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Should I have a flu vaccine?

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Dr Angela Murphy explains why and how a flu vaccine can save millions of lives.    

Every year more than 6000 people die from influenza (flu) in South Africa. Thousands more are hospitalised and many lose income from being absent from work.

What is influenza?

It’s a viral illness which has a sudden onset, causing fever, sore throat, body pains and a headache. In most otherwise healthy adults, it will be an uncomplicated illness and the person will recover within a week.

However, certain high-risk groups, as discussed below, are at risk of more severe infection. Although flu can be treated, it is much better to prevent it. The most effective prevention available is the flu vaccination.

Flu vaccination

A vaccination is designed to get the body to produce an immune response so that when an infection occurs, the body can easily fight against it.

The flu vaccination is an inactivated vaccine i.e. there is no live virus so it is impossible for the vaccine to cause flu.

The flu virus is constantly changing and so the vaccine must be updated every year. The current vaccine contains three different strains of flu which the World Health Organization has predicted will cause this season’s outbreak.

Getting vaccinated

Flu season in South Africa runs from May to September. Ideally vaccination should be done in April as it takes around two weeks for immunity to develop. If during this period, a person is exposed to flu, they may indeed get ill as they would not yet be immune. This illness is not due to the flu vaccine.

It is possible to give the vaccine later in the year, especially in the high-risk groups mentioned below. Preferably, everyone over the age of six months should receive the vaccine, but due to resource constraint the Department of Health has highlighted high-risk groups who are a priority for flu vaccination.

High-risk groups:

  • Pregnant women.
  • Patients infected with HIV.
  • Patients with underlying chronic disease, especially diabetes, lung diseases and heart disease.
  • People > 65 years of age.

Department of Health’s goal

If resources allow, the Department of Health would also like healthcare workers, residents of Old Age Homes, Institutions and Rehabilitation Centres as well as children on Aspirin therapy, aged between six and 18 months, to receive the vaccine.

The dose of flu vaccine recommended by the National Health Laboratory Services is as follows:

  • Adults 0.5ml IMI single dose
  • 3 years – 8 years   0.5ml IMI 1 or 2 doses*
  • 6 months-2 years-0.25ml IMI 1 or 2 doses*

*Two doses should be administered ≥ 1 month apart during first year of vaccination, thereafter one dose.

Side effects of flu vaccine

The vaccine is safe to take in most people but should be avoided if there is a history of severe allergic reaction. Most flu vaccines today are produced using an egg-based manufacturing process and thus contains a small amount of egg protein, called ovalbumin. The Centre for Disease Control in Atlanta, USA recommends the flu vaccine to be safe for most patients with history of egg allergy unless the reaction was life-threatening, i.e. an anaphalaxic reaction. They found in a recent study that the anaphylaxis rate after all vaccines is 1,31 per one million vaccine doses given.

It also better to recover from any flu-like symptoms before receiving the vaccine. Most people will experience little more than the discomfort of the injection. Sometimes there may be a more significant local skin reaction, hoarseness, red eyes, aches and pains, itching and headache. These side effects should not last longer than two days.

How a flu epidemic starts

The flu virus often mutates and different strains arise. When populations are not immune to these new strains, then epidemics arise.

Less commonly, a new strain appears to which most people around the world have no immunity. In this instance, a pandemic arises. The worst of these pandemics started 100 years ago in March 1918 where the Spanish flu killed millions. With today’s improved medical care and availability of vaccines that type of tragedy should not be seen.

Flu vaccine studies

A recent study at Bergen University, in Sweden, confirmed that having the flu vaccine annually improved immunity in the body. The investigators, led by Rebecca Cox, showed that people who had repeated annual flu vaccines had much greater disease-fighting capability than those who did not get the vaccine.

The effects of flu on a diabetes patient

People living with diabetes will know how infection can cause a significant deterioration in their sugar control. Having flu elevates blood sugars due to increased resistance to insulin, and with dehydration it is possible to develop a diabetic ketoacidosis. Paradoxically, hypoglycaemia may also be a feature of flu because of high fevers, sweating, poor appetite and vomiting.

Flu vaccination remains the most effective way to prevent all of this. There are 80% less hospital admissions in diabetic patients who get flu if they have also had the flu vaccine.

Remember, by being vaccinated and becoming immune to the flu, you cannot pass it on. Vaccinate today and keep healthy this winter.

REFERENCES:

http://www.nicd.ac.za/index.php/influenza/

https://www.cdc.gov/flu/protect/vaccine/egg-allergies.htm

https://www.aaaai.org/conditions-and-treatments/library/allergy-library/egg-allergy-and-the-flu-vaccine

http://www.uib.no/en/news/111513/annual-influenza-vaccination-does-not-prevent-natural-immunity

MEET OUR EXPERT

Dr Angela Murphy is a specialist physician working in the field of Diabetes and Endocrinology in Boksburg. She is part of the Netcare Sunward Park Bariatric Centre of Excellence and has a busy diabetes practice.
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What have you gained this year through your diabetes?

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As you reflect on the management of your diabetes in the year 2017, what are the first thoughts that come to mind? Has it been a difficult year where things have gone wrong? Has it been a better year than last year? Have you benefitted from your diabetes in any way?

Hopefully there have not been too many difficulties for you, but if there were, why not try to reframe those difficulties. What have you gained from them? If you don’t believe that you could gain from having diabetes, let me share some ideas of what you probably did gain, over and above all the knowledge you learned as you managed your diabetes.

What you might have gained

  • You developed a greater appreciation of life itself. Diabetes is one chronic condition where you can continue living a healthy life if you follow your treatment well.
  • Your sense of self-worth increased as you realised you really want to live and will do what you have to do to keep living.
  • You developed more resilience – the courage to come back – as you tackled your diabetes each day, even if you did not always succeed.
  • You strengthened your resistance to the tough times and that allowed you to cope better when the tough times came.
  • You learned more perseverance because diabetes is ongoing and requires your input daily.
  • You gained confidence as you coped with the ups and downs and gained experience of what was happening.
  • You developed the capacity to be adaptable and flexible since diabetes is never an exact science and often does the unexpected.
  • You developed the ability to learn from your experiences.
  • You increased your level of tolerance of negative emotions and failures.
  • You have greater compassion and empathy for others who have struggles, especially those who have diabetes.
  • You have developed the ability to maintain courage, hope and informed optimism in the face of diabetes.

Personal growth

So, although negative consequences are usually associated with diabetes, there is positive personal growth too. How many of these qualities do you think you have gained? I am sure if you think about it, there will be at least a little of each. If it is just a little, keep working at your diabetes in the best way you can and you will come to the end of next year with more days of adjustment, inner peace and positive self-worth. At best you will be a stronger person, who is well able to continue managing your diabetes effectively for now and in the future. May 2018 be a year like that for you.

MEET OUR EXPERT

Rosemary Flynn
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.
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Irritable bowel syndrome – do you have it?

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It seems every second person you talk to nowadays has irritable bowel syndrome (IBS), but what exactly is it? Dr Trevlyn Burger sheds insight.

Irritable bowel syndrome is synonymous with ‘leaky gut’ or ‘spastic colon’. It is a condition that affects the function and behaviour of the intestine. It is the most commonly diagnosed gastrointestinal condition and thus has a large impact on healthcare costs. An estimated 10 to 20% of the general population experience symptoms of IBS. Many people experience only mild symptoms, but for some, symptoms can be severe and impact on quality of life and work productivity.

Symptoms
The primary symptoms are abdominal cramping and bloating, a feeling of incomplete evacuation, and altered bowel movements. Some people have frequent, watery bowel movements while others are constipated, and some switch back and forth between diarrhoea and constipation.

Causes
Despite intensive research, the cause of irritable bowel syndrome remains incompletely understood. IBS is a heterogeneous disorder and no single abnormality accounts for IBS symptoms in all patients. Postulated causes include:

  • Post infectious – Some people develop IBS after a severe gastrointestinal infection (e.g. salmonella or campylobacter jejuni). It is not, however, clear how infections trigger IBS.
  • Food intolerances – This raises the possibility that it is caused by food sensitivity or allergy. The best way to detect an association between symptoms and food sensitivity is to eliminate certain food groups systematically (an elimination diet). Note: eliminating foods without assistance from a nutritionist can lead to omission of important sources of nutrition. Several foods known to cause symptoms include gluten, dairy, legumes, and cruciferous vegetables amongst others.
  • Heightened sensitivity of the intestines to normal sensations (visceral hyperalgesia) – The theory proposes that nerves in the bowels are overactive in people with IBS, thus normal amounts of gas or movement are perceived as excessive and painful.
  • Anxiety and stress – These are known to affect the intestine. A strong association exists in patients who have experienced significant early-life emotional trauma.
  • Abnormal contractions of the intestines – There may be an intense prolonged, spastic contraction due to an abnormal electrical system. When two parts of the colon contract simultaneously, the colon between stretches like a balloon resulting in bloating and distension.
  • Alteration in faecal microflora – Emerging data suggests that the faecal microbiota (normal bacterial load in the intestine) in individuals with IBS differs from that of healthy controls.
  • Genetics – Studies suggest a genetic susceptibility in some patients with IBS.
  • Bile acid malabsorption – In some patients, excess bile in the colon may result in diarrhoea-predominant IBS.

Diagnostic approach

Many disorders present with symptoms similar to irritable bowel syndrome, thus it is important to exclude other causes. ‘Alarm’ or atypical symptoms that are not compatible with IBS include:

  • Rectal bleeding.
  • Nocturnal waking with pain and bowel movements.
  • Weight loss.
  • Laboratory abnormalities, such as anaemia, elevated inflammatory markers or electrolyte disturbances.
  • Family history of colorectal cancer, inflammatory bowel disease or celiac disease.

The diagnostic evaluation depends on whether the predominant symptoms are diarrhoea or constipation. The most common conditions that need to be excluded are inflammatory bowel syndrome, hormonal disturbances, infections, diverticular disease and colorectal cancer.

In diarrhoea-predominant, a stool sample is sent for testing and celiac disease needs to be excluded. In constipation-predominant, other causes of constipation, e.g. an underactive thyroid or high calcium need to be excluded.

All persons over the age of 50 years should have a colonoscopy at least once a year.

Treatment

  • Education and reassurance – It is important to establish a therapeutic clinician-patient relationship to validate the patient’s symptoms, and to understand that IBS does not increase the risk of cancer, but that it is a chronic (long-standing) disease. In patients with mild and intermittent symptoms that do not impair quality of life, we initially recommend lifestyle and dietary modification alone. In those with more significant symptoms, we suggest adjunctive pharmacological therapy.
  • Dietary modification – A careful dietary history may reveal patterns of symptoms related to specific foods. More than half of patients’ symptoms are improved by eating smaller meals, avoiding milk products, avoiding fatty foods and gluten.

Patients with IBS may benefit from exclusion of gas-producing foods; a diet low in fermentable oligo-, di- and monosaccharide’s and polyols (FODMAPS), as it is thought that there are bacteria in the colon that ‘feed off’ these foods changing bowel function and behaviour.

There is insufficient evidence to support routine food allergy testing in patients with IBS. The role of fibre is controversial, but given the absence of serious side effects and potential benefits, psyllium and ispagulla should be considered in those constipated.

  • Psychological intervention – Cognitive behavioural therapy may be of benefit.
  • Physical activity – This is advised to be of benefit.
  • Pharmacological therapy
    • Constipation-predominant:
      Loperamide (Imodium) is usually the first line of treatment. Lubiprostone (Amitiza) and linaclotide as second line (not freely available in South Africa).
    • Diarrhoea-predominant:
      Antidiarrheal agents, such as loperamide, as first line treatment. Bile acid sequestrants, such as cholestyramine (Questran and Questran Lite), are used as second line treatment.
    • Abdominal pain and bloating:
      • Antispasmodics as needed.
      • Iberogast
      • Colpermin
      • Simethicone
    • Antidepressants – Tricyclic antidepressants (TCAs) are considered in patients in whom laxatives, loperamide or antispasmodics have not helped. Selective serotonin reuptake inhibitors can also be considered.
    • Antibiotics – Not routinely recommended. A two-week trial of rifaximin may give long-lasting symptom relief, emphasising the role of the gut bacteria. (Microbiome)
    • Probiotics – Not routinely recommended. Although, they have been associated with an improvement in symptoms. The magnitude of benefit and the most effective species and strain are uncertain. Faecal microbiota transplants (stool transplants) are being evaluated in clinical trial.
    • Other therapies – Herbs, acupuncture, enzyme supplements and mast cell stabilisers have been evaluated, but their role in irritable bowel syndrome remains uncertain.

Patients with refractory symptoms should be carefully reassessed, paying specific attention to the type of ongoing symptoms, the degree to which symptoms have changed, compliance with medications, and the presence of any alarm symptoms.

Reassurance that there is no sinister underlying illness is of great importance with these patients as their pain and bowel habits are often abnormal and real, and this can cause anxiety.

MEET OUR EXPERT - Dr Trevlyn Burger

Dr Trevlyn Burger is a consultant gastroenterologist at Morningside Mediclinic, with an interest in inflammatory bowel disease, functional disease and liver pathology.

I have diabetes and I am a theatre scrub nurse

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Nokusa Matlhabe (50) is a divorcee. She lives in Lakeside, Vereeniging, Gauteng with her 18-year-old son. She has Type 2 diabetes.

Diagnosed by gynaecologist

At the age of 32, Nokusa was initially diagnosed by her gynaecologist after giving birth to her second child. Her second daughter was considered a large baby, weighing 4,5kg. This fact, known as macrosomia, made Nokusa’s gynae think she had diabetes.

Being in complete denial, Nokusa ignored what her gynae told her and focused on her new born. Sadly, her second child died three months later due to a heart problem. The brave mother grieved and dealt with the trauma of losing a child, but was overjoyed when she fell pregnant with her third child shortly afterwards. She gave birth to a healthy baby boy, who is currently doing his matric year.

Life carried on and because the mother was asymptomatic she never once gave her ‘so-called diagnosis’ a second thought. However, eleven years later in 2010, the mother paid the price for this choice. She collapsed at home due to diabetic ketoacidosis. Her eldest daughter, who was 20 years old at that time, rushed her to hospital. Nokusa was admitted into high care. She went partially blind and suffered all the complications of uncontrolled diabetes. The doctor at the hospital introduced her to sliding scale insulin treatment. It was time for Nokusa to finally admit and accept that she had Type 2 diabetes.

It was a slow journey to recovery but with the support of her children and her positive attitude she succeeded in her acceptance and self-care. In no time, she was back living her life as normal – only this time taking medication and changing her diet for health purposes.

Control

The theatre scrub nurse is currently on insulin and metformin, and has her diabetes under good control. She will inject before she leaves for work to avoid experiencing a low while driving to work. She tries to eat before her theatre list starts, and loves her Future Life products.

She does, however, find it difficult to maintain her eating times at work (she needs to eats at specific times due to being insulin dependent). This is because she is scrubbed up and can’t find a colleague to relieve her, and can’t leave her duties unattended.

When this happens, she will ask a colleague to fetch her Future Life Smart Drink or Future Life Cereal from her bag. She will have a quick sip or mouthful in order to keep her going. She also keeps sweets or bananas in her bag in case of these situations.

Stress

Even though, her diabetes in under control, the stress of either delaying theatre lists or being late for work due to her check-up days is an issue she struggles with. “Working in the health sector, one would expect colleagues to understand such conditions but it’s not like that. Instead, they think you’re faking it,” Nokusa explains.

Ignoring such behaviour and comments has allowed Nokusa to persevere through her career. “I know I am not faking it and know the importance of eating every three hours, so I just ignore them. Plus, the doctors, like the surgeons, and anesthetists etc. who I work with are incredible. They are understanding and so supportive.”

Hospital employee wellness programmes

Even though the nurse works at a hospital, she says she has never been invited or seen ‘diabetes awareness programmes’ at work. “If there was, I would love to go and get more support from my workplace,” Nokusa says.

Exercise

Nokusa honestly admits she doesn’t exercise as she should. “I have to walk a lot at work and always choose the stairs rather than taking the lift. But, even though, I could walk to the shop from my house, I choose to drive in my car. We get lazy.”

MEET OUR EDITOR - Laurelle Williams

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
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I have diabetes and I’m a senior fraud investigator

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Lauren Grout (30) lives in Pretoria, Gauteng, and is a senior fraud investigator (admitted attorney) at a bank. She has Type 1 diabetes.

 Family history

Both Lauren’s gran and aunt had Type 1 diabetes, however, that never prepared Lauren for the shock of being diagnosed in her matric year. She was fit, healthy, active and was on a well-maintained diet, rarely eating sugary or processed foods nor drank soft drinks. She admits that she was not aware of how one got Type 1 diabetes. “I was hugely hurt, unsure of myself, upset and angry…all the ‘why me?’ questions flooded me. And, being a young woman – all sorts of insecurities followed,” Lauren explains.

Another surprise was all the implications and what treatment would entail: all the snacks required, injections, testing glucose levels, hypos (she had some bad ones), mood swings, diet restrictions and horrible highs.

Treatment

The 30-year-old currently still uses insulin pens (Novorapid and Lantus). She has considered a pump; her GP believes she’ll be a good candidate as she is sensitive to insulin and has lows quite often. The fact that the pump is attached to the body the whole time and must be ‘hidden/kept’ somewhere is somewhat of a deterrent for Lauren. “I also am wary of the location sights – a friend showed me what her abdomen looked like due to the pump,” she adds. But she does see herself eventually making the change in the future as one can control their sugar levels to a greater level with a pump.

Fears

When Lauren began her career as an attorney, she would often fear that she would have a hypo in court and would have to request the magistrate for an adjournment. She was aware that in such instances, it would be understandable and granted but it was still a constant worry. She adds, “I have had moments of doubt; however, it has not stopped me from pursing my dreams or studying further, and I do not believe that it will in the future. But, there are careers that would not really be suitable for a diabetic patient, such as a deep-sea diver, or miner etc. This is due to the risk involved should the diabetic suffer a hypo.

Diabetes in the corporate world

The bank that Lauren works for has been extremely supportive and understanding. She has been open about it, as she attends numerous meetings, which are long in duration, and may need to excuse herself to eat a snack. She explains, “It helps for one’s colleagues to understand your needs etc. In addition, it is a great opportunity to create a greater awareness for diabetes in general.” 

Corporate wellness programme

A free corporate wellness programme is offered through her employer. However, it is managed externally. It caters for all types of concerns, such as physical and mental wellness. Counselling sessions are also offered and remain confidential. 

Eating at work

“I believe in breakfast! So, if it’s a rushed day and I leave early, I will usually have yoghurt and All-Bran, which I keep at the office. Alternatively, I will have a boiled egg or scrambled egg and Provitas/melba toast (as the canteen does not have low-GI bread). Our canteen offers sugar-free smoothies and there is a café with banting options too,” Lauren says.

“Around 10am, I have a snack, either a fruit (apple, plum, pear), biltong, a small handful of almonds or four Provitas with cheese. This depends on whether my sugar level is dropping (then I will have the fruit/crackers option) or if I just need a snack for sustenance (then the protein options).”

“For lunch, I usually take a chicken salad, or I’ll buy a grilled chicken wrap; basil pesto pasta; grilled chicken/beef and veggies or a salad. I also keep a snack in case I need something around 4pm (as sometimes I only get home around 7pm).

Canteen food options

The canteen at Lauren’s office does offer a few healthy options but she feels this could be expanded as the ‘healthy meals get a bit boring after a time’. “Like most large commercial canteens, most of the foods either have added sugar, or have a high fat content. All the things like stir-fry’s, sauces, pumpkin etc. have added sugar, and there is quite a lot of crumbed foods as well as ‘fast food’ like fries, burgers and tramezzinis,” Lauren explains.

“I avoid refined white flour, wheat flour/gluten pasta, high fat foods as well as overly rich foods. However, we have various salad options that one can mix up, as well as grilled chicken/beef wraps, smoothies, veggies, grilled chicken breast, soups, meat options, samp, rice etc. Yet, this depends on the menu for the day. Fortunately, the bank has three other cafés on its premises, which offer healthy and banting options. A bit expensive, but worthwhile for the change at times.”

Misconception

Lauren advises other diabetic patients to tell their employers about their condition. “Being a woman and saying ‘no’ to sugar, many people assume that it is because I’m on a diet to lose weight. I am relatively healthy and slim and this would attract negative assumptions or comments from people, for e.g. “Why won’t you have any cake? Are you on a diet or something? You don’t need to be on a diet!”

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Lauren hiking in Drakensburg with her boyfriend, Georgios Sparis.

She also adds that she often goes on corporate team building, and thus dietary requirements need to be catered for. “But, being open about your condition is mostly important for people to know, if you have a hypo. People need to know what actions and steps to take, as well as who to contact in such circumstances,” she clarifies.

Working out

Exercising is dependent on Lauren’s workload. She tries to exercise at least 2 – 3 times a week for 45 minutes, consisting of a minimum of 20 minutes’ cardio (running usually, or spinning) and weights thereafter.

Support 

Though it has been a challenging journey thus far for the senior fraud investigator, it has become easier to handle. Lauren believes the most important thing is to have a strong foundation of support. “I have a very loving and understanding family, who immediately jumped on board, and we accepted this challenge together. It was not ‘my diet’ and lifestyle that changed, but all of ours, as diabetes does not only affect you, but all those around you. Even within a work environment. Thus, it is important for one to be open with one’s colleagues and staff, and vice versa for a company to be understanding and accommodating.”

MEET OUR EDITOR - Laurelle Williams

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
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I have diabetes and I’m a teacher

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Shelly Schutte (26) currently lives in Krabi, Thailand where she teaches English and Science. She has Type 1 diabetes.

Diagnosed at an early age

At the age of 10, on 19 February 2001, Shelly was diagnosed with Type 1 diabetes. She feels blessed that she was at an age where she could take responsibility for her own injections and self-care in a relatively short amount of time. However, developing the maturity to cope with diabetes in her preteen and teen years that followed was sometimes a challenge. But meeting other teens with diabetes helped. Every year, she celebrates her ‘diaversary’ with a slice of cake!

Diabetes youth camps

Two weeks after the 10-year-old was diagnosed, she attended her first diabetes youth camp in Cape Town. It was here that she realised she would be okay as there were other children out there like her.

“When I am on diabetic camp, I truly feel that I am with ‘my people’- the only people in the world who really share in this thing that is a huge part of my daily life. Being in a room full of others who all must test and inject before eating is a joy and a blessing, that is beyond words. I would recommend attending one, wholeheartedly. At the camps, children learn all about the different legs of the ‘tripod’ of managing diabetes: exercise, food and medication. But most importantly, they get to meet older and younger people with Type 1 diabetes and make friends,” Shelly says.

The 26-year-old doesn’t think the benefits of camp ends at childhood either. She has a dream of establishing a variety of diabetes programmes, including adult diabetes retreats and a ‘big sister/big brother’ programme that couples newly diagnosed diabetics with an older mentor.

Conquering self-doubt

There were times that Shelly believed her diabetes would hold her back, not only in her career but in life, saying: “I think every Type 1 diabetic has at some point. Managing diabetes is hard work: a full-time job on top of your full-time job! It can be difficult to prioritise both when one is being particularly needy or difficult. But there is absolutely no reason for diabetes to hold anyone back. I have pursued almost every opportunity I have wanted to pursue, and I know that when I feel diabetes is holding me back, the problem is psychological, rarely physical. There are so many incredible tools available today to manage diabetes and connect diabetics globally. Being a diabetic means having to put in some extra effort to have experiences and opportunities many consider normal. But it is not beyond reach.”

Openness as a teacher

The high school teacher tests her blood sugar every break time. She eats (and injects) on a regimented schedule and is lucky enough to receive a 45-minute lunch break, with plenty of delicious and healthy options.

She has been as open about her condition as she can, explaining, “From early on, I sent around a ‘protocol’ to describe what to do if I am ever severely low at work or if I am hospitalised and unconscious, such as numbers to call and information to give the doctors etc. I also provided my colleagues with the Youth with Diabetes (YWD) Teacher Handbook and offered to provide more in-depth training for anyone who was interested.”

“I joke about my diabetes a lot and if I am teaching a topic related to endocrinology, I will put a chart up on the wall and we track my blood sugar for the week. This not only teaches students the reality of how blood glucose levels can vary (although to a lesser extent in non-diabetics) but also helps them to understand better what I mean when I need to take 5 minutes out because of a ‘low’. By bringing my diabetes into the classroom, I try to create an environment where students feel free to ask me questions at any point.”

Not only is Shelly honest with her students but with their parents as well. Recently, on World Diabetes Day, Shelly provided parents with the YWD Teacher’s Handbook and gave a short overview of her life story. This was posted to school social media and she has had several positive conversations with parents since.

Travelling and diabetes

This brave young woman has learned so much about her diabetes while travelling, saying, “There are a whole new range of challenges to navigate. Falling ill is a major one of these. My friends and colleagues are wonderful but they don’t fully understand how scary even a simple illness can be. Fears of ketoacidosis, diabetic complications, having a low in my sleep…all are massively exacerbated when I am feeling unwell. The many fears that are a part of having diabetes are quite easily kept at bay most days. But when you are feeling down, diabetes can kick you down quite easily. I have had to learn that when I am feeling like this, the only person who can really take charge and pick myself up again is me. I’ve learned that things often seem worse than they are and even if you’re having a bad week, month or year, you can start again right now!

Logging things religiously has been one of my biggest helpers – from exercise and food to blood glucose…just the simple act of writing these things down helps me feel more in control. This assists me in making more positive decisions regarding my own health. I’ve also had to start being less blasé about seemingly small issues. I cut my hand doing a tug of war just before leaving for a trip to Bali recently. In the hectic days of traveling that followed, I didn’t care for it carefully enough and it got infected. That cost me an expensive trip to a local international clinic and it was a reminder that I always need to be extra careful.

But most of all, I feel like I’ve proven to myself that there’s very little diabetes will ever stop me from doing.

teacher diabetes

Keeping insulin safe

Shelly always travels with a portable cool pack and makes sure she stays in a hotel or hostel with a fridge, and puts her insulin into it straight away when she arrives. Short-acting pens are always in more than one bag. That way, if her bag is stolen, she’ll have short-acting insulin to get her by until she gets properly sorted out.

Obtaining medication overseas

“When I first moved over, I stayed on my South African medical aid and was granted a six month advance of test strips and insulin. After this, I was hopeful I could source my medication locally. I went to the local public hospital soon after I arrived, to make sure they had a file open on me with all my pertinent medical details. When I had two months of supplies left, I visited the hospital again to investigate if I could get my medication there. A friend has epilepsy and she is given her medication for free once a month, as per social security benefits of having a work permit in Thailand.”

“However, as we all know, diabetes is a complex condition that a lot of doctors know very little of. There is also a big language barrier to work around in Thailand. After six hours of queuing and going between floors, I was eventually given two Novomix pens. Now, aside from the fact that two insulins are not enough to last me, I, as a Type 1, cannot be on Novomix! I tried to explain this and eventually got given one Levemir and two Novorapid pens. This is still not enough to last me for long…and I was charged almost 2000 Thai Baht (about R700) for my ‘non-essential’ medical supplies.

This experience, coupled with the fact that small pharmacies are common in the area but majority of them do not sell insulin, I decided just to stick with my medical aid in SA. I return to the country every six months, see my doctor and get all medical tests done and then am given another six months of insulin,” Shelly explains.

The diabetic teacher knows this is not a long-term solution but hopes that in the next country she works in, she will have health insurance as part of her employment contract.

Read Shelly’s travel blog notalllwhowanderarelost.wordpress.com where she writes about her adventures and her diabetes.

MEET OUR EDITOR - Laurelle Williams

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
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I have diabetes and I am a pre-hospital emergency doctor

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Alan Walters (73), a pre-hospital emergency doctor, lives in Noordhoek, Cape Town. He has Type 1 diabetes.

Written by Alan Walters

I currently work as a paramedic doctor; I help run a paramedic/ambulance unit in the Cape Peninsula to the south of the City of Cape Town. My duties involve assisting on the business side, as I am a part-owner, and responding to emergency calls. My emergency response vehicle is covered in colourful stripes, has flashing lights on the roof, and an extremely loud siren.

I am 73 years old, and feel healthy and fit. At times, I carry my 30kg Bergen, oxygen cylinders and cardiac monitor up several flights of stairs to treat a heart attack or other emergencies. I may also have to help remove an injured patient from a wrecked car.

I was 29 years old when I started to lose weight, became very thirsty and passed a lot of urine. Despite being a family doctor in the UK and have worked at a hospital diabetic unit, it took a while for the penny to drop.

Of course, I was upset and worried, not knowing what the future held. I was married with two children and the third was about to be born but I resolved that life must go on. I was surprised by how quickly I got used to the insulin injections. However, adjusting to a proper diet was not easy as I had a sweet tooth but you just do what you should do.

When I was in my forties, I became swamped at work, two of my general practice partners became ill and I ended up working 18 hours a day, for several months. Under a lot of stress, eating the wrong foods, ignoring my diabetic control – I paid the price. I had visual problems and bleeding at the back of the eyes that required a great deal of laser treatment. Fortunately, that did the trick and my vision returned to normal and is fine now. I still pass the eyesight test required to obtain a driving license.

In 2000, my wife and I moved to South Africa after falling in love with the country during a holiday visiting my daughter, who married a South African.

Currently, I go to the gym twice a week, have a personal trainer and can run a kilometre in seven minutes. I have done a fair amount of mountain walking and was a keen skier. I am a qualified scuba diver, although I am not sure if Type 1 diabetes patients can do that nowadays.

Living with diabetes means keeping a watchful eye on your blood sugar with regular finger prick tests and being aware that at times your blood sugar may drop, producing a hypoglycaemic reaction. It is important that you recognise the early symptoms, such as light-headedness, dizziness, and the feeling before the sweating and shaking start.

Fortunately, I have never lost the ability to detect when hypos have started. I always, but always, carry a small pack of sweets in my back pocket. I never ever go anywhere without them, ever since my first traumatic hypo – I had been skiing in Europe and returned to my hotel room. I changed and was going down for my evening meal when the light-headed feeling started. No worries, I thought. I will very soon be eating and didn’t bother eating my sweets and in fact left them in my room. I went down in the lift. The lift broke down on the ground floor and the doors would not open. My hypo got terribly worse – I started to pour with sweat with pronounced shaking. Luckily, the doors were forced open. A waiter saw the state I was in and asked, “What are you worried about? You are on the ground floor.”

“It’s not quite as simple as that,” I replied. My lesson was learnt.

So, what jobs have I done in my life whilst being a diabetic patient? I have been a general practitioner; a hospital doctor working at a surgical colorectal unit; a colonoscopist; an acupuncturist; a British Army doctor serving in Germany; a research scientist involved in experimental treatment for cancer of the colon; and now a paramedic doctor.

As a diabetic patient, you can become pretty much anything you want to be. Okay, so perhaps you won’t be allowed to fly jumbo jets, but never the less, most things. Dr Banting and Dr Best, who discovered insulin, have given us, diabetes patients, the chance to live a pretty good life. Seize it. I love my life and I love my job. No way do I intend to stop soon.

You are in charge of your diabetes. No one else. With efficient care, you too can have a great life!

Careers diabetes

I have diabetes and I’m a…

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Just because you have diabetes, doesn’t mean you can’t achieve your career goals. We hear five inspiring stories of diabetic patients succeeding in their chosen careers.

MEET OUR EDITOR - Laurelle Williams

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
Singer Diabetes

I have diabetes and I’m a singer

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Holly Wasserfall (21) lives in Westville, Durban, and is a house music singer. She has Type 1 diabetes.

Diagnosis

It was a diabetes awareness poster, on the sick bay’s wall at the boarding school Holly attended, that led to the discovery of her diabetes. “I had been feeling unwell for a long time. While I was lying in the sick bay, I read a poster that listed the symptoms of diabetes…this made me think that I could possibly have it,” Holly says.

Holly’s mother picked her up and Holly told her that she thinks she is diabetic. After a visit to their local GP, Holly was diagnosed with Type 2 diabetes, at the age of 9. However, it was only at the age of 11, that Holly was diagnosed correctly with Type 1 diabetes.

“Once I was diagnosed with Type 2 diabetes, I was put on Glucophage and a low-GI diet. I felt marginally better due to the reduced sugar and lower carbohydrate intake but I still felt somewhat unwell. I was suffering with extreme nausea and tiredness. When I went home for half-term in the first term of my grade 7 year, I was vomiting, incredibly sleepy and my vision was extremely blurry.

My mother tested my sugar but it was so high that she could not get a reading on the glucometer. She took me to the nearest doctor, who told her to rush me to the emergency room and called ahead. I was barely conscious when I was admitted to hospital. I was put under the care of a paediatric diabetologist and correctly diagnosed with Type 1 diabetes,” Holly explains.

Denial vs. acceptance

At first, Holly was in complete denial. “I didn’t want to be Type 1 and the idea that I would be injecting insulin for the rest of my life was something I struggled to accept. I kept begging my mom to take me home. I stayed in hospital for almost two weeks; working with a diabetes educator and the nursing staff, learning how to inject and care for myself. At the end of the two weeks, I pretty much had it down. I think having to choose to either master my insulin therapy or leave boarding school, motivated me to accept the diagnosis and move forward,” Holly clarifies.

The young girl got through grade 7 but once she started high school, she struggled to manage her diabetes. This is where music tapped its way into her life. “The high carbohydrate diet presented so many challenges and sport was an even bigger challenge, so I focused on music and it became my coping mechanism. I eventually had to make the tough decision to leave boarding school and go to a school closer to home. Music helped me deal with everything I was going through at the time. It became my best friend,” Holly explains.

House music

The singer started out in Afro Pop music. When she was 14, she went on tour to Cape Town and the band members introduced her to house music. “That was it! Game over! I fell madly in love with house music and the rest is history,” Holly says.

“I started working with some of the pioneers on the Durban house scene, which allowed me to grow and become an artist with a deeper understanding of the evolution of house music, from songwriting to production.”

The ambitious teenager not only recorded her second album during her matric year but released it shortly after matriculating with 8 distinctions.

Sink or swim

Did it ever cross the Durbanite’s mind that her diabetes would stop her from achieving her dream? “No,” she says, “I just found ways to get around any challenges. The music industry is tough and unforgiving; you must be prepared for everything and anything that is thrown at you. It’s just the nature of the beast. Sink or swim. In many ways, diabetes made me tougher and helped me prepare better because you can’t drive to a performance in Nongoma without plan 1,2 or 3 in place, and then a backup plan for the backup plan.”

How does the music industry view diabetes? Holly explains, “The industry is generally accepting but promoters and stakeholders generally want their pound of flesh. There is very little room for self-pity, you must suck it up and keep moving. I am 100% open about being diabetic because I don’t believe I should be apologetic. I believe that openness raises awareness, but I take care of my own needs without any fuss.”

Managing performances

Holly’s tech rider request is sugar-free drinks and bottled water. She travels everywhere with a cooler box with whatever she needs for that day. If catering is provided at events, she makes the best choices she can, depending what is on offer. She will always test her glucose before going on stage. If her sugar levels are low, she will drink a fruit juice or have a snack from her cooler box. Often, when the singer comes off stage, her glucose level is high due to the adrenalin rush and a shot of short-acting insulin is needed.

Career highlights

Performing on the 2015 Cape Town Jazz Festival main stage, when she was just 17 years old, was a ‘seriously big deal’ for her. ‘It still is the biggest moment in my career. Second to that is performing at the Umgababa New Year Picnic to a crowd of 35 000 plus. Mandoza was the headline act but he had to get to another show, so the programme director slotted him in before me. It was insane to get onto the stage after Mandoza. I really thought I was going to crash and burn but somehow, I managed to capture the crowd and maintain the buzz. It was an insane moment for me.”

Current treatment

Currently, the 21-year-old is on insulin pens (Lantus and Aphidra) but is contemplating going on to an insulin pump as when she was first diagnosed, her specialist picked up that she has dawn phenomenon and more recently this has started to play a bigger role in her control.

Regarding fitness, Holly has a personal trainer who visits her my home three times a week. She follows a Paleo-based diet, combined with elements from the Gut Diet, eating hormone-free and genetically modified organism-free organic food. Visit grassfedgirl.com for more information on eating clean.

Don’t hide your condition

Holly is a strong believer in not concealing that you have diabetes, adding “You don’t need to broadcast it but make people aware of it. It’s not only for your own benefit but important that more people become activists for Type 1s. The more we educate people about the disease, the better it is for the future generation of diabetic patients. We need to educate the public that Type 1 is very different to Type 2, and that Type 1 is not caused by bad eating habits. There is a stigma about diabetes that can only be broken down by creating more awareness.”

Follow me @hollymusicsa

    

MEET OUR EDITOR - Laurelle Williams

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

What it takes to have that ‘perfect’ smile…for you

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There is something rather special about a big bright smile. There is a certain warmth that we feel when greeted by someone who is smiling broadly. What is it about a full smile that makes it so attractive? Is there such a thing as a perfect smile? Marc Sher touches on some of the fundamentals of aesthetics in dentistry.

When the human eye sees things in proportion, we immediately find this attractive. This concept is known as the golden proportion or golden ratio, and is mentioned countless times in literature pertaining to cosmetic surgery and dental aesthetics. The golden proportion is an ancient concept, dating back to the times of the ancient Greeks. It has helped us understand why the relationship of adjacent shapes/objects makes it appeal to the human eye. The golden ratio is 1:0.618 or Pi, and is consistent in nature. The ratio between the front eight teeth, when looking directly at the central incisors, is one of these natural concepts that follows the golden proportion.

When the eight front teeth (smile line) of the top jaw follow the golden proportion, they will immediately look attractive; this is what we aim to achieve in dental aesthetics. It will always be a dentist and dental specialist’s greatest challenge when trying to recreate a smile.

The concept of the golden ratio is also seen in the relationship between the lips and teeth, the smile and teeth, and even the eyes and teeth. For any dentist to achieve that perfect smile for their patient, they must understand the golden ratio.

Just to clarify, the perfect smile does not exist in isolation and cannot be copied from person to person. To have a perfect smile is to have the right smile for you. Yes, we follow the principles that can help create that perfect ratio which may lead to a more attractive smile, but to try and achieve ‘perfection’ is only in the eye of the beholder.

Many dentists who specialise in aesthetic dentistry will understand the concept of a smile design. This is a process that we use to analyse a specific patient’s smile that helps guide the dental team in achieving their desired result; it involves using digital photography and videography to evaluate a patient’s smile line, lip line and central line, amongst other important features. We can use this information to digitally design a smile. It allows us (the dentist/specialist) to communicate the needs to the dental laboratory, in order, to create the ceramic/porcelain crowns or veneers which are to be bonded onto the front six to eight teeth (sometimes more) in the smile line. We then communicate this back to the patient. The use of a specialised dental laboratory is essential in this process as the dental technician is the one creating the ceramic/porcelain teeth.

The process of crowning/veneering teeth can be incredibly invasive as the tooth is usually irreversibly cut down to allow the ceramic prosthesis to fit. I, personally, do not advocate the cutting of healthy teeth to change their appearance. Once a tooth is cut/drilled on, there is no turning back. In cases where all other non-invasive options have been investigated and a tooth is already compromised, filled, broken, or missing, only then should the use of ceramics/porcelains be used.

I usually urge a patient to follow a less invasive route if they’re looking at changing their smile line. Orthodontics is my preferred method of moving teeth into their ideal proportion/relationship as orthodontists are incredibly skilled in creating the correct relationship between teeth. I always encourage my patients seeking an ‘aesthetic makeover’ to investigate the orthodontic process. This specific process does involve a sacrifice of sorts; wearing braces or retainers to move the teeth can be uncomfortable, cumbersome and obviously less attractive. However, it is important to understand that it is only a short-term sacrifice in the grand scheme of things, and the benefit is that you do not land up cutting healthy tooth structure.

“We shall never know all the good that a simple smile can do” – Mother Teresa

Tooth whitening

Tooth whitening plays a massive roll in the realm of aesthetic dentistry. I am often bombarded with requests to make my patients teeth whiter. What is important to understand, is the concept of tooth colour and staining. A natural tooth can have a variety of different levels of whites, yellows, blues and, even, greys. Therefore, we classify tooth colour in shades. This can be seen quite easily if you look at your canines; the neck of a canine has more of a yellow shade then the adjacent incisor.

Tooth whitening or bleaching changes the intrinsic (natural) shade of a tooth by penetrating the enamel layer and ‘bleaching’ the layer below, the dentine. The process involves the use of a peroxide-based bleaching agent, and a heated exchange reaction takes place. Tooth sensitivity is a very common side effect. However, it is not long-lasting.

Staining of teeth involves the extrinsic surface of the tooth. This is the after-effect caused by many of the wonderful things we love to eat and drink, such as coffee, tea, red wine, fruits, some vegetables and more. Smoking is also a major factor in extrinsic tooth staining. Fortunately, extrinsic stains can be quite easily removed by an oral hygienist or a dentist with specialised cleaning instruments. I always recommend a professional cleaning before any bleaching procedure is commenced.

All the concepts I have mentioned play a pivotal role in aesthetic dentistry. In today’s times, we can easily become obsessed with our appearance and be incredibly self-conscious of our smile. We may feel pressured to achieve perfection in our smile, and that obsession can alter the very essence of why we smile in first place. The act of smiling is far more important than the way it looks!

It is vital to protect what nature has given you by following a strict protocol of maintenance and prevention. You must also never compromise your dental health and function to achieve an aesthetic outcome. It is however comforting to know that with the help of modern technology in dentistry and with the skilled hands of a dentist, specialist and dental technician, we’re able to create beautiful bespoke smiles if needed.  

MEET OUR EXPERT - Dr Marc Sher

Dr Marc Sher (B.Ch.D) practices at The Dental Practice in Sea Point, Cape Town, and can be reached via email: marc@drmarcsher.co.za