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PORT ELIZABETH BRANCH

Happy 90thbirthday Jean


At our September Diabetes Wellness meeting, held in the Caritas Service Centre, we celebrated the 90th birthday of Jean Cawood.

She regularly attends our monthly meetings even during the cold winter months. Jean brought the most delicious diabetes-friendly homemade muffins for us to enjoy with our coffee and tea after the meeting.

Candice Kemp from Virgin Active was our guest speaker and Jean participated in all the weird and wonderful exercises that Candice demonstrated. Jean is currently in England visiting some of her family.

Jump for diabetes 

Our second annual Jump for Diabetes was held, on Sunday 28 October 2018, at the Gravity Indoor Trampoline Park, Port Elizabeth.

Paula Thom, convener of the DSA Young Guns, hosted this fun-filled afternoon with Kureshin Reddy, owner of Gravity Indoor Trampoline Park.

While the youngsters enjoyed jumping, they also helped raise awareness of diabetes and some much-needed funds.

Highlights from EASD 2018

Dr Louise Johnson gives us a brief overview of what was presented at the European Association of the Study of Diabetes (EASD) Annual Meeting 2018.


From fear to hope

The meeting started with a lecture titled From fear to hope. The lecture was about Dr Banting who discovered the first insulin and moved through the history of insulin up until till where we are now with the second-generation basal (long- acting) insulin. Both insulin glargine U300 (Toujeo) and degludec insulin (Tresiba) are available in South Africa.

The new direction in diabetes with insulin is not only the HbA1c (average three-month blood glucose value) but also glucose variability. Glucose variability is the time spent within target range. This is established with the help of a continuous glucose monitor (CGM) sensor that measure blood glucose every five minutes and displays it on a screen or a cell phone app. Currently, there are five different CGM monitors available in South Africa.

The target range would be a variation of blood glucose between 5 and 10 mmol/L in a 24-hour period. The more time spent within this range, the less likely the appearance of complications.

The lecturer, Dr Rosenstock, showed data from Diabetes Care (2017, 40 :554) that correlates the time in range and the presence of retinopathy complications. 

The BRIGHT study

The results of The BRIGHT study – the first head-to-head randomised clinical trial comparing the two new basal insulins: Toujeo and Tresiba – were released.

The results showed no difference in HbA1c over a 12-week period. The glucose variability between the two groups were the same.

It is important to remember with these second-generation basal insulins to only adjust the insulin dosage once every week, due to the long-onset of action. Toujeo is 32-hours and Tresiba is 42-hours. This gives the advantage of flexibility and less hypoglycaemia, especially at night time.

Diabetes – a diverse and heterogeneous disease

Another highlight was a talk, by Dr James Gavin III, titled Diabetes – a diverse and heterogeneous disease. The core message was that our current diagnosis of Type 1 and Type 2 are not correct anymore since there are a lot of overlapping. The importance of a diagnosis is to be able to predict, prevent complications, and plan correctly.

The new diagnoses are in clusters:

  • Cluster 1 – Severe autoimmune diabetes (previously most of Type 1 diabetes). This has early onset of disease at a young age, relatively low BMI, poor metabolic control, insulin deficiency and the presence of auto-antibodies (GAD antibodies).
  • Cluster 2 – Severe insulin deficient diabetes. This is early onset of diabetes with a relatively low BMI and poor metabolic control. There is low secretion of insulin but the auto-antibodies are negative.
  • Cluster 3 – Severe insulin resistant diabetes (most of Type 2 diabetes fit in here). These patients have high insulin levels and a high BMI.
  • Cluster 4 – Mild obesity-related diabetes. These patients are obese but not insulin resistant.
  • Cluster 5 – Mild age-related diabetes. These are older patients that are not insulin resistant

The importance of the new diagnosis classification is to not only focus on blood glucose control but also on disease modification. It was also stressed to get blood glucose to target early in the disease and this will prompt the legacy effect. The body will remember the good control for years afterwards and prevent complications.

What is new on the drug scene?

The new wonder drug in the Type 2 diabetes arena is the class of drugs called sodium glucose co-transporter 2 inhibitor (SGLT2). This class works on the proximal (first) part of the kidney tubule and blocks the absorption of glucose back into the body. The result of this is glucose in the urine. But there is more:

  • Three to six kg weight loss.
  • Blood pressure reduction.
  • Better blood glucose control.
  • Most important is reduction in the mortality of heart attack and heart failure.

In South Africa, we have dapagliflozin (Forxiga) and empagliflozin (Jardiance).

There is a new drug in this class that is now being tested in Type 1 diabetes. It is called sotagliflozin and works mostly on the gut. It prevents absorption of sugar from the gut and improve glucose in Type 1 diabetes, especially after meals. This drug is still under investigation and is not available yet anywhere in the world. The preliminary data shows the same reduction in mortality.

Can Type1 diabetes use the SGLT2 class?

The two SGLT2 inhibitors, Forxiga and Jardiance, currently available in South Africa are not registered for Type 1 use. The reason is the increase in diabetic ketoacidosis(DKA).

DKA can be fatal if not picked up early and it’s not suggested for Type 1 diabetes. Rather wait for the appearance of sotagliflozin that works mainly on the gut.

Focus on other targets

During the meeting, it was reiterated that diabetic patients should not only focus on glucose control but also blood pressure target below 130/80mmHg, LDL cholesterol below 1,8 mmol\L and not smoke at all. Regular, light exercise was also emphasised. It was shown that if more of these goals are met, the cognitive improvement, especially in older individuals, is achieved.

Does pneumopathy exist?

The last day ask the question Does pneumopathy exist? Pneumopathy is the presence of lung disease without other factors, such as smoking or lung infection being present.

There are only 64 papers worldwide but there is enough evidence to show that a restrictive lung function pattern does exist in long-standing diabetes. The data showed an incidence of 25%. The best predictor for lung disease is the presence of kidney disease. The treatment currently seems to be good control and regular exercise to improve lung function.

The microbiota in diabetes

The final but most riveting session was: The microbiota in diabetes. The microbiota is the normal microorganisms that stay in the gut in the faeces (stool). It was shown how the organisms differ between disease states.

The current thought process is that the microbiome first change to that of Type 2 diabetes and only later does the blood glucose rise. This is a fascinating area since correct diets could have the potential to prevent diabetes. This is unfortunately still early days but keep your eyes peeled.

In summary

Healthy diet, especially if you or your loved ones do not have diabetes yet, is important. Plus, low blood pressure, low cholesterol, low blood glucose and regular exercise are important.

Talk to your healthcare provider about the new drugs and monitors.Remember that the scientists are working diligently around the clock to find to a cure!

Dr Louise Loot

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Dr Louise Johnson is a specialist physician passionate about diabetes and endocrinology. She enjoys helping people with diabetes live a full life with optimal quality. She is based in Pretoria in private practice.


Photo credit: www.blacknote.com

From a mother’s mouth: time-saving lunch boxes

Rita McLuckie, mother of Ethan – a Type 1 diabetes patient, shares her tips for time-saving lunch boxes.


As moms, we are ruled by routines. This may sound familiar to all mothers of all backgrounds, in all countries and of all cultures. Starting early in the morning, after getting ourselves presentable for the day and before heading off, for most of us, to a full day at work, there are many little things that need to be done. My biggest annoyance in the morning has always been “What do I pack in the kids lunch boxes today?”

Son is a fussy eater

I will be the first to admit that I am terrible at planning, I am indecisive and always running late. To top that, I have a extremely fussy eater in Ethan, my 10-year-old son. He has been living with Type 1 diabetes since he was 16 months old. Ethan also has epilepsy and is being treated for attention deficit disorder (ADD).

Some can say that fortunately the hunger-robbing Concerta is counteracted by the hunger-inducer Epilim. Though this is true to a certain degree, Ethan is naturally a person who does not enjoy eating. The only exception is when his blood sugar is dropping sharply, then he becomes a hungry little PacMan.

Thumbs down to an old-school sandwich

Neither of my sons (I have a teenage son Aiden) were ever particularly fond of the old-school favourite – the sandwich. This is a good thing though, since this traditional lunch box filler, coupled with fruit and the occasional treat, is high in carbohydrates.

Nonetheless, Ethan has to eat and because he is reluctant to eat bread, this presented a huge challenge for me. Ethan must eat to maintain good health. If I know he is eating I don’t worry about him at work. Also, Ethan is rather small for his age. With a BMI of 16, he cannot afford to lose any weight at all.

Adapt and plan ahead

As a result of my own tardiness and indecisiveness, and most of all ensuring Ethan has a good selection of snacks to choose from, I have had to adapt and plan ahead a little.

My way of coping is to pre-pack smallish snacks which I can then pop into both kids’ lunch boxes in the morning. The snacks that I tend to go for are: sliders or mini burgers, mini protein filled pancakes, mini pulled beef naanwiches, samosas etc. These are all readily available, with varying prices, from Checkers, Pick ‘n Pay or Woolworths.

I accompany the little convenient snacks with fruit, a dairy (usually different cheeses) and a protein, such as biltong, nuts, meatballs, sausages, fish fingers/cakes. I know that my inclusion of carbs will probably be frowned upon by many in the diabetic community. However, when you have a child who would rather do almost anything than eat, I have had to compromise.

Provide a choice

The whole purpose of the lunches I pack is so that Ethan can choose what he wants to eat. He is not expected to finish absolutely everything in his lunch box.

I write the carb value for each item in his lunch box on a Post-it or similar sized note paper. Once he has decided what he wants to eat, he boluses himself for the carbs for each of the items he has chosen to eat. This way, I don’t have to worry about his blood sugar dropping too low as a result of him not eating enough for the insulin he is injected.

When Ethan’s blood sugar has gone low, the quickest way to fix it, usually involves high-sugar foods or juices, provided by a panicked teacher or school staff member, which then inevitably causes a high blood glucose reading later.

Aftercare lunch

We are fortunate in that the school aftercare lunches Ethan receives are relatively healthy cooked meals with a fruit in the afternoon. If Ethan does not want to eat the aftercare lunch on a particular day, he usually still has some snacks in his lunch box to choose from.

Lunch in pictures

Below are images of my box of snacks, usually pre-packed by me on a Sunday evening, and the resulting lunch boxes from Monday to Friday.

Lunchbox planning

Wednesday

lunch box

Monday

lunch box

Thursday

lunch box

Tuesday

lunch box

Friday

lunch box

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Rita McLuckie lives in Benoni, Gauteng.