Hannie Williams, a dynamic diabetic nurse educator, shares tips on how to live positively with diabetes.

How do you do? What a pleasure to have an opportunity to ‘meet’ on the pages of Diabetes Focus.

This article is all about you – the person living with diabetes, or the spouse/significant other of a diabetic person. We, as healthcare professionals, learn so much from you, our patients. So, thank you for sharing your experiences gained from living with diabetes with us.

Let’s look at the individual words used in the topic of this article: living; positively; diabetes. I want to tackle the last word first.

Diabetes

This requires lifelong management, including the use of various medications (tablets, insulin injections, etc.), diet, exercise, testing your blood glucose, annual checks of your eyes and feet. And, the list goes on.

Add some other chronic diseases, such as high blood pressure and raised cholesterol (more tablets!), the fear of complications of diabetes and, of course, the cost of medical treatment. Wow! It is overwhelming! I am exhausted from listing all of this and you must deal with this daily.

I often notice how stressed patients are when attending their visit as they so want to please the doctor with good results and reduction of weight. If they don’t achieve this, they feel guilty for not doing what was expected, for example, more frequent blood glucose testing, adjustment of insulin dosages, etc. When asked how they are, some will respond, “I will be able to answer you once I have seen doctor.”

Stop. Take a deep breath. We must acknowledge that you are dealing with health issues and the treatment thereof, but let’s look at the other words.

Living

This does not mean to just exist. To exist is just doing what one must do while being alive i.e. paying tax, paying more for food, petrol and electricity.

Living is to be alive. It’s an active process asking us to be involved in life around us. You are a unique human being, with your own special talents. Acknowledge this and use it to make your world a better place.

Get involved – visit a care centre in your town and volunteer your help. You may be an excellent gardener and can help them creating their garden. You may like to read to those with bad eyesight, or just visiting the people in the centre.

Make sure to pass your life experiences, lessons learned and family traditions to the next generation. Write a letter(s) to your children and grandchildren and share your valuable unique life experiences. One of my most treasured items is a handwritten letter from my mother to me.

Sing Happy Birthday to family and friends. I can promise you that this will be a gift more special than anything you can buy. I always do this (to the annoyance of my husband and sons). But last year I was surprised when I was away from home on my birthday and I got a phone call from my oldest son, and guess what, he sang Happy Birthday to me. I felt such an accomplishment that my tradition is rubbing off on the next generation.

Do not let a day pass without doing or noticing something special in your surroundings.

Positively

“I can BE optimistic by showing a positive attitude.”

Abraham Lincoln said, “Most people are as happy as they decide to be.” How true this is?

Is the glass half full or half empty to you? The choice is yours.

Nobody wants to be around someone who is constantly criticising everything and moaning about what is wrong. We avoid people like this. Let us not be the person that others want to avoid.

Changing is difficult. But just start by being the person that will try to make an effort to change a negative conversation to something positive. It’s not that we do not acknowledge that things do go terrible wrong; that bad things happen to good people and that times are tough. Rather try to make everyone in the conversation realise what a privilege it is to be together as family or as friends, sharing a cup of coffee or glass of wine.

Take time to notice the everyday miracles happening around us. How day becomes night. Change of seasons – green leaves quietly changing to beautiful autumn colours. The same tree that provides us with shade against summer heat, shed its leaves in autumn to let warm sunshine through in the cold of winter.

So, if life handed you a lemon tree, what will you do with it? How about making the most wonderful lemonade or pickles from the fruit of the lemon tree? Forget the thorns and smell the heavenly scent of the lemon blossoms.

Do what you can with what life hands you. You will be amazed how much this is once you start embracing your own unique self.

Your legacy in life should not be the ‘Oompie or Auntie’ who had diabetes. You have much more to offer this world.

Active in decision making

I want to encourage you to be actively involved in the decision making about your treatment. Ask as many questions as needed for you to understand why you should take that medication.Don’t just exist. Live your life to fullest with your available resources.Attitude is everything!

MEET OUR EXPERT

Hannie Williams (B Nursing (Stell) 1987) has been working as diabetic nurse educator since 2004, alongside the specialist physician, Dr G Podgorski and his wife, Alice, in Port Elizabeth. She is married to Kobus.

Fats are an essential part of the human diet, helping synthesise hormones, promoting overall brain- and mental health, and keeps us full. But what are the healthiest cooking oils to cook with?

In addition to thinking about the overall nutrient profile of cooking oils and how they are processed, you must consider another factor: the smoke point (which is the temperature at which an oil begins to smoke).

Every type of cooking oil has a different smoke point, and heating an oil beyond its smoke point causes it to oxidise, resulting in the release of harmful free radicals and other compounds.

1. Avocado oil

Surprisingly, avocado oil has a high smoke point, making it a smart cooking choice if you’re scaling back on saturated fats. Avocado is comprised mostly of the monounsaturated fatty acid, called oleic acid, which has potent anti-inflammatory properties and promotes heart health. It also contains lutein, a carotenoid, that can improve eye health. By virtue of it’s high smoking point, it’s suitable for all cooking. But because it’s pricey, it would not be wise to use it for deep- frying and may lose flavour due to prolonged exposure to heat.

2. Ghee (clarified butter)

Many people love cooking with butter for obvious reasons: flavour! But it has a relatively low smoke point at 300°F. When you remove its milk solids to create ghee, however, that smoke point jumps to a safe level for most cooking applications while retaining its amazing flavour. Bonus: It’s lactose-free; contains vitamins A, E, and K2; and is rich in conjugated linoleic acid (CLA) and butyrate, which may help lower body fat and decrease inflammation.

3. Algae oil

Algae oil is high in monounsaturated fats and low in saturated fats. It’s a great option to add to the rotation if you’re looking for a neutral-tasting high-heat oil, as it’s incredibly versatile and a great option for cooking, baking, and salad dressings. The one downside; it tends to be a bit expensive.

4. Olive oil

Olive oil is high in the monounsaturated fat oleic acid, which is anti-inflammatory and promotes heart health. Extra virgin olive oil (EVOO), specifically, is packed with polyphenol antioxidants as well, which are thought to contribute a range of benefits.

However, EVOO is only suitable as a finishing oil and for low- to medium-heat cooking (sautéing vegetables), as it has a smoke point of 325 to 375°F.

Refined olive oil, on the other hand, has a smoke point of 425°F but does not contain nearly as many beneficial polyphenol compounds.

5. Unrefined coconut oil

Coconut oil is mostly saturated fat, which makes it more stable, and it also contains medium-chain triglycerides, a fat source that converts to energy more quickly.

As an added benefit, coconut oil contains an antimicrobial compound, called lauric acid, which has also been shown to have beneficial effects on cholesterol. Refined coconut oil has an even higher smoke point, but it’s thought to lose many of its beneficial health effects.

Oils are a vital component of every meal, more so people with chronic disease, such as diabetes and heart disease.

MEET OUR EXPERT

Matsepo Manyokole is a registered nurse with more than 20 years of international nursing experience. She has worked in a variety of settings, including maternity, infectious diseases, public health and medical units with special emphasis on chronic diseases, such as diabetes and heart disease.

Header image credit by Freepik 

Daniel Sher educates us on how to deal with the psychological burden of financial stress when living with diabetes.

Case study of patient with financial stress

Doug (not his real name) is a 33-year-old Capetonian who visited me looking for a bit of extra support in meeting his diabetes-related goals.

What was Doug struggling with exactly? Well, it wasn’t entirely clear. It never is. When it comes to thriving with diabetes, there are always complex interacting factors that need to be considered. In Doug’s case, however, financial stress was one of the biggest factors leading him to neglect his health.

Doug most certainly isn’t alone in this regard. As a person living with diabetes, how frequently have financial concerns negatively affected your ability to cope? Research has backed up what so many of us know all too well: diabetes is expensive! This, in turn, can create a whole lot of stress and anxiety that makes it even harder for us to thrive.

A tale of two cities

In South Africa, historically-based economic inequality means that a large proportion of people rely on public health to manage their diabetes. Research has consistently shown that public clinics and hospitals are overburdened – and people with diabetes struggle as a result.

However, even for those who are lucky enough to have access to private medical aid, there are hidden costs that hold many back.

The hidden costs of diabetes

1. Your endocrinologist is really good at what she/he does. She/he is now charging above medical aid rates, meaning that you must front a co-payment.
2. Lantus insulin isn’t covered by medical aid, even though your doctor has motivated for it.
3. Having diabetes means that you’re more susceptible to colds and bugs. You find that you’re spending a fortune on vitamins, cold remedies and doctor visits.
4. You have maxed-out your sick leave at work and need to take unpaid leave.
5. When your blood glucose levels are out, you struggle with fatigue and low motivation. This means that at work, you’re not meeting your targets.
6. It’s not cheap to eat healthily.
7. You would love to be able to test more frequently, but extra strips are very pricey. What about that shiny new Dexcom? That would cost the equivalent of three months of rent.
8. You have developed an additional chronic condition, such as hypertension, kidney disease, psoriasis or coeliac disease. People with diabetes are at a higher risk of developing these sorts of conditions. This means more specialist visits and expensive medications.
9. You’re depressed or anxious. As people with diabetes, you’re two to three times more likely to have a psychological disorder. This means extra fees for therapy or psychiatry visits, as well as reduced productivity at work.

What can you do about financial stress?

So, what can you do to cope with these sorts of feelings and barriers to healthcare?

• Get healthy

If you want to manage the costs and financial stress of diabetes, your best bet is to become as healthy as possible.

You’ve heard all of this before. It’s important to think about diet, exercise, testing, medication adherence, mental health, self-care and so on. This is more than just behavioural change. This is a shift in mindset that is going to save you money and allow you to be the happiest and healthiest version of yourself.

Let’s address the elephant in the room: it’s not easy to simply ‘get healthy’. This is a process; and a challenging one at that. It can also be expensive to maintain healthy habits.

But it’s important to see this as investing in yourself. By adopting a healthy lifestyle now, you’re going to avoid developing complications that could cost you more in the future. You’re also going to increase your emotional and financial well-being in the present moment.

• Shift your mindset

When Doug came to see me, he benefited from analysing and altering some of his thinking patterns. As mentioned, one of Doug’s biggest challenges was that he was not all that well-off, financially speaking. Of course, compared to many in our country, Doug was in a very privileged position. Nonetheless, he often made unhealthy choices based on his financial worries. These included:

• Buying cheaper meals rather than opting for low-carb options.
• Seeing his doctor once per year, rather than every six months.
• Choosing not to test in the morning because he wanted to deny the fact that his glucose level was high, so that he could avoid having to up his Lantus dose.

In therapy, we worked on a skill, called cognitive restructuring. This forms a part of cognitive behavioural therapy (CBT), which is a powerful psychological approach that has been shown to help people with diabetes cope better.

In Doug’s case, cognitive restructuring helped him to catch subtle thoughts that lurked just below the level of conscious awareness. These thoughts reminded him of his financial stressors, triggering anxiety and leading him to make unhealthy choices.

Once Doug could identify these problematic thoughts, he was able to replace them with healthier thinking patterns. Often, this involved him reminding himself that it was worth spending that extra bit on his diabetes care so that he could reduce costs in the long run.

If you want to learn more about the basics of CBT and changing unhelpful thinking patterns, you can visit this page.

• Talk to your doctor or therapist

If you’re struggling financially, this is nothing to be ashamed of. It is vital to speak to your treating team so that they can help you find creative solutions. At times, doctors and therapists may be willing to negotiate a reduced rate. Alternatively, they may be able to provide pointers for reducing expenses by, for example, taking full advantage of chronic cover possibilities.

What about counselling and psychotherapy?

Once I had met with Doug, it became clear that he was suffering from clinical depression. Just like many other people with diabetes. Together, we filled out an application form and his medical aid agreed to help cover treatment of depression as a chronic (Prescribed Minimum Benefit) condition.

If you know that you can improve your diabetes control by seeing a therapist, don’t let the costs involved hold you back. Chat to a therapist about applying for chronic cover. This applies to anyone who is on a medical aid, including hospital plans.

Invest in yourself

Diabetes is a complicated and challenging condition to manage. A big part of this challenge involves the hidden costs that we have discussed. Just another one of the many factors that we need to consider and address as a part of our everyday management plans.

Remember, though, that by addressing these concerns, we can learn to take our coping skills to the next level. At times, this may simply be a matter of shifting your mindset, adopting healthier lifestyle habits, or speaking to your treating professional to find creative solutions.

Reference:

• Endocrine Society. (2014, June 23). High blood sugar causes brain changes that raise depression risk. ScienceDaily. Retrieved June 19, 2019 from sciencedaily.com/releases/2014/06/140623092011.htm
• Ismail, K., Winkley, K., & Rabe-Hesketh, S. (2004). Systematic review and meta-analysis of randomised controlled trials of psychological interventions to improve glycaemic control in patients with type 2 diabetes. The Lancet, 363(9421), 1589-1597.
• Pinchevsky, Y., Raal, F., Butkow, N., Chirwa, T., Distiller, L., & Rothberg, A. (2018). Quality of care delivered to type 2 diabetes mellitus patients in public and private sector facilities in Johannesburg, South Africa. International journal of general medicine, 11, 383.

Additional Reading:

• Cognitive Behavioral Therapy: https://www.diabetesselfmanagement.com/diabetes-resources/definitions/cognitive-behavioral-therapy-cbt/
• Comorbid chronic conditions: https://www.verywellhealth.com/comorbidity-disease-diabetes-1087365

* Not his real name

MEET OUR 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 patients to help them thrive. Visit danielshertherapy.com

Header image credit by Freepik 

Did you know only 3% of South Africans will be able to retire comfortably? Ronel Jooste advocates why it is important to start saving from as early as possible.

Only 3% of South Africans retire comfortably

According to the National Treasury, less than 3% of South Africans can retire comfortably, without having to make drastic changes to their lifestyles.

These statistics are worrying. Do you want to work hard all your life, only to struggle financially when you are retired? Or rather work hard and putt away sufficient funds towards your retirement to ensure you can reap the full benefit of your rest period in future.

High cost of living in SA

Living costs in South Africa are high and constantly on the rise. A struggling economy results in several employers no longer being able to reward employees with decent salary increases.

Consequently, many households experience financial strain as their income can no longer keep up with the increase in living costs. If you add to an already trembling budget, a medical condition that requires constant healthcare and medical expenses, budgets are put under further strain.

When expecting this strained budget to also make provision for retirement planning, it becomes crystal clear why retirement planning quite often ends up last on the priority list.

Types of retirement products

Retirement products are designed to help individuals save money towards retirement, usually with tax benefits. The purpose is to provide individuals or their dependents, with an income upon retirement. This income can be paid out in the form of a lump sum and/or a monthly pension until death.

Most employers structure retirement benefits as part of their employees’ remuneration packages. Examples of retirement benefits offered by employers are as follows:

• Pension fund – on retirement, a lump sum, in cash, equal to one third of the total retirement value, plus an annuity/monthly pension over the rest of the lifetime of the employee are paid out.
• Provident fund – the full benefit is paid out as a lump sum upon retirement.
• Preservation fund – when you change jobs, or become self-employed, and don’t cash in your pension, a preservation fund enables you to preserve your pension or provident fund savings in this fund until you retire. A once-off contribution is thus made into a preservation fund once you resign or are retrenched.

Retirement annuities are available for individuals who are self-employed, or who work for a company that doesn’t offer pension benefits, or for employees who want to save for their retirement in addition to their existing pension or provident fund contributions through their employer.

Making your budget work for you

Living with diabetes does have a serious impact on any budget due to expensive medical costs. Therefore, it is important to have a good medical aid or health insurance plan in place to cover most the costs.

Also look out for potential savings:

• Live a healthy and active lifestyle.
• Discuss options for generic medication or alternative healthcare options with your medical practitioner.
• Consider buying medicine online which is often cheaper, and buy medicine from pharmacies who offer discounts and loyalty reward programmes.

Potential cost savings can be allocated to a retirement savings plan. Although diabetes is a serious illness that can have a negative impact on a person’s life expectancy, more and more studies are proving that when diabetes is properly managed through healthy lifestyle programmes there is a minimal impact on the life expectancy of a person living with diabetes compared to a person living without diabetes. This re-emphasises why retirement planning should not be neglected.

Why start saving as early as possible?

Consider a simple example to bring this into perspective. Previous generations generally started working after school at the age of 18. If they had to retire at age 65, they would have had 47 years to save for retirement.

In those days people died on average at a much younger age. If they lived on average to age 75, they had 10 years to live off their retirement savings. Thus, they had 47 years to save and their savings had to last 10 years.

These days many people go to university or college and only start working on average at age 23, which means they have already lost five years of their potential retirement savings period. Current generations tend to live much longer, and it is not uncommon for people to reach 95 years of age. The result is that we have about 42 years to save for retirement, and our retirement savings must last for 30 years should we reach age 95.

This simple example illustrates why it’s important to start saving as early as possible for retirement. If you haven’t started yet or you are not saving enough, don’t wait any longer. Start working towards creating a solid retirement plan today.

Tips to consider for your retirement planning:

• Calculate how much you will need for retirement and review it annually. As your salary package grows and your standard of living improves, your expectation regarding retirement savings will increase as well.
• Be realistic and make sure you save enough. If your monthly living costs are R40 000, for example, and you consider your second property providing you with R10 000 rental income monthly as your retirement plan. You must realise that R10 000 will not be enough to cover your living costs. Additional retirement savings will have to be added to your retirement plan.
• Don’t be tempted to use your retirement savings to start a business or buy a bigger home. Once you have used your savings, it will be extremely difficult to catch up or recover.
• You can get tax deductions for your monthly contributions towards your retirement savings. Make use of these tax savings to build a tax effective asset portfolio.
• Younger people can be much more aggressive with the underlying asset allocation of retirement funds. As you get older, it is advisable to be more conservative. You don’t want to invest in high-risk assets a few years before retirement with a risk of losing the money that you worked hard for over many years.
• Don’t be tempted to buy expensive cars or a holiday home on receiving a lump sum retirement pay-out. Invest your lump sum wisely as you need the money to maintain your required living standard throughout retirement.

This article includes extracts from Financially Fit and Wealthy. The book (hard copy or e-book) can be ordered on roneljooste.com

MEET OUR EXPERT

Ronel Jooste is a director at FinanciallyFiT Group (Pty) Ltd, a company specialising in financial consulting and training for businesses and individuals. She develops online financial courses and employee financial wellness programmes. Ronel is a chartered accountant, speaker and the author of the award-wining book Financially Fit and Wealthy, a guide to achieve financial success.

Header image credit by Freepik 

Did you know that you could qualify for life insurance even if you have diabetes? Janette Rooney tells us more.

If you have a financial advisor, he/she needs to be fully informed about your health and financial status to apply for life insurance for you. Your financial advisor will then conduct a financial needs analysis to ascertain what type of cover you require and how much cover you require under each element.

If you do not have a financial advisor, you, as the client, would deal directly with the insurance company regarding the new business requirements and adverse offers. You don’t have to have a financial advisor, but it’s always better to utilise one as you would be given best advise by an expert who conducts a financial needs analysis. Plus, a financial advisor often negotiates with the insurance companies regarding adverse decisions, as they have the knowledge of the product and the client.

Types of cover

Here are a few examples of the types of cover available:

Life Insurance

Lump sum amount payable in the event of a person’s death. Usually this cover is taken out to cover any financial impact of the person dying:

• Debt
• Estate Duty
• Executors Fees
• Replace lost income of the person dying for a specific period of time.

Disability

Lump sum amount payable in the event of a client being disabled.

1. Debt
2. Revamping of clients lifestyle post disability

• Apparatus, such as wheelchairs.
• Modifying vehicle changing to an automatic vehicle.
• Modifying changes to house, for example, changing a bathroom.

Income Protection

Monthly income replacement in the event of a disability.

Severe Illness

Lump sum amount payable in the event of a server illness, such as cancer.

Life insurance

When it comes to initially applying for life insurance, various initial factors are taken into consideration when generating a life quote, such as age, sex, income, education and smoker status. The initial quote is usually generated with what is called an A1 rating, which is a “healthy life” rating.

The next step is to complete the application form with your financial advisor, where most life insurance companies require full medical history. This is the most important element and it is vital to disclose all health information.

The application form is submitted through to the life insurance companies underwriting team. The application is assessed based on the various risk factors disclosed. The underwriters will then generate a list of requirements. The type of requirements generated would depend on each client’s individual health status.

For people living with diabetes, again depending on the type, the life insurance companies would usually call for glycated haemoglobin (HbA1C) blood test. Depending on the results of this blood test and any other tests required, if the client has any other high-risk health conditions, the life insurance company would then decide on whether to offer the client cover.

Should cover be offered, the offer could be subject to terms and conditions. For example, the premium being loaded, certain ancillary benefits (Disability, Severe Illness and Income Protection) may not be offered, or offered subject to certain exclusions, such as dread disease.

If the life insurance company is not prepared to offer life insurance, some companies are prepared to offer accidental life insurance cover, where you could be covered as the result of accidental death. There are also some life insurance companies who specialise in higher risk clients and it would be best to contact your financial advisor to get guidance in this regard.

Note to remember

All of the insurance companies that I deal with will offer quotes to clients who have diabetes. These include Momentum Life, Discovery Life, Hollard Life, Old Mutual and Brightrock. However, I have had different diabetic clients accepted and other clients declined by the same insurance company. This is because each client is unique and their factors are different compared to the next one. 

Remember, the life insurance company would look at the overall health of the client; what type of diabetes the client has; how controlled the diabetes is. This is determined, for example, by blood tests conducted prior to the company making a decision. Lastly, does the client have any other conditions besides diabetes and how much risk does the other conditions impose? All those factors determine the decision.

Diagnosed after commencement of life insurance

If the client’s health status changes after taking out life insurance, it is always recommended to advise the life insurance company from a disclosure perspective. However, the underwriting was conducted at application stage in accordance with the client’s health status when the cover was taken out. The premiums and conditions cannot be changed due to additional conditions contracted after cover commencement date. The premiums and conditions of cover can be amended when the client adjusts their cover i.e. increases the cover or adds additional cover.

The life insurance companies usually request a health review and depending on the updated health conditions can then underwrite in terms of increasing the premium or exclusions, etc.

MEET OUR EXPERT

Janette Rooney is an independent financial advisor and owns her own brokerage, Le Forge Financial Consultants. She started her career, in 1993, in the medical aid industry, working for Medscheme and then for Discovery.