Zimbabwean Jane Mapfungautsi (52) lives in Kanye, Botswana. She is a single mother of three, Rungano (31), Rutendo (29) and Ashley (23).
In the family
Diabetes isn’t a shocking word in my family; my daughter, sister and late nieces, cousins, aunts, and my late paternal grandmother all lived with diabetes.
I was diagnosed with Type 1 diabetes when I was 10-years-old, in 1980, in my home town, Gweru, in Zimbabwe. I was doing Grade 4 and my young sister, Blessing, had been diagnosed two years earlier. My mother, who was a nurse, noticed that I was drinking a lot of water and urinating a lot, especially at night. Before even going to the doctor, she said that she knew I had diabetes.
I was immediately admitted at Gweru Provincial Hospital under Dr Taylor, the resident physician. I still remember him well. Just like I remember all the doctors who’ve looked after me and have done such a wonderful job.
Forty-two years of manging my diabetes with insulin hasn’t been easy, but I’m a living testimony that it’s possible to survive. I was first put on a long-acting insulin. While I was been stabilised in hospital, I was taught how to inject myself. I would be given an orange and syringe with water and told to imagine that the orange skin was my skin and to prick at an angle of not more than 45°. It was a fun way of learning.
Once home, my mum would talk to my sister and I about diabetes care: the do’s and don’ts, what to eat and not to eat. Till now I admire the way she would place a flask of warm milk and some bread on top of the bedside cabinet in our bedroom and would wake us up at 2am every day to eat this snack. She had noticed how difficult it was to deal with a hypo attack in the middle of the night.
As I have grown older, I’ve realised that eating a snack just before bedtime helps me get through the night. The body actually uses a lot of energy while sleeping.
Primary and secondary school were not easy. I would envy other children eating all the candy, biscuits, chocolates, and ice cream and so on. My parents would try to get non-sweetened substitutes for us, though of course they were not readily available.
When I started high school, I refused to be in boarding school after just a term. I didn’t like the fuss that was made over my diet and the strict monitoring of all my movements as my teachers were so scared that I would fail to inject or would eat the wrong food.
My parents tried to make sure that I enjoyed my childhood while adhering to the regime set by my doctors. My sister and I often attended Diabetes Association meetings, which gave us a chance to meet other people who had the same condition as us and share experiences. I remember Dr Lutalo, my physician, saying I needed to have a life like other children. I played a bit of netball and basketball, taking note of my blood glucose levels.
One of the biggest challenges I had was during my pregnancies. For all my three children, I had Dr Purazi as my physician and he always referred me to good gynaecologists. All my children were born prematurely. Of course, the doctors always knew the expected complications and always helped me to the best of their ability.
Exercising is quite important for people living with diabetes as it helps insulin to work better as well as keeping us strong and feeling good. I do my own household chores and enjoy attending to my vegetable garden. Listening to some music and dancing along helps me relax. I don’t overexert myself as there is a danger of having a hypoglycaemic attack. Being a teacher, when I’m hungry or tired, I quickly sit down and eat. I’ve to be careful about what I eat, how much I eat and when I eat.
I’m what is called a brittle diabetic. This means I have subtle to severe swings in my blood glucose levels and have had frequent episodes of hypoglycaemia. Brittle diabetes is hard to control. The changes in my blood glucose levels are unpredictable and sharp, like going to sleep with blood glucose level over 20mmol/L and waking up with a reading ranging between 2mmol/L and 4,5mmol/l. Thus, I’ve had my fair share of hospitalisation. My doctors always need to work out a care plan, aimed at stable control of my blood glucose levels. I always have to make sure that I have enough test strips for my glucometer and of course I always have it with me in my handbag or on my bedside table.
Most people with diabetes complain that their glucose levels go high when they’re stressed; with me the opposite applies. Dietary control is essential; I eat a lot of different vegetables, fruits, more white meat than red meat and avoid fatty foods and try to replace excess salt with different spices (not too spicy so as to avoid gastric pain). Of course, eating regularly in recommended portions is needed.
Been on various insulin
I have been on six different types of insulin in a bid to stabilise my blood glucose levels. It has since been realised that since my blood glucose levels can go from one extreme to the other, the best regime is for me to take insulin (Humulin R) or insulin aspart (which are both short-acting) pre-breakfast, pre-lunch and pre-supper, and then take insulin glargine insulin (long-acting) as I go to sleep.
My doctors have a care plan for me which I try to adhere to and I always diarise and discuss with them any problems or adjustments I would have made. I have been taught how to titrate my short-acting insulin dosages. I’m given a certain range within which I adjust the insulin dosages according to my blood glucose levels. Hopefully, one day I’ll be able to afford an insulin pump, or a continuous glucose monitor and avoid the pricks.
I also try to always have my routine blood tests done for Hb1AC, kidney and liver function and have my eyes checked annually.
Finding out about DSA
One Saturday morning, I was watching TV as I always try to watch programmes which address health issues. On Mzansi Insider, Diabetes South Africa (DSA) was addressing diabetes and Covid-19. I listened and learnt from the discussions. I found it interesting, so I visited the website and made contact to get more information.
Diabetes care in Botswana
I moved to Botswana in early 2007 and the diabetes care is quite good. What I appreciate most are the two big diabetes clinics the government has set up since 2012, one in the capital city, Gaborone, and the other in Francistown. I attend the Gaborone clinic.
These are facilities specifically built to attend to diabetes patients only and manned by teams of doctors well-versed in diabetes care and control. The facilities also have rooms where you get to have your eyes checked, get to see a dietitian, foot-care specialist, diabetes educators and so on. They also have well-equipped laboratories and pharmacies. Other government hospitals and private facilities also run diabetes clinics. The Botswana Diabetes Association holds meetings monthly and one can easily follow them on Facebook.
Taking care in winter
In winter, my biggest challenge is peripheral neuropathy, which causes a burning, painful pain in my hands. For this, I constantly take Vitamin B complex and a strong painkiller. I have since learnt the trick of sleeping with my gloves on and socks on my feet, with a hot water bottle. I have to make sure that I keep very warm all the time.
Just before the cold season starts, I have the flu vaccine. I usually tend to get throat infections and always make sure that I seek medical attention speedily, as any infection in my body makes my blood glucose levels to rise.
Winter also means taking multi-vitamins, not forgetting my green or mint tea with lemon. A warm cup of water first thing in the morning helps me detox. Although we don’t have a winter break at school, I make sure I rest indoors a lot and keep very warm. I try to avoid crowded places, worse now with the current Covid-19 pandemic, as having diabetes and having other underlying conditions means I’m at high risk of catching infections.
Candida is a problem I often have to deal with, especially when my glucose levels are high. I always quickly seek medical attention and get an anti-fungal cream or appropriate, recommended treatment. Pap-smear is a recommended must do.
Diabetes care challenges
Diabetes care is expensive. We appreciate governments who subsidise diabetes care. Not been able to go for check-ups when needed or not having enough money to buy all the required medication and glucose monitoring equipment is a challenge in most African countries.
Outreach programmes are really needed to teach the population at large especially in rural areas. People usually end up having amputations or going blind, because either they didn’t know that they have diabetes or due to poor diabetes control, or lack of nearby health facilities.
Educate all the time
Though a teacher by profession, my family and I do charity work. We always try to be a blessing to others, especially those who spend time hospitalised. Together we initiate community ventures both at home, in Zimbabwe, and here in Botswana whenever we can. We appreciate the gift of life.
I’m not shy to teach others about diabetes. Whenever I get a new class at school, I tell my pupils about my condition and teach them how they can help me, e.g. when I’m acting funny. I always talk to students, workmates, and friends about diabetes and the need for constant check-ups especially if there is a history of diabetes in the family.
To other people living with diabetes, I always talk to them about the need to know our bodies and the symptoms of high or low glucose levels. At the Diabetic Clinic, I always make new friends as we discuss our conditions.
Proper management is essential
The hardest lesson I have learnt in the 42 years of having diabetes is that without proper management, one can lose their life to diabetes complications. I have lost relatives and friends to diabetes and it’s very sad and painful. Diabetes is life-threatening but manageable if the necessary resources are there.