if you’re not aware of any problems currently.

These initial visits will allow for a baseline from which deviations can be assessed. Getting assistance from a dietitian will be invaluable. Diabetes nurse educators, like myself, make understanding your diabetes much simpler. We are fortunate to be able to spend more time with you than the average doctor can. All the above-mentioned services will complement each other, hopefully making your diabetes journey a smooth one.

  1. What are realistic goals and targets?

Glucose:

Fasting readings of between 4-7mmol/L.

Two hours after a meal the reading should be below 7,8mmol/L.

Time in range (TIR) is a relatively new concept. This focuses on having above 70% of glucose readings within the range of 4-10mmol/L instead of focusing on specific numbers. There is a strong correlation between TIR and HbA1c.

HbA1c:

The usual target is 7,0%. These targets may be individualised between you and your practitioner.

BMI:

Maintaining a healthy weight with a BMI of between 18,5-24,9 is advised.

Exercise:

The World Health Organisation recommends 150 minutes of moderate exercise per week. This will be broken down to shorter sessions spaced out over the week.

  1. How often should I test my blood glucose levels?

People with Type 1, 2 and gestational diabetes using insulin need to test more often than people using oral medication only. People with T1 should be testing at least four times a day, pre meals and at bedtime. Before and after exercise may also be necessary. A 2am test is useful to rule out overnight hypoglycaemia.

For people not on insulin, less testing is required. Testing a fasting reading twice a week would be sufficient. It’s also useful testing two hours after meals from time to time, to establish the effects of your meal on your blood glucose levels. Try to aim for no more than 2mmol/L increase after meals.

When medication is being altered, more regular testing may be required, up to seven tests a day for three days. CGM is a convenient way to track blood glucose levels 24 hours a day. Unfortunately, it’s an expensive tool.

  1. Why should I make all these changes?

Unfortunately, uncontrolled diabetes can result in many long-term complications including eye, feet and kidney damage. There is also an increased risk of cardiovascular disease.

Having good communication and support from your diabetes team will lighten your burden, and managing diabetes will hopefully not weigh you down.

eating time budget

MEET THE EXPERT


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


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Different types of flour and what they are used for

Dietitian, Retha Harmse, educates us on the different flours and what they are used for.


At a couple’s conference, the speaker mentioned that many husbands and wives are so disconnected that 85% of husbands didn’t know their wives’ favourite flower. One husband turned to his wife next to him and whispered,”It’s self-rising, isn’t it?”

All jokes aside; I laughed at the irony of the wordplay until I realised that these two words were actually derived from one another. The English word flour is originally a variant of the word flower, and both words derive from the Old French fleur or flour, which had the literal meaning blossom, and a figurative meaning the finest. The phrase fleur de farine meant the finest part of the meal since flour resulted from the elimination of coarse and undesirable matter from the grain during crushing until it resembled a fine powder.

There are many flours on the market these days, some we know very well and others with very distinct characteristics and purposes.

The protein content 

Protein content is the primary factor that varies in flours.

  • High-protein wheat varieties (10-14% protein) are classed as hard wheat.
  • Low-protein wheat (5-10%) are known as soft wheat.

Simply put: More protein equates to more gluten which results in more strength. More strength results in more volume and a chewier texture. High-protein flours lead to doughs that are both more elastic (stretch further) and more extensible (hold their shape better), which are desirable qualities in bread and other yeasted products where a firm structure is required, but undesirable in pastries and cakes, where the objective is flakiness or tenderness.

Types of flours

All-purpose flour 

When recipes call for flour, it’s referring to all-purpose flour. This type of flour is made from a mixture of soft and hard wheat, with moderate protein content in the 10-12% range. All-purpose flour is a pantry staple; it’s the most versatile of flours, capable of making flaky pie crusts, fluffy cookies and chewy bread.

Cake flour 

This type has the lowest protein content (5-8%). The low amount of gluten-forming proteins makes it ideal for tender baked goods, such as cakes but also muffins or scones. It’s commonly chlorinated, a bleaching process that further weakens the gluten proteins and modifies the starch content, increasing its capacity to absorb more liquid and sugar (guaranteeing a moist cake).

Pastry flour 

An unbleached flour made from soft wheat with protein levels between cake and all-purpose flour (8-9%). This type achieves the ideal balance between flakiness and tenderness, making it perfect for pies, tarts and many cookies.

Make your own pastry flour by mixing 1 ⅓ cups of all-purpose flour and ⅔ cup of cake flour together.

Bread flour 

With a protein content of 12-14%, bread flour is the strongest of all flours, delivering the most structural support. This is especially crucial in yeasted bread, where a strong gluten network is needed to contain the CO2 gases formed during fermentation. The extra protein also results in more browning in the crust (in a process called the Maillard reaction).

Self-rising flour 

This is flour that has baking powder and salt added during the milling process. Self-rising flour is best stored tightly wrapped in its original box and used within six months of purchase. After that the baking powder in it begins to lose its strength.

Make your own self-rising flour: Mix 1 cup of pastry flour with 1 ½ teaspoons of baking powder and ¼ teaspoon of salt.

Whole wheat flour 

During grinding, the wheat kernel is separated into its three components: the endosperm, the germ and the bran. Fluctuating quantities of the germ and bran are combined back into whole wheat flour.

It’s usually high in protein, but its gluten-forming ability is altered by the bran and germ therefore tends to produce heavier, denser baked goods.

Whole wheat flour is far more perishable than white because the germ is high in oils that are prone to rancidity. For ultimate freshness: store it at cool room temperature for up to three months, then transfer it to a freezer.

Gluten-free flour 

There are numerous gluten-free flours available today, made from all sorts of grains, nuts and starches. A small proportion of xanthan gum is sometimes added to recreate or mimic the chewiness typically associated with gluten.

  • Almond flour: Ground almonds. It’s low in carbohydrates, high in healthy fats and fibre. When replacing flour with almond flour, substitute it 1:1 and add more of a rising agent (like baking powder or baking soda) as needed to contain the heavier weight of the almonds.
  • Bean flour: Ground dried or ripe beans. Garbanzo and fava bean flour is a combination with a high nutritional value but a strong aftertaste.
  • Brown rice flour: Great significance in Southeast Asian cuisine. Edible rice paper is made from it.
  • Buckwheat flour: Commonly used for pancakes all over the world (United States, Russia, Brittany in France). On Hindu fasting days (Navaratri and Maha Shivaratri), people eat cuisine made with buckwheat flour.
  • Coconut flour: Made from ground coconut, it has the greatest fibre content of any flour and has a very low concentration of digestible carbohydrates therefore making an excellent choice for those who are restricting their carbohydrate intake.
  • Hemp flour: Made by pressing the oil from the hemp seed and milling the residue. Hemp seed is approximately 30% oil and 70% residue. This type of flour doesn’t rise and is best mixed with other flours. Added to any flour by about 15-20%, it gives a spongy nutty texture and flavour with a green hue.
  • Tapioca flour: Obtained from the root of the cassava plant (commonly used for bread, pancakes, tapioca pudding, etc).

Remember, adapting recipes is both a science and an art. Bake it till you make it!

Retha Harmse is a Registered Dietitian and the ADSA Public relations portfolio holder. She has a passion for informing and equipping the in the field of nutrition. She is currently in private practice in Saxonwold, Houghton and believes that everyone deserves happiness and health and to achieve this she gives practical and individual-specific advice, guidelines and diets.

MEET THE EXPERT


Retha Harmse is a registered dietitian and the ADSA Public relations portfolio holder. She has a passion for informing and equipping the in the field of nutrition. She is currently in private practice in Saxonwold, Houghton and believes that everyone deserves happiness and health and to achieve this she gives practical and individual-specific advice, guidelines and diets.


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