Veronica Tift elaborates why reflexology has a place in working with hyperactive children or adults on medication or not.

As kids we used to have to entertain my hyperactive brother. My mom would insist on my sister and I being outside and making sure we ran around all day with him. Looking back, I think she was trying to tire my ADHD brother out so that he would be able to sit at the dinner table. This strategy seldom worked.

When we were kids, we never realised that there was ever anything wrong with my brother. It was only when he struggled in school, attended extra lessons and went for test after test, did we become aware that he had a problem. To us he was our excited little brother who kept us on our toes always coming up with the best games.

I then married a man with ADHD and he couldn’t even sit still long enough to read this article to the end (he did try to his credit). I guess that’s why when I read the overview for ADHD, I felt a little sad, referring to it as a condition that can’t be cured.

The condition includes difficulty with hyperactivity and impulsiveness. These can contribute to low self-esteem, troubled relationships and difficulty at school or work. While these things might all be true, it’s a simplistic way of describing a condition that is extremely complicated and unique to each individual and their circumstances.

To medicate or not?

The pressure to fit into this society and education institutes makes medication not only necessary but also a blessing for many children or adults. The many friends and family that have taken medication for ADHD have had different reason for taking it, different side effects and experiences about how it affects them.

The decision to put your child on medication if diagnosed with ADHD is deeply personal and dependent on your circumstances, the environment of the child and the child themselves.

As a reflexologist working in holistic healing, I always encourage clients to try the natural route first. As an aunt, cousin, sister and wife of family struggling with ADHD I would say, do what works for you and your family.

ADHD presents its self, differently for many people, so what works for one might not work for everyone. Don’t be afraid to try a combination of different therapy’s until you find the one that works for your child and yourself.

Stimulants

Stimulants are the most common types of prescribed medication for ADHD (methylphenidate or amphetamine). These are equally effective and also seem to carry the same risk. There is either short-acting formulation or a longer-acting, depending on your needs and the child.

The most common side effect according to The Child Mind Institute, is loss of appetite. This can be a scary side effect for parents, especially if your child starts to lose weight and used to be a good eater. Sleeping problems like difficulty falling asleep seems to effect younger children more. Depression can be another worrying side effect.

Working with a reflexologist

Important points that a reflexologist will work on to assist the body with ADHD medication and even symptoms of ADHD will be the solar plexus, digestive reflexes, pineal glands, the endocrine system, the brain and spinal reflexes.

By working on the digestive reflex, it helps stimulate the digestive system, which can possibly assist with the lack of appetite. The solar plexus is a calming and relaxing reflex point helping with insomnia and stress.

The reason we focus on the endocrine system is to help coordinate the body functions like growth, development and general wellness of the body.

Working the brain reflex and spinal reflexes, reflexology can encourage the body to deal with stress, encouraging the release of endorphins among other benefits.

Parents are sometimes worried that their child won’t be able to sit still during a treatment, chat to a therapist beforehand if this concerns you. A light gentle treatment is recommended for children and treatments should be adjusted according to the child.

The amazing thing about reflexology is how quickly most kids responds to regular treatments. The parent or guardian is always in the room and conformed consent is mandatory. Often, I give parents a few techniques to do at home; it’s always special how a child responds to a loving parents touch.

There definitely isn’t a cure for ADHD and while reflexology doesn’t claim to be the answer, it can absolutely be considered as a tool and has a place in working with hyperactive children or adults on medication or not.

References

Childmind.org – complete guide to ADHD medication

The complete guide to reflexology – 2^nd edition Ruth Hull

The complete idiots guide to Reflexology – Frankie Avalon Wolfe, Ph.D, Alpha books

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For many women menopause can herald a rather turbulent time. For women living with diabetes, the turbulence can be tumultuous. In other words, managing menopause and blood glucose presents significant challenges but is possible.

Let’s first make sense of all the terms that get used during this period.

Menopause is officially the time when the ovaries have stopped working and reproductive life is at an end. A woman is said to be in menopause when she has not had a period for a year. The average age range of menopause is 45 – 55 years.

Peri-menopause is the time before menopause when oestrogen levels start to decline and some symptoms of this may occur, for example: sleep disturbances, night sweats, hot flashes and mood changes. This can start eight to 10 years before menopause.

Post-menopause is the time after menopause and is life-long.

Early menopause is when menopause occurs before age 45 years and often there is no other cause.

Premature menopause occurs before age 40 years. It can be due to surgical removal of or damage to the ovaries from radiation or infection. In many instances this is genetic or autoimmune.

Menopause

Cause

Natural menopause occurs due to aging of the ovaries and a decrease in the production of oestrogen. Surgical menopause occurs if both ovaries are removed.

Symptoms

Menopausal symptoms are traditionally divided into:

Vasomotor – This includes hot flashes (sudden sensation of heat in body) and night sweats (these can be in the day as well).

Mood changes – New onset or worsening anxiety and depression; insomnia.

However, there is a long list of other symptoms which women may experience, such as local vaginal dryness and urinary problems; headaches; decreased libido; decreased concentration; hair thinning or falling out, and the one concern almost all women have, weight gain.

Changes in a women’s body at menopause

Oestrogen decreases during peri-menopause and will eventually be undetectable in the female body. Studies have shown that this hormonal change was the reason for decreased energy expenditure. If there is no simultaneous decrease in energy intake, that is daily calories remain the same, then weight gain begins. This weight being gained is all fat. In fact, menopause itself is associated with muscle loss, a condition called sarcopenia. This affects the distribution of weight and hence, the despised middle-aged spread. This increase in fat around the middle of the body as well as the reduction in lean muscle mass is what can cause insulin resistance.

At this time of a woman’s life, she is often less physically active, and the cycles of work stress, family responsibilities and having to deal with unpleasant menopausal symptoms often triggers unhealthy eating. This worsens weight gain and insulin resistance, and of course diabetes control.

Is diabetes more common after menopause?

There is a definite relationship between oestrogen levels and blood glucose levels. The European Prospective Investigation into Cancer Study showed that women with premature menopause had a 32% higher risk for developing Type 2 Diabetes. This data has been replicated in several studies. If a woman has other risks, such as a family history of diabetes or increased body weight, it’s a good idea to be screened for diabetes. Interestingly, women who experience hot flashes and other vasomotor symptoms have an increased risk of developing Type 2 diabetes.

Is diabetes harder to control after menopause?

As mentioned, insulin resistance is a feature of menopause, so this will make diabetes management more challenging. It is possible that there will be a deterioration in HbA1c, requiring an increase in medication, particularly insulin doses. However, key to improving glucose levels is a healthy lifestyle and maintaining a normal body weight.

Treatment

For many years menopausal women with Type 2 diabetes were not offered menopausal hormone therapy (MHT) due to the concern that this would increase the risk of cardiovascular disease. In fact, research has shown benefit rather than risk. MHT can reduce insulin resistance, abdominal fat and improve glucose metabolism, as well as other cardiovascular risk factors, such as blood pressure and cholesterol levels. This is largely due to MHT acting directly on the liver and pancreas.

MHT comes in various combinations:

Oestrogen only – Oestrogen is the hormone that gives most relief to symptoms and overall benefit. Only women who have had their womb removed can use this.

Oestrogen plus progesterone – Women who still have their womb have to take progesterone to stop unopposed oestrogen effect on the lining of the womb which could cause cancer.

MHT can be given either as a pill or patch. Oestrogen alone is also available as a gel. The advantage of giving MHT through the skin (transdermally) is that it does not get metabolised through the liver and this reduces its overall side effect profile.

Side effects

For women concerned only about vaginal dryness, oestrogen is available as vaginal creams or pessaries. As this is only absorbed locally, side effects are much lower.

Overall side effects of MHT are low, especially if used at the time of menopause, the lowest effective dose, shortest time necessary and transdermally. There is always concern about the risk of:

Breast cancer – Risk is seen with more than five years of continuous use of combination MHT and increases in the over 60 years age group. In most instances, women who have had breast cancer or have a first-degree relative (mother or sister) with breast cancer are not given MHT.

Blood clots – All MHT can increase the risk of deep vein thrombosis and lung embolism but this is rare in the 50 – 59-year age group. If a woman has had a blood clot or has a strong family history of blood clots, then she should not use MHT.

Most effective therapy

MHT is the most effective therapy for controlling the symptoms of menopause. Additionally, it prevents osteoporosis and given at the time of menopause provides cardiovascular protection. These latter two are significant advantages in the women with Type 2 diabetes.

Each woman should discuss these pros and cons with her doctor. MHT should improve overall glucose control, but again there can be a variable response. Home glucose testing is important during this time.

Many women will navigate menopause without any treatment or choose herbal or natural remedies. Women with diabetes need to be aware of the risk of deteriorating glucose control. As always, the most effective protection and management of this is a healthy lifestyle which aims to maintain a normal (or as close to as possible) body weight.

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With October being ADHD Awareness Month, Daniel Sher educates us on the links between ADHD and diabetes, and how to manage both.

Defining ADHD

Attention-Deficit Hyperactivity Disorder (ADHD) is a common childhood developmental condition, affecting about 7.2% of all children. People with ADHD experience a hijacking of the brain’s executive system, which is responsible for focus, planning, organisation and impulse control. For those affected, ADHD can cause problems with school or work performance. In addition, ADHD symptoms can have a serious spill-over effect for diabetes management.

Is there a link between Type 1 diabetes and ADHD?

While some studies say that there is no clear link between Type 1 and ADHD, some research has found that as many as 12% of Type 1 adolescents have ADHD. But why would this be the case?

Research has found that people with Type 1 diabetes frequently have changes in the brain’s grey and white matter areas. These changes, which are linked to poorer blood glucose control, are thought to underlie and worsen some of the cognitive difficulties that people with ADHD experience. For children who develop Type 1 diabetes early in life, therefore, the brain may be changed in a way that makes them vulnerable to ADHD.

Is there a link between Type 2 diabetes and ADHD?

People who grow up with untreated ADHD are more likely to develop Type 2 diabetes, as well as obesity and hypertension, as they get older. How does this happen? A part of the theory is that ADHD impacts planning and organisation, making it harder to regularly engage in healthy physical activity and nutritious meal preparation. Furthermore, ADHD brains tend to crave dopamine rewards and for many, this causes overeating and sugar addiction. 

Diabetes management

There’s no doubt about it: having ADHD makes the already challenging job of managing diabetes that much tougher. How? Anyone with diabetes will know just how complicated it can be to manage this condition. To thrive with diabetes, some of the skills that we need include:

• Knowing how to plan properly and set achievable goals;
• Having good strategies to manage our impulses;
• Finding ways to sustain motivation and avoid burnout;
• Establishing a schedule that makes it easy to remember all of our testing and medications; and
• Knowing how to multi-task and find balance in life.

The common thread between all of these skills is that they are based on the brain’s executive control networks: the very functions that people with ADHD struggle with. For this reason, people with diabetes and ADHD often struggle to plan, set realistic goals, motivate themselves, manage impulses and remember to take their medications on time.

Diet

People with ADHD have reported that they struggle with their diet, which makes diabetes management extremely challenging. This happens because ADHD is an impulse control disorder, meaning that people who have it struggle to stop themselves from engaging in a certain behaviour. This helps to explain why, for example, many people who have ADHD also have binge-eating disorder and related eating difficulties, such as snacking frequently between meals and night-eating.

Additionally, the brain of people with ADHD tends to crave dopamine hits, which often leads a person to snack on foods that are high in refined carbs or sugars. This can lead to insulin resistance and fluctuating blood glucose, which in turn makes the ADHD even harder to manage.

It should come as no surprise, then, that research shows youngsters with diabetes and ADHD often have higher A1c (average blood-glucose) readings. They also tend to have more hospital admissions, longer times spent in hospitals and, consequently, doubled healthcare costs.

How is ADHD diagnosed and treated?

The diagnosis should be made by a medical specialist (paediatrician or psychiatrist) or a clinical psychologist. At times, a psychologist may perform neuropsychological testing to help the doctor make the diagnosis. This helps the parents and doctors understand the exact cognitive strengths and weaknesses that a person presents with, which can help with getting the right support.

If you suspect that you or your little one may have ADHD, it’s important to get a diagnosis from a clinician who has a detailed understanding of how diabetes can change your behaviour and brain. For some children, their behaviour will look like ADHD when in fact it’s being caused by other factors, such as stress, diabetes burnout or fluctuating blood glucose levels.

Is it all bad news?

There’s no doubt about it: having ADHD makes the already tough job of managing diabetes even harder. With the right support, though, people can learn to thrive with diabetes and ADHD. There are many effective treatment options out there, ranging from medication to therapy and lifestyle change. Speak to your doctor or psychologist about getting the right help, to assist you or your little one in learning to establish harmony between the brain, body and behaviour.

References

Akaltun, I., Tayfun, K. A. R. A., Cayir, A., & Ayaydin, H. (2019). Is There a Relation between type 1 diabetes mellitus and ADHD and severity of ADHD in children and adolescents? A case-control study. Osmangazi Tıp Dergisi.

Hilgard, D., Konrad, K., Meusers, M., Bartus, B., Otto, K. P., Lepler, R., … & German/Austrian DPV Study Group, the Working Group on Psychiatric, Psychotherapeutic Psychological Aspects of Paediatric Diabetology (PPAG eV) and the BMBF Competence Network Diabetes, Germany. (2017). Comorbidity of attention deficit hyperactivity disorder and type 1 diabetes in children and adolescents: Analysis based on the multicentre DPV registry. Pediatric diabetes, 18(8), 706-713.

Macek, J., Battelino, T., Bizjak, M., Zupanc, C., Bograf, A. K., Vesnic, S., … & Bratina, N. (2019). Impact of attention deficit hyperactivity disorder on metabolic control in adolescents with type1 diabetes. Journal of psychosomatic research, 126, 109816.

Thomas, R., Sanders, S., Doust, J., Beller, E., & Glasziou, P. (2015). Prevalence of attention-deficit/hyperactivity disorder: a systematic review and meta-analysis. Pediatrics, 135(4), e994-e1001.

Volkow, N. D., Wang, G. J., Kollins, S. H., Wigal, T. L., Newcorn, J. H., Telang, F., … & Swanson, J. M. (2009). Evaluating dopamine reward pathway in ADHD: clinical implications. Jama, 302(10), 1084-1091.

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Alzheimer’s disease and diabetes are both increasing in numbers. Dr Louise Johnson explains why the associations are getting stronger with better data.

Alzheimer’s disease

Alzheimer’s disease was diagnosed by German psychiatrist, Professor Alois Alzheimer, in 1906. Alzheimer’s disease is the most prevalent form of dementia in the aging population. Recently declared as the sixth major cause of death in the world.

Patients affected with Alzheimer’s suffer a gradual decline of cognitive abilities and memory functions till the disease renders them incapable of performing normal daily activities, such as eating, dressing and bathing.

Over 30 million people suffer from Alzheimer’s disease in the world. And this number is estimated to double to 60 million by 2030.²

Clinically Alzheimer’s disease (AD) can be classified into two sub-types: Late-onset or sporadic AD and early-onset or familial AD.

Late onset AD

This type affects about 95% of the Alzheimer population. These people are older than 65 years of age. Other than ageing, other risk factors for late onset AD are:

• Stroke
• Family history of diabetes
• Hypertension
• Obesity
• ApoE4 gene

Studies revealed that the apolipoprotein E (ApoE4) gene is a significant risk factor for the development of the disease.

Early onset AD

It affects 5% of the Alzheimer population. This disease is diagnosed in thirties, forties or fifties. It’s due to the mutation of three genes: amyloid precursor protein, presenilin-1 and presinilin -2.¹

Type 2 diabetes

Diabetes mellitus is a chronic metabolic disorder that is increasing worldwide. In 2019, there were 415 million people with diabetes worldwide. Of this number, 95% are Type 2 diabetes. There is another approximate 50% (220 million) walking around undiagnosed. Currently, one in every 11 people worldwide has diabetes according to the International Diabetes Federation 2019.

The salient features of Type 2 diabetes are:

• High levels of blood glucose
• High insulin levels
• Insulin resistance

Insulin resistance arises due to decrease insulin sensitivity in the muscle, fat tissue and liver.

What evidence proves there is link between diabetes and Alzheimer disease?

Epidemiology studies show that Type 2 diabetes increases the risk for AD by two-fold. Type 2 diabetes is strongly associated with late onset Alzheimer’s disease. This association is partially due to cerebrovascular disease (stroke and TIA). But that isn’t the only reason. The reason that the connection between these two major diseases can be made are:

• Insulin resistance
• Inflammation and blood vessel damage
• Blocked nerve communication
• Tangled tau proteins

Insulin resistance

When cells don’t utilise insulin the proper way, this can affect the brains mechanics. When your brain cells aren’t fuelled properly, the brain can’t function correctly, resulting in blood glucose to rise. Over time this can result in harmful fatty deposits in the blood vessels.

Having too much insulin can upset the chemical balance in the brain. The impact on the brain is so strong that Alzheimer’s disease related to insulin resistance should be referred to as Type 3 diabetes.

Inflammation and blood vessel damage

Those who have diabetes are at higher risk for heart attack and stroke. High blood glucose levels can cause bouts of inflammation, which puts stress on the blood vessels. Those damaged vessels can then result in Alzheimer’s disease. Inflammation can also make cells more insulin resistant. This is worse in obese people.

Blocked nerve communication

High blood glucose relates to high levels of beta amyloid, which is a protein that, when clumped together, can become stuck between the nerve cells in the brain and caused blocked signals. Nerve cells that fail to communicate are a big trait associated with Alzheimer’s disease.

Tangled tau protein

Your cells are always moving food and other supplies along pathways, akin to railroad tracks. A protein, referred to as tau, helps these tracks run in straight rows. In brains of Alzheimer patients, however, tau gets all tangled up, leading to falling apart tracks and dead cells. Some studies say those with diabetes have more tangles of tau protein in their brains, resulting in more dying cells in the brain, which as we know can lead to dementia.

How to reduce your risk?

1. Prevent diabetes or manage it effectively with the correct medication with the help of your doctor.
2. If you already have metabolic syndrome, weight loss and diet and exercise will help. Address your risk factor of high blood pressure and abnormal blood cholesterol with the correct prescribed tablets.
3. Eat healthy foods including vegetables, fruit, lean meats, whole grains and low-fat milk and cheese.
4. If you’re overweight, start a healthy diet and exercise to lose weight.
5. Exercise for at least 30 minutes five times a week.

Metabolic syndrome raises the risk of dementia in people under 60

Metabolic syndrome is defined by the presence of three of these risk factors:

• Impaired fasting glucose
• Waist circumference in a female more than 80cm and in a male more than 94cm
• High blood pressure above 130/85 mmHg
• Increased triglyceride cholesterol
• Low HDL cholesterol

In a recent study running over 20 years, the Whitehall II cohort showed that the risk of dementia is increased by 13% in people with metabolic syndrome younger than 60 years of age. In the age group between 60 and 70 years, the risk increase with 8%. The Whitehall II cohort consisted of UK civil servants: 10 000 in London (1991 to 2016).

The study concluded that the dementia risk was significantly high in study participant under age 60 years who had at least one metabolic syndrome component even when they didn’t have cardiovascular disease (heart attack or stroke)

Type 1 diabetes and Alzheimer’s disease

Most data have focused on Type 2 diabetes. It has been found that impaired learning, memory, problem solving, and mental flexibility have been found to be more common in patients with Type 1 diabetes than in the general population.

Treatment of Alzheimer’s disease

There is currently no treatment for Alzheimer’s, only drugs to slow down symptoms.

Pioglitazone

The diabetic drug, pioglitazone, improves insulin resistance and promotes cholesterol management by the liver. In 12 small studies of Type 2 diabetes with mild cognitive impairment, pioglitazone was promising in three studies. There was cognitive improvement.³

Intranasal insulin

Intranasal insulin enters the brain direct via the olfactory pathway. Participants who were treated with intranasal insulin showed greater improvement in memory and attention 21 days after start of treatment.

Alzheimer’s disease and diabetes are both increasing in numbers. The associations are getting stronger with better data. The best treatment currently is to manage glucose and other risk factors optimally.

References

1. Dorszewska J, Prendecki M et. al. (2016) Molecular basis of familial and sporadic Alzheimers disease. Curr Alzheimer Res, 13, 952-963
2. James BD, Leurgans SE, Hebert l et. al.(2014) Contribution of Alzheimers disease to mortality in the United States. Neuroloy 82,1045-1050
3. Watson GS, Craft S.” The role of insulin resistance in the pathogenesis of Alzheimer’s disease: implications for treatment” CNS Drugs 2003;17:27-45

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Mitchells Plain Wellness Workshop Week

From 22 till 30 July, a Wellness Workshop Week was held at Strand chalets in conjunction with the Mitchells Plain DSA support group.

Blood pressure and blood glucose testing took place every morning and a walking and light exercise programme combined with a fancy dress competition took place.

Camp Diabetable

This December, the second Camp Diabetable (Eastern Province) will be held from 15 to 17 December 2022 at Hobbiton-on-Hogsback. Ernest Groenewald, our Camp Director, will be organising this fun-filled and educational event. More information will be available closer to the time.

Gravity Jump for Diabetes

On 2 October 2022, our branch will again be having a Gravity Jump for Diabetes. Our first one was held in November 2017. Paula Thom and Darren Badenhuizen, the DSA Young Guns leaders, will be organising this fun event.

Diabetes nurse educator, Christine Manga, offers valuable advice for parents of children with T1D experiencing interrupted sleep patterns.

A diagnosis of Type 1 diabetes in a child comes with many physical, mental and emotional challenges for both the child and parent. As parents assume most of the responsibility for managing the diabetes, it’s no surprise that parental burnout is real.

Of the plethora of feelings parents experience, fear and guilt appear to be common threads in literature. Chronically disrupted sleep resulting in chronic sleep deprivation is another standout topic. Parents who are sleep deprived have an increased risk for depression, anxiety and potential weight gain. It can have a detrimental impact on relationships, work and day-to-day functioning.

How to deal with 2AM testing

2AM testing of blood glucose is a part of the deal. If the glucose level is in range, that is great. If not, it probably means not much sleep for the rest of the night. How do you deal with this?

Good overall blood glucose management is key to a better night’s sleep. If there are regular night-time hypos, the treatment regimen that the child is on will need reviewing. Reassessing the basal doses, carb ratio as well as correction factor and carb counting skills will aid in achieving good stable glucose levels. A pre-bedtime low-GI snack may be recommended. Even with all of these parameters met there is still a chance of night time hypos. Remember, diabetes does not sleep.

Rotation basis

If there is more than one parent at home, working on a rotation basis for testing will allow for better sleep. This could be split up for day to day, week to week or even half evening shifts.

If you are a night owl, staying up until 1am and then your partner being responsible from then until the morning will guarantee a few hours of quality sleep.

If you are a single parent, ask for help. You could teach a relative or friend how to test and what to do depending on the outcome. A solid night of sleep once a week will do wonders.

Minimise the fuss

Be prepared for evening testing and treating, the less fuss involved, the quicker you can get back to sleep. Have the tester and strips out, have a sweet or juice on hand in case of a hypo. Use dim lighting and make sure the passage and room is free of obstacles. Don’t engage in conversation unless necessary.

Good sleep hygiene

Good sleep hygiene will make falling asleep easier for you when initially going to bed or after testing. This includes no use of electronics an hour before bed; a cool, quiet environment if possible, and avoid caffeinated drinks. Try sticking to a routine. Same bedtime every evening, make it early even if it means missing out on some adult time. The extra sleep will help you.

CGM

Using continuous glucose monitoring (CGM) technology to track blood glucose levels that give predictive warnings of an impending high or low reading will provide peace of mind and negate the need to physically get up and test your child. Sensor augmented insulin pump therapy plays a huge role in reducing overnight hypos.

Unfortunately, this technology is expensive and not financially feasible for most of the population. If you are fortunate enough to use any of these, do not do sensor changes or infusion site changes before bed. Calibrations may be required or there may be a site failure that goes unnoticed until intervention is required that will take extra time.

Be kind to yourself

When there has been a rough sleepless night, be kind to yourself. If you are unable to complete all the home chores, park some for the next day. Try to get in a 10-minute power nap. Type 1 diabetes stretches the boundaries of what we believe is possible and what we are capable of.

It is important to know that if blood glucose levels are stable then there is no need to test at 2AM every night. Once or twice a week is sufficient.

Seek counselling for you and your child

Children with T1DM can experience feelings of guilt and believe they are a burden. They may also show anger or resentment towards the parent or caregiver who does their testing. An over-tired parent may struggle to show compassion thereby aggravating the child’s ability to accept their condition. Seek counselling for both you and your child if necessary, reach out to your diabetes team, join support groups and learn how other families cope. Sharing your experience and insight may just be what another parent needs to survive.

Remember, this 2AM testing ritual will not be forever.

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