Timeless Care Team

Timeless Care Team hosted their monthly Soft Spot session in November 2021 at the Jolly Carp. To create awareness on World Diabetes Day, and with the kind assistance of Diabetes SA, they distributed reading material and Sister Kopolo of the Grassy Park Clinic delivered an informative talk on the ‘silent killer.’

It was a session filled with various activities from dry-haircuts to painting nails and health services provided various testing, such as glucose testing, blood pressure and Pap smears.

The chatter and laughter was evidence of a wonderful time had by all. The knitting club members proudly handed over their amazing love projects of baby beanies, booties, blankets to be distributed to those in need.

In the background the sounds of memorable music played and here and there a few sang along and some showed a dance move or two.

DeafSA

Margot McCumisky, National Manager of DSA, went to DeafSA on 26^th November to do a talk on diabetes. An interpreter was present and the group had many questions and showed a great interest in diabetes. Two of the attendees had Type 2 diabetes and found the information very helpful.

Diabetes Awareness in Kamvelihle, Motherwell

On 4 November 2021, Pamela Molefe, Martin and Elizabeth Prinsloo were privileged to be invited to address a group of elderly residents in Kamvelihle. They meet regularly in a large container and were so keen to learn more about diabetes. Pamela, our Xhosa speaking nursing advisor, spoke to them and answered their many questions. She also tested everyone’s blood glucose.

Diabetes Wellness meeting in Newton Park

The last meeting for this year was held on 10 November 2021. Our guest speaker was Felicity Black, a registered dietitian, who helped us all to understand more about how our bodies react to insulin and what we eat and drink. A time for questions and lively discussion followed her presentation.

DSA Young Guns World Diabetes Day – Boerie Braai

On World Diabetes Day, the DSA Young Guns held an event at The Willows, Three Pools. This was well-attended by not only the Young Guns but also by family members and friends who could chat while the youngsters had fun.

The day started at 10am and ended at 5pm. One of the DSA Young Gun leaders, Darren Badenhuizen, braai’d one hundred boeries in the pool lapa area. The kids enjoyed boeries with low-cal juice and a protein bar which was sponsored by Future Life.

Diabetes South Africa’s National Chairman Martin Prinsloo and his wife Elizabeth, who is the chairman of the Port Elizabeth Branch arrived with their grandson; Joshua, and his dog, Jessica. Joshua performed a lovely obedience show with Jessica and everyone was impressed with the dogs good behaviour and stylish outfit.

Martin did the raffle draw with the help of five Young Guns. Thereafter the kids took a break from swimming and did a potato and spoon race. The Young Guns played their own version of dodge ball which was most enjoyed by young and old. There was an exciting game of Tug of war where the rope snapped. This did not stop the kids as they tied a knot and carried on with the war in good spirits.

Families from Port Elizabeth and surrounding areas such as Jeffery’s Bay and Grahamstown joined the event. The youngest DSA Young Guns member in attendance was 4-years-old Type 1 diabetic.

Prizes were donated in the form of vouchers by The Valley Craig and Wacky Water World. These prizes were awarded to the winners of the many games played on the day.

A tribute to Rentia Kinchenton

The song is ended (but the melody lingers on). – Irving Berlin.

The Diabetes South Africa Pretoria Support Group members fondly remember Rentia who passed away in March 2021, especially on 27 September as she celebrates her birthday in heaven. She loved the Lord, had a compassionate heart, was a wonderful person, a born helper and a very courageous woman.

Rentia was a dedicated member of the DSA Pretoria Support Group. She volunteered her services on an ongoing basis with a heart-warming smile.

She was famously known as the sandwich lady as she was the maker of many tasty chicken, egg and mayo sandwiches for the Pretoria Diabetes Support Group meetings. Rentia was a loyal member always helping where she could. May her beautiful soul rest in eternal peace.

New Benoni support group

At the request of Nursing Sister Ferosa and in line with DSA’s objectives to empower all those affected by diabetes through support, education and information, the DSA Pretoria Branch encouraged and supported the establishment of a new support group in Benoni on 16 October 2021.

The meetings of this support group will be held monthly to provide support and information to the Benoni community and the surrounding areas.

It’s encouraging to note that as a build-up to World Diabetes Day on 14 November, an initiative pioneered by Sister Ferosa resulted in a number of people joining a Diabetes Support Group at the Northmead Clinic in Benoni.

The group benefitted from the awareness campaign which highlighted risk factors associated with diabetes as well as the promotion of a healthy lifestyle.

The turnout at this event is evidence that people are keen to know and understand what diabetes is all about. The more people know, the easier it will be for them to make better-informed choices and decisions. Furthermore, they will be able to manage diabetes effectively.

The more new support groups created, the better it’s for DSA to reach a wider audience. This has the capacity to increase DSA’s membership and to curb the scourge of diabetes which has a negative impact on health, families and society at large.

Benoni Lakes Lions Club Diabetes Awareness and Screening Day

Benoni Lakes Lions Club held a Diabetes Awareness and Screening Day at Elate Eatery in November. It was a great success despite some rainy weather which forced them to pack up early.

They managed to screen 47 people over a four hour period and are happy that all readings except two were within normal range. We had two men that had readings of 7,4 and 18,1 respectively. The gentleman with the 18,1 reading has already been diagnosed with diabetes.

DSA contributed literature which made a huge difference to the success of the day. Benoni Lakes Lions Club really appreciat the guidance and materials which DSA National Office provided. They are planning more Diabetes Awareness and Screening days in 2022 with the support and assistance from DSA.

Wound Care Wellness Workshop

The Diabetes South Africa Pretoria Support Group hosted a Wellness Workshop on wound care on 16 October 2021. We are thankful to Nursing Sisters Backeberg and van Zijl for an informative and detailed presentation on wound care. This insightful session was followed by a live demonstration on a willing volunteer on what to do when testing your feet at home. 

For a person living with diabetes, the reality is that short-term and long-term complications of the feet are potentially life-threatening. The diabetic foot in South Africa, as in all parts of the world is associated with a high risk of amputation. The daily individual foot checks and annual foot assessment by a professional are important consultations to mitigate against possible complications.

Ulundi Diabetes and Hypertension Fighters

Ulundi Diabetes and Hypertension Fighters along with DSA planned a community outreach service to educate and do testing for free to disadvantaged people. Ulundi Diabetes and Hypertension Fighters works together with a multi-disciplinary team in conducting community services. They promote diabetes and hypertension awareness in different communities around Northern KZN.

We started this Diabetes and Hypertension Wellness Drives mid-year 2021. Our first drive was at Ulundi on 28^th May. The day was all about educating the community about the signs, symptoms, treatment and management of hypertension and diabetes.

We also did screenings for all the attendees according to our specialisations and we have referred some of them for further investigations to their nearest doctors and clinics. We had the following practitioners on that day: biokineticist, dietitian, diabetes educator, optometrist, clinical nurse, coastal nephrology clinic, physiotherapist, and podiatrist.

Nongoma

On 18^th June, we went to Nongoma to promote and install the same vision and goal of managing diabetes and hypertension. The community was so welcoming and they were eager to listen to the information we had to share with them. We managed to see 50% of patients of which was really good, hence it was the first thing to be done in the community.

Hlabisa

On 29^th June, we visited Hlabisa community to promote diabetes and hypertension awareness with an aim of educating the community and getting access to the health care resources they need to manage these conditions.

Due to COVID-19 restrictions, we did not do the presentations but we were able to do one-on-one patient education. Based on the information we received, we discovered that they need more of education mainly about medication, management and the importance of testing. We also referred a few for further investigations to their nearest doctors and clinics since we all stay far from their community. We planning to re-visit them again next year and we are hoping for better results.

Melmoth

On 5th July, we visited Melmoth with the same drive and vision of spreading the word of diabetes and hypertension management and treatment. Patients did come but there were few and most of them were rushing to work, we assume they also did not get the information plus we also had tight COVID -19 restrictions. We did all the testing and the patient education through one on one.

Jozini

On 18^th September, we visited Jozini (Sisizakele Special School), there was aerobics competition The Noah’s Ark presented by Intengu fitness centre.  We managed to conduct tests on few but most of them were focusing on the event. What we discovered with them is that yes they are into “fitness” but they lack guidance on proper exercise techniques and proper nutrition to avoid unnecessary complications.

Ulundi – WDD

On 14^th November, we had a World Diabetes Day (100 years of insulin) in Ulundi. This was our end-year event. The purpose of the day was to mainly educate diabetic patients and the community of the disease and management. The plan is to make it an annual event.

On the day, we did testing (glucose, blood pressure, HbA1c and body composition), management exposure where they were oriented to different stations of different HCP. Participants had a Q&A session after the talk and prizes were given. All participants were given goodie bags for participating in the event.

We had a 30 minutes session of an exercise as part of the event. Exercise forms part of  diabetes management and treatment. It is highly recommended because it helps to lower HbA1c values by 0,7% (with medication and diet), lowers blood glucose, and boosts body sensitivity to insulin. It has been highlighted that people with diabetes who walked at least 2 hours/week were less likely to die of heart failure than sedentary individuals.

Dr Angela Murphy tells us how she went from being a diabetes doctor to a mother of a child who has diabetes.

Angela Murphy (54) lives in Brakpan, Gauteng with her husband and three children.

I woke on the morning of 25 November 2005 to a new world. For the third morning in a row, my two-year-old daughter, Olivia, complained of being very thirsty at 5am. I had been trying to suppress a worry for the previous few days and decided to do a blood glucose test on her: 16, 6 – a number I will never forget.

By the end of the day, my husband, Olivia, and I were sitting in the offices of my medical school classmate and colleague, getting a prescription for insulin. In one day, I was unceremoniously pushed from being diabetic doctor to diabetic mother.

Our lives became consumed by numbers: fear of the low ones, annoyance with the high ones, relief if the numbers were good. Olivia had to learn that being injected several times a day with a sharp needle was her new normal. We were blessed to be able to put her on an insulin pump within six months of her diagnosis. It took the injection burden away but not the testing.

Support and special bonds

My first thought as I woke and my last at night was: What is her blood glucose? Handing her over to the care of her teachers was terrifying but we were so blessed that she was well looked after at St Dominic’s School, Boksburg. Special bonds were made with people that helped so much in those earlier years, especially the wonderful diabetes educator Jen Whittall. Through her we met other families and formed a support group on the East Rand that met once a month: Super Kids With Diabetes (SKWID). Our children always had friends with diabetes, so they never felt odd.

Coming to terms with the diagnosis

When Olivia was diagnosed with diabetes, I was almost eight months pregnant with her sister, Julia. Her brother, Lorenzo was just four years old. In that first year, I lived in a fog, battling an immense sense of loss. I clearly remember seeing billboards advertising fruit juice and being heartbroken that Olivia would not be able to just drink that without thinking and planning. I was angry that she would have restrictions and anxious to keep her safe.

Doctor vs mother

The comment I heard most often was how lucky Olivia was to have me as a mother. I understood what was meant, that all my knowledge about diabetes could be used to care for her. However, as a specialist physician my patients are adults; a toddler with diabetes was completely outside my clinical realm.

As a doctor I knew controlling the glucose levels to target was vital. As a mother, I was terrified of my child slipping into a hypoglycaemic coma. I was privileged to attend the International Society for Paediatric and Adolescent Diabetes conference in Durban 2008. I gained so much new knowledge and insight, not only medical but also on parenting a child with Type 1 diabetes. One statement was a light-bulb moment for me: “A child’s HbA1c is proportional to the mother’s fear of hypoglycaemia – the higher the fear, the higher the HbA1c”.

With the guidance of her endocrinologist, we adjusted insulin doses and gradually Olivia gained good control. I still woke to check her glucose every night for years to come but learnt not to accept higher glucose levels out of fear. This was a big step among many small steps in learning to manage the constant tight rope of highs and lows.

The realisation that there is no holiday or break from diabetes can be crippling in the days after diagnosis, something I have felt with my own patients. Having crossed the line from advising about diabetes to living with diabetes (a parent with a young child almost takes on the diagnosis), I do truly empathise with my patients. However, it’s still my job to guide, advise and help them aim to reach those diabetic goals. I never judge, as I know how tedious glucose testing, carb counting, and bolus timing can be. I have really had to try and practice what I preach. We all need to learn to ride the diabetes rollercoaster while we live our daily lives.

Proud mom

I would still wish Olivia’s diabetes away, but I know she can cope. However, I’m so grateful for the technological advances and the fact Oliva can use an insulin pump and glucose monitoring system. I remain hopeful that more breakthroughs will be made, and as radical a discovery as insulin was 100 years ago, something else may change the burden of diabetes in the future. In the meantime, I know Olivia will continue to live her best life.

Type 1 diabetes patient and postdoctoral research fellow, Thea de Gruchy, shares why she chose to become a Diabetes South Africa volunteer.

Diagnosis

I was diagnosed with Type 1 diabetes on 26 December 1999. While the rest of the world was waiting to see what Y2K would mean for computers and alarm clocks, my family was anxiously trying to figure out how to adapt to life with a diabetic eight-year-old. My prevailing memory from this time was looking intently at the front pocket of my doctor’s coat, knowing that there was a lollipop in there and not quite understanding why I wasn’t getting it.

Interesting experiences

Since being diagnosed, I’ve had a lot of experiences that I’m sure people with diabetes all over the world share. The insulin pump rep who took the battery out of my pump even after I told her that whenever I took the battery out the whole pump resets, and who was then surprised when the whole pump reset.

The new GP I went to for a throat infection who told me my HbA1C wasn’t good enough, and then admitted that he hadn’t seen a patient with diabetes since the 90s.

The friend of a friend who told me not to eat a very delicious looking piece of cake at a birthday party. The barrage of messages every time there’s a newspaper article that talks about a ‘cure’ for Type 1 diabetes.

Limited access of care

Although I don’t believe the ‘there will be a cure in five years narrative’, I do feel incredibly lucky to be diabetic at a point in history where there are sufficient pharmacological and technological developments that enable me to live and enjoy a good quality of life. But I also know that although insulin has been around for 100 years, access to it, and other life-saving and life-improving tech and medicine, is limited to just a few of us.

Barriers to healthcare, in addition to the narratives around ‘deservingness’ that often permeate conversations about diabetes and terms like ‘co-morbidity’ or ‘underlying health conditions’ that have served to explain away the deaths of people with diabetes during the pandemic, are all completely unacceptable, but all completely accepted as part of how society operates and thinks about illness.

Pandemic has made me feel ‘diabetic’

Reflecting on her experiences with cancer, Susan Sontag famously wrote, “Illness is the night-side of life, a more onerous citizenship. Everyone who is born holds dual citizenship, in the kingdom of the well and in the kingdom of the sick. Although we all prefer to use only the good passport, sooner or later each of us is obliged, at least for a spell, to identify ourselves as citizens of that other place.” (Sontag, Illness as metaphor, 2002)

I’ve just turned thirty. So, I’ve now lived in the ‘kingdom of the sick’ for a lot longer than I ever lived in the ‘kingdom of the well.’ For most of my life, however, I’ve always understood myself as being well or healthy, just having diabetes. It’s only been more recently that I’ve started to understand that I don’t just live with diabetes as an added extra (another item on my to do list). But rather that diabetes is all-encompassing; an integral part of my life that affects everything I do, and which is affected by everything I do. Trying to get through the last two years of the pandemic has definitely made me feel diabetic in a way that nothing has before.

Offering help to DSA

This feeling prompted me to reach out to Diabetes South Africa (DSA) in early 2021 and ask if I could be of assistance in anyway. I reckoned that if I was feeling isolated and frustrated, others would be to, and I wanted to know if there was anything I could do.

People living with chronic illnesses, specifically diabetes, are often referred to as ‘patient experts’ in recognition of the amount of expertise and agency that goes into living with a chronic disease on a day-to-day basis. I was interested to know if there was anything I could do as both a patient expert and someone with professional expertise in understanding barriers to healthcare in South Africa. And I’m so glad that I did. I’m learning so much about diabetes and people living with diabetes in South Africa and supporting an organisation like DSA feels increasingly important in the current context.

Acceptance

Living with diabetes has definitely become a more important part of my identity as I’ve grown up. Learning to accept that diabetes does in fact define me and does create limitations has been an important step is figuring out how to live the life I want to and do the things I want to do with diabetes. Except for eating pizza. I gave up on that fight a long time ago.

Instead of seeing the things I do as a person with diabetes as a chore, I try (although not always successfully I must add) to see opting out of pizza, needing extra sleep or extra time to recover from a run, ensuring I always have extra meals in the freezer as reminders that “The fight is still going on, and I am still a part of it.” (Lorde, Cancer Journals, 2020).

Noy Pullen educates us on Jin Shin Jyutsu and how it achieves harmony in your hand.

Ever really looked at your hands? The soft generous palm with four distinct fingers raying out: the pointer or index finger traditionally shows the way. It’s also known as the teacher, the prayer finger or even the pot-licker.

The expressive and powerful middle finger, or tall poplar, is often employed to gesture anger.

According to medieval belief, either a nerve or artery connected the ring finger to the heart which gave the finger a prominent role in medical practice. Doctors would use the ring finger when applying treatments. As a make-up artist, I have always done this unconsciously when applying any cream. Similarly, when applying any ointment to my family’s wounds. Our beauty therapy trainer said that it was the most delicate finger and would not pull the skin. This finger is called doctor finger, healing finger and heart finger. Because of its healing and pious reputation, our gentle ring finger is also known as the finger that no-one dares speak its name.

The amusing pinkie, so called for its diminutive size and because pink means ‘small’ in Dutch. This finger also bears the titles of youngest daughter or ear-finger for its ability to remove wax from the ear.

The dexterous opposable thumb gets its name from the word, tum, meaning swollen, being thicker, stronger and shorter (with only two joints instead of three) than the fingers. It’s also referred to as chief finger or grandfather, or even lice finger for obvious reasons.

The fingers are recognised for their roles in praying, hunting, healing, cursing, licking pots, and squashing pests.¹ Our hands create the most beautiful works of art, a flourishing vegetable garden, a superb meal or they can soothe and comfort one in distress.

Harmony in your hand

We also shake hands, press our hands together or clap hands for communicating, for worship or contemplation, or cogitating walking slowly with hands clasped behind the back. We hold hands, interlock or press together for prayer, or even pressing down on the earth. Enjoying a relaxing head massage, both you and the one doing the massage, benefit from this gentle acupressure of the fingers.

Managing a difficult diagnosis

My integrative medical doctor, while discussing a serious diagnosis and the accompanying feelings with me demonstrated a simple yet effective technique called Jin Shin Jyutsu to practice when those debilitating companions – worry, fear, anger, sadness or apathy – threaten to overwhelm me. Everyone who has some difficult or tragic news has met these feelings.

Jin Shin Jyutsu (pronounced Jin Shin Jitsu)

This ancient healing art from Japan, Jin (meaning man of knowing and compassion) Shin (creator) Jyutsu (Art), translated into English might translate as The Creative Art of Harmony.

The idea is to hold each finger with all the fingers of the other hand wrapped gently around that finger for a few minutes until you feel a gentle pulse, breathing deeply. Repeat with each finger then to complete the process, press the palm of the hand with the thumb while supporting that palm with the other fingers. Repeat for the opposite hand.

This brings a sense of well-being to the whole body. You may wish to focus on one emotion. For example, fear, if it’s the over-riding emotion, wrapping and holding the appropriate finger till you feel the pulse together with the positive energy, peace of mind, in this case, washing over you. Repeat on the other hand.

Some practitioners take only the tip of the finger gently squeezed by the index finger and thumb of the other hand, ‘dripping’ the negative energy downwards towards the ground so it can ‘run out.’

The main dis-ease which focuses on each finger meridian

• Thumb (earth) – worry (also stress, tension, headaches)
• Index finger (water) – fear (addictions, back pain)
• Middle finger (wood) – anger (impatience, indecision)
• Ring finger (air) – sadness (grief depression, asthma)
• Pinkie (fire) – low self-esteem (overwhelmed, anxiety, criticism)

Organs associated with each finger

Thumb – stomach, spleen, skin
Index finger – kidney, bladder, digestion
Middle finger – gall bladder, liver, blood
Ring finger – lung, large intestines
Pinkie – heart, small intestine, bone
Palm – diaphragm is a special harmonising point

A positive response is released after holding each finger:

Thumb – trust
Index finger – peace of mind
Middle finger – joy
Ring finger – comfort
Pinkie – truth
Palm – for nourishment and intuition

This gentle form of acupressure develops an awareness of the life force (energy body) within yourself and can bring harmony to your body and mind, also calming the spirit. Your hands can perform this healing art by addressing physical symptoms or latent emotions that could be hindering your own sense of well-being.

How to get your own Jin Shin Jyutsu vinyl mat

Agents for Change has developed a beautiful vinyl mat that you could paste up on a wall for easy access, or as a placemat or mousepad, to remind you of this valuable accessible method of creating harmony. Mine goes in my bathroom door as a regular reminder of how wisely we are created.

For your very own Jin Shin Jyutsu mat/s, contact Linoia Pullen 0722587132 [email protected] for any orders.

References

1 https://www.tbsnews.net/offbeat/confusable-quintet-names-5-fingers-and-their-origins

2 https://www.youtube.com/watch?v=twFjKXU79Go

Please contact Noy Pullen if you would like more information: [email protected] or 072 258 7132.

AGENTS FOR CHANGE IS A DIABETES SOUTH AFRICA PROJECT MANAGED BY NOY PULLEN.

Jeannie Berg, pharmacist and diabetes nurse educator, offers good practical tips on how to manage your medical aid.

Healthcare has become hugely expensive. Even a minor operation can have you digging into your long-term savings. The high cost of hospital stays, specialist fees and other medical expenses (including medication) makes it important to have at least some form of medical cover: medical aid or medical insurance.

Let’s start off by differentiating between medical aid and medical insurance. Although, these terms are often used interchangeably, there are significant differences between them.

Medical aid

A medical aid scheme focusses on providing members with cover for expenses associated with necessary medical treatment. Members are often obliged to use healthcare specialists who belong to a provider’s network, and conditions rule which treatments are covered, but taking scheme tariffs into account, the amount you’re paid out will depend on what medical attention you need.

Medical insurance

Medical insurance, however, is intended to ensure that when you need funds for medical purposes, you receive a fixed lump sum. This amount won’t differ, regardless of the type of treatment that’s required or which healthcare providers you use. Here you would pay the health providers up front and the insurance will give you the agreed upon lump sum and you have to sort it out.

Governed strictly in SA

Both medical aid and medical insurances are governed very strictly in South Africa. All medical aid schemes are regulated by the Medical Schemes Act and governed by the Council for Medical Schemes. Medical insurance is regulated by the long-term insurance act and governed by the Financial Services Board.

By law, medical aid providers are required to provide prescribed minimum benefits (PMB) for a list of chronic disorders, such as asthma, cardiac conditions, diabetes, hypertension, etc. There are 26 conditions that are covered.

However, medical aids still decide what drugs are on their ‘essential drug list’ for a certain condition. If you use a drug for a condition that is not on this list, chances are that you might have to pay in full for it, or a bigger co-payment is required.

So, how do you manage your medical aid?

• It’s like a bank account. You have a certain amount of “money” in it and you need to take care that you don’t waste it. You need to check all the claims that go through it.
• Use your options carefully. Do you need to see a doctor, or can a pharmacist help you? Pharmacists are highly trained and many have done courses on primary healthcare. This means that they are able to help you with OTC medicine for conditions like sinus, colds and pain, without you having to see a doctor and use your doctor visits unnecessarily. Pharmacists are drug specialists. Many drugs have generic alternatives and are often priced at a fraction of the cost. Usually, medical schemes will pay in full for generic options. Generic medicine has the same active ingredient as the original brand, and should be just as effective with the same strength and dosage. Your pharmacist can guide you for the best generic options, especially if you are on chronic medication. If you do still insist on the original drug, you will have to pay some or all of it.
• Gap cover is a good idea if you have any worries about potential co-payments. This cover could help avoid costly out-of-pocket in-hospital medical fees. Gap health insurance works with your medical plan to close in-hospital payment gaps if your medical aid benefits are exhausted. Some medical aids also offer Gap cover. It’s worthwhile looking into this.
• Managed Care Benefits are offered by medical aids and it’s a good thing to look into this. These programmes typically help those who need to manage chronic conditions, such as diabetes, cancer, and HIV/AIDS. They are usually funded by your medical contribution’s risk portion and not from your savings account, meaning that you are getting the most from your benefits while receiving the medical care that you need.
• Always ask questions. You are the client/patient and entitled to ask what you are unsure of.
• If you need to be hospitalised for a routine procedure, ensure that the hospital and doctors are on your medical scheme list.
• Ask your doctor or specialist how much they will charge and ask them to explain the bill in terms of your medical aid coverage. If your medical aid doesn’t cover enough of the doctor’s fee, ask him if he would be willing to negotiate a lower rate.
• Ensure that you have obtained the necessary pre-authorisation for procedures and that the correct ICD-10 codes are being used.
• Remember that you’re the owner of your medical aid “bank account”. Use it wisely. Check your statements to make sure that your funds are being well spent by yourself and your beneficiaries.
• Don’t buy OTC medicine unnecessary, because your medical aid pays for it. Remember that when medical aids budget for the following year, they also take into consideration the spending trend of the patients. This affects your following year’s contribution.
• Don’t do someone a favour by buying something on your medical aid. This is fraud and can get you into serious trouble.
• The best you can do for yourself is to have a good medical aid that is right for your style of living. If you have many chronic complications, you need a more comprehensive plan. If you are young and healthy, you can opt for a lower plan. All plans include a hospital plan.

Looking after your health by having a good lifestyle, which includes healthy eating, stress management and exercise is already a great way to save on medical expenses.

Header image by Adobe Stock

Dr Louise Johnson, a diabetes specialist, clarifies what Maturity Onset Diabetes in the Young (MODY) is.

MODY was first recognised in 1974 as mild familial diabetes with a dominant inheritance. This form of diabetes can be confused with either Type 1 or Type 2 diabetes.

 The criteria for suspecting MODY are:

• Diabetes before the onset of 25 years of age
• Absence of autoantibodies against the Beta cells (also called GAD antibodies and are present in Type 1 diabetes and Latent Autoimmune Diabetes in Adult (LADA))
• Presence of diabetes in two consecutive generations of your family.
• C-peptide of more than 200 pmol/L (this indicates the presence of beta-cell function of the pancreas) even after three years of insulin treatment.¹

To date, 14 different gene mutations are recognised in MODY. MODY is a rare condition accounting for 1-5% of all cases of diabetes and 1-6% of paediatric cases of diabetes.

Approximately 80% of patients with MODY may be misdiagnosed with Type 1 or Type 2 diabetes at diagnosis and current calculations indicate a delay of approximately 15 years from diagnosis of diabetes to the genetic diagnosis of MODY.²

Diagnosis of MODY

At diagnosis, MODY can’t be distinguished easily from Type 1 or Type 2 diabetes based on clinical characteristics. Rather, Type 1 diabetes mostly differs from MODY in terms of disease aetiology. In Type 1 diabetes, the cause is autoantibodies, called GAD antibodies, against the beta cell of the pancreas.

Patients with MODY usually maintain beta-cell function. This can be demonstrated by doing a blood sample and measuring C-peptide. In MODY this value is above 200 pmol/L. Their diabetes is well-controlled with no or low dose insulin for at least five years after diagnosis.

The clinical manifestation of Youth Onset Type 2 diabetes clinically resembles MODY but Type 2 diabetes patients are obese. Patients with MODY may become obese due to poor diet habits and lack of exercise but are usually lean. Both Type 2 diabetes and MODY patients have a strong family history. To detect MODY, genetic testing should be done.

Candidates for genetic testing

• Non-obese person with abnormal glucose.
• No autoantibodies against the beta-cell of the pancreas.
• Preservation of beta-cell function as shown by a C-peptide of more than 200pmol/L.
• Strong history of the same type of diabetes in first-degree relative (mother or father).

However genetic testing remains expensive and is limited to cases of strong suspicion of MODY.

MODY subtypes

There are at least 14 different MODY subtypes reported. However, there are six major subtypes, as discussed below. MODY subtype determination is important as the subtypes differ in terms of age of onset of diabetes, clinical course and progression, and response to treatment.

• MODY 1(HNF 4 alpha MODY)

This group has a progressive decline of beta-cell function. They present in adolescence. These patients also have increased triglycerides (blood fat content).

• MODY 2 (GCK -MODY)

This mutation increases the glucose threshold for insulin secretion and thus results in increased fasting glucose values. These patients are asymptomatic, and the majority are discovered during pregnancy through a routine glucose evaluation. MODY is present in 2-6% of gestational diabetes. The clinical course of this subtype may be mild and non-progressive, and complications are rare.

• MODY 3 (HNF1 Alpha MODY)

This mutation causes a progressive insulin deficiency that manifest as mild hyperglycaemia in childhood and early adulthood. In this group, the risk of complications is similar to Type 1 or Type 2 diabetes.

• MODY 4 (PDX-MODY)

These patients have neonatal diabetes. This is very rare.

• MODY 5 (HNF 1 beta MODY)

This presents in children with abnormal glucose and abnormality of the kidney and urinary tract to the bladder. These patients will develop kidney failure by 45 years of age. This should be suspected in diabetes with non-diabetic kidney disease. They develop insulin deficiency early in their disease progression.

• MODY 6 (NEURODI-MODY)

This can cause neonatal diabetes or childhood diabetes with associated neurological manifestations and learning difficulties.

How can MODY be diagnosed correctly?

The clinical characteristics of:

• Diagnosed before 25 years of age.
• Presence of diabetes in two consecutive family generations.
• Absence of beta-cell autoantibodies.
• Preserved insulin secretion as demonstrated by a C-peptide of more than 200 pmol/L.
• Not obese.
• Not prone to ketones.

Treatment of MODY

Children and adolescent diagnosed with diabetes will initially be treated with insulin. After glucose is stabilised, an evaluation can be done to exclude MODY by applying the above-mentioned criteria.

MODY 2 can be treated by diet and oral antidiabetic tablets.

MODY 3 needs to be treated with oral diabetic tablets, such as gliclazide or glimepiride. The newer class drug GLP1 agonists (liraglutide) have also been approved.

MODY 5 patients need intensive insulin treatment to control glucose.

Remember MODY should be suspected in the presence of mild to moderate hyperglycaemia without ketones in the presence of a non-obese individual with a strong family history of diabetes.

References

1. Ellard S, Ballane-Chantelot C et. al. Best practice guidelines for the molecular genetic diagnosis of maturity onset diabetes of the young. Diabetologia.2008; 51:546-553

2. Shields BM, Hicks S et. al.Maturity onset diabetes of the young (MODY): how many cases are we missing? Diabetologia.2010;53:2504-2508

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