Tag: diabetic

diabetic alert dog

Is it worth getting a diabetic alert dog in South Africa?

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James Leech explains the pros and cons of a diabetic alert dog in the South African setting.

What is a diabetic alert dog?

A diabetic alert dog is a guide/service/assistance dog trained to detect high or low levels of blood sugar in humans with diabetes. These dogs then alert their owners to dangerous changes in blood glucose levels.

South African setting

A service dog is an amazing resource. Diabetic alert dogs, in many cases, perform better and are more advantageous than diabetic alert equipment. The idea and novelty is amazing. However, in South Africa, you really need to identify the pros and cons if it is really worth investing in one for the following reasons:

Training programme and suitable match

Having a dog qualify to become a service dog is the equivalent to applying to the South African Special Forces. From all the entrants, there is a very low conversion rate.

This is not because the dogs were not of amazing calibre but because one must first assess: the dog’s traits, training ability, environment they will be going into, and whether the dog will be a suitable match to the owner.

Watch this video. It gives a full account of potential issues including the trainer’s personal bias.

Enforcement and support of the law

The Promotion of Equality and Prevention of Unfair Discrimination Act, 2000 (PEPUDA or the Equality Act, Act No. 4 of 2000) is a comprehensive South African anti-discrimination law. It prohibits unfair discrimination by the government, private organisations and individuals and forbids hate speech and harassment. A powerful and supportive piece of legislation. I have used it several times in court applications in protecting the rights of my service dog usage.

The cultural rainbow of South Africa

In South Africa, there is a fairly large subset of the population with a fear of dogs. Adding to that, certain religious objections to dogs being within a home environment or public spaces.

  • Encountering resistance

In South Africa, typically, if you are not visibly blind, i.e. a cane, sunglasses and a guide dog in a full uniform and accessories, you are likely to encounter resistance.

This is a cultural and retail training issue. For example, a decade ago, when I was helping in difficult cases for the South African Guide-Dogs Association for the Blind, an incident occurred. A woman went to a government bank. She was 90% blind and had a guide dog. However, she didn’t look the typical biased view of a blind person.

The security personal stopped her, continually berated her, bringing her to tears on the floor. Her guide dog starts barking and causing a further scene. None of this ended happily in the end.

After hearing this story and many others I was the first in South Africa to develop a certificate, issued by the court, that can be carried by special service dog carriers, acting as a proxy medium of assistance.

This document greatly helps but one still encounters resistance in needing to approach the courts. I highly recommend you have money saved aside to hire an advocate (not attorney) in handling these matters on your behalf, as it can be great stress undertaking it on your own when you are not familiar with the system.

The blessing

If you are fortunate enough to have a guide/service/assistance dog, they can provide an amazing blessing. In the picture (above) is my non-nativeelectromagnetic fields (nnEMF) service dog, Pebble and one of my children.

I have electromagnetic field intolerance syndrome (EMFIS). She picks up when my tolerance to the radiation in the environment is low, and/or when causing a neurological and functional impairment she helps me navigate through the space.

From my personal point of view, if I didn’t have to have a service dog, I would prefer not to. The obstacles one faces in terms of unfair discrimination, unwanted attention, questions and hoops having to jump through can be taxing.

However, in my circumstances, I am blessed that she is able to do her job in aiding me in certain environments and helping provide added independence.

Getting her was a family choice based on our circumstances. It was deemed unfair to rely on my wife and three children in assisting me for the rest of my life. Plus, it is more reasonable to have Pebble as an assistive aid to improving the quality of life for all of us.

Conclusion

Do not get a diabetic alert dog because it sounds and looks cool. First, take all steps to treat the epigenetic disease of Type 1, 1,5, 2 or 3 diabetes.

Once it is well-managed and depending on your circumstances, and environmental exposures, if needed, then consider getting investing the time, money and patience into one.

List to my podcast [ jameslech.co.za/podcasts/] ep 31 – How SARS helps with my service dog – Disability Tax Incentives

MEET OUR EXPERT

James Lech is a consulting scientist to doctors, architects and attorneys. He is a doctoral candidate in sub-molecular medicine/ biophysics and a contracted agent of national government in novel research and solutions.

pastry chef

A tale of a diabetic pastry chef

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Type 1 diabetic, Carla Claasen, tells us why she became a pastry chef: to open a diabetic bakery with the most amazing and mouth-watering pastries, cakes and desserts.

Carla Claasen (23), a Type 1 diabetes patient, lives in Centurion, Gauteng.

No more “sweeties”

I was diagnosed at the age of 11 with Type 1 diabetes. After some scary weeks – where I was watched over by truly amazing angels at the hospital – my mom and dad explained, to ease my mind, that diabetes is not an illness, disease, or disorder. Just like some children can’t eat nuts or drink milk, I could not have any sugar. So, as a family, our goal would be to focus on a healthy lifestyle which excludes sugar.

Though that was easier said than done. I had grown up with a “sweetie” as a special treat and when we went out to eat I couldn’t wait for the dessert menu. Plus, pudding after Sunday lunch was my favourite. Suddenly being a diabetic became very real. Add to that, now my poor sister could not have any sweet unless there was something that I could eat. She never said anything, but I think deep down she must have resented my diabetes.

Sowing the sugar-free seed

I guess, this was where the seed was planted. Surely there must be something that is sugar-free and still tastes like a special treat?  My mom and aunts were on a perpetual search for “treats” so I could have a dessert (and so relieving my long-suffering sister from her banishment to the land of no sugar).

Not believing in accidents and coincidences, my life took an interesting turn. In Grade 8 I was presented with an option to take Hospitality as an extra subject. Not knowing what I wanted to do after school, my parents suggested that I explore it. And, so, a whole new world opened to me.

My Hospitality teacher, Fiona Muller, nurtured my natural talent and complimented my passion as a budding chef. The seed planted so long ago – there has to be amazing desserts and pastries for diabetics – suddenly started growing. I can be a chef that specialises in diabetic pastries.

From there it was a short hop to my ultimate dream of opening a diabetic bakery with the most amazing and mouth-watering pastries, cakes and desserts made with no sugar.

Setting the foundation

My family was amazing. They supported me without any hesitation from day one. After school, we spent hours investigating culinary schools. After lots of research, my heart was set on 1000 Hills Chef School.

Following a gruelling interview with Chef Sharmine Dixon, my road of two years of training and endless discovery started. She understood about being a diabetic and supported me in my quest to become a master pastry chef for a diabetic market.

Chef Dixi wanted me to be able to hold my own anywhere in the world, as well as being able to offer something unique. Her belief in my passion and her relentless requirement for perfection is what prepared me for my first adventure.

Five Palm Jumeirah

I spent 15 months working, at Five Palm Jumeirah Hotel in Dubai, as a pastry chef under Michelin-star chefs from all over the world. This extraordinary experience unlocked a whole new magical world. With me always in awe, saying “I never thought you could do that with pastry!”

At the end of my contract I came back to South Africa, wanting to hone my craft closer to home. I have, however, found that there still seems to be a lack of understanding and availability of sugar-free pastries and desserts in South Africa. So, looking at the glass as half full I saw this as my opportunity.

How can a diabetic be a pastry chef?

For most people, being diabetic and a pastry chef seems quite absurd. Though it is easy. If I work with sugar, I ask one of the other chefs to taste, and if I work with sugar substitutes, I do the tasting myself.

I must say the internet is not very helpful with appetizing alternatives to sugar either. With some diabetic recipes indicating the use of avocado or beans. Not the first thing that comes to mind for a yummy dessert!

The easiest tip I can give readers that want to make sugar-free desserts is to replace the sugar with a sugar substitute like xylitol, stevia, etc. It sounds like a no-brainer but it took me a while before I tried it.

I was unsuccessful the first time (I did not know that sugar substitutes taste much sweeter than real sugar), but had amazing results the second time around. I halved the said sugar amount. That is how new recipes are created…try and try again.

My favourites

My most popular desserts (and family favourites) are sugar-free lemon cheesecake and sugar-free tiramisu (non-alcoholic). Interestingly enough, I now have numerous weight-conscious admirers of my desserts and pastries.

And so, with every set of challenging circumstances, we are also provided with opportunities – if that is how we choose to look at it – and this is mine.

Click below for Carla’s recipes:

Lemon Cheese Cake
Lemon Cheese Cake
tiramisu
Tiramisu
Chocolate Jellies
insulins

Making insulin work for the diabetic, and not the other way around

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Michelle Carrihill educates us on how to use various insulins with their unique actions to meet the desired requirements.

There is no ‘easy-peasy’

As a student, I remember being taught that the only thing wrong with a Type 1 diabetic is that they are deficient in insulin. So, the treatment is simple – replace the insulin, and all is returned to normal. Easy-peasy.

Except it is not. Each person is an individual. Each person has variable insulin requirements, and these may change minute-to-minute, hour-to-hour, day-to-day, week-to-week, and especially year-to-year as the body grows and changes.

Very few people have predictable, regular lives. Nevermind predictable regular metabolic rates. Add the variability that is introduced with different amounts and types of carbohydrates, plus protein and the altered absorption with fat in a meal; throw in exercise, emotions and stress, and it might feel almost impossible to exactly figure out which insulin and how much of it should be given at any one time.

Another factor is that each individual may respond slightly differently to a brand or type of insulin, and that the individual’s response may not be the same at each injection.

Also, unlike the insulin produced naturally, once insulin is injected in the body, it cannot be switched off. Once it is in the body, it will continue working, whether needed or not!

Individualise insulin treatment

The most important thing is to individualise the insulin treatment regimen to best fit the individual’s needs. Obviously, the available insulins, the budget and the willingness of the diabetic (or their carer) to test sugar levels and adjust doses are important to take into consideration when designing insulin replacement therapy.

To understand this, let’s look at the available insulins, and their action times. This information is provided by each of the manufacturers.

 

Type of Insulin & Brand Names

Onset

Peak

Duration

Role in Blood Sugar Management

Rapid-Acting
Lispro (Humalog) 15-30 min. 30-90 min 3-5 hours Rapid-acting insulin covers insulin needs for meals eaten at the same time as the injection.
Aspart (Novorapid) 10-20 min. 40-50 min. 3-5 hours
Glulisine (Apidra) 20-30 min. 30-90 min. 1-2 1/2 hours

Short-Acting
Regular (R)

Actrapid

Biosulin R

Humulin R

Insumam R

 30 min. -1 hour 2-5 hours 5-8 hours Short-acting insulin covers insulin needs for meals eaten within 30-60 minutes

Intermediate-Acting
NPH (N)

Biosulin N

Humulin N

Insumam N

Protophane

  

 

1-2 hours

  

 

4-12 hours

 18-24 hours Intermediate-acting insulin covers insulin needs for about half the day or overnight.

Long-Acting
Insulin glargine (Basaglar, Lantus, Toujeo, Optisulin) 1-1 1/2 hours No peak time. Insulin is delivered at a steady level. 20-24 hours Long-acting insulin covers insulin needs for up to one full day.
Insulin detemir (Levemir) 1-2 hours 6-8 hours Up to 24 hours
Insulin degludec (Tresiba) 30-90 min. No peak time 42 hours

Pre-Mixed*
Humulin 30/70

Actraphane

 30 min. 2-4 hours 14-24 hours These products are generally taken twice a day before main meals.
NovoMix 30 10-20 min. 1-4 hours Up to 24 hours
Humalog mix 25 15 min. 30 min.-2 1/2 hours 16-20 hours
*Premixed insulins combine specific amounts of intermediate-acting and short-acting insulin in one bottle or insulin pen. (The numbers following the brand name indicate the percentage of each type of insulin.)

If you combine these insulin profiles, and superimpose them over what the individual’s insulin requirements are, you then get to understand when the insulin will be working for them, and which combination will suit their needs. These needs may vary from time-to-time and over time, so it is important they monitor their sugars, either with finger-prick tests, or if viable, a continuous glucose monitor.

Let’s look at some regimens:

Twice a day insulin

Benefits: Disadvantages:
Easiest regimen Must be given 30 minutes before the meals.
Only two injections a day Midmorning snack required.
Lunch carbohydrates may not be adequately covered.
No flexibility in meal component of the insulin (if using a premixed insulin combination).
The intermediate-acting insulin given before an early dinner may mean inadequate basal cover by the early morning – a risk of waking up with a high fasting sugar, and some ketosis.

 Three times a day insulin

Benefits: Disadvantages:
Covers overnight requirements better by the later injection of the intermediate insulin, decreasing the chance of morning high levels. Regular insulin must be given 30 minutes before the meals.
Midmorning snack required.
Lunch carbohydrates may not be adequately covered.
Requires a bedtime snack.

 Basal bolus regimen

Benefits: Disadvantages:
Flexible dosing for carbohydrates and correcting. In-between meal carbohydrates need to be counted and dosed for. Or carbohydrate free snacks considered.
More frequent injections (and testing) required.
More expensive.

 Long-acting insulin analogues

Benefits: Disadvantages:
Flexible dosage for carbohydrates and correcting. ‘In-between’ meal carbohydrates need to be counted and dosed for. Or carbohydrate free snacks considered.
Fasting is possible. More frequent injections (and testing) required.
Flexibility in the timing of the meals/snacks. Much more expensive.
Less risk of nocturnal hypoglycaemia.
No need for night time snack.

Continuous sc insulin infusion

Benefits: Disadvantages:
Built in calculator for carbohydrate counting and corrections. Only rapid insulin is used, so any disruption in delivery can rapidly lead to ketoacidosis.
Insulin can be suspended. Very expensive.
Basal rates can be individually set. Needs high quality training and ongoing interaction.
Dawn phenomenon can be covered. Permanently attached to a device.
Fasting easy to achieve.
Temporary increase or decrease in basal requirements easy to achieve.

Mix and match

Mixing and matching of insulins is also possible. For example, a child attending primary school might do well on regular and intermediate-acting insulins half an hour before breakfast, without requiring any insulin for their school break; a rapid insulin analogue for after-school lunch and dinner; and then a long-acting basal analogue for their basal insulin overnight.

As mentioned already, monitoring the blood glucose then opens the eyes to the effect of the insulin doses – both for the individual dose, as well as for the pattern of dosing. Fasting sugars reflect the long-acting doses and post-meal levels reflect the bolused doses for carbohydrates and corrections.

Carbohydrate counting affords the closest-to-physiology use of mealtime insulin, and is to be encouraged. Even if using a fixed-dose insulin regimen, knowing how much carbohydrate is in a meal allows for consistency of insulin to carbohydrate dosing – which then helps prevent sugar variability after meals.

Monitoring sugar levels before and after activities and sports helps with planning of extra carbohydrates or a change in insulin dose for the meal before or after the exercise.

The message is that getting sugars to target is possible by knowing what the individual needs, and using the available insulins to suit those needs. Monitoring sugars and adjusting doses and types of insulin along the way will keep the person with diabetes healthy, and able to get on with living their lives.

MEET OUR EXPERT

Dr Michelle Carrihill is a paediatric endocrinologist working with children and adolescents with diabetes and chronic endocrine and metabolic conditions. She runs the adolescent sub-speciality ward at Groote Schuur Hospital and has a large ambulatory service for the chronic medical needs of these patients.

Shaun Tobela

Young and thriving – Shaun Tobela

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We speak to 20-year-old Shaun Tobela and hear how he has dealt with Type 1 diabetes during his youth.

Shaun Tobela (20) lives in Midrand, Gauteng with his parents. He is currently studying logistics – supply chain management. 

When were you diagnosed?

I was diagnosed in 2007 at the age of eight (about to turn nine) and was doing third grade. I got extremely sick before the whole symptom phase. No one knew what was wrong with me. I was raised by my grandmother; she thought it was just a bug or infection that could be dealt with. But as time went on, the diabetes symptoms stepped in: I urinated a lot and was always thirsty. My mouth was dry and, at times, I would feel drowsy. I was always hungry and my immune system was weak. My bed was my best friend until I was taken to the doctor where I was declared diabetic.

What medication are you currently on?

I am currently on Biosulin (long-acting insulin) and Humalog (short-acting insulin) and inject three times a day using an insulin pen: morning, afternoon and night. I take the long-acting for morning and night. Then I take the short-acting midday.

How did you handle managing your diabetes at school?

It was embarrassing to have my peers know that I was diabetic and having to take insulin at school. I was looked at in a different way – I was known as ‘that sick kid’, which was not nice.

For a long time, I would go to a private place to inject myself. Thankfully, I finally found the courage and started injecting myself in front of the whole class. They did all stare at me and it would humiliate me – which made me resent the condition. But as time passed, I gained confidence and became proud of my diabetes.

I think more than anything, it has been this experience that has helped me grow – having to accept myself for who I am. Nowadays, I am the one to tell people I am diabetic before they even ask.

In Grade 11, when I gained my self-assurance, I was bold enough to teach my Life Science class about diabetes with no shame.

How did you overcome the embarrassment?

I eventually got over the shame because I accepted the fact that I will always be diabetic and it was something I have to live with for the rest of my life. That changed my attitude. I had to accept diabetes myself before I could expect people to accept me.

What does your diet consist of?

I eat almost everything, but in small portions of course. Nowadays, most food items come sugar-free. As a diabetic, you’re able to eat and live like a normal person, it is just your diet will be slightly different with more sugar-free products.

For breakfast, I have cereal. My mid-morning snack is usually fruits. Then for lunch I have a sandwich and my 330ml can of Coke Zero. At night, I eat meat and vegetables. I try to avoid carbs, but I do eat them now and then and in small portions. Throughout the day, I try to eat protein as snacks: peanuts, meat, fish, biltong. That’s how most of my days go.

Are your friends aware of your diabetes?

Yes, my friends are. I’ve involved everyone close to me – they know the different types of insulin I use and are aware of the times I must take them.

When you go out with friends, do you drink alcohol? 

No, I don’t. Well, I’ve tried and it makes me sick, so I avoid it. Plus, you can still have fun without alcohol. I have my sugar-free energy drink (Red Bull) while my friends consume alcohol and we get the night going.

How have your family supported you?

My family have always been supportive. They help me eat healthy and stay on a good healthy diet. My father had been the most supportive. He made sure I always took my insulin and that my sugars levels were where they are supposed to be. Though, he is harsh at times. I only understand now why he is like that – for my own health.

What bugs you the most about having Type 1 diabetes?

Nothing really bugs me. Though, my biggest fear is missing my insulin shots. I just hate missing them, I feel a bit off.

What is the best thing about having diabetes?

The best thing about having diabetes is the fact that you’re different. You’re unique. You’re not normal and not being normal is a specialty. That’s my personal take on it.

How do you want to help youth who have diabetes?

I want to help the youth by raising awareness. I want to help diabetic kids that are going through what I went through. Especially those that think life is not worth living simply because they have diabetes. I am living proof that it’s possible to live with diabetes and live normally like everyone else. I want to change lives. Someday, I want to start a foundation to teach people about diabetes, even people without it. We need to spread the word.

When you got tattoos did your doctor inform you that your blood sugar needs to be well managed and if not it can slow down healing?

Honestly, I didn’t consult with my doctor before I got my tattoos. But I knew my healing process would take time compared to a normal person if I didn’t manage my sugar levels well.

What are your hobbies?

Playing soccer and lots of video games. I enjoy motivational speaking, bike riding, exercising, cycling and reading.

Do you have any side effects from diabetes?

No, I don’t and I’m grateful to God for that. I’m healthy and still in good shape.

MEET OUR EDITOR

Laurelle Williams is the Editor at Word for Word Media. She graduated from AFDA with a Bachelor of Arts Honours degree in Live Performance. She has a love for storytelling and sharing emotions through the power of words. Her aim is to educate, encourage and most of all show there is always hope. Feel free to email Laurelle on editor@diabetesfocus.co.za

exams

The everyday life of a diabetic teenager: stress, studying and exams

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Fourteen-year-old, Aiden Nel, tells us how he handles the stress of exams and studying.

I have just completed my June exams and would like to share the challenges facing a diabetic during exam time.

Coping with studying and exams as a diabetic can be difficult, but if I manage my blood sugar levels correctly, then studying and exams is no different than someone who does not have diabetes.

Tips to handle diabetes during exams

There are only a few of things you need to do to handle your diabetes during studying and exams.

Firstly, make sure that you test yourself regularly. For example, before each study session. If you do not feel one hundred percent, then first test yourself to see if maybe your blood sugar is high or low. You also need to remember to test yourself before each exam.

Secondly, it is very important to make sure that your blood sugar levels are stable. If your blood sugar levels are high while studying, you will not be able to concentrate. This would be the same during an exam. This means your marks may be lower because you could not focus. There will be less stress if you remember to test your sugar levels.

Remember, you also need to put in the study hours in order to do well. You can’t just keep your blood sugar stable and expect to do well.

Thirdly, as a diabetic, I always need to have a snack handy. I try to have regular snacks so that I can keep my blood sugar reading at the right level. Again, testing helps me to regulate my readings.

Lastly, it is important to have regular breaks while studying. Getting outside into the fresh air during breaks is important.

The most important point for me to remember is that as long as I am in control of my blood sugar levels, then I know I will feel fine during my study sessions and during my exams.

Aiden Nel lives in Port Elizabeth. He is 14 years old and has Type 1 diabetes.
puberty

Teenagers with diabetes tackling puberty

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Rosemary Flynn helps us comprehend what children with diabetes encounter when they transition through puberty.

When children become teenagers, they go through a huge transition. They rapidly develop in all areas of their lives: physically, sexually, emotionally, mentally, and socially. As if that is not enough to negotiate, teenagers with diabetes have extra challenges to face during their puberty years.

Early puberty

In early puberty, insulin works together with growth hormones to enable normal growth. When the growth hormones get going, insulin resistance increases. So, it’s important for those with diabetes to ensure they have enough insulin to allow growth to proceed as normal.

With diabetes, the insulin levels depend on how well the teen manages their diabetes. Sufficient insulin is the key to reaching their normal final height. They also gain weight as their body grows into a more adult body. With self-image being of great importance to them at this stage, the rapid weight gain often makes them feel very self-conscious. One of the most important tasks of adolescence it to accept these dramatic physical changes as normal and develop a positive body image.

Sexuality

Teenagers develop a keen interest in the opposite sex during this time. Many teenagers become sexually active, and for the teen with diabetes, this presents extra risk. For girls, there is the risk of an unwanted pregnancy even if they take precautions. In all pregnancies, women have to keep their blood glucose levels as normal as possible before, during and after the pregnancy. This ensures the baby is protected from birth defects. Unplanned pregnancy puts the baby at high risk. For both boys and girls, information about their sexuality and advice about contraception should be given well before they need it.

Responsibility

Another development of adolescence is that they are able to start taking responsibility for their lives and their diabetes. Teaching children and adolescents to take up this responsibility is a parental task. If teenagers are never asked to be responsible, they will have a tremendous battle to take up the challenge of managing their own diabetes. They will always expect others to be responsible or alternately, they will neglect it. The teen will have to consciously make a choice to  take on the responsibility of diabetes. Some are resistant to this transition and may take longer to do so.” 

Changes in the brain

During puberty the brain is going through impressive intellectual changes. Knowledge increases in leaps and bounds and teenagers are able to absorb much more information. They can imagine ideas which are actual possibilities, and use these to reason with and solve real problems. Their ability to pay attention and concentrate increases a great deal and they can remember much more than before. All this development means they are ready to make a transition from a dependent child to a responsible teenager.

It is worthwhile for teens to remember that poor control of diabetes can have a negative effect on the developing brain and prevent it from developing fully. Maintaining good control will protect their intelligence and allow it to develop to its full potential.

Attitude

The teenager’s attitude towards their diabetes can be influenced by how they perceive the illness. If they see it as a life-threatening disease over which they have no control, they will have a sense of hopelessness. They will always feel like a victim and have a very negative attitude towards their diabetes.

If they understand that diabetes can be controlled and believe they can learn to manage it effectively, they can develop a positive attitude and feel empowered to participate in all the activities that other teens do. They then believe and see that they can also do well at school.

Social life

Teenagers’ social lives become very important to them. The idea of being different from their peers is very threatening. Especially in early adolescence when they are finding their place in social groups.

They may struggle to be open about their diabetes and try to conceal the testing and injecting from their peers. This may mean that they miss injections or eat whatever the others are eating, even if it has a bad effect on their blood glucose levels. Sadly, the resulting poor control can mean missing lots of school, or being hospitalised due to diabetic ketoacidosis. In turn, this removes them from their social environment, or when it leads to poor growth it reduces their self-image.

The quest for social acceptance may lead them to try risky behaviours, like smoking, drinking alcohol and having unprotected sex. Somehow, they have to find a balance between having a good time socially and remaining responsible for their diabetes care.

Many teens have successfully negotiated their puberty years and have developed a maturity which exceeds that of their peers. With lots of support and encouragement, they can all succeed if they can get their minds around the challenges they face.

Rosemary Flynn

MEET OUR EXPERT

Rosemary Flynn is a clinical psychologist at the Centre for Diabetes in Johannesburg. She has worked with children, families and adults with diabetes for 24 years, enabling them to overcome their anxieties about their condition and to deal with the difficult events in their lives.

Emerging science of probiotics in diabetic foot ulcers

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Anette Thompson explains the use of probiotics in diabetic foot ulcer treatment.

Treating diabetic foot ulcers

Diabetic foot wound care practitioners understand that the three pillars of foot ulcer healing consist of: tight blood glucose control; offloading of pressure on the wound; and optimum care of the wound itself (ensuring good blood supply to assist the wound healing process).

Good blood supply delivers nutrition to the wound, although the word nutrition in diabetes has other dietetic connotations. In the past decade, emerging research into the specifics of the wound bed environment has brought further understanding of such entities: wound biofilm; proteases (protein destroying enzymes); colonisation by microorganisms and antibiotic resistance.

Wound dressing companies have developed specialised dressings to address each wound scenario, bringing in different approaches to break down biofilm, reduce the harmful bacterial load and stimulate tissue growth.

Biofilms

Biofilms are complex microbial communities containing bacteria and fungi. The microorganisms produce and secrete a protective matrix that attaches the biofilm firmly to a living surface, such as in a wound, or a non-living surface, such as an instrument7.

Biofilms are dynamic heterogeneous communities that are continuously changing3. They may consist of a single bacterial or fungal species, or may be polymicrobial, i.e. contain multiple diverse species9.

In a wound, you can imagine the biofilm as a densely-packed colony of bacteria embedded in a thick, slimy barrier of sugars (polysaccharides) and proteins. The biofilm barrier protects the harmful microorganisms beneath from external threats.

Probiotics

Most people will have heard of probiotics (a substance which stimulates the growth of microorganisms, especially those with beneficial properties) as a supportive treatment to gastrointestinal disorders. The human gut is naturally populated with millions of beneficial bacteria which in healthy individuals exist in balanced colonies, collectively called our gut microbiome.

Antibiotics destroy both beneficial and harmful bacteria, hence one should administer probiotics with a course of antibiotics (but not to be taken at the same time of the day). An imbalanced microbiome or dysbiosis is related to both gastrointestinal problems, such as diarrhoea and inflammatory bowel disease but also, outside the gut, such as obesity, allergy and skin disorders 12.

Most early studies in the literature regarding skin outcomes were those in which probiotics were taken orally. Newer studies are investigating topical application but there are limitations due to a lack of regulatory consensus in different parts of the world.

2010 research

In 2010, medical researchers, in Tucuman, Argentina, tested bacteriotherapy with lactobacillus plantarum (probiotic) on infected chronic leg ulcers6.

They produced a culture of the probiotic and applied it to the wounds of 14 diabetic patients and 20 non-diabetic patients. Wound debridement (clearing of dead tissue), granulation tissue formation (healthy new tissue containing new blood supply) and total healing after 30 days were found in 43% of diabetics and in 50% non-diabetics.

When the researchers looked at cells from the wounds after 10 days, they found that there was a decrease in the percentage of diseased and necrotic (dead) cells and an enhancement of interleukin-8 production.

Interleukin-8 (IL-8), now renamed CXCL8, is an important mediator of the immune reaction in one’s immune system response. It has two main functions:

  • It is the primary cytokine (messenger protein) involved in the recruitment of neutrophils (white blood cells that fight infection) to the site of damage or infection – in a process called chemotaxis4. This causes target cells, primarily neutrophils but also other granulocytes, to migrate toward the site of infection. It induces phagocytosis (engulfing of the bacteria to destroy them) once they have arrived.
  • It is also known to be a potent promoter of angiogenesis (formation of new blood vessels).

Probiotic strains

There are hundreds of different probiotic strains. Even within the genus lactobacillus, there are more than 150 different species, such as L plantarum, L acidophilus, L reuteri and L rhamnosus to name a few.

Many of these are found in fermented food items, such as yoghurt, kefir, kimchi, sauerkraut and salt-pickled vegetables. Within each species, there are further hundreds of strains which are numbered, such as Lp299v.

Probiotics can strengthen the immune system, reduce inflammation and promote wound healing through an array of mechanisms, such as the production of inhibitory substances like acids or bacteriocins; excretion of natural antibiotics; blockage of pathogen adhesion; nutrient competition and antioxidant activity8. Painstaking research is required to pinpoint the exact effect of each strain on the body before any claims can be made.

Latest research

In 2016, continuing research, at the national university in Tucuman, Argentina,1 designed two pharmaceutical dosage forms by using lactobacillus plantarum culture supernatants (clear liquid left above the solids after spinning in a centrifuge to concentrate the cells). These formulations have been cleared for use in clinical trials on chronic wounds that lack good blood supply (ischemic wounds).

Animal studies

Animal studies have been used to investigate the efficacy of probiotics, such as L brevis, L fermentum, L plantarum and L reuteri, as treatment for skin wounds. A meta-analysis of animal studies performed, in early 2017,10 found that probiotics administration is an effective pharmacological treatment of cutaneous animal wounds but further research is required.

Diabetic foot ulcer study

Late last year, a study at Babol University of Medical Sciences in Iran, tested the benefits of probiotic administration in patients with diabetic foot ulcers5. Patients with a diabetic foot ulcer who received probiotic supplementation for 12 weeks experienced faster wound healing coupled with an improved glycaemic and lipid profile compared with patients who had been assigned a placebo, according to findings from a randomised double-blind, placebo-controlled trial.

The probiotic capsules contained L acidophilus, L casei, L fermentum and Bifidobacterium bifidum. All participants also underwent standard treatment for wound care.

Probiotic supplementation also influenced lipid profile and inflammatory markers when compared with placebo. The researchers noted that information was not collected on faecal bacteria loads before and after probiotic administration, or on the characterisation of the microbiome at baseline, during and after therapy and bacterial cultures were not taken (a shortcoming of the study).

Lactic acid bacteria

Most recently, Dr David Armstrong reports, from the USA, that researchers are showing faster wound healing following the administration of lactic acid bacteria into wounds.

He refers to a study by Vågesjö et al., published online in the Proceedings of the National Academy of Sciences of the United States of America, that used a mice model to show wound healing.

Researchers transformed lactobacilli with a plasmid encoding chemokine 12 (CXCL12), noting that this enhanced wound closure via proliferation of dermal cells and macrophages. It also resulted in more transforming growth factor-beta (TGF-β) expression in macrophages. The study notes that bacteria-produced lactic acid reduced the local pH, which inhibited the peptidase CD26 and facilitated a higher availability of bioactive CXCL12.

The authors also note that lactobacilli delivering CXCL12 improved wound closure in mice with hyperglycaemia or peripheral ischemia, conditions associated with chronic wounds. The study adds that the treatment showed macrophage proliferation on human skin in an in vitro model of wound epithelialisation.

Final note

This is exciting news—although admittedly in early days—that we can use a probiotic (lactobacillus species) that is already a part of our beneficial bacterial microbiome2 and enable it to produce, in this case, CXCL12, which may have positive wound healing attributes.

REFERENCES

  1. Cabrera CA, Ramos AN, Loandos M del H, Valdez JC, Seso Cabral ME. Novel topical formulation for ischemic chronic wounds -Technological design, quality control and safety evaluation. Pharm Dev Technol 2016;21(4):399-404.
  2. Dixit N, Simon SI (2012). Chemokines, selectins and intracellular calcium flux: temporal and spatial cues for leukocyte arrest. Frontiers in Immunology. 3: 188. doi:10.3389/fimmu.2012.00188. PMC 3392659 Freely accessible. PMID 22787461.
  3. Hall-Stoodley L, Stoodley P. Evolving concepts in biofilm infections. Cell Microbiol 2009; 11(7): 1034-43.2.
  4. Modi WS, Dean M, Seuanez HN, Mukaida N, Matsushima K, O’Brien SJ (1990). “Monocyte-derived neutrophil chemotactic factor (MDNCF/IL-8) resides in a gene cluster along with several other members of the platelet factor 4 gene superfamily”. Hum. Genet. 84 (2): 185–7. doi:10.1007/BF00208938. PMID 1967588.
  5. Mohseni S, Bayani M, Bahmani F, et al. The beneficial effects of probiotic administration on wound healing and metabolic status in patients with diabetic foot ulcer: A randomized, double-blind, placebo-controlled trial. Diabetes Metab Res Rev. 2017;e2970.
  6. Peral MC, Rachid MM, Gobbato NM, Human Martinez MA and Valdez JC. Interleukin-8 production by polymorphonuclear leukocytes from patients with chronic infected leg ulcers treated with Lactobacillus plantarum. Clin Microbiol Infect 2010 Mar; 16(3):281-6
  7. Stoodley P, Sauer K, Davies DG, Costerton JW. Biofilms as complex differentiated communities. Annu Rev Microbiol 2002; 56:187-209.
  8. Tavaria F Topical use of probiotics: the natural balance. Porto Biomed J. (Portugal) 2017:2(3):69-70.
  9. Trengove NJ, Stacey MC, McGechie DF, Mata S. Qualitative bacteriology and leg ulcer healing. J Wound Care 1996; 5(6): 277-80.
  10. Tsiouris, Christos G., Martha Kelesi, Georgios Vasilopoulos, Ioannis Kalemikerakis, and Effie G. Papageorgiou. 2017. “The efficacy of probiotics as pharmacological treatment of cutaneous wounds: Meta-analysis of animal studies”. European Journal of Pharmaceutical Sciences. 104 (8): 230-239.
  11. Vågesjö E, Öhnstedt E, Mortier A, et al. Accelerated wound healing in mice by on-site production and delivery of CXCL12 by transformed lactic acid bacteria. Proc Natl Acad Sci USA. 2018;115(8):1895-1900.
  12. Vandenplas,Y, Huys G, Daube G. Probiotics: an update. J Pediatr (Rio J Brazil) 2015;91:6-21).

MEET OUR EXPERT

Anette Thompson
Anette Thompson (M Tech Podiatry (UJ) B Tech Podiatry (SA)) is the clinical director at Anette Thompson & Associates, Incorporated, a multi podiatrist practice in KwaZulu-Natal. Tel: 031 201 9907. They run a member service for Diabetes SA members at their Musgrave consulting rooms as a service to the community.
breastfeeding diabetic mother

Breastfeeding and the diabetic mother

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Many diabetic mothers are concerned that their diabetes may be transmitted to their baby via their breastmilk, but this is a myth. Clinic sisters, Lara Kaplan and Timor Lifschitz, talk us through breastfeeding if you are a diabetic mother.

Breastfeeding is best

Breastmilk is the most beneficial source of nutrition for infants. It provides the perfect amount of nutrients, antibodies and immune protecting components for your growing baby.

For women, it is important to remember that having diabetes comes with increased risks of having a caesarean section; delayed milk production onset; a lower breastmilk supply; and risk for candida (thrush) or mastitis infections. All of which can impact breastfeeding.

Health benefits of breastfeeding

For diabetic mothers

  • It can assist to lose weight gained during pregnancy. Remember, it is important for diabetic women to maintain a healthy weight and still get the correct amounts of nutrients while breastfeeding. You may need to develop an eating plan with your healthcare provider.
  • Bonding with baby is enhanced due to oxytocin release. This can help improve how you feel physically and emotionally. In addition, it can help to decrease stress, which can aggravate diabetes.
  • Some mothers may need less insulin post-partum because breastfeeding helps to lower blood sugar levels.
  • Breastfeeding assists in keeping glucose levels more constant. Mothers may have a remission of symptoms during this time.

For babies

  • They are less likely to get ear and respiratory infections, allergies, eczema, asthma, and, more importantly, diabetes later in life.
  • Being diabetic, your baby’s genetic predisposition may be increased but by breastfeeding you can help to mitigate and prevent that risk.
  • A child of a mother who has gestational diabetes during pregnancy has an increased risk of becoming obese during childhood and therefore a risk of diabetes later in life. However, studies found that breastfeeding a baby for at least six months neutralises this risk.

Will your diabetic medication affect baby?

Most medications used to manage diabetes can be safely used while breastfeeding, but you should confirm this with your doctor or lactation consultant. Medications, such as insulin and oral treatments, often must be adjusted in the period following birth under the guidance of a doctor.

Breast milk production

Breast milk production is controlled by a delicate balance of hormones, and any metabolic imbalances, such as diabetes, can interfere with this balance.

Having diabetes – and the increased risk of having a caesarean section – may delay the onset of the milk ‘coming in’, or lactogenesis II.

There is also a risk of baby being hypoglycaemic because of having higher insulin levels in utero of the diabetic mother, due to her higher blood glucose levels. When baby is born, baby gets glucose through breast milk but it is often lower than that in utero.

Colostrum

Colostrum – the very first milk – produced in small amounts and densely packed with nutrients, helps to stabilise blood glucose levels in new-borns.

Pregnant mothers can gently hand express colostrum from 37 weeks under the care of an obstetrician or midwife. The expressed colostrum can be collected on a spoon and then placed into a container. This should be labelled with the date and time of collection, and then placed in the freezer. Expressing colostrum can cause contractions, and it is recommended to stop as soon as you start to experience them.

Once baby is born, mom must remember that breast milk production is all about supply and demand. You need to make sure to feed regularly and on demand. Feeding 8 – 12 times a day will help to empty the breasts and tells the brain to produce more milk.

Skin-to-skin contact

Once baby is born, skin-to-skin contact is important. It keeps baby warm and stimulates hormones to produce breast milk. Feed your baby as soon as possible after birth. The baby needs to be positioned and latched on correctly, if you have any difficulties please contact a lactation consultant.You can ask the lactation consultant to come immediately after birth.

Regular feeds help to stabilise and maintain baby’s blood sugar levels. These can drop after birth due to the higher levels of insulin that your baby’s body generally produces while in utero.

Should baby struggle or be unable to feed, baby can be fed expressed breast milk by syringe or cup. The hospital staff will assist you. If expressed breast milk is not available, mom can look in to donor milk or formula.

24-hour monitoring

The blood sugar levels of babies born to diabetic mothers are monitored for the first 24 hours to check for hypoglycaemia. If the levels drop too low, baby will be fed via other temporary measures so as not to burn more energy trying to feed.

If this is the case, you should continue to express regularly to stimulate milk production. Once baby’s blood sugar levels have stabilised, the staff will stop measuring them. The baby should continue to feed on demand. If the blood sugar levels do not stabilise, baby may need to be admitted to the neonatal unit for monitoring. Here baby will be fed your expressed breast milk.

Jaundice

Jaundice is a yellow discolouration of the skin and sclera (whites of eyes) due to a build-up of bilirubin, which occurs when red blood cells are destroyed and haemoglobin is broken down. A breastfeeding baby of a diabetic mother has an increased risk for jaundice.

These babies are often born bigger and thus have more haemoglobin to be broken down. Fortunately, this problem is treated easily with light treatment (phototherapy).

Lack of insulin in the body can cause ketosis, the presence of ketones. This can pass directly into breast milk, which increases the workload on the baby’s liver and can contribute to jaundice. It is thus important to continue taking your insulin doses and be in contact with your physician. The more baby feeds, the more baby will pass stool, which helps to eliminate the bilirubin out the baby’s system.

Thrush

Diabetes increases the risk of developing thrush and/or mastitis during breastfeeding. This is more likely to happen when your blood sugar levels are poorly controlled.

It is also important to treat breast infections quickly, as they can otherwise increase blood sugar levels. The main symptoms of thrush are: pain in the nipples or breasts – usually a sharp stabbing/shooting pain and itching, burning and sensitive nipples. Sometimes there may be no symptoms at all.

Baby can also have thrush in the mouth – creamy white patches. Baby may be fussy and pull away from the breast while feeding, and have a nappy rash. Both mom and baby do need to be treated together, but you do continue breastfeeding during treatment.

Mastitis

Mastitis is an infection diagnosed following hard, tender, red areas on the breast that may be painful when touched, coupled with flu-like symptoms, such as fever and aching. If left untreated, it can cause a breast abscess.

You should continue feeding on the affected breast and call a lactation consultant to assist you. Ensure the latch is deep, and massage the affected area before and after feeds. You can use paracetamol to relieve pain and reduce temperature, and ibuprofen to reduce inflammation and pain. Try to rest as much as possible to allow for healing. If it does not get better, please contact a lactation consultant to assist you together with your doctor.

Tips to ensure a successful breastfeeding relationship with diabetic control:

  • Remember that during a breastfeeding session, the body uses up large amounts of sugar to produce milk. This can cause a modest drop in blood glucose levels, resulting in a hypoglycaemic episode.
  • Eat before you feed baby to stop your blood sugar levels from dropping. Especially if you are alone when you feed baby. Alternatively keep a snack handy when you are breastfeeding so that you do not have to stop the feed.
  • Mothers who breastfeed will need to increase their calorie intake by an extra 500 calories spread throughout the day, as breastfeeding burns calories. Avoid dieting while you are breastfeeding as your body needs calories for energy.
  • You are more likely to have hypoglycaemic episodes if you start breastfeeding when you already have low blood sugar levels, or if the feeding session goes on for a prolonged period. New-borns usually feed for 45 minutes to an hour, but may be exacerbated if baby is not latching well. If you are concerned, contact a lactation consultant.
  • It is normal to feel thirsty when breastfeeding, and is not necessarily a sign of high blood sugar levels. By monitoring your blood sugar levels, you will be able to tell whether it is due to natural thirst, or if it is caused by a hypoglycaemic attack.
  • Weight loss will almost always result in decreased insulin requirements. As maternal weight drops, medication doses will need to be reduced.
  • It is important to avoid hypoglycaemic episodes while nursing as they trigger the production of adrenaline, which reduces milk production and milk let-down reflex.
  • Rooming-in with baby improves breastfeeding outcomes as you can feed baby on demand and practiSe skin-to-skin to enhance milk production.
  • Avoid taking supplements, such as fenugreek, as it can have a dangerous effect on blood glucose levels. Always discuss medications and galactogogues with your lactation consultant for safety measures.
  • Try to sleep when baby sleeps. Lack of sleep can result in blood sugar level problems related to basal insulin doses.
  • Avoid stress as it can cause blood sugars to rise and stay high.
  • There is a significant association between diabetes and post-partum depression; this risk is exacerbated when blood sugar levels are not well-controlled. If you experience any feelings of inadequacy, major sleep/appetite changes, lack of bonding with baby and thoughts of harm to baby or yourself, contact your physician.
  • Babies often feed more frequently (cluster-feeding) during a growth spurt. Continue monitoring your blood sugar levels regularly and seek advice from your healthcare professional if your insulin/medication regime needs adjusting.
  • Allow your partner, family and friends to assist with caring for baby. Check if there are any ‘Mother and Baby groups’ in your area to connect with other mothers.
  • Always have a snack on hand when you are out with baby. To be prepared, make a special place in baby’s nappy bag for your key diabetes equipment, such as your blood glucose meter; strips; lancets; insulin; and medication.

Team effort

When managed, diabetes and breastfeeding can work but you will most likely need support from healthcare professionals, family and friends.

Your lactation consultant can assist you with any challenges related to breastfeeding. Your multi-disciplinary team must work together to give you and your baby the best start in your breastfeeding journey. It really does become a team effort, and you and baby are the stars!

MEET OUR EXPERT

Timor Lifschitz a qualified nurse and lactation consultant. She comes from a midwifery background and is passionate and knowledgeable about the antenatal, birth and post-partum period as well as child growth and development.

MEET OUR EXPERT

Lara Kaplan is a registered nurse/midwife and certified lactation consultant with a passion for working with moms and babies. She has worked in both government and private sector clinics. She is dedicated to helping moms according to their own needs through the journey of early motherhood.

Type 1 diabetic

Reflections of a Type 1 diabetic: diagnosed during WW2

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Nadine Lang says living with Type 1 diabetes for 74 years has not been problematic. She reflects back to the time she was diagnosed and tells her tale.

Nadine Lang (79) – a widow – lives in Summerstrand, Port Elizabeth and has two daughters and a granddaughter. She moved to South Africa from Britain in 1964.

1944

I was diagnosed one week before my 6th birthday. The onset was very quick; I was constantly drinking, tripping off to the toilet and bed wetting. I landed up in the local children’s hospital and a few days later, all the children, except me, were enjoying my birthday cake. Naturally, my parents were in shock but quickly recovered with the wonderful help and encouragement they received from the hospital staff.

Insulin options

It was only 22 years after the discovery of insulin and there was little choice: only the long-acting Protamine Zinc and short-acting insulin, I think called Soluble. Because I was so young, it was thought better (and kinder) to only have one injection a day, so I was put on Protamine Zinc.

After I left hospital, I used to go every fortnight as an outpatient. The Protamine Zinc-alone regimen proved ineffective, so it was complemented with Soluble. Eventually, the Protamine Zinc was discontinued and thereafter I was only on Soluble twice a day.

Waiting game

I had to wait 20 minutes to half an hour in those days after having my injection before I could eat. This was to allow the insulin to start to work before the food had chance to raise my sugar level. As I became more stable and my mother more confident in coping, my outpatient visits occurred less frequently. They became monthly, then every six weeks and finally every six months, unless a problem cropped up.

I continued to use Soluble twice a day with occasional adjustments of dosage as I grew up until the mid 80s. In fact, I must have been almost the last person to use Soluble as I refused to change until it ceased to be manufactured. I considered myself quite stable on it and had no wish to bother to change.

Changing insulin

From the mid 80s, I still had two injections a day for a long while with my doctors trying different alternatives and dosages. Eventually, around the turn of the century, I changed to Levemir twice a day and NovoRapid three times a day, until recently when my diabetes began to give problems. My sugar readings have always yo-yoed but were getting out of hand. Currently, my doctor and I are trying Ryzodeg twice a day and NovoRapid at lunchtime.

Diabetes old syringe.

Glass syringes

Initially, injections were a hassle. How much easier it is today! Back then, there were no pumps, pens or even disposable syringes. Only glass syringes, which had to be sterilised by boiling in water and/or be kept in spirits. Needles were longer and thicker by today’s standards. Mine were often re-sharpened when they got blunt as we were too poor to buy new ones.

Sugar test by urine sample

Another problem was testing sugar levels. We had no blood testing with a glucometer. It was urine testing with a test tube, a spirit lamp and Fehling’s or Benedict’s solution. Once mixed together and heated, the results merely showed whether there was no sugar (no colour change); green (a little or 1+); yellow (more or 2+); or red (far too much or 3+).

Later, it was easier by dropping a pill in the test tube which contained a sample of my urine. Then it became a paper strip which just had to be held in the urine flow. Urine testing was never very accurate but we managed.

If one was feeling hypoglycaemic (having a low), it was useless to test to ‘prove’ one was indeed having a low as the urine could be ‘stale’. Comparing those urine test readings with today’s blood tests with glucometer readings, one realises just how inaccurate they were.

I must admit, because testing was such a hassle, from my early teens I never tested unless I was going to the doctor or if I was pregnant. I relied on how I felt. This was until glucometers and the new insulins arrived.

Weighing what you eat

Because testing results were so limited, diets were rigid. Everything had to be weighed. It was 1944, in wartime Britain with food rationing which persisted for several years afterwards. Though, diabetes patients were allowed extra meat, cheese and butter in place of sugar and sweets.

There was little choice and apart from diabetic apricot jam, which came in a jar not unlike the old small anchovette jars. There were no alternatives for many years, such as tins of ‘lite’ or sugar-free versions of fruit, custard, biscuits, soup, sweets and cool drinks, etc.

Finding a good paediatrician

When I went to kiddies parties, I was not allowed any sweet things the other children had. Instead my mother would make me blue jelly made with gelatine and colouring. When I was about nine, I was lucky to get a new paediatrician. He explained as he had four children himself, he knew all too well that children broke rules, and it was better to break the rules of rigid dieting and times of eating and learn how to avoid problems that could ensue. Which I did.

His reasoning has stood me in good stead and I have enjoyed everything that life has offered me. My diabetes has not prevented me from doing anything. At school I was treated like everyone else. Only once, in primary school, was it a problem when teachers were hesitant to take responsibility for me on a day trip out of town. Thankfully, my mother came so I enjoyed the outing.

No diabetologists

In the early days, there was no such speciality as a diabetologist. You either saw a GP or specialist physician. I was under the care of a diabetologist for several years.

Over the years, I have seen several other medical experts, such as podiatrists and dietitians, etc. There is always something new to be learned. For instance, I find it fascinating that there always seems to be a newer insulin on the market, which is ‘better’ than the others. I must admit, I do not always follow the changes, particularly if I am stable. It is both wasteful and expensive if the new is ineffective, since insulin usually comes in batches of 5 pens. At times I was left with some I couldn’t use.

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Diabetic pen pal

At 16, I stayed with my diabetic pen pal in Holland for five weeks. I also went on the first three overseas trips, organised by the British Diabetic Association; twice to Switzerland then to Austria. At varsity, I participated in several extramural activities, where I met my husband, Cyril – a South African. We both became dental surgeons and spent many years together in private practice. I have been fortunate to have travelled extensively, enjoyed a variety of hobbies, been involved in several community and charitable organisations and studied further.

Starting a family as a Type 1 diabetic

After finishing varisty, Cyril and I migrated to South Africa, finding I was pregnant with our first child. When I was pregnant, urine testing and Soluble insulin were still common practise. I would test meticulously and watched my diet, though I had given up weighing my food years before. There were no dietitians in town and I relied on past diets, experience and my specialist physician and gynaecologist. My daughters have not inherited diabetes, and as far as can ascertain, I am the only one of my many cousins who has it (I am an only child).

Type 2 diabetic husband

However, I am ashamed to admit that I failed to recognise the symptoms when my husband developed Type 2 in his seventies. Though he complained of a dry mouth, I was more concerned with his sudden and dramatic loss of weight. When we were given the diagnosis by the doctor, I burst out laughing both with the relief that it was not cancer and at my stupidity. My husband was on insulin for a couple of weeks, then moved to tablets for the rest of his life. He only retired at 83 when he had a successful quadruple bypass heart operation. He lived very well afterwards until his sudden death of natural causes, a month short of 88.

Can’t picture a life not as a Type 1 diabetic

I really cannot imagine my life without diabetes. Starting so young, I have little recollection of life before it arrived. My experiences, when things were more difficult, taught me to be more self-reliant; to be pro-active and not reactive; and not to take risks.

I am well aware of how infections and relatively minor illnesses can upset my diabetes control. Thus, I always seek medical advice sooner than later and have flu vaccinations and the like. But, with that said, I don’t worry about all the other diseases that diabetes may lead to because they can affect the normal population too.

Fear of an amputation

However, I am petrified of having an amputation. I only buy shoes that I have fitted properly in the shop. Though, I once bought a pair of shoes with had a label inside, just over the toes, which I could neither feel nor see. The next day, my big toes, on both feet, were septic. I sought a doctor immediately. I lost the toenails a couple of days later. The doctor and my podiatrist admitted how lucky I was not to have needed surgery which they had both anticipated.

Personal records

Since the mid 80s, I have kept a record of my tests, insulin taken and food eaten. I find it useful when things go haywire to see why, by turning a few pages back to find similar circumstances and compare. Also, I am never without sweets, chocolate or biscuits within reach, in case of a low.

Past vs Present

I read the labelling on foods in supermarkets these days and know the contents are listed in order from highest percentage to least. These labels weren’t always listed in the past. Also, one must be wary of ‘lite’ now that our government is promoting less consumption of sugar. Some cool drinks are ‘lite’ with no sugar, but others are ‘lite’ in the sense they that they contain less than the normal product but far more than a diabetic should have.

There is definitely an element of luck with my surviving so long. When you get to my age, you’ve lost many friends along the way. I’m lucky. My only handicap at the moment is that I am very hard of hearing and getting slower with age.

Article written by Nadine Lang.