The see-saw of life

Noy Pullen tells us about the see-saw of life when living with diabetes.

When I got the email with the theme, The highs and lows of living with diabetes, for the winter issue of Diabetes Focus, two parts of me start wrestling, like Jacob and the angel – the informed scientific one and the creative artist. One instance of the see-saw of life.

One thing you can learn from the creative process is to use what comes to meet you. The material is not always obvious. You need be awake to possibilities, to recognise the miracle in the day. Or, to use the modern term – be mindful.

The day I got the emailed theme, two things happened which energised me. A radio interview with South African, Paddy Upton, a renowned cricket coach, about his new book: The Barefoot Coach. Something drove me to go and buy his book immediately.

Then came a post on Facebook from a friend whose younger daughter, aptly named Faith, has certain mental and physical difficulties. It read: When she can’t do something, Faith doesn’t say “I got it wrong”, she says, “I’m learning!”

This and Paddy Upton’s use of a quote of T. H. White’s The Once and Future King, where the wizard, Merlin, gives advice, “You may grow old and trembling in your anatomies, you may lie awake at night listening to the disorder of your veins, you may miss your only love, you may see the world about you devastated by evil lunatics, or know your honour trampled in the sewers of baser minds. There is only one thing for it then – to learn…That is the only thing which the mind can never exhaust, never alienate, never be tortured by, never fear or distrust, and never dream of regretting.”, 1showed me my direction for the article. We can learn.

How do we communicate? From autocrat to collaborator

Living or working with diabetes affects everyone nowadays, even if it is only being aware of the dangers of a careless lifestyle.

The current way of giving so-called health education (via recommendations, instructions and advice) when dealing with patients, whether with diabetes awareness, prevention and management, has been found to be ineffective according to many of our participants on the Agents for Change modules.

Comments that are shared are: “The patients are non-compliant.” The term that is used on patient records is defaulter. All health providers are trained in what is called health education. This is a similar model of that of the coach who has the strategies, the answers and the plan that the players need to obey.

Paddy Upton introduces a refreshing possibility of collaboration through questions, self-reflection and opportunities for growth in both the player and the coach. Learning effective ways based on conversations.

Our philosophy was to create an environment that empowered the players to think and decide for themselves. For the players to be able to make good decisions, they needed to become and be treated as the leading experts on their own lives, physical, mental and spiritual. No one knows you better than you do, and sometimes you just need a bit of help in allowing that understanding to emerge from within you.” 1(p103)

When my son, who is living with Type 1 diabetes, had to undergo surgery, his surgeon said to him, “You know your body better than anyone so please advise the surgical team on how your insulin should be administered.” The staff nurse had the same request. An empowering discussion followed and all ended well.

See-saw of patient-focused rather than disease-focused

The individual who has diabetes is not a diabetic, but rather a person with aspirations and unique talents who also happens to be living with diabetes.

It is by unlocking the potential within that the healing becomes reality. So, that people can radiate their individuality, and not just aim for acceptable blood glucose levels. Vibrant health is not absence of disease; it is empowering self-knowledge and the possibility of development.

Upton explains that when one is criticised, the negative emotion causes the body to produce cortisol, triggering a shutdown in thinking. This can cause one to go into conflict or defence mode, and generate unnecessary stress.

The way to manage so-called failure is to view it in terms of a solution in the future – a learning moment. The person can be asked, “When you are faced with a similar situation in the future, what will you do differently?” Possibilities can be explored in relation to the suggestions, offered by both the person and the coach.

See-saw of head-thinking and heart-thinking

There are two kinds of knowing: head-thinking –  the left brain, logical, academic, instructive, outer and scientific aspect. The kind that has the motto: ‘If it can’t be measured, it can’t be managed!’1

Then there is heart-thinking: the inner space, creative, sensing, inspired and intuitive knowing. The kind when you just know something. You have a hunch, or it just feels right.

Why did I go out to by The Barefoot Coach? What does diabetes have to do with cricket? It is not logical. Within the heart-thinking one finds an ‘ear’ amid the word heart. It has to do with subtle listening with every fibre of your being, to find the direction that the moment wants to go. The health provider or loved one of the patient who can practise this kind of sensing/minding will help develop the sense organs for finding the healthy option in any situation – a truly collaborative effort.

Minding or sensing – being in the zone or in flow

Paddy Upton refers to what he calls the small wins. The ones and twos that are often the runs that can make a difference between winning and losing.

Changing micro-habits that you practise daily. Perhaps ,just one eating habit, a small change in physical activity or a decision to meditate, can deliver significant results.

Tick your own tendencies

Look at the lists of the words below. Invite yourself to tick your own tendencies to add to your self-awareness.

These are natural tendencies which we can acknowledge and treasure as bits of self-knowledge. It is not a self-corrective tool, but rather one to make one more aware of your own one-sidedness. Knowing this may help you with managing micro-habits. This may highlight what you are very good at and you could use this when planning a change.

Upton also shares an amusing thought that some of us are born optimists while others veer more to the pessimistic side. According to George Bernard Shaw, both contribute to society, “The optimist invented the airplane and the pessimist invented the parachute.”

Enjoy finding your position on this verbal see-saw. The right side tends toward flair, flamboyance, exaggeration while the left is strict, law-related, rigid, cold or paralysing. In between these extremes are the lessons we are given by life to become more centred.

Optimist                          Realistic                      Pessimistic

Confident                        Present                       Doubting

Artistic                             Intuition                    Scientific

Feeling                              Holistic                      Thinking

License                             Foster                          Instruction

Success                             Practise                       Failure

Win                                   Grow                            Lose

Flattery                             Collaborate                 Criticise

Fun                                   Play                             Rules

Addiction                        Compassion                Violence

Abandon                     Rhythm                       Rigidity

Enjoy finding your special uniqueness and working with that to change what you choose to change. Change is like singing (or cricket). Anyone can do it with a bit of practice and enjoy the see-saw of life.

For information about the Agents For Change project, contact Noy Pullen.


Reference

  • Paddy Upton: The Barefoot Coach LIFE-CHANGING Insights from Coaching the World’s Best Cricketers. Published by Paddy Upton Coaching

Please contact Noy Pullen if you would like more information: linoia@web.co.za or 072 258 7132.


AGENTS FOR CHANGE IS A DIABETES SOUTH AFRICA PROJECT

MANAGED BY NOY PULLEN

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Screen for life – know your score

We hear why diabetic retinopathy screening, Screen for life, is so important for diabetes patients.


Modern technological advances have made it possible to detect the earliest signs of diabetic disease by taking a photograph of the retina at the back of the eye. A new appreciation of the importance of the detection of any retinopathy has changed the way doctors are managing the disease.

The detection of retinopathy, done by human and artificial intelligence graders, informs the risk of future disease, including blindness. This makes it imperative for people living with diabetes to know their retinopathy score while there is still time to change it by looking after themselves better.

#Redflag communication system

The Ophthalmology Society of South Africa (OSSA) has developed the Screen for life programme to help communicate these important messages, using three red warning flags. The #Redflag communication system is communicated using the patient held record:

  • Screen for life, #Flag 1: Detection of any retinopathy determines the person to be retinopathy positive. This increases the risk of future complications, especially heart attack. The primary care giver needs to be informed of this.
  • Screen for sight, #Flag 2: Detection of sight-threatening retinopathy, glaucoma, and age-related macular degeneration. Referral to an ophthalmologist is indicated for this.
  • Screen for progression, #Flag 3: Progression of retinopathy disease means that the steps to control the disease are not working and more help is needed to prevent severe disease. This will require more urgent intervention by the primary care giver and may require referral to a diabetologist.

All people living with diabetes should be screened to determine whether retinopathy is present. If no retinopathy is detected, the person is advised to be screened in one year’s time. Diabetic patients are encouraged to keep looking after themselves well to stay retinopathy negative. When retinopathy is present, review is advised based on the severity of disease detected. This may be yearly, six-monthly or three-monthly. Once retinopathy is more severe, referral to an ophthalmologist is indicated.

MEET OUR EXPERT


Stephen Cook is an ophthalmologist and works at the Eye Centre which strives to provide a comprehensive eye service to people in the region. He is also a part-time consultant at the Frere Hospital and supports the registrar training programme for Walter Sisulu University. His special interests lie in making medical services more accessible and communication regarding conditions more understandable. He has developed the Screen for life diabetic retinopathy screening programme on behalf of the ophthalmology society (OSSA).


Physical activity for life

Janine Paladin tells us why physical activity is needed in all stages of life, especially in the beginning stages of youth.


Children have extremely high energy levels and have an innate sense to move; this should be nurtured. Children need to be encourage to partake in a variety of sports and movement as it helps to increase brain stimulation as well as enhance gross and fine motor control.

But what if your child has diabetes?

As a parent your first thought is to protect your child and pull them from all sporting activities. You want to hold them and protect them. More than likely, you feel that nobody else can take care of them like you can – which is true. However, exercise is one of the best things for a child with diabetes. Though, understanding diabetes and the effects exercise has on it is key.

Type 1

The onset of Type 1 diabetes is most common among young children. Type 1 diabetes is defined as a chronic medical condition whereby the pancreas produces little or no insulin. Insulin is the hormone needed to transport sugars (glucose) across the cell membranes to be used for energy. Without this hormone (insulin), sugar builds up in the bloodstream which can become toxic to the body.

Type 2

Type 2 diabetes was originally known as adult-onset diabetes as it mainly occurred in the sedentary adult population. However, the prevalence of Type 2 diabetes has risen dramatically over the last few years, especially in young children and adolescents.

Type 2 diabetes is also a chronic condition. The body either resists the effects of insulin or doesn’t produce enough insulin to metabolise the amount of sugars in the bloodstream and thereby cannot maintain a normal sugar level. The cause is mainly due to poor lifestyle choice and inactivity.

The increased use of technology at a young age promotes a sedentary lifestyle and thereby increases the risk of Type 2 diabetes. Technology is like a drug for the younger generations. It filters negatively through all aspects of their lives, affecting their health and mental well-being.

How will physical activity help?

Exercise has so many benefits; the biggest one is that it makes it easier to control blood glucose levels.

It increases the insulin sensitivity for Type 1 diabetics. So, basically after exercise, the body doesn’t need as much insulin to process complex sugars (carbohydrates).

Type 2 diabetics have too much sugar (glucose) but muscles can use glucose without insulin when exercising. So, it doesn’t really matter if you are insulin resistant (Type 2) or if you don’t produce enough insulin (Type 1) as when you exercise your muscles gets the sugar they need. Therefore, blood glucose levels go down.

So, what does this mean for your child?

To go wild and do as much activity as they possibly can. No. Obviously, there are precautions to take as diabetes is a serious condition and if not managed correctly can be extremely dangerous.

Managing diabetes holistically is important. A combination of a healthy meal plan, utilising prescribed medications or insulin with regular exercise will help maintain your child’s blood glucose levels.

Try pick an activity that your child enjoys. Consistent regular exercise is the best and your child is more likely to stick to it if he/she enjoys it.

It’s important for them to test their blood sugar levels before and after exercise to prevent their sugar levels spiking (hyperglycaemia) or dropping too much (hypoglycaemia).

Blood glucose response to exercise will vary depending on:

  • Blood glucose level before starting activity.
  • The intensity of the activity.
  • The length of time you are active.
  • Changes made to insulin doses (Type 1).

Remember to always keep snacks, juice, water, and glucose tabs nearby to assist in keeping those sugar levels normal. If you manage the sugar levels consistently throughout the day, it’s easier to manage it during and after exercise.

Added benefits of physical activity

Everyone wants their kids to be happy and the more active children are, the happier they are.

Plus, promoting exercise into their lifestyle will have other benefits including, weight loss (Type 2), emotional well-being, stress management and acceptance from their peers.

Also, introducing exercise at a young age will help children maintain it as a part of their lifestyle. It makes it easier to continue it throughout their lives as a positive habit.

As parents, we must remember that our child who has diabetes is just like any other kid. They have the same dreams, goals and aspirations and can pretty much do anything that the other kids can. All they need to do is understand their condition and learn to manage it through positive steps and have a great support system through their family and friends.

MEET OUR EXPERT


Janine Paladin currently runs a Biokinetics practice and Pilates studio in Green Point, Cape Town. She completed an internationally recognised STOTT Pilates Course.  She completed a Human Movement Sciences Degree at the University of Port Elizabeth (Nelson Mandela Metropolotan University) obtaining her Cum Laude for her degree.She then continued her studies at the University of Cape Town completing her Honours degree in Biokinetics.


Building blocks of life – Ethan McLuckie

We hear the extraordinary story of 10-year-old Ethan McLuckie, a Type 1 diabetes patient.


Ethan McLuckie (10) stays in Benoni, Gauteng with his parents, Craig and Rita, and his older brother, Aiden.

Little scientist

When you meet Ethan, you instantly recognise just how intelligent he is. He loves building things, especially from Lego pieces and proudly shows off his latest creation. In fact, he was the youngest person to have taken part in the Lego Expo 2017. His parents call him their little scientist. “He has such unique interests, he loves robots and is always watching documentaries on space. He can tell you about the speed of light and black holes. A few years back, he called himself a cyborg because of his continuous glucose monitoring system,” Rita explains. Not only is he smart but for a 10-year-old boy, he handles his Type 1 diabetes with utmost ease and acceptance.

Sickly baby

Ethan was born with a cleft of the soft palate. As a result, he had many ear infections and was put on plentiful cortisone and antibiotics. He had his first grommets at three months and at the age of five months, his palate was repaired. Rita believes the trauma of this could maybe explain why Ethan developed Type 1 diabetes as there are studies that say childhood trauma may increase the risk of Type 1 diabetes.

Then when Ethan was 16 months old, in April 2009, the McLuckie family went on holiday. Ethan had transformed from a puffy marshmallow (from the cortisone) into a skinny baby with no baby fat. At that time, Ethan was still in nappies and the urine seeped through them. Rita assumed the nappies were just a poor-make brand that she had bought, reasoning why she had to change his bed linen three times a night. Ethan also had an insatiable thirst.

Once the family got back from holiday, they went straight to a paediatrician. Luckily, due to Craig having studied medical biochemistry (he had written a paper on diabetes), he immediately linked the symptoms to diabetes. Ethan was listless and had dark rings under his eyes. By this time, they could smell the ketones in his breath (a fruity acetone smell).

The paediatrician, after seeing the sky-high results of the urine dipstick, instantly referred Ethan to a paediatric endocrinologist. Insulin was administered in the paediatric endocrinologist’s rooms and within an hour Ethan was up and running around. “He didn’t have to be kept overnight. The change due to the insulin was remarkable,” Craig says.

Epilepsy

Then at age 4, Ethan was diagnosed with epilepsy. Rita says epilepsy is quite common in children with Type 1 diabetes. It took a while for doctors to get to the diagnosis as at first they suspected Ethan had a heart problem. Fortunately, for the past two years Ethan hasn’t had a seizure and he continues taking his medication – Epilim. Interestingly, when Ethan had fits, his sugars levels were always normal.

Hope from a friend

A family friend, who also has Type 1 diabetes, gave Craig and Rita hope. He showed them that life can be lived to the fullest with diabetes. He was diagnosed as a kid and is still doing well. The friend also proved the warning of not using the same spot to inject insulin true, as he had fatty deposits on the side he favoured (as it wasn’t that painful) to inject.

Injection woes

When Ethan was diagnosed, his treatment regime was long-acting insulin (Lantus) during the day and at night he was on fast-acting insulin (Humalog), and Humulin N insulin. An injection was used, which was quite traumatic for him, as an insulin pen couldn’t administer such small doses (less than half a unit). Even using an injection proved arduous to get the exact dose that was needed.

However, after a few years of using an injection, Ethan experienced numerous lows and the paediatric endocrinologist suggested he use the insulin pump. Ethan was six years old when he started using a Medtronic MiniMed insulin pump.

Changing to a pump

The pump was welcomed by his nursery school teachers as they were quite nervous injecting him. Nonetheless, all the teachers were willing to assist. Though, once when Ethan was having hyperglycaemia, one teacher panicked and rummaged through his bag and instead of using the insulin, she injected him with Glucagon. Craig noticed this when he picked Ethan up and corrected it. “We can look back at it now and see it as an anecdote but back then it was scary,” Craig says.

For the first two years of using the pump, Ethan’s teachers would help him with it. A book was kept where they recorded what he ate and monitored his sugar levels. But now, Ethan manages the pump himself. The added-bonus is that his current teacher is also a Type 1 diabetic. Rita says, “The great thing with her is that she doesn’t baby him but rather encourages him to do it himself.”

About two years ago, Ethan was put on the Dexcom continous glucose monitoring system.  The Dexcom has given Craig and Rita better sleep at night. “If he has a high or a low, it sounds an alarm so we are not having interrupted sleep like we used to when we had to check his levels,” Craig says. Rita adds, “We still check the monitor readings every two hours, but it is just opening one eye and then seeing white lines and saying ‘Yay!’ and going back to sleep.”

Taking responsibility

Ethan is not a good eater so Rita packs him a variety of food items to choose from. She then writes all the grams of carbohydrates of the items on a Post-it and leaves it in his lunch box. Then once he chooses the items he wants to eat, he adds the carbs together and adjusts the pump dose accordingly. “It helps with his maths too,” Rita says.

Craig explains that Ethan is at the stage now where he can recognise if he is having a hypo or hyper and alerts them. They have also found an advantage to Ethan having diabetes – they can pick up when Ethan is coming down with something, like a cold or the flu. “Literally, 24 hours before he starts to show the symptoms, his blood sugar levels will go up and we can’t get them down. Then we start giving double-doses of insulin, taking up the basal rates up to 150%+. So, the advantage is that you can almost pre-empt when the body is going under extra stress,” Craig says.

Food is foe

Craig and Rita find it very hard to go out to eat as a family. Not many restaurants have the nutritional content of their food items so Ethan can’t ever try something new. “The only restaurant that gave us a booklet on the nutritional content was Wimpy,” Rita says.

Then also because Ethan is not a good eater, and has low muscle tone so he doesn’t like to chew a lot, they find that his sugar levels are low as he doesn’t always eat dinner. “We will open the fridge and low and behold there is his full dinner plate,” Rita says. “Then during the night, his sugar will go low…try feeding a sleeping child! We normally give him milk with a bit of sugar in it, as the fat in the milk rises the sugar levels slowly.”

Luckily Ethan loves nuts, biltong sticks and yoghurt. Rita gives him the full cream yoghurt as it absorbs slower. She admits breakfast is tricky as Ethan eats slowly; they solved this by giving him smoothies to drink. But now, Ethan seems to like French toast.

The family did try the whole carb-free diet. However, Aiden, their  teenage son has a huge appetite. So, this had to change.

Trial and error

On average, Ethan has insulin four to six times a day at mealtimes. Though on weekends, it can differ due to not being in his normal routine.

Craig and Rita have also discovered that Ethan’s body reacts differently to insulin at different times of the day. In the morning, from time to time, Ethan’s body isn’t that sensitive to insulin so they will have to inject him almost 45 minutes before he eats, where the normal time is about 10 to 15 minutes.

“If we inject the usual time, then he has a spike at school and they try to correct it, then he has a drop. It is a nightmare! These are the things that no one teaches you and you must learn for yourself. And just when you think you are on top of it and you have worked it all out, sugar levels go crazy, or he has a growth spurt or the sniffles, or his port gets blocked,” Craig and Rita say.

“In the afternoon, every so often, Ethan’s sugar levels can go a bit low. It is partly due to him being active as he is at aftercare and running around. His sensitivity to insulin also increases so less insulin can give the same result.”

Concerns as parents

To date, Ethan has never slept out, not even at his grandparents. Next year will be the first year that Ethan will go on a school camp. Rita is besides herself as she doesn’t know if he can go unless the school allows her to go with. Plus, she is worried that he will be upset if he can’t go. But her biggest concern is she doesn’t want him to miss out. “At the end of the day, he is just a normal little boy,” she says.

“If he is invited to children’s’ parties, you can’t expect parents to put out broccoli or carrot sticks. It’s hard. Recently, a child celebrated his birthday and the parents bought the whole class McDonalds. But we are proud to say Ethan came home with it, he had two tiny small bites and then his brother got hold of it,” Craig says.

Though once Ethan is a bit older, they would like to send him on camps for children with diabetes.

Hard on the family

Due to Ethan being diagnosed so young, he never knew what sweets were. With that said, Rita knows it was harder for her older son as he was told, “No, you can’t have that or else your brother will also want it.”

She also says that it is hard for family members, especially Ethan’s grandparents, as they just want to spoil him with treats. “There is the thinking that if you have a pump, you can still eat whatever you want, but it isn’t like that,” Craig says. “For example, peanuts or sugar-free sweets. These might be safe but all in small amounts. To much sugar-free sweets can lead to diarrhoea due to the aspartame in them.”

Pros and cons

When asked what he dislikes and likes about his diabetes, the 10-year-old responds, “I like that is it easy to control but what I don’t like is getting ports.”

The ports for the pump need to be changed every three to four days. Ethan doesn’t like the ports on his tummy, so it is put on his buttocks. The sensor for the Dexcom is inserted on Ethan’s arm and Rita does this when he is sleeping.

“Last year, for two months, Ethan asked for the injection. He was just fed up with the port and pump. We also like to give him a break from the pump, especially if we are at the beach,” Rita explains.

Tough kid

Ethan is very small for his age and Rita says because of this and the fact that his teachers initially had to give him extra time nd attention to test his sugar levels and inject him, the other children might have resented him a little. As small as Ethan is, he gives as good as he gets and is a tough kid. We concur especially due to the way he has faced all his health challenges.

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


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

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.

A day in the life of a diabetes nurse educator

Christine Manga, a diabetes nurse educator (DNE), explains what her job entails and shares some of the challenges faced as well as the pluses.


I am a diabetes nurse educator. I use this title without much thought. My mistake, not everyone knows what DNE stands for, let alone what we do. So, let me explain what a diabetes nurse educator is, why we are necessary, and what an average day routine consists of.

Part of a team

DNE is an acronym for diabetes nurse educator. A DNE is a healthcare professional who possesses comprehensive knowledge, skills and experience in diabetes management. We work as part of a diabetes management team, along with doctors, podiatrists, dietitians and ophthalmologists. Patients tend to spend more time with their diabetes nurse educator than any other of the team members.

Role

Our role, as DNEs, is to assist patients to effectively manage their own diabetes. We strive to do this through education, coaching and support. Being non-judgemental is of paramount importance.

Because diabetes is a chronic condition – patients have to live with it 24/7 365 – it’s not surprising that managing diabetes effectively requires a lot of time and effort. Patients are required to take various medications at multiple times in the day. These may be tablets or injectables. Regular structured glucose testing is recommended. Constantly being aware of what they’re eating is tiring. It is therefore imperative that DNEs equip these patients with the tools and coping mechanisms to master self-management. We know that each patient is unique, hence we tailor a management plan around this.

First consultation

During the first consultation, a DNE does a thorough history taking. From this information, we can assess diabetes duration, comorbidities, medication, diet, lifestyle, and patient motivation level.

Working within the South African guidelines for diabetes management and taking into account the patient’s preferences and habits, together we can formulate a management plan.

General information is given to all patients. This includes explaining what diabetes is. Many patients are not aware of what diabetes is and the serious complications that can occur without good control. A lot of time is spent correcting misconceptions. We explain the various targets that they should be aiming for.

Basic dietary information including meal planning, portion sizes and timing of meals are explored. Small changes to these choices can result in improved glucose control. Educating patients on blood glucose testing technique, injection technique, needle and site rotation is key to good management.

Explaining how the medication works in the body, what side effects to expect, and what medication may need to be used in the future seems to have improved medication compliance in my patients. Highlighting the importance of exercise and quitting smoking is vital to incorporate.

This generic information is given to all patients. Without the basics, one cannot easily progress.

SMART goals

In future consultations, DNEs coach patients on how to set a Specific, Measurable, Attainable, Realistic and Time-based (SMART) goals. Once the patient has set goals, we sit together and discuss how he/she can attain these goals. These goals are much more than just achieving a good blood glucose reading.

It’s the patient who needs to formulate a plan; a DNE will assist or give potential options that he/she may not have been aware of. By coming up with the solutions themselves, it empowers them and builds self-confidence. It encourages self-management, which is what we are aiming for.

Daily routine

A routine day consists of consultations, checking and responding to patient emails and, in most cases, managing an emergency hotline. Remember, diabetes doesn’t go away after office hours.

Though, saying a day is routine is not very accurate. No two patients ever present in the same way. So, although saying a consultation is routine is true, the content will never be routine. The patient may be in a bad space – unrelated to diabetes – resulting in 90% of the consultation being spent on that issue.

A DNE needs to be flexible. A consultation should have structure, but the content should be led by the patient. Our agenda may not meet the patient’s needs. We need to be attentive to where the patient is leading us.

Pros and cons

As with every profession, there are both rewarding and challenging moments. The most challenging issues being language differences, financial constraints, and a general resistance (from patients) to change.

These changes include lifestyle modification, increasing, changing or adding medication. Resistance is also common when initiating insulin. Financial constraints affect the choice of medication, the amount of testing strips that a patient can use as well as food that can be purchased. All of these have an effect on the way the patient responds to the recommendations.

On the up side, I love being the first person to interact with a newly diagnosed patient. Being able to allay the fear these patients feel is extremely rewarding. Many people are scared when they have been diagnosed with diabetes. They also fear being judged.

As time goes on and my patients come for follow-up appointments, it is wonderful to see how many of them have embraced the diagnosis, worked through and with it. Their self-esteem appears to blossom.

Sadly, this is unfortunately not the case with all patients. At the end of the day, we are all human. Helping one person might not change the world, but it could change the world for one person.

MEET OUR EXPERT - Christine Manga

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

Maintaining a healthy sex life

Newly diagnosed diabetes patients may have many questions at first, but, “How will this chronic illness affect my sex life?” is probably not one of them. However, diabetes and the medications used to treat it can cause sexual challenges for men and women, but with some education and a little extra planning, there’s no reason for diabetes to be a downer in the bedroom.

It’s important to be aware of these possible sexual changes, and to discuss any sexual malfunctions with your doctor no matter how embarrassing you may find the topic.

Women’s sexual health

Most commonly, women who have diabetes will experience a lower sex drive compared to women without the condition.

This can be for several reasons:

  • Blood glucose level changes can cause irritability or a lack of energy.
  • Depression and anxiety associated with diabetes can lower a desire for sex.
  • Anti-depressive medications can lower sex drive.
  • Autonomic neuropathy can lead to vaginal dryness and painful sex.

In some cases, nerve damage in diabetic women can make it more difficult for a woman to experience an orgasm. Sex can also be uncomfortable and unpleasant when a woman has a yeast infection or experiences vaginal itching.

These sexual difficulties are not a normal part of aging and can be addressed if you broach the topic with your doctor. They may suggest the following options to maintain a healthy sexual appetite:

  • Monitor your blood glucose levels closely before having sex to increase energy and reduce irritability.
  • Seek medication for depression or anxiety.
  • If anti-depressive medicines are causing your low sex drive, speak to your doctor about trying a different medicine, or discontinuing the medication and seek counselling instead.
  • Use water-based lubricant to combat vaginal dryness and practice Kegel exercises to relax vaginal muscles.
  • Avoid drugs that may cause painful yeast infections.

Men’s sexual health

Diabetes can also cause sexual complications in men; most notably, erectile dysfunction and retrograde ejaculation. Those with erectile dysfunction cannot get or maintain an erection. In men with retrograde ejaculation, semen empties into the bladder, rather than out of the tip of the penis. In both cases, diabetes-related autonomic neuropathy is likely the cause. This type of nerve damage often occurs when a person maintains poor control over their glucose levels.

In the case of erectile dysfunction, when the autonomic nerves are damaged, they can no longer communicate arousal from the brain to the penis. Similarly, damaged autonomic nerves may stop a sphincter in the bladder from opening, stopping semen to exit the penis. Erectile dysfunction can be embarrassing and makes the act of sex physically impossible. Men with retrograde ejaculation will likely experience infertility.

Additionally, some uncircumcised men who take certain drugs may also notice a high frequency of genital bacterial infections. While neither condition is, painful or causes bodily harm, both can cause problems in the bedroom.

Fortunately, both erectile dysfunction and retrograde ejaculation have solutions. To treat erectile dysfunction, men may consider trying:

  • Oral prescriptions, such as Viagra.
  • Injections of prostaglandins into the penis.
  • Vacuum pumps to draw blood to the penis.
  • Surgical implants.
  • Counselling to reduce anxiety about sexual performance.

To treat retrograde ejaculation, men may consider trying:

  • Meeting with a urologist for a more specific diagnosis of the condition.
  • Medication that strengthens the bladder sphincter muscles.
  • Fertility treatments, such as extracting semen from the urine to use in artificial insemination.
References:
American Diabetes Association. (2013, June 7). Autonomic Neuropathy. Retrieved from http://www.diabetes.org/living-with diabetes/complications/neuropathy/autonomic-neuropathy.html.

American Diabetes Association. (2013, August 1). Sexual Health. Retrieved from http://www.diabetes.org/living-with-diabetes/treatment-and-care/women/sexual-health.html

Auteri, S. (2014, March). How Chronic Illness Can Affect Sexual Function. Retrieved from https://www.aasect.org/how-chronic-illness-can-affect-sexual-function

The National Institute of Diabetes and Digestive and Kidney Diseases. (2008, December). Diabetes & Sexual & Urologic Problems. Retrieved from https://www.niddk.nih.gov/health-information/diabetes/overview/preventing-problems/sexual-urologic-problems

Nyirjesy, P. (2013, May). Genital mycotic infections in patients with diabetes. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/23748505

MEET OUR EXPERT – Taylor Griffith

Taylor Griffith2Taylor Griffith is an award-winning journalist with a background in newspaper, magazine and digital writing. She earned her degree from the University of Maryland’s Philip Merrill College of Journalism. She regularly contributes to drugwatch.com, along with other publications.