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This article is sponsored by Sock Doctor. The contents and opinions expressed are entirely the medical experts and not influenced by Sock Doctor in any way

Did you know heart disease and strokes are the leading cause of death in people living with diabetes? The good news is that there are many things that you can do to control your diabetes, reduce your risks and stay healthy.

How does diabetes affect your heart?

Heart disease and stroke are the leading cause of death in people living with diabetes. The constant high blood glucose causes damage and narrowing of the blood vessels, increased blood triglycerides (a type of fat), decreased levels of “good” HDL cholesterol, high blood pressure and increased risk of a heart attack or stroke.

People living with diabetes are also more prone to the development of atherosclerosis and blood clots. Diabetes also accelerates the damage done by smoking, high blood pressure and high cholesterol.

Diabetes can even affect the heart muscle itself, making it a less efficient pump. As diabetes can affect the nerves to the heart, symptoms of angina may not be felt in the usual way and may be passed off as indigestion or an upset stomach. This leads to delays and difficulties in diagnosing angina and heart attacks.

As you can see, diabetes increases the risk of stroke and heart disease, especially if other risk factors are already present. The risks multiply!

So, prevention is key. Up to 80% of heart disease and strokes that happen before the age of 70 years can be prevented by simply living a healthy lifestyle and treating conditions, such as high blood pressure, high cholesterol and diabetes.

Knowledge is also vital and the best knowledge you can equip yourself with are the signs and symptoms of a heart attack and stroke so that if ever you are in a situation, you are armed with what to do.

Signs and symptoms of a heart attack

Not all people experience the same symptoms when they suffer a heart attack. Sudden chest pain is the most common symptom of a heart attack. In some cases, mostly women or people with diabetes, a heart attack can happen without any chest pain.

Chest pain can also be caused by several other conditions that affect the stomach, chest wall, muscles or lungs. Ambulance staff or a doctor can do the necessary tests to find out if chest pain is caused by a heart attack.

Below are the common symptoms of a heart attack. You may experience only one or several of these symptoms during a heart attack.

• Pressure, tightness, pain, or a squeezing or aching sensation in your chest or arms that may spread to your neck, jaw or back.
• Nausea, indigestion, heartburn or abdominal pain.
• Shortness of breath.
• Cold sweat.
• Lightheadedness or sudden dizziness.

If you are in doubt, get checked out.

Signs and symptoms of a stroke

Because stroke is usually not painful, patients may ignore the signs or symptoms and not seek medical attention, in the hope that they will improve. Acute stroke or TIA should be treated as a medical emergency and should be evaluated as soon as possible.

• Weakness/numbness or limited movement to the affected side.
• Memory loss/confusion, impaired thinking the loss of concentration.
• Speech difficulties, (talking or understanding speech).
• Visual disturbances.
• Inability to control bowel or urine activities.
• Loss of balance and difficulties in walking.

FAST is a simple way to remember the signs of a stroke and to seek medical help urgently.

F – Face drooping

A – Arm weakness

S – Speech difficulty

T – Time to call emergency medical services 

FACE: ask the person to show their teeth or smile and see if one side of the face droops or doesn’t move as well as the other side does.

ARMS: ask the person to lift both arms up and keep them up and see if one arm doesn’t move or drifts downward when extended.

SPEECH: ask the person to repeat a short sentence (e.g., “it is a sunny day in Cape Town”) and see if the person uses the correct words without slurring.

TIME: make a careful note of the time of onset of symptoms and call for help urgently if you spot any one of these signs.

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Diabetes Wellness meetings

We are thrilled to report that after more than a year of lockdown we have had two successful Diabetes Wellness meetings so far this year, in April and in May.

They were both held at our main meeting venue in Newton Park. Sadly, the venues for the Malabar and  Springdale meetings are not yet available, but they are most welcome to join us at the main meeting.

Camp Diabetable

Our exciting news is that we have a camp for Type 1 children, thanks to the dedication and enthusiasm of Ernest Groenewald and his helpers, Paula Thom and Darren Badenhuizen. They are all young adults with Type 1 diabetes. There is still space available if you are in the Eastern Cape area.

Dr Paula Diab addresses some of the more common questions and concerns around COVID vaccines in people with diabetes.

Have you ever considered that there is not a single cell in your body that is as old as your birth certificate says you are? Cells regenerate all through life. So, age is literally just a number.

What is age, actually?

Much more significant for health is celebrating the rhythm of life, having a healthy relationship to your biographical seven-year cycle (1-7; 7-14; 14-21; 21-28, etc), your sleeping and waking patterns, connecting with nature and nurturing your inner core. A healthy balance between your own time and community living is important too.

All of these impact on your energy body. For example, at the end of the first seven years, you lose your milk teeth and also the protection of your mother’s own immune shield (especially if you have been breast-fed). By fourteen, you have a changed body form, with the odd pimple suddenly showing itself and a voice change from an angelic piping to the expression of your emerging individuality.

The changes in the later cycles may not be as obvious physically but there is a shift every seven years as we mature. If we don’t consider the significance of these subtle changes, spiritually and physically, then we just grow old. If we do acknowledge and respond to these subtle changes we grow ‘up’ to where we came from and we can die healthy.¹

Can we enhance our immune response system?

When we don’t feel well, we usually say, “Something is wrong with me.” or “What’s wrong with you?” The conventional approach is to reach for pharmaceutical help. One could also recognise this dis-ease as a messenger that something is out of balance. How you view it is entirely up to you.

Although this is your journey, especially in the case of diabetes, most people around you have an opinion on how you could, should or must change your life, even if they don’t tell you to your face. The vibe is palpable; the concern is written in their voices. This is completely understandable on a physical level because those close to you are affected by the way you view and deal with your situation. No one likes to experience their loved one in a coma, or at the mercy of mood swings resulting from fluctuating blood glucose. Besides adhering to your medication prescribed, there are things you can do to enhance your immune system and lower the rate of complications.

Nurturing through nature  

Sue Visser is a well-respected health writer and produces an effective range, Nature Fresh, found in local pharmacies and health shops. I asked her whether she had anything she could say about diabetes management. Turns out that she has a lot to say.

Did you know, for example, that metformin is based on the molecular components of the plant, French Lilac and Goat’s Rue? And, besides being a tried and trusted drug used to treat insulin resistance, it was originally developed to fight the flu in the 1920s?

Even more topical during this time of COVID, is her report on the benefits of metformin which has demonstrated the potential to inhibit the SARS-CoV-2 infection directly. A comparative reduction in the rate of mortality in diabetic patients on metformin with severe SARS-CoV-2 has been observed according to four hospital studies that show lower instances of death in their patients who take metformin.²

A tip Sue offered is to check and treat depleted magnesium levels, especially when diagnosed with diabetes prior to prescribed treatment.

Baobab powder

Sarah Venter worked as a Forestry Scientist for the Department of Forestry in Limpopo. One day while driving through the northern rural areas of Limpopo, where baobabs grow, she noticed that the baobab fruit was just rotting under the trees. This led her to do a PhD study on baobab fruit.

The excitement around her research led her to start a successful and sustainable enterprise, EcoProducts, involving the local villagers. Situated in Limpopo province, it employs up to 50 people in the processing of the fruit and over 800 helpers for harvesting. Together they create BaoActive, a pure baobab powder which is gluten free, suitable for vegans, and has been certified Halal and Kosher.

Baobab powder is naturally rich in vitamin C, vital for the support of the immune system, boosting defence against disease and infection.³ It has both high soluble and insoluble dietary fibre content. Soluble dietary fibres stimulate the growth of intestinal microflora allowing the more effective absorption of nutrients from food. The insoluble fibre provides the roughage necessary for the movement of food through the gastrointestinal tract. Being rich in polyphenols, baobab powder has a stabilising effect on blood glucose, especially when consuming high-starch foods, such as bread and pap.⁴ An exciting research paper is rewarding reading: “The polyphenol-rich baobab fruit reduces starch digestion and glycaemic response in humans.”

Bon Voyage!

It’s the persistent pursuit of small changes in lifestyle that leads to surprising and significant results. And this is the goal of Agents for Change. We all know what lies at the end of our road; let us arrive healthy and positive and looking forward to the inevitable next step.

References:

1. William Bryant – The veiled pulse of Time
2. http://naturefresh.co.za/metaformin-offers-protection-for-diabetics/
3. https://www.baoactive.co.za

Please contact Noy Pullen if you would like more information: [email protected] or 072 258 7132.

AGENTS FOR CHANGE IS A DIABETES SOUTH AFRICA PROJECT MANAGED BY NOY PULLEN.

Daniel Sher dives into the science of empathy to show why empathy is a healthcare necessity, rather than a luxury.

As people with diabetes, most of us have experienced leaving the doctor feeling unheard, despondent, fearful, anxious or misunderstood. If we’re lucky enough to have a doctor who really cares, though, we may leave the consult feeling hopeful, heard, supported and considered. Through empathy, our doctors are setting us up for success in more ways than one.

What is empathy?

It is the ability to put yourself in the shoes of another and see things from their perspective. Ultimately, empathy involves a healthy, authentic connection between two people. Empathy comes easier to some than others, but it is a skill which, ultimately, can be learned and refined.

While some think of empathy as a vague and ‘fluffy’ concept, science has explored this ability fairly rigorously. We know, for example, that people who lack empathy tend to have reduced functioning in a specific part of the brain (the right supramarginal gyrus) which helps us to gauge the emotional state of others. We also know that empathy has real and significant implications for a person’s health, as we’ll discuss in more detail below. But first:

What does a doctor’s empathy look like?

There’s no doubt that some doctors’ empathy skills are stronger than others. The following are possible indicators that your healthcare professional is doing a good job on the empathy front.

• You’re engaged in collaborative decision making about your treatment, rather than being told what to do.
• You feel heard during the session.
• You’re left feeling genuinely cared for, rather than told-off.
• Your doctor explores the reasons for your difficulties, rather than simply pointing out where you’re going wrong.
• Your doctor asks open-ended questions and really listens when you respond.
• You feel that your concerns have been acknowledged, rather than brushed aside.

Barriers 

What stops a doctor (or any other person) from practicing empathy? If a person is anxious, sad, exhausted or over-stressed, this can stop one from being able to access the parts of the brain that help us to empathise with others.

For those who know how gruelling medical school can be, therefore, it may come as no surprise that medical training is known to lower empathy. It’s important for us to be empathic with our doctors in this regard. However, it’s also important that our doctors take responsibility for managing their workload and mental health properly, so that they can continue to fulfil the Hippocratic Oath by providing empathic care.

Keep in mind that in South Africa, state healthcare services are often under a great degree of pressure. Doctors with huge caseloads and ongoing exposure to trauma are less likely to be able to muster empathy than those who are not exposed to such conditions.

Does empathy really matter?

In short, yes. The science quite clearly tells us that empathy matters when it comes to diabetes care. More specifically, the research shows that empathy is more than just a vague and fuzzy feeling that is perhaps nice to have. Rather, empathy from your doctor may have a direct impact on your health. Let’s look at what some of the research has shown:

• A study found that patients who have empathic physicians are more likely to follow treatment recommendations, including glucose testing, diet, exercise and medications.
• The same study also found that patients who have empathic doctors tend to have a higher quality of life.
• In this 2004 paper, it was shown that empathic doctors are better able to help their patients stick to proper self-care routines. Interestingly, the research showed that empathy ratings were, in fact, more important than the doctors’ medical expertise.
• These researchers found that patients with empathic doctors tend to have lower HbA1C levels.
• Amazingly, this 2019 study found that patients who have very empathic doctors are up to 50% less likely to die of heart-related issues.
• Finally, this study found that empathic doctors help their patients to avoid admissions for diabetic ketoacidosis.

So, luxury or necessity? 

For many of us, empathy is little more than an afterthought. We feel lucky if our doctor leaves us feeling heard; but we don’t really feel that we have a right to expect empathy from our healthcare team. The science, however, suggests that empathy is far more than just a luxury. Rather, having an empathic doctor is a necessity and something to which we, as diabetic patients, have a right.

References

1. Dambha-Miller, H., Feldman, A. L., Kinmonth, A. L., & Griffin, S. J. (2019). Association between primary care practitioner empathy and risk of cardiovascular events and all-cause mortality among patients with type 2 diabetes: A population-based prospective cohort study. The Annals of Family Medicine, 17(4), 311-318. 
2. Del Canale, S., Louis, D. Z., Maio, V., Wang, X., Rossi, G., Hojat, M., & Gonnella, J. S. (2012). The relationship between physician empathy and disease complications: an empirical study of primary care physicians and their diabetic patients in Parma, Italy. Academic medicine, 87(9), 1243-1249.
3. Eltaher, S. M., Rashid, M. A., Mahdy, A. W., & Lotfy, A. M. M. (2020). Physicians’ Empathy and Its Effect on Adherence to Treatment of Diabetic Patients in Al-Qassim Region, Saudi Arabia. Annals of Tropical Medicine and Health, 23, 231-638.
4. Hojat, M., Louis, D. Z., Markham, F. W., Wender, R., Rabinowitz, C., & Gonnella, J. S. (2011). Physicians’ empathy and clinical outcomes for diabetic patients. Academic Medicine, 86(3), 359-364.
5. Kim, S. S., Kaplowitz, S., & Johnston, M. V. (2004). The Effects of Physician Empathy on Patient Satisfaction and Compliance. Evaluation & the Health Professions, 27(3), 237–251

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