DSA News Spring 2023

– DSA Western Cape News –

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Mitchells Plain Women’s Day event


As August was Women’s Month, we celebrated ourselves as African woman. We had breakfast with coffee and tea, and some ladies did an African dance. We really had an awesome amazing morning with the group.

Parow Community event


Sr Onyinye from Diabetes Community Wellness Group in Milnerton gave a talk at acommunity event in Parow recently.

Diabetes Awareness Day held for pastors’ wives


A Diabetes Awareness Day was held for pastors’ wives recently. The event was organised by Sr Onyinye from Diabetes Community Wellness Group in Milnerton and assisted by Sr Veronica from the Diabetes Group in Strandfontein.

Diabetes Screening Day for pastors


A Diabetes Awareness and Screening Day for pastors was held recently. It was organised by Sr Onyinye from Diabetes Community Wellness Group. Margot McCumisky from Diabetes SA gave a talk for the pastors who attended.

– DSA Port Elizabeth News –

Malabar Diabetes Wellness meeting


Dr Gracjan Podgorski, a specialist physician, was the guest speaker at the Malabar Diabetes Wellness meeting in August. His topic was Fifty Years of Taming the Sugar Dragon: Reflections and Revolution in Diabetes Management.

Many people attended this meeting as Dr Podgorski will be retiring the end of this year. He will be missed by so many people with diabetes in our area.

Dr Podgorski was born in Warsaw, Poland and studied at the Department of Internal Medicine and Diabetology, Warsaw Medical School and qualified as a specialist physician in 1989. He came to South Africa in 1991.

We met Dr Podgorski for the first time in 1994 when he was the guest speaker at our Diabetes Wellness meeting that was held in Newton Park.

Over the years, Dr Podgorski has shared his vast knowledge of diabetes at least once a year at our various wellness meetings and helped us all to learn more about diabetes. He will be missed, but the knowledge he has shared with so many will not be forgotten.

The Port Elizabeth Branch of Diabetes SA wishes Dr Gracjan Podgorski a peaceful and well-deserved retirement.

This photo was taken while Dr Gracjan Podgorski was giving his last address to a Diabetes Wellness group in Port Elizabeth.

Springdale Diabetes Wellness Group


Our Springdale Diabetes Wellness Group has shown that diabetes is a Family Affair. At the August meeting Clive Burke, co-ordinator of Springdale Diabetes Wellness Group, spoke about the importance of family sharing the care of living with diabetes.

The Springdale group is like a large family caring for each other and the community. They recently collected over 60 cakes of facial soap and donated this to the nearby Gelvandale Frail Care Centre. When one of their member’s lost her husband, they took a bunch of flowers to her.

Keeping it in the family Clive’s niece, Afton Thysse, shared her diabetic journey at the June meeting.

The versatile Clive Burke addressing the August meeting. Afton Thysse with her uncle, Clive Burke, when she was the guest speaker.

Newton Park Diabetes Wellness meeting


At the August Newton Park Diabetes Wellness meeting, we were treated to a most interesting presentation on the Benefits of Body Stress Release, an almost unknown topic to most of us.

By the end of the meeting, we were all wiser after seeing and hearing the presentation by Dawn Spies, qualified Body Stress Release practitioner. She also donated a book all about Body Stress Release to our diabetes library as well as two generous gift vouchers for our attendance draw, each valued at R1 200, for a series of Body Stress Release treatments

Dawn Spies in action at the August meeting.

– DSA Pretoria News –

June Wellness Support Group meeting


On a beautiful clear, sunny Saturday, over 30 people attended the informative and empowering presentation on wound care by the renown wound care specialist, Liezl Naude.

It was a terrific afternoon that focused on creating awareness, connecting and sharing information. We all learnt on prevention, importance of movement, wound management and practical things to do and type of shoes recommended for people living with diabetes. A diverse group of attendees were active participants, enthusiastic, friendly and welcoming.

A special thanks to Liezl for an informative talk. For further enquiries, contact the Eloquent Health & Wellness Centre at 012-3480940.

A warm welcome to the new members who joined the support group through the aQuellé sponsorship. The new members were presented with their membership cards and complimentary gift pack. It was a pleasure to see young people, familiar, regular and new faces. A big thank you to the DSA Pretoria Wellness Support Group team for bringing this event together.

July Wellness Support Group meeting


A special note of appreciation to Dr Padayachee, an expert who enlightened and advised us to be aware of reactions to medications. The session also covered risks of combining prescribed and over-the-counter self-medication. The reactions should immediately be brought to the attention of health professionals.

If you’re living with diabetes or interested to know more, make an effort to attend the once a month wellness support group meeting, there is always something new to learn. Knowledge is power.

August Wellness Support Group meeting


Hattie Lubbe, an audiologist, gave an educational talk on the effect of diabetes on the ear structure. She explained that hearing loss is regarded as a progressive degenerative disorder.

We were enlightened and empowered as she unpacked the link between diabetes and hearing loss, the signs and symptoms. The importance of annual screening, servicing hearing aids as well as how treating hear loss can slowdown dementia were discussed.

The next DSA Pretoria Wellness Support Group meeting will be on 16 September 2023, please save the date.

A call for volunteers


Diabetes SA is primarily a volunteer organisation and relies heavily on people living with diabetes and their families who pool their talents, share their knowledge and experiences and give of their time to help each other.

You too could be a great organiser and get everyone off on a big walk or you may, equally valuable, be a friendly face that is willing to initiate a support group, or you may equally have a valuable skill.

❤️ DSA Pretoria branch is looking for volunteers to assist with the spreading of awareness of diabetes in communities. Start-up wellness support groups, guidance and booklets will be provided.

❤️ Someone with a little time on their hands to assist with admin. You will need a laptop and internet.

❤️ We would love to be assisted with social media awareness.

❤️ People who are keen to start support groups in their areas. Guidelines and start-up materials are available

❤️ We are looking for young and old vibrant people who have a passion for sharing information and creating awareness.

❤️ People who could be coached for two years to take up various roles in the near future.

The majority of us are volunteers and not paid workers. Most of us are retirees who do not have offices and work from home.

Anyone is welcome to join the group; one can become a friend of the group and indicate what services one is willing or capable of assisting with.

For further information and to see where you may be able to assist people living with diabetes, please kindly contact Liz by email at: [email protected]

Thyroid disease

Thyroid disease is common and treatment is highly effective. Dr Louise Johnson tells us more.


What is the thyroid?

The thyroid is a small gland, measuring about 5cm, that lies under the Adam’s apple in the neck. The two halves (lobes) of the gland are connected in the middle (called the isthmus), giving it the shape of a bow tie. Normally the thyroid gland can’t be seen and can barely be felt.

The thyroid gland secretes thyroid hormones, which control the speed at which the body’s chemical functions proceed (metabolic rate). The thyroid hormone influences the metabolic rate in two ways:

  • By stimulating almost every tissue in the body to produce proteins.
  • By increasing the amount of oxygen that cells use.

Thyroid hormones affect many vital body functions, such as the heart rate, the rate at which calories are burned, skin maintenance, growth, heat production, fertility and digestion.

Thyroid hormones

There are two thyroid hormones:

  • T4 (Thyroxine)
  • T3 (Triiodothyronine)

T4, the major hormone produced by the thyroid gland, has only a slight effect, if any, on speeding up the body’s metabolic rate. Instead T4 is converted into T3, the more active hormone.

The conversion of T4 to T3 occurs in the liver and other tissues. Most of T4 and T3 in the bloodstream is carried bound to a protein called thyroxine-binding globulin. Only a little of T4 and T3 is circulating in the blood. However, it’s the free hormone that is active.

To produce the thyroid hormones, the thyroid gland needs iodine, an element contained in food and water. The thyroid gland traps the iodine and processes it into thyroid hormones. As the thyroid hormones are used, some of the iodine contained in the hormones is released, returns to the thyroid gland, and is recycled to produce more thyroid hormones.

The body has a complex mechanism for adjusting the level of thyroid hormones. First the hypothalamus, located above the pituitary gland in the brain, secretes thyrotropin-releasing hormone, which causes the pituitary gland to produce thyroid-stimulating hormone (TSH).

TSH stimulates the thyroid to produce hormones. The pituitary gland slows or speeds the release of TSH, depending on whether the level of thyroid hormones circulating in the blood are too low or too high.

Diagnostic tests for thyroid disease

  1. The neck of a person is examined to feel whether the thyroid gland is palpable.
  2. Blood tests are done measuring T4, T3 and TSH. Usually, the level of TSH in the blood is the best predictor of thyroid function.
  • If the TSH levels are high, the thyroid is underactive. It’s called hypothyroidism.
  • If the TSH is very low, the thyroid is overactive. It’s called hyperthyroidism.

Hypothyroidism

Simply put, this is an underactive thyroid gland and leads to inadequate production of the thyroid hormones and a slowing of vital bodily functions.

Clinical picture

  • Facial expressions become dull
  • Voice is hoarse
  • Speech is slow
  • Eyelids droop
  • Eyes and face become puffy (myxoedema)
  • Hair becomes sparse, coarse and dry
  • Skin becomes coarse, dry, scaly and thick
  • Fatigue is common
  • Weight gain
  • Constipation
  • Muscle cramps
  • Unable to tolerate cold
  • Older people may become forgetful; can easily be mistaken for Alzheimer’s disease
  • People with hypothyroidism have high levels of cholesterol

Causes of hypothyroidism

Primary hypothyroidism is due to a disorder of the thyroid gland. The most common causes are:

  • Hashimoto thyroiditis is an autoimmune disease where antibodies are formed against the thyroid gland and eventually destroy it.
  • Thyroid inflammation (thyroiditis) is caused by a viral infection and is usually temporary.
  • Treatment of thyroid cancer or hyperthyroidism treatment.
  • Lack of iodine in the diet is common in many developing countries. South Africa’s iodine is added to salt to prevent this.
  • Radiation of the head and neck due to the treatment of cancers.

Diagnosis of hypothyroidism

Measurement of the TSH levels in blood. If this value is high, then a second test of T4 can be done to confirm that it is low.

Treatment

Replacement of the thyroid hormone using oral preparations. The preferred form of hormone replacement is synthetic T4 (levothyroxine).

Hyperthyroidism

Simply put, this is an overactive thyroid gland and leads to high levels of thyroid hormones and speeding up of vital body functions.

Clinical picture

  • Heart rate and blood pressure increases
  • Heart rhythm may be abnormal
  • Excessive sweating
  • Feeling of anxiousness
  • Difficulty in sleeping
  • Weight loss without trying
  • Increased bowel movements
  • Hand tremors
  • Increased activity level despite fatigue and weakness
  • Change in menstrual periods in women
  • Changing in the eyes with a look of one that is staring

Causes of hyperthyroidism

The most common causes are:

  • Graves’ disease is an autoimmune disorder. In this disorder the antibodies that are produced against the thyroid, stimulate it to produce more thyroid hormones. This leads to enlargement of the thyroid called a goitre. The eye symptoms are very pronounced with puffiness around the eyes, increased tear formation, irritation and sensitivity to light. This is sometimes called thyroid eye disease. Two distinctive signs are: bulging eyes (proptosis) and double vision (diplopia).
  • Toxic multinodular goitre is a disease where there are multiple nodules (small lumps) in the thyroid. One or more produce excessive thyroid hormones. This is more common with ageing.
  • Thyroiditis is inflammation of the thyroid that at first causes an overactive thyroid due to viral disease or auto antibodies (Hashimoto’s). The thyroid stores become depleted in time and this will lead to hypothyroidism.
  • Single toxic nodule.

 

Diagnosis of hyperthyroidism

Measurement of TSH level in the blood. TSH level will be suppressed and T4 will be very high.

Antibodies against the thyroid can also be done to establish a cause.

Treatment

  1. Treatment of the cause.
  2. Betablockers to block the effect of the thyroid hormone and relieve the symptoms of palpitations, sweating, tremors and anxiety.
  3. Sometimes medication (carbimazole) to block the production of the thyroid hormone.
  4. Radioactive iodine to destroy the thyroid gland. This is the most common treatment of hyperthyroidism since it’s easy to administer a radioactive dosage of iodine that will destroy only the thyroid in a three-to-six-month period without surgery.
  5. Surgery (thyroidectomy) to remove the thyroid or part of it. Sometimes eye surgery is needed in Graves’ disease.

Thyroid disease is a very common disease and should always be suspected. Treatment is highly effective, and any person can live a full life with the correct medical treatment.

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.


Header image by FreePik

Coping with life transitions

We learn eight tips to help make life transitions more bearable and positive experiences.


There is no escaping change or life transitions and its potential to impact your life. Change can often be stressful and may require adjustment time. Various types of change can seem overwhelming but may also present valuable opportunities for personal growth.

Whether you have been actively seeking change or it has been imposed upon you, there are unique challenges that come with different forms of change.

Typical life changes may include pivotal transitions in work or studies, relationships, or family dynamics, moving home or relocating, loss of a loved one or significant health diagnoses. Change and the uncertainty it brings are part of life and resisting change will not make it any easier.

Change is normal and adjusting to it comes naturally to most people, however, major transitions may mean letting go of the life you are accustomed to and embracing a new one. If a transition is intensely challenging, it can destabilise your thoughts and emotions, leaving you feeling overwhelmed and distressed.

Knowing how to cope with the curveballs life throws at you, is therefore a crucial life skill. Embracing change in a positive way helps you to become stronger and more resilient. Managing change in life is key to personal growth and enables you to live a life where you are thriving, rather than just surviving.

8 tips to cope with life transitions

  1. Understand and accept the limits of what you can control and what is beyond your control. Focus your energy and efforts constructively rather than becoming stuck in anger and denial.
  2. Practise good self-care. Get plenty of sleep, eat a balanced diet, and feel the benefits of physical exercise.
  3. Embrace healthy coping skills. Fun activities such as listening to music, spending time in nature, reading a good book or playing with a pet are good for your well-being and can reduce your stress levels.
  4. Cut out unhealthy coping skills. If you have been turning to activities or habits that do more harm than good, make a conscious effort to cut back.
  5. Seek meaningful connections and support. Spend time with family and friends who are good for you.
  6. Let go of your regrets. Regrets can hold you back in life. Looking back at the past may cause you to miss the opportunities change presents for the future.
  7. Practise self-compassion. Treat yourself with the same kindness and compassion as you would a loved one going through a challenging time in their life.
  8. The gift of gratitude. With reflection you may discover a greater appreciation for what you do have and what remains constant in your life during a period of change.

A life worth living

To create a life that you do not feel you need to escape from, a life worth living, you need to be proactive about how you manage the changes you face in your life. However, sometimes, adjusting can be so daunting and overwhelming that it leads to an adjustment disorder.

This may happen when the stress associated with change exceeds your resources for coping, and your reaction becomes disproportionate to the event. Consider seeking professional mental health support if you are struggling to cope with change.

While the personal experience of adjustment to any change is unique, and may be expected to be uncomfortable initially, it may be cause for concern if you still feel overwhelmed three months later, or your suffering is disproportionate in response to the situation.

If you are not coping in your day-to-day life, social relationships, at home, work, or school, talking to a mental health professional can be helpful in providing emotional support and learning to identify healthy coping mechanisms and stress management strategies.

Seek proper treatment from a therapist or psychiatrist who can help you to manage the condition and learn the skills you need to cope with change and future life transitions.

If you are having a difficult time coming to terms with change or experiencing emotional distress, Netcare Akeso’s 24-hour crisis line is always here for you on 0861 435 787. Trained counsellors are available to listen and can guide you on the various options for assistance, whether for yourself or a loved one.

Belinda Campher is an occupational therapist and the general manager of Netcare Akeso George.

MEET THE EXPERT


Belinda Campher is an occupational therapist and the general manager of Netcare Akeso George.

Is there a link between food and feelings?

Kate Bristow expands on food and feelings: what food improves mood and knowing the difference between emotional eating and real hunger.


Happiness is something that we are all looking for. Generally, things like exercise, meditation and therapy are top of the list of recommendations. But did you know that the food you eat can play a role in your feelings?

There have been studies done on food and mental well-being and certain foods can be linked to increased serotonin levels in the brain. Serotonin is a chemical, also known as the happy hormone, which plays a big role in regulating your mood. Serotonin levels which are low can cause low mood.

Which foods lift mood and how to manage in diabetes

  1. Dark chocolate – There are components in dark chocolate which have been shown to produce serotonin and have anti-depressant properties. Dark chocolate isn’t a complete no in diabetes; in moderation it can be used to take away that craving for something sweet, and now to bring on a better mood.
  2. Bananas – Although not recommended in large quantities in diabetes, bananas contain vitamin B6 and the body needs vitamin B6 to create serotonin.
  3. Coconut – More research is needed here, but animal studies have found that coconut milk can possibly reduce anxiety.
  4. Coffee – Research shows that coffee consumption has been significantly associated with a decreased risk of depression, including the decaffeinated version.
  5. Avocado – This fruit is packed with good stuff, including choline which the body uses to regulate the nervous system and mood. Studies have shown decreased anxiety in women when they eat avocados. Avos are also rich in vitamin B which is good to decrease stress levels.
  6. Berries – Higher fruit and vegetable intake has been linked to better mental health. Berries are rich in antioxidants, which may reduce symptoms of depression.
  7. Foods which are fermented – Sauerkraut, kimchi, kefir, kombucha and yoghurt help with a healthy gut and may improve your mood. Up to 90% of serotonin is made in the gut, so eating these products will promote the production of serotonin.
  8. Mushrooms – These are packed with vitamin D which has been linked to antidepressant properties and mood enhancement. It’s also easily absorbed in this form by the body. For the best benefit, expose your mushrooms to the sun for a couple of hours before you cook them.

The good news is that the above, eaten in the right proportions are healthy choices and can be included as part of an eating plan in diabetes.

Emotional and comfort eating

We all have a relationship with food, just as we have a relationship with family and friends. And without even thinking about it, you could be an emotional or mindless eater. Add diabetes into the mix with a whole lot of strangers, as in the healthcare team and your family and friends taking extra interest in what you are eating, and it can get complicated.

Food is not just fuel for the body; it can be soothing and nurturing as in a baby receiving breast milk to settle and sooth. It’s not surprising then that you reach for food to help you cope with feelings (stress, conflict, anxiety, relationship challenges), we all need comforting from time to time.

However, even though eating does make you feel better and help settle emotions of distress, it may be beneficial to recognise the cause of the emotion and manage this rather than dull everything with food.

Diabetes itself can be a cause of stress and depression. Having to pay close attention to what you eat and learning on the job can be tough and possibly a cause of emotional eating.

Express your emotions in a safe way

Here’s one example of a conversation with yourself, “I’m eating because I’m frustrated for not being as productive as I would have liked today.”

It’s important to recognise behaviours like this and figure out your triggers and ways to express your emotions in a safe way. For example:

  • Talk to a friend or family member
  • Allow yourself to show emotion e.g. cry
  • Journal
  • Exercise
  • Do something fun to distract yourself

What can you do differently next time?

Dr Jen Nash, a psychologist who is living with diabetes, says that food challenges are real. But she also says that food should be pleasurable and a diagnosis of diabetes shouldn’t mean the end of this. Hunger is only one of 30+ reasons why you eat.

She suggests setting goals which are achievable. Strive to do the right thing 90% of the time and don’t feel guilty when things don’t go according to plan. She suggests an Oh-well attitude and to use the experience as a learning tool – What can I do differently next time?

  • Try not to feel that you’re being watched by everyone and equip yourself to face the challenges that food may give you in the journey ahead.
  • Try practical ideas such as experimenting with new recipes but planning a weekly shopping list and menu is a good idea.
  • Phone a friend who is there to support you and that you can be accountable to. This isn’t stalking, but rather support for choices that you make. Keep in touch with family and friends and reach out if you’re struggling. You are not alone.
  • Look after your body – make healthy choices with regards to food, get enough sleep and exercise regularly.

Mindful eating and how it helps in your meal plan choices

As a person with diabetes, you’re required to pay attention to what you’re eating constantly. Feeling stressed or depressed can be a cause of emotional eating. If you find yourself eating as a form of comfort, substitute this behaviour with an alternative treat: have your nails done, go to a movie or visit a friend.

You should enjoy food but eating mindlessly for the sake of eating means that you’re not taking time out to really savour what you’re eating. Before reaching out for a tasty treat, ask yourself “Why am I eating, am I actually hungry?” This is a more mindful approach.

Mindful eating means that you use all your emotional and physical senses to enjoy the food you’re eating. It encourages better choices for food, which are satisfying and nourishing.

Mindless eating or distracted eating can be associated with anxiety and stress, overeating and the associated weight gain.

How unhealthy eating patterns cause mayhem

Unhealthy eating patterns have been known to lead to mood swings, fluctuations in blood glucose levels and nutritional imbalances. With this lack of stability, your mind and body doesn’t function well.

Examples include:

  • Skipping meals leads to low blood glucose levels which can leave you feeling weak and tired.
  • Cutting out food groups can lead to not getting all the essential nutrients in your diet, which can also lead to mood swings and decreased energy.
  • Too many refined carbohydrates can cause erratic blood glucose levels, low energy and irritability.

Health eating habits

Evidence suggests that a healthy eating plan is both physically and mentally protective. Some general guidelines include:

  • Eat at regular set intervals during the day.
  • Choose less refined sugars and eat more whole grains.
  • Make sure you have protein at every meal.
  • Keep a variety of food in your eating plan.
  • Try to reach and maintain a healthy weight.
  • Drink enough fluid, particularly water.
  • Exercise regularly.

Pause mindfully

Pause mindfully when you eat, intentionally create time between each bite.

P    Present – Stop multi-tasking when you eat, and just eat.

A   Awareness – Be aware of the feeling of hunger, how does it make you feel physically?

U   Understand – Your feelings and how they may influence the food choices you make.

S    Savour – Take a mindful bite – smell, taste, touch, listen.

E    Enjoy – How much are you enjoying this bite?

Mindful eating becomes a strategy to encourage meals with fewer distractions, as well as better eating habits. Taking the time to enjoy the flavour of your food, atmosphere and company has been shown to lead to better psychological well-being, increased pleasure when eating and satisfaction.

So, go out there and enjoy mindful meals with your loved ones and in doing so create better health for yourself and fewer emotional eating habits.

Physical hunger vs. emotional hunger

PHYSICAL

Stomach growling

Thinking/considering choices

Low energy levels

Hunger grows slowly

How much time since the last meal?

Is food satisfying?

EMOTIONAL

What am I feeling? (anger, bored, stress)

How strong were the emotions?

When did you start feeling like this?

How did you hope food may help? (soothe or help you escape feelings)


References

https://www.diabetes.org.uk/guide-to-diabetes/enjoy-food/eating-with-diabetes/food-psychology/the-eating-journey

https://www.cnet.com/health/mental/8-mood-foods-that-will-make-you-happy/

www.eatingmindfully.com

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

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


Header image by FreePik

Polycystic ovarian syndrome

Dr Louise Johnson expands on polycystic ovarian syndrome and the risk of it leading to Type 2 diabetes.


Polycystic ovarian syndrome (PCOS) is one of the most common metabolic and reproductive disorders among women of reproductive age. It was described in 1935 by Stein and Leventhal.

Systematic screening of women according to the National Institute of Health diagnostic criteria estimate that 4 to 10% of women of reproductive age suffer from PCOS.1

Understanding PCOS

PCOS is a hormonal imbalance when the ovaries create excess androgen hormones.

The diagnosis of PCOS can follow one of three guidelines:

National Institute of Health criteria:

  1. Hyperandrogenism (high male hormone)
  2. Menstrual irregularity

Androgen Excess PCOS Society criteria:

  1. Hyperandrogenism
  2. Menstrual irregularity or polycystic ovaries on ultrasound

Rotterdam criteria (2 of 3):

  1. Hyperandrogenism
  2. Menstrual irregularity
  3. Polycystic ovaries on ultrasound

In polycystic ovaries there are small follicle cysts (fluid filled sacs with immature eggs) visible on your ovaries on ultrasound due to lack of ovulation (anovulation). This is one of the most common causes of infertility in women.

Signs of PCOS

  • Irregular periods which include missing menstruation or heavy bleeding.
  • Abnormal hair growth on arms, chest and abdomen. This is called hirsutism and affects up to 70% of women with PCOS.
  • Acne especially on face, chest and back. This may continue past teenage years and is difficult to treat.
  • Obesity is common in 40 to 80% of women with PCOS and they have trouble maintaining a healthy weight.
  • Darkening of skin in the folds of the neck, armpits and groin and under breasts. This is called acanthosis nigricans.
  • Cysts on ovaries that appear larger or with many follicles (egg sac cysts) on ultrasound.
  • Skin tags in armpits or on the neck.
  • Thinning hair or patches of hair loss.
  • Infertility is caused by PCOS.

What are the main causes of PCOS?

The exact cause is unknown. Genetics may play a role. Several other factors, most importantly obesity, also play a role. Other factors that play a role are:

  1. Higher levels of androgens (male hormones)
  2. Insulin resistance
  3. Low grade inflammation

How is PCOS diagnosed?

Clinical history of abnormal menstrual cycle.

Signs and symptoms as discussed above.

High levels of testosterone and luteinizing hormone (LH).

On ultrasound more than 12 follicles in each ovary.

Follicle size between 2 and 9mm.

Morbidities associated with PCOS

Obesity

This is one of the most common features of PCOS and varies between 61 and 76%. Childhood obesity is a well-documented risk factor for PCOS.

Insulin resistance

This is considered the main pathogenic factor in the background of increased metabolic disturbances in women with PCOS which can explain high androgen levels, menstrual irregularity and abnormal blood lipid levels.3

Type 2 diabetes

PCOS confers a substantially increased risk for Type 2 diabetes and gestational diabetes from early ages. About 1 in 5 women with PCOS will develop Type 2 diabetes.

Cardiovascular disease

In 1992 Dalhgren et al2 identified a 7 times higher risk of heart attack in women with PCOS compared to healthy people. More recent data shows higher burden of atherosclerosis and early onset cardiovascular dysfunction and heart vessel calcifications.

Infertility

In a 2015 study it was shown that infertility is 10-times more common in women with PCOS than in healthy controls. Women who conceive with PCOS might suffer from pregnancy-related complications, such as gestational diabetes and pregnancy-induced hypertension. Concerning the effects of the foetus, women with PCOS are 2.5 times at a higher risk of giving birth to a small for gestational age child.

Cancer

Females suffering from PCOS are at risk for endometrial cancer. Studies show a three-fold increase risk to develop endometrial cancer.

Psychological well-being

Women with PCOS are more prone to suffer from depression, anxiety, disordered eating and psychosexual dysfunction. It’s worth noting that obesity, acne, hirsutism and irregular menstrual cycles, all associated with PCOS, are major contributors to the psychological stress that the patients experience due to the challenging of the female identity and her body image.

Treatment

The management of PCOS targets the symptomatology for which patients usually present: anovulation, infertility, hirsutism and acne.

Lifestyle

Lifestyle modifications, such as exercise and a calorie-restricted diet, are considered as a cost-effective first-line treatment. Excessive weight is associated with adverse metabolic and reproductive health outcome. For instance, female fertility significantly decreases with body mass index (BMI) more than 30.

Multiple studies show that weight decrease as little as 5% regulates menstrual cycle, improves fertility, reduces insulin and testosterone levels, decreases acne and hirsutism and benefits psychological well-being.

Medical treatment

  1. Oral contraceptive pills

Oral contraceptive pills are the most used medication for the long-term treatment of women with PCOS. It’s recommended for regulating of menstrual cycle and decrease of testosterone levels as first-line treatment. A minimum of six months on oral contraceptives is usually required to obtain satisfactory results against acne and hirsutism.

  1. Metformin

Metformin is an oral antidiabetic biguanide drug that acts on suppressing glucose production from the liver and increasing peripheral insulin sensitivity. The use of metformin in women with PCOS decreases insulin resistance, reduces testosterone levels and improves glucose managing in the body.4

Screening recommendations

Screening for Type 2 diabetes

Women with PCOS should be routinely screened for Type 2 diabetes. Studies have shown that measuring only fasting glucose in patients with PCOS miss up to 80% of prediabetics and 50% of diabetics.

Current guidelines suggest screening women with PCOS using an oral glucose tolerance test every three years. Risk factors that require screening more often are:

  • Family history of diabetes
  • Hypertension medication use
  • Smoking
  • Increased waist circumference more than 80cm in females
  • Physical inactivity

Screening for cardiovascular disease

Women with PCOS should be screened regularly for risk factors such as:

  • Increased waist circumference
  • Smoking
  • Blood pressure
  • Abnormal cholesterol profile (increase triglycerides and low HDL)

 Screening for psychological well-being

Screening women with PCOS for depression, anxiety, negative body image and eating disorders is important.

PCOS is a complex disease and should be managed by a team of medical practitioners from a dietitian, psychologist, gynaecologist, dermatologist and specialist physician. Team work can lead to a successful outcome.


References

  1. Azzizz R, Woods K et.al. (2004)’The prevalence and features of the polycystic ovary syndrome in an unselected population.’ J Clin Endocrinol Metab. 89,2745-2749
  2. Dahlgren E, Janson P et.al. (1992) ‘Polycystic ovary syndrome and risk for myocardial infarction.’ Acta Obstet Gynecol Scand. 71,599-604
  3. Diamanti -Kandarakis E, Dunaif A (2012) ‘Insulin resistance and the polycystic ovarian syndrome revisited: an update on mechanisms and implications.’ Endocr Rev, 33 981-1030
  4. Hayek S.E., Bitar L et. al. (2015) ‘Polycystic ovarian syndrome: an updated overview’ Physiol, 7:124
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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Managing hypoglycaemic anxiety

Dr Paula Diab discusses hypoglycaemic anxiety, its impact on diabetes management and provides practical strategies to help take control and reduce it.


Living with diabetes can present numerous challenges, including daily glucose monitoring; paying careful attention to what you eat and when you eat; and compensating for normal, everyday lifestyle challenges such as stress, exercise and hormonal changes. Added to these challenges is the ever-present danger of low blood glucose levels (hypoglycaemia). While hypoglycaemia can be concerning in itself, it can also trigger hypoglycaemic anxiety and stress which may even exacerbate glucose levels further.

Understanding hypoglycaemic anxiety

Hypoglycaemic anxiety refers to the fear or worry experienced by people living with diabetes regarding the possibility of experiencing low blood glucose levels. This anxiety can stem from concerns about the physical symptoms as well as potential complications associated with hypoglycaemia.

Symptoms associated with hypoglycaemia include dizziness, confusion, and even loss of consciousness. These may often be misinterpreted as an anxiety attack or exacerbated by associated anxiety.

A previous experience of hypoglycaemia will also have a significant impact on future decision-making. Additionally, the fear of not being able to manage or control these episodes can contribute to heightened anxiety levels.

This is particularly true for the elderly; people who live alone and those who have poor or unstable support systems. Even an adult living with a spouse at home may feel unsupported and anxious if the spouse’s work demands irregular working hours or shift work. Children who have unpredictable daily routines where one day involves a two-hour sport practise after school and the next day is more sedentary or when sports practise is suddenly cancelled, or the time moved, or some aspect of the exercise changed.

Even those who rely on served meals (old age homes, hospitals, boarding schools, work conferences, travel, etc.) may experience anxiety at not being in control of what food they have access to at any time.

Impact on diabetes management

Hypoglycaemic anxiety can have a significant impact on diabetes management. Anxiety and stress can lead to hormonal changes that affect blood glucose levels, potentially triggering a vicious cycle of unstable glucose control.

Fear of hypoglycaemia may also result in intentionally maintaining higher blood glucose levels to avoid low episodes, which can lead to long-term health complications. It’s crucial to address hypoglycaemic anxiety to maintain a balanced and healthy approach to diabetes management.

Strategies to prevent hypoglycaemia

As with most challenges in diabetes, awareness and education are key to gaining control. Understand the signs and symptoms of low glucose levels and discuss them with your healthcare team.

Learn to recognise your individual triggers and identify the steps to prevent and treat low blood glucose effectively. This may differ for each and every individual.

Insulin

The most common culprit is short-acting insulin as this is exactly what it’s designed to do. Long-acting basal insulins don’t generally have a high risk of hypoglycaemia. Particularly the newer basal analogue insulins are very stable and don’t have a high risk for hypoglycaemia.

Pre-mixed insulins may also cause hypoglycaemia as they have a short-acting component in them and if you haven’t eaten enough to compensate for the insulin, your glucose levels will drop. Try to opt for newer insulins that have a lower risk profile.

Delayed food intake

Skipping meals, delaying meals, or inadequate carbohydrate intake can cause a drop in blood glucose levels. It’s important to maintain a regular eating schedule and include balanced meals and snacks to provide a steady supply of glucose to your body. When planning and scheduling isn’t in your control (boarding schools, catered meetings, travel), make sure that you speak to your healthcare team and mitigate this risk as best you can.

Physical activity

Engaging in physical activity or exercise can lower blood glucose levels, particularly if you aren’t properly fuelling your body before and after exercise or if the activity level is more intense than usual.

Once again, a change in scheduling of exercise, may enhance your risk of hypoglycaemia so try to mitigate the risk as best you can and understand what changes can be made if necessary.

The combined anxiety of a change in routine added to the risk of hypoglycaemia with exercise may well be a perfect storm so try to plan your exercise and stick to the regime as best you can.

Alcohol

Alcohol can interfere with the liver’s ability to release stored glucose, leading to hypoglycaemia. It’s important to consume alcohol in moderation and with food to help prevent low blood glucose.

Again, an honest discussion with your healthcare team can prepare you for this risk and help you to make the necessary adjustments rather than being afraid of a potential glucose low and making incorrect decisions around your medication.

Illness

Factors such as illness, hormonal changes (during menstruation), and stress can affect insulin sensitivity. These changes can result in increased insulin activity, potentially leading to hypoglycaemia. Education and awareness are the key ways to understand how these events will impact you and what you need to do to avoid hypoglycaemia.

Mistakes

You are human. You make mistakes. Sometimes you may confuse your long and short-acting insulins or miscalculate a carbohydrate intake. Such errors often result in glucose lows. Know how to correct your mistakes and have emergency plans in place.

Insulin pump malfunctions

If you use an insulin pump for diabetes management, a malfunction or infusion site issue can lead to improper insulin delivery. This usually results in glucose levels to rise but the corrective action may be a bit too severe and you may end up with a rebound hypoglycaemia. Many of the newer pumps have cut-off alarms and suspend functions that can now predict hypoglycaemia and switch off insulin delivery to prevent the event occurring.

However, a past experience of hypoglycaemia may tempt the user to override the pump actions and this generates artificial machine learning. Disconnecting your pump and allowing it to deliver insulin outside of your body or manually overriding settings aren’t encouraged as this will result in incorrect decision-making in the future. Speak to your pump specialist about individualising these settings and ensuring they work best for you. Too many alarms and alerts can also result in alarm fatigue where users ignore warning signs and don’t act appropriately.

Medications

Certain medications, such as those used to treat other health conditions like beta-blockers or some antibiotics, can mask the symptoms of hypoglycaemia or affect blood glucose regulation, increasing the risk of low blood glucose. If you’re taking other medications, make sure that they aren’t compounding the problem and be aware of additional signs and symptoms to look out for.

Test, test and test again

Regular monitoring of blood glucose levels empowers you to detect and address potential fluctuations promptly. There is unfortunately no easy and cheap way around this. Regular finger-pricking and interpretation of the numbers can give you important information as to how various lifestyle events, medications and situations affect your blood glucose levels. The more often you test, the more you can predict future patterns.

As an example, if you test regularly before going to bed and know that you’re generally safe if your levels are around 7 – 8mmol/L, then you can be assured that your levels will remain at that level overnight and not drop low.

Not testing leads to too many unknowns and consequent anxiety that a potential hypo will occur which, in turn, leads to false decision-making. By keeping a close eye on your glucose levels, you can gain confidence in managing your diabetes and reduce anxiety associated with hypoglycaemia.

Managing anxiety

Once you’re aware of the nuances of diabetes management and have educated yourself on the effects of daily food intake, activity and hormonal changes, then you can start to plan and make the necessary adjustments that are required.

Try to build a strong support network which can provide a valuable source of encouragement and assistance. Identify one (maybe even two) person/s that you trust (and who you have educated on diabetes) who can call you out and alert you to signs of potential danger.

One of the many downsides of hypoglycaemia is that it affects your executive brain function and decision-making abilities. It can also make you irrational, irritable and angry. Very often, people who are experiencing a severe low glucose level will make decisions that they would not normally make simply due to the physiological changes in their body as a result of the low glucose. Have a trusted friend who can very directly comment on your behaviour and enforce correct decision-making.

Try to find your tribe. Connect with other people living with diabetes through support groups or online communities. Sharing experiences and seeking advice from peers who understand your challenges can help alleviate anxiety. Very often these community groups can provide sound advice and understanding when healthcare professionals are unable to. It’s difficult to empathise with the fear associated with a severe hypoglycaemic episode if you have never experienced it yourself.

Mitigate stress

We are all far too stressed. At this time of year, we’re usually mentally exhausted. Having navigated the cold winter months, the onslaught of public holidays in the first half of the year that wreak havoc with business practices and still just too many months left until the end of the year. Medical aid funds are often depleted at this time and people are unwilling to invest time and money into healthcare.

Although the end of the year may rehabilitate your medical aid benefits, it will do no more than that. There will be more breaks in business function, more stress, more curveballs. Try to incorporate stress management techniques into your daily routine, such as regular exercise, meditation, deep breathing exercises, or engaging in hobbies you enjoy.

Reducing overall stress levels can positively impact both your mental well-being and your blood glucose control and will go a long way to improved diabetes management in the long run.

If hypoglycaemic anxiety significantly impacts your quality of life and ability to manage diabetes, don’t hesitate to seek professional help. Mental health professionals with expertise in diabetes care can provide guidance and support to address anxiety-related challenges effectively.

Questions to ask yourself are:

  1. How confident are you that you can stay safe from hypoglycaemia when:
  • Exercising
  • Sleeping
  • Driving
  • Social situations
  • Alone

If you feel that you lack confidence in any of these situations, then seek professional assistance from your diabetes team before you encounter the problem. Ensure that you know how to avoid and respond to hypoglycaemia and this will greatly diminish your anxiety. Involve your family and friends and ensure that those close to you are also well-equipped to support you.

Conclusion

Hypoglycaemic anxiety is a common concern among people living with diabetes. However, by understanding the condition, implementing effective strategies, and seeking support when needed, you can regain control over your diabetes management and reduce anxiety surrounding hypoglycaemia. Remember, managing diabetes is a journey, and with time, patience, and support, you can overcome hypoglycaemic anxiety and live a fulfilling life while effectively managing your condition.

Dr Paula Diab

MEET THE EXPERT


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


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The use of nutritional supplements in diabetes

Dietitian, Esteé van Lingen, educates us on nutritional supplements, what ingredients to look for and highlights the benefits of using Lifegain® Advanced Nutritional Supplement.


Before we can get into why nutritional supplements could be beneficial for people living with diabetes or not, we need to first understand the difference between meal replacements and nutritional supplements.

We also need to understand the ingredients nutritional supplements may contain and why each one is important. This will assist you in making an informed choice before buying a nutritional supplement.

Nutritional supplement vs meal replacement

A nutritional supplement is an extra supplement that you can take on top of your meals to add extra nutrients your body may be lacking. This can be taken with meals or in between meals to add extra nutrition where needed. Lifegain® is an example of a nutritional supplement.

Meal replacements, on the other hand, are as the words say, a replacement option instead of having a meal. You will have this instead of a meal. An example of this is a Meal Replace Shake like Replace® Diabetic.

Ingredients in nutritional supplements

When looking at the different ingredients that nutritional supplements contain, we start with protein then carbohydrates and lastly fats.

Protein

Protein is one of the most important macronutrients needed for the body to function. The word protein comes from a Greek word meaning primary or holding the first place and that’s why they say protein is seen as the building blocks of the body. Because it is an essential nutrient, you need to consume it daily whether it’s from an animal or plant source.

Protein helps stabilise blood glucose levels when eaten together with a carbohydrate so that the impact isn’t as high on blood glucose compared to eating carbohydrates alone.

As you get older, you quickly start to lose muscle and since most people cut their protein intake (due to various reasons), there is nothing to help sustain muscle mass. To then try and rebuild muscle when you are older is much harder compared to when you were young.

The average person needs at least 0,8g protein per kg of bodyweight per day to sustain basic functions. For example, a person who weighs 50kg will need at least 40g of protein per day.

If you are training a lot or want to build muscle, you would need at least 1,2 – 2g of protein per kg of bodyweight per day. For example, a person who weighs 50kg will need 60 – 100g of protein per day.

It’s interesting to know that many people don’t even reach 1g of protein per kg of their bodyweight per day through meals alone.

Note: This doesn’t mean 120g meat is equal to 120g protein. For example, 1 chicken breast of 120g contains 28g of protein. 

Carbohydrates

Out of the three macronutrient types, carbohydrates have the most marked effect on postprandial blood glucose response (blood glucose level after a meal).

Carbohydrates provide the body with energy and can be found in various foods, including bread, pasta, cereals, rice, potatoes, sweet potato, butternut, fruits and dairy products.

You should also then distinguish between healthy (unrefined) and unhealthy (refined) carbohydrates. Unrefined carbohydrates are minimally processed and eaten as close to their natural state with the grain and germ still intact.

Refined carbohydrates are processed to get a softer, more available carbohydrate. The end results: quicker absorption and release into the bloodstream, causing a spike in blood glucose levels.

One starch portion is equal to 15 grams of carbohydrates. So, depending on how well-controlled your glucose levels are, your gender and other chronic conditions, you don’t want to consume more than two starches in one meal.

The lower the carbohydrate content of a certain meal is and the less processed it is, the lower impact it will have on blood glucose levels. Therefore, it’s encouraged to rather eat a lower amount of carbohydrates in a meal and when consumed, choose the unrefined options instead.

You should also rather spread it out evenly throughout the day instead of eating no carbohydrates the whole day and then eating three servings at night.

Fats

Fat is the final macronutrient. It is also a source of energy but more importantly it assists in keeping the cell walls healthy as well as assists the body in making healthy hormones.

When consuming fats, you want to consume more healthy fats (omega-3) versus unhealthy fats (saturated fats, trans fats, and cholesterol).

Omega-3 helps reduce and prevent inflammation in the body as well as keep the cell walls healthy for the body to properly absorb nutrients and medication into the cells making blood glucose control more effective.

Lifegain® Advanced Nutritional Supplement

When looking at Lifegain®, it contains 4g of carbohydrates per serving and 15,3g of protein which makes it low in carbohydrates and higher in protein.

Furthermore, Lifegain® has a protein blend that contains three sources of protein (soy protein, whey protein isolate and milk protein isolate) that helps with muscle recovery. This is very helpful in the case of an active person living with diabetes or in the elderly to assist in maintaining muscle mass.

This makes it a good substitute for a person with diabetes that needs to consume a small amount of carbohydrates and still keep blood glucose levels stable without it dropping too low or going too high. Provided it fits within your nutrient requirements and/or consulting with your healthcare provider or dietitian first before starting on anything.

Glutamine

Lifegain® also contains glutamine that assists with immune function and gut health which is important. Uncontrolled blood glucose levels reduce immune function and makes a person with diabetes more susceptible to infections. If your gut health is not great, you can’t absorb the nutrients that you do consume properly.

Glutamine improves gut health to assist with digestion and absorption of nutrients. With the improvement in absorption, it may then in the long run assist with weight loss when combined with a balanced lifestyle and consumption of the correct amounts of healthy foods.

Vitamins and minerals

Vitamins and minerals are essential to assist with muscle functions as well as boost your immune system and provide you with energy. The combination of the vitamins and minerals found in Lifegain® includes calcium, magnesium, vitamin D3, zinc, iron and vitamin C. Again, these help protect your muscles, bones and boost immunity.

Free from intolerant ingredients

Lifegain® is free of gluten, lactose, cholesterol, trans fat and preservatives which makes it ideal for someone suffering from gluten or lactose intolerance or anyone with sensitivities to preservatives. This also means that there is no added sugar and no refined carbohydrates.

How to make a nutritional supplement part of a healthy balanced diet

If you are a very busy individual (especially someone living with diabetes) that tends to miss meals as you don’t have time to eat a proper cooked meal, have certain food preferences, or you don’t have a big appetite to eat a large meal, a nutritional supplement will then be an ideal option for you.

Lifegain® only has 507kJ per serving so it will work well as a snack in between meals or used as a base of a light meal. If you want to increase the nutrients, you can do so by mixing it with low-fat milk instead of water or eating a fruit and/or raw vegetables on the side. Or you can make a smoothie out of it with unsweetened plain yoghurt or low-fat milk, one fruit serving, raw vegetables and a fat, such as almonds and chia seeds.

Since Lifegain® has 15g of protein per serving, it has about the protein content of half a chicken breast making it an ideal nutritional supplement even for someone that has kidney issues. This only counts as long as it is made with water and the protein intake for the rest of the day is restricted. Any additions or changes should of course only be made under the guidance of your healthcare professional.

A nutritional supplement is recommended for the elderly who might have a poor nutritional status due to not cooking nutritious meals as often and especially for the elderly who also have diabetes. For example, instead of eating two slices of bread, they can have one serving of Lifegain® once or twice per day and then add fresh vegetables and protein as needed. Thus, making it more balanced and sustainable in the long term.

Kidney problems and protein

A low protein diet is recommended for people with kidney problems and renal disease. The protein requirements for people with renal disease is 0,6 – 0,8g per kilogram of bodyweight but this depends on the stage of kidney disease.

Protein increases the pressure in the kidney tubes by attracting more water as it passes through them, thus leading to increased strain on the kidneys and increased loss of renal function. People on dialysis have higher protein requirements due to the protein loss during the dialysis process.

The function of the kidneys includes: removing waste products from the blood, maintaining fluid balance in the body as well as controlling blood pressure. When the kidneys are failing, damaged or only one of them is functioning, they can’t perform these essential tasks.

Seek professional guidance

Before taking any nutritional supplement or meal replacement, please consult your dietitian first to see if it would be suitable for you and how it can be worked in as part of a healthy balanced diet and lifestyle.

For people with kidney problems (a complication of diabetes), protein does need to be restricted depending on kidney function and you should contact your dietitian to calculate your specific needs and work it into a balanced and sustainable diet.

 

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

MEET THE EXPERT


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


Header image by Adobe Stock
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DSA News Winter 2023

– DSA Western Cape News –

BOOK YOUR SPOT TODAY!! Email [email protected]

 A BIG THANK YOU TO AQUELLE


“Have a Heart for Diabetes” is a Diabetes Awareness Campaign which Aquelle and Diabetes South Africa promoted during October 2022 to March 2023.
Aquelle Company supported Diabetes South Africa during the 2nd half of 2022 and 1st quarter of 2023 and sponsored 2000 free Diabetes South Africa memberships.  They also donated 2000 Aquelle drawstring bags and thousands of bottles of Aquelle Water to encourage people with diabetes to drink more water. Margot Mc Cumisky, National Manager of Diabetes South Africa says: “Aquelle Company and staff have given Diabetes South Africa amazing support and encouragement by donating funds and driving the “Have a Heart for Diabetes” campaign to create more awareness around diabetes.  They have done what no other company has done during our 54 years since we started Diabetes S.A. in 1969. We only wish that we could receive similar support from other companies and Foundations.  People with diabetes need the education, motivation and support that our organisation provides, but for us to continue providing our services we need the kind of help that Aquelle has offered Diabetes S.A.”

Diabetes Wellness Day


DSA Western Cape handed out 75 aQuellé sponsored DSA membership packages to patients who attended a Diabetes Wellness Day at the Retreat Community Centre in November 2022.

The patients were delighted with the DSA membership benefits which would not have been possible without the generous sponsorships from aQuellé, Pharmaco, Spec Savers and Cape Mohair.

Diabetes picnic


A Diabetes picnic was held in the park held in November 2022 at Green Point Urban Park. There were several speakers including Nicholas from City Bowl Gym, Heinrich and Lynette Grobelaar, two paramedics from Wellness Excellence, and Daniel Sher, a psychologist. It was a beautiful sunny day with lots of shade to picnic under the trees and listen to these amazing people talk about diabetes.

– DSA Port Elizabeth News –

R10 000 donated to DSA Port Elizabeth


Lynne Vorster, one of our branch management board members, invited us (representatives of DSA Port Elizabeth) to attend the EC Teen Gala Event that was held in the Feather Market Centre. They presented us with a small gift box and what a lovely surprise it was when saw R10 000 donation.

Malabar Diabetes Wellness Meeting


At the April Malabar Diabetes Wellness Meeting, Dr Harshil Ranchod, a dentist, explained all about How to maintain sound oral health in the diabetic patient.

Dr Ranchod’s grandmother, Mrs Shanti Ranchod, and parents came to support him and were honoured guests at the meeting. His grandmother who, at almost 90 years old, is the oldest lady in the Indian community. See the photo of Surendra Daya and these four special people.

Sweet beats of music


Angelo Du Plessis, a registered counsellor, had all the people at the Springdale March Diabetes Wellness Meeting enjoying and learning about the benefits of exercise and music.

Worker’s Day treat


On Workers Day, we, the volunteers on the Port Elizabeth Management Board, treated themselves and their partners to a most delicious brunch at Heaven’s Kitchen. After brunch, we gathered round a large table to have our first live management board meeting since the start of COVID. It was a great time of socialising and really getting to know each other and our families.

Humansdorp Hospital DSA membership handout


Representatives of DSA Port Elizabeth travelled to Humansdorp Hospital in the Eastern Cape to handout DSA membership packs, sponsored by aQuellé and DSA.

The Community Liaison Officer for Nutrition, Elizabeth and Martin Prinsloo, and Nomsa Satula (Nutrition Manager/Dietitian).
The Community Liaison Officer for Nutrition, Elizabeth and Martin Prinsloo, and Nomsa Satula (Nutrition Manager/Dietitian), Kouga Sub-District showing the packed aQuellé goody bags and the bottles of aQuellé water that were all crowded with us in Nomsa’s small office.
news
Elizabeth, Nomsa and Martin outside the hospital.
Some happy recipients from the Weston suburb of Humansdorp.
Some happy recipients from the Weston suburb of Humansdorp with their aQuellé goody bags.

Collection of aQuellé goody bags


Two members collected their aQuellé goody bags at the April Port Elizabeth Diabetes Wellness Meeting.

– DSA Pretoria News –

March Diabetes Wellness Support Group Meeting


What a powerful, informative and interactive Wellness Support Group gathering on 25 March 2023. A note of appreciation to members who showed up and to our guest speaker, Christine Steyn who shared her knowledge and demonstrated the use of various Fora glucometers as well as high blood pressure machines.

We were all empowered with the information on how to link them to cell phones and the benefits thereof. Attendees had their blood glucose levels tested and blood pressure measured. Christine is willing to help each person who needs individual help on these tech savvy meters.

April Diabetes Wellness Support Group Meeting


A special note of appreciation to all people who showed up at the Diabetes Wellness Support Group Meeting on 22 April. We were all empowered by Bernadine Blom, a dietitian. Her interactive and informative session highlighted how to manage diabetes through a healthy diet. We learnt how food choices and quantities can affect our health condition. An additional nugget was to learn of the benefits of taking the vitamin B12 and vitamin D supplements for those who use Glucophage or metformin.

If you’re interested in diabetes or living with diabetes, make an effort to attend the once a month support group meeting, there is always something new to learn. Knowledge is power.

May Diabetes Wellness Support Group Meeting


The DSA Pretoria Wellness Support Group would like to thank all members who braved the icy cold weather on 20 May to listen, engage and tap on vast, practical knowledge on diabetes by diabetes nurse educator, Sr Louise Pywell.

We all benefitted from the extensive expertise and knowledge about the care of people living with diabetes and learnt about diabetes and how to live a healthy life with this health challenge.

The information covered a broad spectrum of issues on appropriate diet, monitoring of blood glucose, administration of insulin, hypoglycaemia and hyperglycaemia. We were also informed of newest techniques and interventions available.

For further information, you may contact Sr Louise: +27 82 451 0706

Please diarise the next Wellness Meeting on 24 June 2023. Each one bring one!

A call for volunteers


Diabetes SA is primarily a volunteer organisation and relies heavily on people living with diabetes and their families who pool their talents, share their knowledge and experiences and give of their time to help each other.

You too could be a great organiser and get everyone off on a big walk or you may, equally valuable, be a friendly face that is willing to initiate a support group, or you may equally have a valuable skill.

❤️ DSA Pretoria branch is looking for volunteers to assist with the spreading of awareness of diabetes in communities. Start-up wellness support groups, guidance and booklets will be provided.

❤️ Someone with a little time on their hands to assist with admin. You will need a laptop and internet.

❤️ We would love to be assisted with social media awareness.

❤️ People who are keen to start support groups in their areas. Guidelines and start-up materials are available

❤️ We are looking for young and old vibrant people who have a passion for sharing information and creating awareness.

❤️ People who could be coached for two years to take up various roles in the near future.

The majority of us are volunteers and not paid workers. Most of us are retirees who do not have offices and work from home.

Anyone is welcome to join the group; one can become a friend of the group and indicate what services one is willing or capable of assisting with.

For further information and to see where you may be able to assist people living with diabetes, please kindly contact Liz by email at: [email protected]

Farewell Noy, farewell A4C

Sadly Noy Pullen passed away in February 2023, we look at all she achieved with the DSA project: Agents For Change.


When did Agents for Change start?

Agents for Change (A4C) began in 2007. The World Diabetes Foundation (WDF) began financially supporting Agents for Change in 2008.

In June 2015, Martin Wolf Andersen and Susanne Olejas from WDF Denmark, attended Agents for Change seminars in Western Cape and North West Province during a field visit.

Aim and the mission of A4C

Diabetes is a huge problem in South Africa (SA) and worldwide. There are over four million people diagnosed with diabetes in SA. The International Diabetes Federation reports that 50% of people with diabetes are undiagnosed worldwide.

Lack of trained healthcare providers in diabetes in SA is the most critical issue impeding the delivery of high-quality diabetes care. The aim of A4C is to train healthcare providers and other healthcare practitioners in diabetes in all provinces, including rural areas.

The programme creates awareness about the importance of lifestyle change when living with diabetes and reducing the risk of getting it.  Participants attend intensive two-day workshops, six months apart, where they learn about diabetes, how to manage it and prevent complications. They are also taught communication skills so that they can empower people living with diabetes for self-management. To do this, they are encouraged to change their own behaviour for better health.

In 2006, Noy Pullen relocated to Cape Town from Johannesburg where she met Buyelwa Majikela-Dlangamandla who was then a diabetes educator at Groote Schuur Hospital. They worked together on this project (A4C) through DSA since 2007 until January 2022.

Noy was also the editor of Diabetes Focus for many years. She had interest in diabetes and helping people as she had a family member with diabetes.

What are the greatest achievements for A4C?

The greatest achievements of A4C were training more than 2 000 healthcare providers. The majority of participants managed to change their own lifestyle, such as eating healthily, losing weight and doing physical activity.

Some of them started vegetable gardens. A4C supported them by providing them with tools, such as seeds, skipping ropes, measuring tapes, information booklets, etc.

During all trainings, A4C did practical food demonstrations, and everybody helped. Many said they thought that healthy eating was boring, but said they enjoyed the food during training and changed the way they prepared food at their homes.

A4C was recognised by the South African Department of Health and the trained healthcare workers reached more than 100 thousand people in the country.

What was Noy Pullen known best for?

Noy loved colour. Although she had a teaching qualification, she stopped teaching many years ago. She was also a make-up artist. Noy was an excellent article writer, interviewing people and writing their stories. She was a spiritual person who loved her family and was good at uniting them. She was a coach and teacher and encouraged people to be themselves and do their best.

How did she impact A4C?

A4C would never be the same without Noy. Her guidance helped and encouraged Buyelwa to use the guiding style of teaching rather than the old way of directive teaching. Noy had great influence and encouraged Buyelwa to write a diabetes book. She was accurate with bookkeeping and writing up of reports including financial reports to the sponsors.

A4C project stopped

Unfortunately, due to the sponsor stopping their financial support of A4C, the last A4C training was in January 2022.

Farewell Noy and farewell A4C; may your soul rest in eternal peace.


References

Agents for change WDF08-378 (project description)

Agents for change WDF11-590 (project description)

Agents for change WDF14-876 (project description)

Agents for Change: champions in the fight against diabetes in South Africa (Diabetes Voice, June 2009 | Volume 54 | Issue 2) http://www.idf.org/sites/default/files/attachments/2009_2_Pullen.pdf

HRH Strategy for the Health Sector: 2012 to 2017 (pdf) (http://www.ahp.org.za/files/1896/HRH%20Strategy%202012%20to%202017.pdf)