Diabetes nurse educator, Christine Manga, explains why screening for diabetes complications should form part of your diabetes healthcare plan.

Screening for diabetes complications

Diabetes is a disease that affects and damages the vascular system, large and small blood vessels. It is damage to the vascular system that leads to diabetic complications.

Large blood vessel damage is associated with increased risk of heart attack and strokes. Small blood vessel damage is associated with increased risk of kidney failure, retinopathy (blindness) and peripheral neuropathy.

Maintaining good blood glucose control can help with delaying and possibly preventing complications. But this alone is not enough. Blood pressure and cholesterol levels also need to be managed.

Screening for diabetes complications should form part of your diabetes healthcare plan. Regular screenings allow for early detection of complications before you are aware of the problem.

Most of the complications are ‘silent’ with symptoms developing after damage has occurred. All people with diabetes should undergo screening for complications.

Screening for retinopathy

Eyes should be screened annually. An ophthalmologist usually does the screening, though some optometrists have the training and equipment required to perform the test.

Drops are placed into the eyes to dilate (widen) the pupils so that the examiner can see the retina of the eye. The drops may cause your vision to blur and driving would not be possible for a few hours after the procedure.

Any abnormal blood vessels, scar tissue, new blood vessels, swelling, bleeding or fatty deposits in the retina will be detected. In addition, any damage to the optic nerve and cataract development would be observed.

A separate test will be done to measure the pressure of the eye. Increased eye pressure, a condition called glaucoma, can also cause blindness.

The results of the screening will show:

1. No signs of the complications.
2. Early signs of complications.
3. Follow-up and treatment decision required. Treatment may not improve sight, but it can prevent further deterioration.
4. More frequent check-ups required.

Early detection and treatment of eye complications is usually successful and can prevent vision loss.

Screening of peripheral neuropathy 

Peripheral neuropathy is pain, weakness or numbness in the feet and, occasionally, hands caused by nerve damage. It can also present as a burning sensation or pins and needles.

Due to damage of the small blood vessels, the nerves can’t receive nourishment. The blood vessel damage will cause ischaemia (poor blood circulation) in the lower legs and feet. This can further cause redness or a blueish tinge, swollen and sore feet. It also increases the risk of developing skin infections and skin ulcers.

Seeing a podiatrist (foot specialist) at least once a year is recommended. A podiatrist will examine your feet for blood flow, temperature, sensation and general condition. They may detect a ‘silent’ loss of sensation.

You will also be educated on good foot care. This will include the teaching of self-foot examination, proper nail cutting technique and the importance of foot moisturisation. Footwear choices as well as the appropriate type of shoes for your feet and how to wear in new shoes will be discussed.

Blood pressure and cholesterol screening

Blood pressure should be checked at least every three months. This can be tested at a routine visit to the doctor, your local chemist or at home on a home device.

Blood pressure targets should be personalised and discussed with your doctor. There are general guidelines that he/she will follow. Blood pressure and cholesterol management go hand in hand.

A lipogram, a full cholesterol test, checks all aspects of the cholesterol and should be performed annually. The reference ranges of results are different for people with diabetes who have more risk factors compared to the general population. Medication and dietary modification will be prescribed to manage these conditions if necessary.

Dental screening 

People with poorly-controlled diabetes are at a greater risk of developing dental problems, such as periodontal disease. Other oral manifestations could include a very dry mouth, a burning sensation in gums, delayed healing of mouth sores as well as an increased frequency and severity of infections.

Poor glucose-control exacerbates dental complications. The reverse is also applicable, periodontal disease worsens blood glucose control.

Dental treatment may need to be delayed until blood glucose levels are under control. A dental screening should be performed at least every six months.

Early detection is key

It is vital that screening is done on a regular basis for all possible complications. As stated earlier and cannot be emphasised enough, early detection is key to early management.

MEET THE EXPERT

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

Header image by FreePik

According to medical experts, urea, an organic compound, is the gold standard treatment for dry skin. We learn why this is so.

When it comes to treating patients, and giving advice on special conditions, doctors often turn to trusted medical bodies and their latest research for advice.

Dry skin (or xerosis cutis) is a common skin complaint, caused by internal and external factors disturbing the skin’s moisture balance. This skin condition is highly prevalent among the South African population. Yet, surprisingly, there was no standardised approach on how best to treat the condition until recently.

Medical experts agree on the best way to treat dry skin

In 2018, a group of renowned physicians published a medical paper on the Diagnosis and Treatment of Xerosis cutis. The report summarises the latest research findings in the prevention, diagnosis and treatment of dry skin and gives doctors practical advice on how best to treat the condition.

The medical paper states that dry skin can, in principle, be treated effectively. The decisive factor in the effectiveness of dry skin treatment is choosing the appropriate care product.

Moisturising should involve a combination of hydrating and lipid-replenishing ingredients, formulated to restore the skin’s natural barrier function in the best possible way and prevent skin from drying out further.

Urea – the gold standard treatment    

The paper explains that, “based on the available scientific data, urea is the gold standard for the therapy of xerosis cutis¹.”

Urea has the advantage of being effective on two fronts; as a natural moisturising factor, it binds moisture into the outermost layers of skin. Plus, it also supports desquamation which is the natural process by which skin sheds dead skin cells. Healthy desquamation is linked to smooth skin.

The Diagnosis and Treatment of Xerosis cutispaper also explains that when urea is combined with other moisturising ingredients and lipids, the effect is even better: It states, “The combination of urea with ceramides, NMF and glycerol shows a significantly better effect than the effect of urea or the vehicle alone².”

Eucerin UreaRepair PLUS

Eucerin scientists were the first to effectively include urea in a dermo-cosmetic product, and now have more than 25 years’ experience of maximising the benefits of urea in skincare formulas. Experience that includes more than 30 clinical and dermatological studies, involving 10 000 volunteers.

The lotions and creams in the Eucerin UreaRepair PLUS range offer people with dry skin exactly what the independent expert paper recommends. The formulas include:

• various concentrations of urea (ranging from 5% to 10%).
• other natural moisturising factors (NMFs), ceramides and gluco-glycerol.

The range is clinically and dermatologically proven to offer immediate and 48hour dry-skin relief.³

Urea and 17 other natural moisturising factors help the skin to attract and bind in moisture, thereby improving the symptoms of dry skin.

Ceramides repair and strengthen the skin barrier and thus reduce moisture loss.

Urea binds water into the outermost layers of skin and, at the same time, breaks down the connections between dead skin cells. This promotes desquamation and ensures a smoother skin surface.

References:

1. Augustin M et al., Diagnosis and Treatment of Xerosis Cutis. JDDG, July 2018: Suppl 4, Volume 16.
2. Weber TM et al., J Clin Aesthet Dermatol 2012, 5:29–39.

3. Beiersdorf. Data on file

Sarah Nicholson, Justmoney’s commercial manager, offers ten tips to help ensure you enjoy the medical aid scheme benefits to which you’re entitled.

Extremely high medical costs mean that many South Africans prudently subscribe to a medical aid scheme. But how do you make the most of your selected package, which needs to meet your medical needs for the year ahead?

Read the fine print

You may have stayed with the same plan for many years. Take time to understand the rules and benefits, which may have changed since you first signed up.

Maximise your money

Take up preventative health screenings and tests, free vaccinations, and baby programmes. You may also decide to register for a programme to better handle a chronic condition.

Explore loyalty programmes

Benefits could vary from product discounts to travel and retail promotions, and subsidised gym memberships.

Spread out claims

Rather than blow your allocation early in the year on over-the-counter purchases, speak to your pharmacist and health practitioners about how to best allocate medical, optical, and dental purchases.

Keep your benefits for essential medicines and services to be used as the need arises. This is especially important if you have small children or sickly dependants.

Choose wisely

Build up a good relationship with your pharmacist, who can advise you on general health topics from seasonal allergies to stress management.

Ask your doctor to prescribe generics which cost less. Whether you are looking at over-the-counter medication, or prescription drugs, generics can cut your bill considerably. You can also shop around and compare prices.

On the record

Be meticulous about filing claims and saving correspondence.

Plan for a procedure

If you require an operation or specialist treatment, obtain pre-authorisation. Do your homework, get a quote from the hospital and medical practitioners before you are admitted. Determine if there will be a shortfall and plan how to fund this. Check if you can use designated healthcare providers on your medical aid’s network for cheaper negotiated rates.

Back a buddy

Oncology and other treatments can make one feel under par for a lengthy period. Ask a family member or friend to help you keep track of medical claims and submissions, or offer to do the same for them.

Conflict resolution

If you’re having difficulties resolving a problem with a call centre agent, find out if your medical aid has a walk-in service. Dealing with someone face to face can help resolve a problem quicker.

Saving grace

Should you have problems keeping up with payments,speak to your medical aid about alternative, cheaper plans. Don’t drop your medical aid completely as medical bills can be enormous.

If you don’t yet have a medical aid, do comparisons online or ask for advice from a qualified broker. This will help you to choose the scheme and plan that offers the best possible cover for your age and personal circumstances.

MEET THE EXPERT

Sarah Nicholson is the commercial manager for Justmoney. Justmoney is a personal finance website that provides busy and digitally savvy South Africans with easy access to financial products, services and information, including medical aid.