Too much blood sugar, too bad for your ears

Audiologist, Sakhile Nkosi, unpacks whether there is a link between diabetes and hearing loss.

Every person living with diabetes worldwide knows upon diagnosis that there are different types of diabetes e.g. Type 1 and Type 2 diabetes. Your doctor likely provided rigorous counselling, explaining all the clinical manifestation present in diabetes, such as loss of sensation in the feet (neuropathy), vision disturbances, kidney problems, etc. and the importance of taking medication and maintaining a healthy lifestyle to prevent these complications.

Most research conducted, so far, gave concrete evidence on what can possibly go wrong with an individual living with diabetes. Though, one of the unfamiliar complications that the diabetic community isn’t often made aware of, is the effect of diabetes on the ear structure. Hence, hearing and balance.

The ear

The ear is one of the most important organs in the human body. It provides two basic functions: hearing and to balance. Hearing itself is a special sense, just like vision; it forms basis of communication.

Hearing loss occurs as a result of damage either in the outer, middle or inner (retro-cochlear) part of the ear. If hearing loss is left untreated, it can have negative consequences on an individual’s life. This includes physical, emotional and social health and can cause disturbing effects in relationships with colleagues, family and friends.  In children, hearing loss can cause a delay in speech and language development.

The link between diabetes and hearing loss and balance

Current research reveals the link between diabetes and hearing loss. As early as 2008, the National Health and Nutrition Examination Survey results found that individuals with diabetes are at risk of developing hearing loss compared to those without diabetes.

The results of the survey revealed that individuals with diabetes are prone to a degree of hearing loss ranging from mild to moderate. The type of hearing loss common in diabetic patients is sensorineural in nature, implying the hearing loss is caused by damage to the inner ear or the hearing nerve that carries sound to the brain.

In terms of balance, patients who are diagnosed with diabetes may be at a higher risk for falls. This happens because of how diabetes affects the normal function of vision, sensation in feet, ankles, knees, hips, and inner ears.

As you may be aware, diabetes can affect the normal function of the retina of the eye. If the retina is damaged by diabetes and vision is distorted, the brain is deprived of information and needs help to maintain your balance.

Diabetes also can affect whether you have sensation in your feet. If your feet are numb (due to diabetes), you’ll not be able to sense when you are leaning forward, backward or side to side. In darkness, this becomes a larger problem because you lose the help that you normally would get with vision. This becomes a larger problem, a fall risk, if you also lose function in the inner ears.

Signs and symptoms of hearing loss

One might experience a few or a combination of symptoms.

  • Speech and other sounds are perceived muffled.
  • Difficulty understanding words or speech in a presence of background noise or crowd.
  • Frequently asking other to speak more slowly, clearly and loudly.
  • Constantly turning the TV/radio volume up.
  • Often withdrawing from conversations.
  • Avoiding certain social settings.

How to protect your hearing and balance?

You might have not yet experienced symptoms related to hearing and balance, but prevention is better than cure. Take charge of your diabetes by:

  • Controlling your blood sugar by taking your prescribed medication.
  • Noise can damage your hearing. At home, wear ear plugs when you are running the lawn mower or any other loud appliance. Take ear plugs with you when you attend concerts and sporting events that may be too loud.
  • Have your hearing tested by an audiologist on a regular basis. At least annually or sooner if you notice changes.
  • If you have a hearing impairment, your audiologist might fit you with hearing devices that will improve your ability to converse with others (e.g. hearing aids and assistive hearing devices).
  • Reduce background noise when you have a conversation (radio, TV, etc.)
  • Your doctor may recommend that your inner ears be evaluated by an audiologist to diagnose why you are dizzy and whether it is vertigo. Referrals will be made to other professionals, such as physiotherapists and occupational therapist.
  • Work with your doctor to determine whether changes in your medications might explain changes in your balance.


The Audiology Project

Bainbridge, K., Hoffman, H., & Cowie, C. (2008). Diabetes and Hearing Impairment in the United States: Audiometric Evidence from the National Health and Nutrition Examination Survey, 1999 to 2004. Ann Intern Med

Akinpelu, O., Mujica-Mota, M., & Daniel, S. (2014). Is type 2 diabetes mellitus associated with alterations in hearing? A systematic review and meta-analysis. Laryngoscope, 767-76.

Arlinger, S. (2003). Negative consequences of uncorrected hearing loss – A review. International Journal of Audiology, 42(2), S17–2 S20.

Hlayisi, V., Petersen, L., & Ramma, L. (2018). High prevelance of disabling hearing loss in young to middle-aged adults with diabetes. Int J Diabetes Dev Ctries, 39(1), 148-153. doi:10.1007/s13410-018-0655-9.


Sakhile Nkosi is an audiologist in the public sector. He has been exposed to lots of conditions that are in line with the global burden of diseases, one of them is diabetes. Currently, Sakhile holds a portfolio as a public sector representative at the South African Association of Audiologists (SAAA) and is also part of The Audiology Project (TAP), South African Cohort. 

Managing your diabetes at your matric dance

One of the biggest highlights of the Grade 12 year is the matric dance. Finding the perfect dress and splurging out on nails, hair and make-up and celebrating the last year of high school. Shelly Schutte, a Type 1 diabetes patient, tells us how she made the most of hers.

Shelly Schutte (28) lives in Fish Hoek and has had Type 1 diabetes for 18 years.

My matric dance

Whether you have diabetes or not, your matric dance is the perfect opportunity to treat yo-self. I matriculated almost 10 years ago now and overall, my matric dance is a night I remember with a great deal of fondness.

It took place at the Kelvin Grove Ballroom, in Cape Town, which is a stunning location. During the run-up to the event, we went to ballroom dance classes in the school sports hall. We had great fun attempting the Boogie to the dulcet tones of Katy Perry.

After the dance, we headed out to the club Velvet, where the “official after-party” was being held. It was honestly such a palaver at first. The club was too full and we ended up waiting on the pavement for almost half an hour. Not the glamorous night of dancing and partying we had been imagining!

Luckily, but somewhat embarrassingly, a friend’s dad, who had been our transport eventually came to the rescue. He had some words with the bouncer and got us in.

Although the after-party has much hype in the run-up to the event, it paled in comparison to the brilliant fun that was the dance itself. We happily headed home a little after 3am.

Six am saw us at the local beach for the traditional matric breakfast, with many pale-skinned, dark-eyed students wandering into the restaurant at various times. Some of whom had apparently slept on the beach itself.

How to enjoy your matric dance

As a Type 1 diabetic, events like a matric dance can often come with an extra layer of stress. I often wish I could just have a diabetes timeout every now and then. A chance to a have an evening completely free from the responsibility that is being your own pancreas.

Alas, science has yet to gift us with a cure or a timeout card. However, it is completely possible for you, as a diabetic, to have a matric dance experience that is as wonderful and carefree as every other person in the grade. To this end, I offer a few pieces of advice:

  1. Be safe: face your number

We have a wonderful saying at the DSA diabetes camps: face your number. No matter how high or low your glucose level is. Once you know, you can fix it. This is especially the case on nights like the matric dance when it’s tempting to ignore the fact that you have diabetes. Test regularly throughout the evening.

Whenever I go out and know I will be moving from place to place or drinking alcohol, I set alarms on my phone to check my blood glucose or scan my Freestyle Libre every hour. Time flies by when you’re having fun and especially if you are dancing a lot, but remember dancing can make your blood glucose drop very rapidly.

Nothing is more of a mood-killer than crying in the bathroom because you’re recovering from a low. Test yourself so you can prevent extreme highs and lows throughout the evening and the associated complications.

  1. Appoint a dia-buddy

This is especially important if you are planning to drink alcohol. It is essential that you have a ‘dia-buddy’ – a close friend who knows exactly what to do if you experience a low or high. This person should also have your ICE details, in case you need medical help.

  1. Maintain your normal eating patterns on the night

Keeping diabetes under control is all about routine and predictability. Although the temptation to let loose for a night is probably strong, you will enjoy yourself way more if your blood glucose is not yo-yoing. Keep to your normal eating patterns, count your carbs and be careful with your insulin doses.

  1. Maintain healthy exercise and eating routines in the months before the dance

I have always struggled to keep my BMI in the normal range. Whereas my non-diabetic friends and family members seem to be able to be able to eat whatever they want. I simply was not gifted with a similar metabolism.

In the months before my dance, I was constantly fighting the urge to crash diet to lose those extra 3kg. If there’s anything I’ve learned since then, it’s that a steady routine of exercise and a predictable diet is the biggest gift you can give yourself as a T1 diabetic.

The incredible, stabilising after-effects of a workout at the gym can last for more than 24 hours, which can really transform my whole day into a calmer experience. Also, somehow, a salad always tastes better when I’m eating it after a workout. Exercise at least three times a week, adopt a carb-controlled diet and your body will look after itself in so many ways.

  1. Enjoy yourself

Most of all, you must enjoy yourself! Make beautiful memories and always remember that your diabetes does not define you…but you are braver, stronger and more brilliant because of it.


Shelly Schutte is the youth representative on the board of Diabetes South Africa. She loves spreading awareness and showing the world that she lives an amazing life with diabetes She is currently the Head of Department at a school for children with learning barriers.

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.


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).

Improve your health at work

It’s Employee Wellness Week in South Africa from 1 to 5 July. South Africans are encouraged to participate in wellness within their workplace.

How important is wellness at work?

Extremely! A physically, mentally, and emotionally well employee is a productive employee. A healthy work atmosphere also enables positive morale and job satisfaction. 

With an estimated 56% of women and 29% of men being overweight and obese in South Africa, corporate wellness should be a top priority at all organisations. Further alarming facts show that 1 in 3 men and 1 in 4 women in South Africa will develop a heart condition before the age of 60. Heart disease and strokes are the biggest non-infectious killers in our country while heart attacks and strokes are two of the major health complications which cause premature deaths in people with diabetes.

Did you know that up to 80% of these are due to our lifestyles and behaviour? Which means that 80% of premature deaths can be prevented through lifestyle changes.

Employee Wellness Week

The focus of this week is on wellness in the workplace and encouraging all personnel to follow a healthy lifestyle, even at work. Investing in employees’ health through Employee Wellness Programmes (EWP) is increasingly being recognised as a value-add for both the company and its people.

Companies are benefiting through reduced absenteeism, improved productivity and lower medical costs. Individual benefits are risk reduction in heart disease and strokes, and other occupational conditions, such as stress related illnesses, knowing your numbers and what puts you at risk.

Employees are the backbone of any organisation and if they are in top shape mentally, emotionally as well as physically, it benefits both the organisation and the employees to reach goal of productivity.

Improve your health at work

  1. Step up! Opt for the stairs instead of the elevator – it’s a great way to get in shape.
  2. Experience yoga, it helps with focus, flexibility, and posture.
  3. Stay hydrated! Drink at least eight glasses of water a day.
  4. Snack well! Choose to snack on fruit or yoghurt during your work day instead of sweets and chocolates.
  5. Laugh! Don’t allow work to become mundane. Take time to share a joke with a colleague or laugh at an email. Laughter is a great stress reliever.

For more information go to or find us on Facebook @HeartStrokeSA or on Twitter @SAHeartStroke

Rethink your drink; choose water

The Heart and Stroke Foundation South Africa, together with the National Department of Health, Diabetes SA and other stakeholders, remind you to rethink your drink and choose water.

Why you need to rethink your drink?

Sugary drinks, such as fizzy drinks, flavoured waters, iced teas and even fruit juice, are the main source of added sugar in the diets of most South Africans. This excessive intake of sugar stacks up the kilojoules and often leads to weight gain.

A typical 500ml fizzy drink contains roughly 885 kJ, which would require walking for 5,5km or running for 30 minutes to burn it off. Drinking just one sugary drink a day increases the likelihood of being overweight by 27% in adults and 55% in children.

Despite the impact on your waistline, drinking just one sugary drink per day has also been found to increase the risk of developing diabetes by 26%, and having a heart attack by 29%.

Diabetes is an independent risk factor for cardiovascular disease, the leading killer worldwide, increasing its risk by 200% to 400%. With a country already heavily burdened by obesity, heart diseases, and strokes, please rethink your drink and make water your beverage of choice!

How much sugar is okay?

The American Heart Association recommends no more than 6 to 9 teaspoons of added sugar per day from all food and drinks. This is based on the World Health Organisation’s recommendation to limit added sugar to less than 5% of total daily energy intake for added health benefits. This includes any sugar in a food or drink that was added by the manufacturer or sugars naturally present in honey, syrups, fruit juices and fruit juice concentrates.

How much sugar is in your drink?

The best way to see how much sugar is in your drink is to read the label. Look out for ‘total sugar’ on the nutrition information table then calculate the number of teaspoons by dividing the sugar in grams by 4.

Use the ‘100g’ column to easily compare sugar content between different products, or use the ‘per serving’ column to see how much sugar you’ll have in that serving size.

On average, commercially produced sugary drinks available in South Africa contain the following amounts of sugar per 500ml serving:

  • Fizzy drink: 15 teaspoons
  • Energy drink: 14 teaspoons
  • Sports drink: 7 teaspoons
  • Fruit juice: 13 teaspoons
  • Sweetened dairy drinks: 10 teaspoons (includes naturally occurring milk sugar).
  • Iced tea: 9 teaspoons
  • Flavoured or vitamin-enriched water: 6 teaspoons

So, let’s choose water

Water – still, sparkling or flavoured with fruit – is the best beverage to choose. It serves so many essential purposes in the body:

  • Keeps you hydrated
  • Lubricates joints
  • Prevents headaches
  • Helps with digestions
  • Prevents constipation

Water is far cheaper than other drinks and contains zero sugar or kilojoules and will therefore help to maintain a healthy weight and lower the risk of developing diabetes or heart disease.

Tasty twists

Add a twist to your water with exciting flavours by using any of these ingredients:

  • Fresh slices of lemon, lime, grapefruit or other citrus fruits.
  • Fresh slices of cucumber.
  • Mint leaves.
  • Other fresh fruit, including strawberries, pineapple, or watermelon.
  • Unsweetened rooibos or fruity herbal teas.
  • Add sparkling or soda water if you’re craving some fizz.
  • If you really want to add a bit of sweetness, add a small splash of 100% fruit juice.

Not in the mood for water

Then swap your sugary drink for any of these healthier alternatives:

  • Tea or coffee without added sugar or honey.
  • Sugar-free iced tea, fizzy drinks, energy or sports drinks and cordials.
  • Try our Homemade iced tea recipe.
  • 100% fruit juice diluted with plain, soda or sparkling water.
  • A glass of milk.

Protecting your eyes in summer

Eye Care Awareness Month has passed and with summer fast-approaching, it is a good idea to relook at ways to protect your biggest gift of all – eyesight.

Annual eye examination

Firstly, it’s important to get an eye examination annually. A lot of underlying health issues can put your eyes at risk, with diabetes being one of them.

At the annual eye exam, your optometrist will look at the general retinal health. Diabetic retinopathy can be picked up and a treatment plan can be put in place.

Avoid prolonged UV exposure

Another area to look at is prolonged ultraviolet (UV) exposure during the summer months. UV can cause conditions like cataracts and macular degeneration. If you think sunglasses alone is enough to protect your eyes, think again.

Certain medications may make your body and eyes more sensitive to sun, so take the necessary precautions to protect them.

Buy 100% UV protective sunglasses

Always make sure the sunglasses you buy is 100% UV protective, and also covers your whole eye area. The bigger the better.

A great piece of advice we all know but seem to forget is to rather stay out of the direct sunlight between 10am and 3pm.

Things to remember

  • Eye protection is very important all year long.
  • Early detection can save your vision.
  • Prevention is always better than a cure.


Werner Fourie (B.Optom UVS) believes optometry enables him to help people in unique ways, and The Eyewear Boutique gives him the ability to stay passionate and to be his creative self.
Werner Fourie (B.Optom UVS) believes optometry enables him to help people in unique ways, and The Eyewear Boutique gives him the ability to stay passionate and to be his creative self.

What have you gained this year through your diabetes?

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

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

What you might have gained

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

Personal growth

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


Rosemary Flynn
Rosemary Flynn is a clinical psychologist at the Centre for Diabetes in Johannesburg. She has worked with children, families and adults with diabetes for 24 years, enabling them to overcome their anxieties about their condition and to deal with the difficult events in their lives.

Meet your inner king, hero and court jester

Noy Pullen explains how you can access your inner king, hero and jester when tackling the management of your diabetes.

Motivation can be defined as one’s direction to behaviour, or what causes a person to want to repeat a behaviour and vice versa1. Motivation is a buzzword bombarding the modern individual. Back in the day, our parents and, certainly our grandparents, would never have been exposed to this idea of ‘being motivated’.

Words have their own magic living within them, so exploring a few of these words in popular culture reveal their own wisdom.

Motivation – has to do with ‘move’ and ‘motive’.

Change – would have been what was left over from a purchase.

Coach – in the past, a coach was a conveyance that took people to their chosen destination.

Creative – using an adjective as a noun adds to its power. Juggling these letters around to form the word reactive, gives you the opposite of what a creative implies.

Influencer – tries to get ‘in’ to you from the outside.

Looking throughout history

Whenever we hear the words ‘Once upon a time…’, we know we can settle down to hear a story – a story of heroism, wisdom and adventure.

The king

The regal king or ukumnkani led his people through times of plenty and famine, through war and peace, and solved problems brought to his throne by his subjects. People relied on his wisdom and knowledge of the inner and outer world.

The heroes

Then, there were the heroes (amaqhawe) doing the bidding for the king, bravely facing monsters and other enemies to bring peace and well-being to the kingdom.

The king (or head) knew about everything, but did not do anything; the hero (or limbs) fought for the king and for the stability and health of the whole country. But without the heart man in the centre, neither of these characters could function.

The jester

The fool (jester), wizard or iphakathi (the creative centre of the people) not only played jokes on the king but was his closest advisor. “The fool had the right to sit at table with his master and say whatever came into his head. He could be juggler, confidant, scapegoat, prophet, and counsellor all in one. Entertaining, but also offering criticism and advice couched in with…Laughter frequently turns the scale in matters of great importance. The jester’s detached stance allows him to also take the side of the victim, to curb the excesses of the system without ever trying to overthrow it. His purpose is not to replace one system with another, but to free us from the fetters of all systems2.”

What has this got to do with diabetes?

The good news is that we now each have access to our inner king, hero and jester. Look at any self-help category in a bookstore for irrefutable evidence that we have discovered these beings within us in this modern time. It is called identity.

A manual called The Diabetes Toolkit7, written by Buyelwa Majikela-Dlangamandla, is filled with simple but good information of all aspects of diabetes, for your inner king to come to terms with diabetes.

Two other books come to mind: The Obstacle is the Way3 is one where Ryan Holiday using techniques of the jester explores the ancient art of turning your tragedy into a strategy. Then, the charming book Be a Hero- Lessons for Living a Heroic Life4, by Alan Knott-Craig and Craig Rivett, uses delightful playful visuals, in the form of rules, guides, cartoons, quotes, powerful daily exercises, and useful lists to help you become creative, rather than reactive (by knocking yourself against the same old brick wall). Both these books can be read in an afternoon but their effects will last a lifetime.

Thanks to Friedrich Nietzsche, you will also find various comics which call forth the hero, such as Clark Kent becoming Superman (Übermensch). Superman knows everything, can do anything, even recognising his own vulnerabilities and, more importantly, senses through his heart when a fellow being is in difficulty and does only what is needed in that situation. He does not blame or question, or judge. He has pulled his own inner kingdom together. He, like the jester, helps his community out of the danger and seeks to free us ‘from the fetters of all systems’2.

Music of healing

Unfortunately, people – diabetes educators and many others – who want to assist those living with diabetes, out of the noblest of intentions and prior official training, treat the patient as though he/she needs to listen to an outer king, who gives him orders. Then, they expect him/her to act like a hero, vanquishing the dragon.

If only the diabetes healthcare provider or loved one could play their own court jester, and, in finding the patient’s own court jester, then their combined creative energy would create the wisest and most effective ways of meeting the immediate situation.

No wonder the fate of the entire nation was put in the hand of the jester. Everyones’ lives depended on it. The sense of humour can make the most desperate situation bearable, where wisdom and action meet in the heart.

Creative people know they are all jesters. What they do with paint, or music, or on the stage is not called ‘play’ for nothing. If the diabetes team players could find their way into an orchestra of ‘harmonious instruments’, they, together with the patient, would create the music of healing.

Identity is a journey 

In a recent interview, Glen Phillips, a musician, who recently suffered personal tragedy, characterised his own journey by saying, “I’m not sure if I’m entirely post-sabotage yet. It’s a process and old habits are hard to break…Part of getting out of self-sabotage is just avoiding the territory where I know I’m conflicted, so the more I concentrate on service and art, the better life gets. I can tour enough to make a living, and the less I stress about the business side of things, the more things seem to open up creatively…I think we could benefit more if there was some better encouragement for just being a citizen, a helper and healer, a good friend, a member of a community. I realise, there’s a power to money and success that can make things move in the world, but for most of us the work is less abstract, more about the people we touch and the love we give…If you feel entitled to some kind of immortality, it kind of sucks the passion out of making the most of the few days you have. The living days are where the gold is.6

Soweto-born, Elo Zar, another creative says one of her biggest struggles was, “Getting over myself. Self does not play a role when serving people and I’d like to do that – serve. Self-love is a struggle for all of us. I believe we ought to be reminded and supported to be different and to stay different… Identity is, after all, a journey5.

Tim Pullen, another creative in the musical and artistic realm, has this message for heroes like himself, who carry out the task of living with diabetes day to day: “It’s your diabetes. It’s your life. it’s your freedom. Enjoy it7.”

Track your progress each day 

Remember an artist, musician and sportsperson improves by playing often and by practising their chosen discipline regularly. They form new habits towards excellence.

To liberate your inner king, train your thinking

  • Think of a very simple object, like a matchstick, every day for five minutes. Just building up a logical picture of the object for a few minutes.
  • Keep a daily journal and review what has happened on that day, jotting down patterns and rhythms you noticed about yourself. Mark it with a blue dot.
  • Read biographies.

To liberate your inner hero, enliven your will

  • Do something no one has asked you to do, at the same time every day e.g. moving your keys from one pocket to another at noon.
  • Keep a diary of the main obstacle of the day, where you felt unfairly attacked, or given bad news, or accused of something which you had to defend, etc., and write it down. Mark with a red dot.
  • Watch biographies.

To liberate your inner jester, warm your heart

  • Keep a diary each day of extreme emotional outbursts from either yourself or others. Look for the trigger and write it down.
  • Keep a diary of your obstacle of the day (see above). Try to find what triggered your reaction – fear, hatred, doubt, jealousy, pain, boredom – and mark it with a yellow dot.
  • Get into a habit of asking people about their life stories in casual conversation. You will be fascinated no matter how difficult your relationship might be.

Reflect, assess and share

  • Compare what you wrote in your diary next to the blue, red and yellow dots over a period of a week. Look for clues of how to make some changes that you feel would help you find a new creative step. Let your inner king and hero know what you have discovered and have a conversation with them.
  • Write down what the king thinks. Add to this, what the hero wants to do about the situation and write down how you, the jester, feel. Come to some agreement and try it out.
  • Repeat this as a life-long practice in various creative ways.
  • Have fun and let people know how your journey is progressing. You never know you may be the hatching your own best-seller.


  1. Maehr, Martin L; Mayer, Heather (1997). ‘Understanding Motivation and Schooling: Where We’ve Been, Where We Are, and Where We Need to Go’. Educational Psychology Review. 9 (44
  3. Holiday Ryan (2015) ‘The Obstacle is the Way -The ancient art of turning adversity into advantage’.  Profile Books
  4. Knott-Craig Alan; Craig Rivett (2015). ‘Be a Hero – lessons for living a heroic life.’ Fevertree Publications
  5. City Press13 August 2017 Phumlani S Langa
  7. Majikela-Dlangamandla Buyelwa (2016). ‘The Diabetes Toolkit’ manual. P22

Please contact Noy Pullen if you would like more information on her resources: or 072 258 7132.

Don’t let glucose levels scare you this Halloween

If your family is planning to go trick-or-treating, Donna van Zyl shares ways to enjoy Halloween without fussing over glucose levels.

Halloween need not only be about the trick-or-treating. Encourage your child to partake in non-food activities, such as carving a pumpkin; make decorations; having fun with friends and family whilst watching a scary movie; dressing up or visiting a ‘haunted’ house. It is, however, important to know what your child is looking forward to on this day, so that you can help meet their diabetes management in the middle.

Plan ahead

Sit down with your family and make Halloween plans in advance so your child knows what to expect. Create boundaries and general rules with your family. Your child will be more likely to be on board with a plan they helped create.

The rules of the plan may include:

  • Make sure your child does not go alone.
  • Ensure your child eats well and smart throughout the day, prior to the trick-or-treating so he/she can start off the evening with normal blood sugar level.
  • Then, make a deal with your child to avoid snacking until you’re both home from trick-or-treating.
  • Your child should take his/her own water or non-sugary drinks along, as they may get thirsty.
  • Your child should keep track of his/her sugar levels throughout the evening. Trick-or-treating may include a lot of excitement, running around or even having a treat out of the extraordinary.
  • Be prepared – test and ensure your child has something appropriate to treat a hypo. It is likely that he/she will have something in their bag to treat a hypo, however, the chocolate containing sweets do not necessarily act rapidly. Ideally, they should choose the sugary option and may need a follow-on snack, like a half of a peanut butter sandwich.
  • Friends and family can be very supportive and have healthy snacks waiting for your child. These options may include nuts, dark chocolate and fruit (strawberries dipped into dark chocolate). If they do have chocolate, encourage them to make sure they’re the snack-size versions.

Returning home

Once both of you have returned home, allow your child to choose his/ her favourite treat and administer an insulin dose accordingly.

The non-chocolate treats could be sorted into 15g carb packets and kept to treat a hypo. Those chocolate coated treats can be exchanged for a desired gift i.e. a toy, TV game, movie ticket, or a trip to the zoo etc. The exchange of sweets for a desired toy or game could apply to all the children of the house. The exchanged treats can also be donated to the less fortunate community groups as a treat they often do not receive.

Diabetic-friendly Halloween recipes

You can also make great Halloween diabetic-friendly recipes that will allow your children with diabetes to enjoy the day, without missing out treats.

Suitable Halloween treats:


Donna van Zyl is a private practicing dietitian for Nutritional Solutions, Bloemfontein. She is growing in the field of paediatrics and plays a key role in individualising nutritional therapy for Type 1 diabetics. She has a special interest in optimising health, managing chronic lifestyle related diseases, and sports nutrition. She lectures part-time at the University of the Free State, which she enjoys thoroughly.