DIABETESDIABETESDIABETESDIABETESDIABETESDIABETESDIABETESDIABETESDIABETESDIABETESDIABETESDIABETESDIABETESDIABETESDIABETESDIABETESDIABETESDIABETESDIABETESDIABETESDIABETESDIABETESDIABETESDIABETESDIABETESDIABETESDIABETESDIABETESDIABETESDIABETESDIABETESDIABETESDIABETESDIABETESDIABETESDIABETESDIABETESDIABETESDIABETESDIABETESDIABETESDIABETESDIABETESDIABETESDIABETESDIABETESDIABETESDIABETESDIABETESDIABETESDIABETESDIABETESDIABETESDIABETESDIABETESDIABETESDIABETESDIABETESDIABETESDIABETESDIABETESDIABETESDIABETESDIABETESDIABETESDIABETESDIABETESDIABETESDIABETESDIABETESDIABETESDIABETESDIABETESDIABETESDIABETESDIABETESDIABETESDIABETESDIABETESDIABETESDIABETESDIABETESDIABETESDIABETESDIABETESDIABETESDIABETESDIABETESDIABETESDIABETESDIABETESDIABETESDIABETESDIABETESDIABETESDIABETESDIABETESDIABETESDIABETESDIABETESDIABETESDIABETESDIABETESDIABETESDIABETESDIABETESDIABETESDIABETESLifestyle

The offi cial magazine of The Centre for Diabetes and Endocrinology

Issue Two

R30.00incl. VAT

My life with diabetes

Diabetes and depression

Making time for breakfast

Getting to grips with GI and GL

Issue Two Getting to grips Getting to grips Getting to grips Getting to grips

Diabetes in babies and toddlers

Distributed free via selected pharmacies and medical aid schemes

LIFESTYLE COVER2.indd 1 9/30/2010 6:21:25 PM

DL2IFC.indd 1 9/30/2010 6:18:18 PM

DL2IFC.indd 1 9/30/2010 6:18:18 PM

REGULARS

Editor’s Note 2

FOCUS ON THE CDE

The insider’s view 11

DIABETES MANAGEMENT

Eye Spy 6

What is an insulin pump? 17

Diabetes and gum disease 22

Talking about E.D. 30

Sick day management 44

LIVING WITH DIABETES

Youth with diabetes 10

Podiatry vs. pedicure 14

The depression dilemma 33

Maths, your health depends on it 34

My life with diabetes 40

FITNESS

How to get the most out of your workouts 46

PARENTING

Diabetes in babies and toddlers 36

EAT RIGHT

Getting to grips with GI and GL 20

Making time for breakfast 26

Losing weight the healthy way 28

LETTERS

Feedback 48

DISCLAIMER

Views expressed in editorial are not necessarily those of the CDE , the Publishers, or Editors. While every effort is made to ensure the accuracy of the content of this maga-zine, the CDE, the Publishers, and Editors do not accept responsibility for omissions or errors or their consequences. Any general advice contained within cannot and is not in-tended to be a substitute for professional medical advice, diagnosis or treatment and is not purporting to be the practice of medicine. Never disregard professional medi-cal advice, or delay in seeking it, because of something you have read here, or rely on this information in place of seeking professional medical advice. Always discuss any new information with your Diabetes Team before acting on any aspect of it. Use of the information contained within this publication is thus with the understanding that it is at the readers own risk. Acceptance of advertising does not imply that these products and services are recommended by the CDE, the Publishers, or Editors.

CONTENTS•

INSIDE

Published for the Centre for Diabetes and Endocrinology

by

DevAd Publishing ccP O Box 377, Strubens Valley, 1735Telephone - 011 475-1536devad@polka.co.za

EditorMichael Brown - CDE Houghton

Managing Editor / EditorialSharon Dale Wiggilldevad@polka.co.za

Advertising ExecutiveAngela Bell011 787-9366 / 0824510193angbell@mweb.co.za

Editorial AdvisorsDr Larry DistillerDr David SegalDr Stan LandauVanessa BrownMandy MarcusAndrew HeilbrunnTracey JohnsonPaul Baker

Design and layoutDragon Designs

Project ManagerPeter Black - CEO, CDE Diabetes Management Programme

Repro & PrintCTP Web Printers

Centre For Diabetes And Endocrinology011 712-6000www.cdecentre.co.za

CopyrightMaterial published in Diabetes Lifestyle,including all artwork, may not be copiedreproduced or published without the per-mission of the publishers.

Michael Brown Editor Michael@cdecentre.co.za

4 LifestyleDIABETES

Through this publication we aim to spread messages about good diabetes care and how in spite of diabetes (and in some cases with

its help!), you can achieve a healthy, productive and fulfilled life.

Welcome to our second issue of Diabetes Lifestyle! It has been quite a journey for the editorial team and we have been gratified by the feedback we have received from our new readers and from our advertisers. Diabetes can only be managed with a team effort - no less so with this publication.

My aim as Editor is to create a virtual community amongst our readership. To this end I would welcome any feedback and suggestions you may have. We also will welcome your stories about your personal journeys with diabetes to share with others who may think that they are alone in their experiences.

Our Second Issue again covers a wide spread of topics, the diversity of which reminds us of how pervasive diabetes can be in your life. Paul Baker (our very insightful patient contributor), writes about a crucial issue in diabetes – that of numerical literacy. Diabetes requires that you, the person with diabetes does most of the thinking. Research has shown that one of the most difficult tasks for many is working with numbers (for example, calculating the number of carbs in a portion of food and deciding how much insulin to take to match). People vary in their ability to understand numbers and solve arithmetical problems. This can impact on their diabetes self-care ability. Topics also covered include the under-recognised issue of depression and diabetes, the difference between ‘podiatry’ and ‘pedicure’ and between ‘GI’ and ‘GL’ and how to get the most out of your workouts. But, that is not all… start reading for much, much more.

In commemoration of World Diabetes Day (November 14) CDE is planning to recognise those people who have lived with diabetes for many years. We will be presenting ‘Diabetes Milestone Awards’, bronze, silver and gold medals to any South Africans who have lived with diabetes for 50, 60 and 75 years respectively. Your stories can provide inspiration to those who follow. If you were diagnosed 50 or more years ago as at 14 November 2010, please contact me Michael@cdecentre.co.za for an application form.

Finally, congratulations to Nena Hipper, the first person to correctly identify the potential problem in our inaugural Readers Competition (page 8 of Issue 1). She correctly identified that the lid of the box of testing strips had been left open instead of closing it immediately. This is a common preventable cause of blood glucose reading errors which we aim to cover in more depth in a later issue. When I asked Nena for a ‘bit’ about herself she wrote “I have had diabetes for 6-7 years and live a very full life. I paint, sculpt, make pots, porcelain dinner services and fabric books. I also work in the garden, like classical music, opera, jazz, films, read literature in English, German and French. I go to gym where I cycle and swim and I walk my dogs. Of course,

each interest takes its turn with short and long breaks, so a bit about myself is rather tricky”. Well done Nena – your prize of a R200 Pick n Pay gift Voucher is on its way to you!

Nena Hipper

www.cdecentre.co.za

Eye care is especially important for people with diabetes because they are at increased risk of

developing eye complications

People with diabetes do have a higher risk of blindness than people without diabetes. But the good news is that most people who have well-

controlled diabetes may develop nothing more than minor eye disorders.

Retinopathy

Diabetic retinopathy is a general term for all disorders of the retina (the light-sensitive membrane at the back of the eye) caused by diabetes. There are two major types of retinopathy: non-proliferative and proliferative.

Non-proliferative retinopathy is the most common form of retinopathy. In non-proliferative retinopathy, capillaries in the back of the eye balloon and form pouches. Non-proliferative retinopathy can move through three stages (mild, moderate, and severe), as more and more blood vessels become blocked. Although retinopathy does not usually cause vision loss at this stage, the capillary walls may lose their ability to control the passage of substances between the blood and the retina. Fluid can leak into the part of the eye where focusing occurs, the macula. When the macula swells with fluid, a condition called macular oedema occurs, vision blurs and can be lost entirely. Although non-proliferative retinopathy usually does not require treatment, macular oedema must be treated. Fortunately, treatment is usually effective at stopping and sometimes reversing vision loss.

In some people, retinopathy progresses after several years to a more serious form called proliferative retinopathy. In this form, the blood vessels are so

damaged they close off. In response, new blood vessels start growing in the retina. These new vessels are weak and can leak blood, blocking vision - a condition called vitreous haemorrhage. The new blood vessels can also cause scar tissue to grow. After the scar tissue shrinks, it can distort the retina or pull it out of place - this is called retinal detachment.

Your retina can be badly damaged before you notice any change in vision. Most people with non-proliferative retinopathy have no symptoms. Even with proliferative retinopathy, the more dangerous form, people sometimes have no symptoms until it is too late to treat them. For this reason, you should have your eyes examined regularly by an eye care professional.

Who’s at Risk for Retinopathy? Several factors influence whether you get retinopathy or not. These include your blood glucose control, your blood pressure levels, how long you have had diabetes, and your genes.

The longer you’ve had diabetes, the more likely you are to have retinopathy. Almost everyone with type 1 diabetes will eventually have non-proliferative retinopathy, and most people with type 2 diabetes will also get it. But the retinopathy that destroys vision, proliferative retinopathy, is far less common.

Remember, people who keep their blood glucose levels close to normal are less likely to develop retinopathy, or if they do, they will have milder forms.

Cataracts Many people without diabetes get cataracts, but people with diabetes are 60 % more likely to develop this eye condition. People with diabetes also tend to get cataracts at a younger age and have them progress faster. With

DIABETES MANAGEMENT•

EYE SPYDr. Brian Kramer

Specialist Physician / Endocrinologist

CDE, Houghton

DIABETESLifestyle

8

cataracts, the eye’s clear lens clouds, blocking light.To help deal with mild cataracts, you may need to wear sunglasses more often and use glare-control lenses in your glasses. For cataracts that interfere greatly with vision, doctors usually remove the lens of the eye and sometimes the patient gets a new transplanted lens. In people with diabetes, retinopathy can get worse after removal of the lens, and glaucoma may start to develop.

Glaucoma People with diabetes are 40 % more likely to suffer from glaucoma than people without diabetes. The longer someone has had diabetes, the more common glaucoma is.

Glaucoma occurs when pressure builds up in the eye. The pressure pinches the blood vessels that carry blood to the retina and optic nerve. Vision is gradually lost because the retina and nerve are damaged. There are several treatments for glaucoma. Some use drugs to reduce pressure in the eye, while others involve surgery.

Taking care of your eyes

All people with diabetes should take precautions to help reduce their risk of developing eye problems.

Most importantly, keep your blood glucose levels under tight control. High blood glucose levels may also make your vision temporarily blurry. Bring down high blood pressure as it can make eye problems worse.

See your eye care professional at least once a year for a dilated eye exam. Having your regular doctor look at your eyes is not enough. Only optometrists and ophthalmologists can detect the signs of retinopathy and only ophthalmologists can treat retinopathy.

In addition, see your eye care professional if:

your vision becomes blurry •you have trouble reading signs or books •you see double •one or both of your eyes hurt •your eyes get red and stay that way •you feel pressure in your eye •you see spots or floaters •straight lines do not look straight •

If you are between 10 and 29 years old and have had diabetes for at least five years, you should have an annual dilated eye exam. If you are 30 or older, you should have an annual dilated eye exam, no matter how short a time you have had diabetes. More frequent exams may be needed if you have eye disease. You should also have a dilated eye exam if you are pregnant or planning to get pregnant.

EYE SPY

LIVING WITH DIABETES•

DIABETESLifestyle12

Hester Davel Registered Nurse, Diabetes Educator CDE, Houghton

Youth with Diabetes (YWD) is a non-governmental and non-profit organisation established in 2007 by teens living with Type 1 diabetes.

It is an organisation for the Youth, by the Youth. Our aims are to educate and raise general public awareness about diabetes, to establish support groups, and to host

educational diabetes weekend camps. Our most important goal is MOTIVATION. We wish to provide young people with a platform where they can learn to accept their diabetes and obtain the information to master their condition. With our positive attitude, innovative ideas and enthusiasm, we are making a difference. “Life can be sweet” for those living with diabetes.

Developing bonds and friendships

YWD assist and help with diabetes camps all over Southern Africa with great success. Diabetes camps have numerous advantages for the patient and family, the community and the diabetes care team. They provide a non-confrontational arena for education including: healthy nutrition, insulin therapy, home glucose monitoring and the management of acute emergencies and prevention of long-term complications. Children and adolescents are exposed to different environments, challenges and new gadgets. No longer feeling isolated and alone, campers meet other children with diabetes from all walks of life. They have the opportunity to develop friendships and bonds that transcend age, sex, race and religion through the commonality of their diabetes. They also get to have fun in a safe and supervised environment while giving their parents and siblings a much-needed breather from the constant stresses and strains of diabetes care.

YWD has also been involved in a school project, by performing a play at schools to increase awareness of and rule out misconceptions regarding diabetes. The focus is on healthy living as a child with diabetes.

YWD proudly offered our Fourth National Diabetes Youth Leader (DYL) Training Camp from the 29th September to the 3rd October 2010, at Magalies Retreat. The National Diabetes Youth Leader Training was initiated by Dr David Segal and Sr. Hester Davel in 2006. The DYL Programme is offered to attendees from other African countries as well. Teens and young adults with good diabetes care and lead-ership skills are invited to participate in a rigorous educa-tional course. The course covers all areas of diabetes from basics to advanced topics, camping logistics and leader-ship skills development. The graduates are positive, well-educated diabetes ambassadors capable of educating communities and mentoring newly diagnosed children. They also form the backbone of a successful Diabetes Camp Pro-gramme, by providing knowledgeable sentries that facili-tate the smooth and safe operation of diabetes camps.

Focusing on leadership

This year the focus of the leadership training was not only to empower the young leaders to walk their talk when it comes to living with diabetes, but also for them to imple-ment projects in their communities through which others will be empowered. To achieve this aim the programme fo-cussed on achieving three objectives:

To create opportunities for the leaders to learn 1. more about themselves and discover their natural leadership talents;To strengthen these insights further by allowing 2. leaders to practice their team leadership skills in a relaxed and fun environment;To facilitate a process whereby leaders can learn 3. how to plan a project and lead a project team in the execution of the plan.

After the 5-day programme, local project implementation will be supported by mentors that will assist the teams. Feedback on the success of the projects will kick-off the 2011 leadership training to allow reflection on and sharing of the lessons learned. As an extra motivation, the projects will be judged and a winner chosen.

Youth with Diabetes facilitates the Youth leaders training under the auspices of the Diabetes Education Society of South Africa (DESSA) and the Paediatric and Diabetes Society of South Africa (PAEDS-SA). The initiative is proudly sponsored by the Centre for Diabetes and Endocrinology (CDE), Lilly and Accu-Check (A special thank you to Accu-Chek for supporting us every year since 2006). As a NGO we depend on our sponsors for funding all our initiatives. We want to thank them all for their support throughout the years and their role in the successes of all our projects.

If you are interested in the work of YWD, or would like to make a donation to fund our initiatives, please contact Hester Davel at 011 712-6000 or e-mail Hester@cdecentre.co.za

Youth with Diabetes

FOCUS ON THE CDE•

DIABETESLifestyle

13

The CDE Diabetes Management Programme (DMP) has been running in South Africa for over 15 years

No other diabetes programme in South Africa can boast such longevity, and success. Our history has taught us some very important lessons, some of

which are highlighted here.

Lesson number 1: It is the person with diabetes that ultimately determines how successful the programme will be for them

We see this time and time again. The DMP provides an infrastructure for successfully managing a person’s diabetes. However, the key component of the programme, is the patient them self. They have to take that all-important decision to take control of their condition, and become the managers of their own health and well-being.Simply seeing various healthcare practitioners at various times only plays a small part. Yes, it is important to do the right things, but if the person with diabetes does not tell themselves: “I am taking control, and I am taking this seriously”, there will be limited success.

Lesson number 2: Expertise in diabetes care varies tremendously - there is much excellence, but there is also some very poor advice being given by some healthcare providers in South Africa

People with diabetes who join our Programme are often amazed to experience what they have been missing – a focused, team approach, in which the patient is an integral part. We encounter some healthcare practitioners who know what to do and who go out of their way to make sure that their patients with diabetes get what they need. However, many healthcare practitioners are either totally ignorant of what to do, or they don’t have the passion and / or time, or they don’t really care.Our DMP members often tell us how they were told to simply take their new tablets and avoid sugar!

The CDE has been at the forefront of educating and accrediting

healthcare providers in best diabetes care principles, for many years. An important part of our mission is to enhance diabetes care standards across the country.

Lesson number 3: Some funders of healthcare (medical aids) do not invest in good diabetes care for their members - they only look at saving money in the short term

The medical aids that are contracted to the Diabetes Management Programme all understand that their main purpose is to provide their members with the BEST POSSIBLE care. This is vital, since poor care can lead to debilitating chronic complications for people with diabetes. Interestingly, a number of medical aid schemes elect not to contract with the CDE; these schemes simply try to minimise the short-term diabetes treatment costs that their members with diabetes incur. A massive (mainly cardiovascular) cost burden of the long-term mismanagement of diabetes is the result of this lack of insight or lack of will to budget beyond the next scheme AGM.

Peter Black CEO – CDE Diabetes Management Programme

The Insider’s View

Dr. Everard S Polakow and Sr. Lynne Kruger have CDE Centres

at:

Linksfield and Edenvale• - 34 Meyer Street, Linksfield

Kempton Park • - Unit 1, 40 Monument Road

Boksburg • - 8 Albrecht Street (behind Sunward Park Hospital)

Contact:

Sr. Lynne Kruger

on

082 330-2031

If you are lucky enough to belong to a medical aid scheme that takes diabetes

care seriously, please consider joining the CDE Diabetes Management Programme

(if you are not a member already)

It is crucial that the care, advice and

support relating to feet and diabetes are

both suitable and adequate

Amputation is unfortunately a possible result of

poorly controlled diabetes. In the end, it is the

result of foot ulceration, due to a mix of various

problems, that affect the feet.

The risks of developing foot ulcers and thus the possibility

of amputation can be reduced if diabetes foot care is

adequately managed. This means both by the person at risk and by experts equipped to deal with feet and diabetes. However, shockingly enough, international research

has shown that most global healthcare providers are

insufficiently trained and do not have enough knowledge to

ably manage complications of the feet owing to diabetes.

If this is the case, then it stands to reason that foot care

of patients with diabetes, should not be carried out in the

beauty salon - commonly termed a pedicure.

Put your foot down

While it is often true that any foot care is better than none

and that many people are lucky to receive any kind of foot

care, the feet of a person with diabetes are best cared for

by a team. Your diabetes team should consist of healthcare

professionals from different disciplines (the educator, the

diabetes specialist and the podiatrist, to name a few) who

share information and work with you to help you care for

existing foot problems and to prevent future ones.

Too many patients with diabetes have regular pedicures only. Most patients love the pampering and relaxed feeling of a pedicure, but are unfortunately blissfully unaware of

potential dangers that lurk.

Podiatry vs.Pedicure?

Tracey JohnsonPodiatrist, CDE, Houghton

LIVING WITH DIABETES•

DIABETESLifestyle16

Putting your feet up

Several institutions offer pedicure courses. These range

from a part time one-month course in pedicures to offering

a pedicure component as a part of a 3-year degree. None

of these options is sufficient to cover the extensive anatomy

and pathology of the foot, let alone the medical care of

the foot in the context of diabetes. In addition, practicing

pedicurists vary widely in their level of training.

A typical part of a pedicure is the pressing back or cutting

away of the cuticles. Whilst neatly groomed cuticles might

look aesthetically pleasing to society, this area overlies and

protects the area from which the nail grows, called the nail

matrix. Damage to the matrix could permanently effect nail

growth. A cut cuticle (or any break in the protective mantle

of the skin) provides an entry point for germs.

Beauticians are not qualified to use a blade of any sort.

Not even registered nurses in South Africa are permitted

to do this. Unfortunately, many available callus removing

implements are unsuitable. Additionally, there are two

different kinds of callus. Physiological callus should not be

removed as it is protective. The removal of hard skin during

a pedicure is often too aggressive and unnecessary.

Correct infection control standards are vital to stop the

spread of diseases. Scores of patients have testified

to being infected following a routine pedicure. Many

infection causing bacteria, viruses and fungi are only killed

by sterilisation, a process that effectively kills or eliminates

infectious agents. Sterilisation of commonly used instruments

for foot care is only achieved through use of heat in a

pressurised environment (autoclaving).

Chemical means of sterilisation are unsuitable - although

they prevent the growth of bacteria, they may not kill

them. Whilst most salons will inform their patrons that they

keep everything spotlessly clean, they are typically only

disinfecting. A disinfectant is a chemical that kills the cells

of certain germs but not necessarily the spores causing infections. Hence, a high rate of fungal infections is often seen following pedicure care.

Ultimately, the reason for a pedicure is for beautification

i.e. aesthetic reasons. In contrast, podiatric assessment and

treatment is done for medical reasons. It is carried out for

improvement of the general overall health and well-being

of the patient, and in particular to avoid foot problems.

If you learn about diabetes and your feet, you are more

likely to avoid foot problems in the future. As a minimum, all

patients with diabetes should have an annual assessment of

the feet (more if your risk of foot complications is higher).

This is an essential component of diabetes management.

Research into care of the feet in diabetes has shown that

reductions in ulcerations and amputations are possible.

If you have diabetes, you need to know how to check and

look after your feet on a daily basis. You should know and

understand your level of risk for developing ulceration. You

should know how you could prevent future problems. You

need to make sure that your foot care is as good as it

can possibly be or, as is often the case, better than it is

at present. Be aware, and make others aware, that foot

ulcers and amputations can be prevented with good care.

The gatekeeper for dealing with feet in diabetes is the

podiatrist and not the pedicurist.

Editors Note: The CDE Diabetes Management Programme

offers an annual screening visit with a Podiatrist as part

of the minimum benefits. When last did you see your

podiatrist?

If you have diabetes, you need to know how to check and

look after your feet on a daily basis

DIABETESLifestyle 17

LIVING WITH DIABETES•

Pretty feet vs. healthy feet

DIASOCKS AD

An Insulin Pump is a way of giving insulin continuously into the body

It is about the size of a pager and holds a reservoir of insulin. The pump delivers insulin into the body through a plastic tube called an infusion set. The pump can be

worn in a pouch or on a belt on the outside of the body. Many people have found clever ways of attaching it to their clothes.

The infusion set is inserted just below the skin using a small flexible tube called a cannula. This is very much like giving yourself an injection. The cannula stays in place up to three days and then has to be changed.

What the Insulin Pump can and cannot do

It is really important to understand what the pump offers but also what it cannot do. An insulin pump is not an easy way out. As many of you know, the pancreas is an organ in the human body which controls your blood glucose levels. In type 1 diabetes the insulin producing beta-cells of the pancreas stop working and therefore your blood glucose level rises. The insulin pump is not an artificial pancreas; it cannot measure your blood glucose and then decide on how much insulin to give you. You still need to do this yourself.

How is the Insulin Delivered?

If you decide to go on an insulin pump, we will discuss this with you in a lot of detail. An insulin pump delivers only rapid-acting insulin and therefore it mimics the human body in that the insulin works very quickly and wears off very quickly. The pump delivers insulin in two different ways:

Basal rate : this is where a small amount of insulin is delivered continuously 24 hours a day in order to keep your blood glucose stable between meals

and during the night. The pump can be programmed to deliver different basal rates depending on the time of day. For example, most people require less insulin at night and then this requirement increases just before breakfast. This will all be explained to you if you decide to go on the insulin pump.Bolus : this is when a large amount of insulin is delivered over a short period of time to cover food and drinks from meals or snacks. Since a bolus can be given at anytime and in varied amounts, there is greater flexibility with regards to timing and the size of meals. It also enables you to give an extra bolus (correction or supplemental bolus) to compensate for high blood glucose. To be able to do this correctly you have to be able to carbohydrate count so that you can look at your food and what you are eating, and give the appropriate amounts of insulin to keep your blood glucose in single figures.

The Insulin Pump

Insulin pumps are changing all the time and getting more and more sophisticated. Many of you know how to use a mobile phone or Gameboy. Insulin pumps menus share similarities with these and those who are “tech-savvy” will be able to work them out very easily. It is important however, that the insulin pump is not abused in anyway otherwise it can cause

serious problems in diabetes control. There are now 2 makers of insulin pumps on the market in South Africa. Diabetes Specialist Nurses who are certified as Pump Trainers will show you the types of insulin pumps available and you can decide on which one you would like to use. They all work on

the same principle as discussed earlier with a basal rate and a bolus doses.

How to go on the insulin pump?

Guidelines for good pump candidates were covered in the first issue of Diabetes Lifestyle - discuss your eligibility with your doctor and educator

A couple of Golden Rules

If you decide use a pump, you need to work very closely with your Diabetes Team. This implies careful ongoing monitoring of your pump function and blood glucose, keeping a diary and staying in contact with your Team.

You do need to use the insulin pump sensibly and not abuse it. Despite your newfound flexibility, this requires you to be sensible about what you eat and how much you eat otherwise you may put on a lot of weight.

What is an insulin pump?

Hester DavelRegistered Nurse EducatorCDE, Houghton

DIABETES MANAGEMENT•

DIABETESLifestyle

19

health investment I have ever made. My new pink Veo insulin pump with CGMS arrived!

The key in getting this system to work for me, was to be teachable, ask questions, be deliberate, and accept advice from the CDE team. I could never have done this without their experience and their 24-Hour Diabetes Hotline number. I found that reading the manual thoroughly and taking ownership of my situation gave me confidence.

For me, the 2.6% drop in my HbA1c is huge. I would never have managed that unless I was on the Veo. I love having more predictable glucose readings. The trend graph has changed everything. The ‘low predict alert’ has saved me more than once and the active insulin indicator means that I never over-correct if I am hypoglycaemic.

I have always appreciated changing the infusion set only once in three days, as opposed to the multiple daily injection site routine. I put huge value on feeling empowered and controlling my diabetes with this advanced medical device.

With the Veo, the guessing game is over. I now know whether my glucose levels are on an up or down trend and whether I can hop in the car and drive or if I should eat sooner rather than later.

I am on the cutting edge of what Medtronic has to offer and the peace of mind is priceless.

In 2008, after having type 1 diabetes for 20 years, I was desperate about not being

able to fine tune my insulin requirements in order to perfect my control. I was extremely

skeptical when Dr Brian Kramer at the Centre for Diabetes and Endocrinology (CDE) suggested an insulin pump as one of my options.

Vanessa, a highly qualified diabetes specialist nurse at the CDE, demonstrated the Medtronic pump and infusion set to me, and after that I knew that for sure I would NEVER wear a pump. (Note to self: never say never!) I refused the pump option and went on battling with multiple daily injections. I was extremely focused on my health. Diabetes had infiltrated every corner of my life. It had become my full time job.

I went back to the CDE, consulting with Mandy the dietician this time. She analysed my [failing] attempts at my glucose control. Her commitment and concern for my health made me realise that there is huge benefit in the team approach at CDE! Although I had had diabetes for so long, things had changed and I had a lot to learn. She taught me how to count carbohydrates, (vital to insulin pump therapy) and I emailed her my finger prick results and my daily food diary. It was hard work for both of us, and my resulting HbA1c was a devastating 9.6 %. It was time to revisit Dr Kramer’s insulin pump suggestion.

I purchased my first insulin pump and have never looked back. The questions I had about being tethered and tubed up 24/7, being ‘attached’, or where I would wear it failed to be major issues.

Then towards the end of 2009, Ronel from Medtronic, contacted me with exciting information regarding the new Veo Insulin pump. I was especially intrigued with the CGMS (continuous blood glucose monitoring system). So, in January 2010, going into my 22nd year of living with diabetes, I made the best

My insulin pump journey…

By Loraine Long

Taking back control of my life

DIABETESLifestyle20

ADVERTORIAL•

The glycaemic index (GI) rates on a scale from 0-100 how fast a carbohydrate-containing food is digested into glucose and how quickly and how

high it raises the blood glucose level

Pure glucose, which is absorbed into the bloodstream the quickest, has the value 100. The closer the value of a carbohydrate-containing food is to zero, the

slower it is absorbed into the bloodstream. Carbohydrate-containing foods are divided into three types – Low GI, Intermediate GI and High GI – and each category is useful in different situations.

Low GI foods (GI ≤ 55) are useful before exercise •and as a bedtime snack;

Intermediate GI foods (GI = 56-69) are useful •during and after moderate to strenuous aerobic exercise;

High GI foods (GI ≥ 70) are useful to raise low •blood glucose levels, or during and after endurance exercise (> 90 minutes).

For the following reasons, however, the glycaemic index is not a precise tool:

Although the relative differences between foods are • known, their exact effect on blood glucose levels differs significantly among individuals.

The GI may be further affected by:•

the amount of fat in the meal;−the amount and type of fibre in the meal;−whether or not you drink during the meal;−how fast and in what order the foods are eaten;−preparation of the carbohydrate before eating− (raw or cooked and by the cooking time);

the time of day it is eaten and if there has been −recent activity.

Some low GI foods are not necessarily healthier. • Foods that are high in fat, such as chocolate, tend to have lower GI values than do some healthy foods. So eating more chocolate is not the best option if one wants to make healthy food choices. The GI concept should be used in conjunction with low-fat food choices.

Confining meals and snacks solely to low GI • foods could also lead to more hypos especially with exercise and if using a rapid-acting insulin analogue.

Portion sizes are not taken into consideration. Most • people think that just because a food has a low GI, they can eat as much as they want! The GI should thus also be used in conjunction with controlling portion sizes, which brings us to a concept known as the Glycaemic Load (GL).

The Glycaemic Load

The glycaemic load “fine tunes” the glycaemic index concept. It addresses concerns about rating carbohydrate foods as either “good” or “bad” based on their GI. There is no such thing as a good or bad carbohydrate food - all carbohydrate foods can fit into a healthy meal plan. It all depends on when you eat a certain carbohydrate, how much you eat and with what you combine it. The GL of a specific food portion is an expression of how much that amount of food will affect the blood glucose levels. It is calculated by taking the carbohydrate (CHO) content in a specific portion of food and multiplying it by its glycaemic index value:

GL = (CHO content per portion x GI)100

It is thus a measure that incorporates both the quantity and quality of the dietary carbohydrates consumed. Some fruits and vegetables, for example, have higher GI values and might be perceived as “bad”. Considering the quantity of

Getting to grips with GI and GL

Mandy MarcusRegistered Dietician, CDE Houghton

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carbohydrate per portion, however, the GL is low, resulting in a small rise in the blood glucose level.

For example, the GI of watermelon is high (GI = 72), but its glycaemic load is small (GL = 7) because the amount of carbohydrate in a serving (or portion) of watermelon (150g or 1 cup watermelon cubes) is little (about 10g). This does not hold true for watermelon juice (GL = 21), as the amount of carbohydrate in a cup (250 ml) of watermelon juice is much higher (~ 30g) as fruit juice is a more concentrated source of carbohydrate. A carbohydrate food that has a low glycaemic load (GL) will have a small impact on blood glucose levels, as it is either not high in carbohydrate and /or has a low Glycaemic Index (GI).

Apples are low GI. Therefore, one medium size apple has a GL of 7. This means that eating one apple will have little effect on blood glucose levels. However, if you eat a whole 500g packet of dried apples, the GL would be 50, which means that it will have a huge effect on your blood glucose levels. This occurs despite the low GI, as this portion size contains a lot of carbohydrate.

The GL therefore shows us how important it is to watch portion sizes!

Therefore, it is recommended to use the GL in the following manner:

Restrict the GL of a typical meal to between 20 •and 25 as far as possible. Definitely keep it below 30;

The GL of a typical snack should preferably be •10-15, but if your meals are all close to 30, the total of your snacks should be no more than 10;

Keep your total daily GL below 100.•

Which type of person with diabetes benefits most from using the GI / GL?

Those using a regular short-acting insulin at each •meal such as Biosulin R or Humulin R;

Those using a regular pre-mixed insulin twice a day •(before breakfast and supper) such as Actraphane, Humulin 30/70, Biosulin 30/70 or Insuman Comp 30/70;

Those who are only injecting an intermediate or •long-acting insulin, such as Lantus, Levemir, Humulin

N, Biosulin N, Biosulin L or Protaphane;

Those who are taking oral glucose-lowering •medications;

The above-mentioned types of people with diabetes can use the GI to help them make wise food choices. Frequent blood glucose testing 2 hours after a meal, is the best way to see the effect that specific carbohydrates have on their own blood glucose levels.

However, for people with diabetes who are on an insulin pump or who are injecting a rapid-acting insulin analogue before each meal, the GI should not be the foundation of the meal plan. Instead, the pre-meal insulin doses should be adjusted based on the amount of carbohydrate eaten (i.e. based on a concept known as carbohydrate counting). Only once this has been established, wise use of the GI may then be incorporated to help improve control further.

In both cases, people may discover that some carbohydrate foods cause a higher after-meal glucose rise than others. In noticing this, they can then establish their own personal “glycaemic index” and make decisions about food choices, portion sizes and doses of insulin and / or medication, that will result in the best possible glucose control.

Use the tools

Research studies have drawn mixed conclusions on the benefits of using the GI as the main strategy in meal planning. It may be used, however, as just one of the many tools available when determining your eating plan - as long as it is used in conjunction with healthy eating principles and used in the appropriate situation, taking into consideration your individual requirements. If you are interested in learning more, talk to a registered dietician who can help you make informed choices.

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GUM DISEASE

DIABETES MANAGEMENT•

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Prof P Joshi Centre for Diabetes & Endocrinology, Pretoria Branch

It is well documented that not only does diabetes increase the incidence of gum disease, but the presence of such gum disease also worsens

glycaemic (blood glucose) control.

Gingivitis is a reversible condition, characterised by inflamed and bleeding gums. Since it can be a precursor to chronic periodontitis (inflammation around the tooth and its supporting structures), gingivitis requires appropriate treatment.

Gingivitis results from plaque (a sticky film of bacteria and other substances) accumulation at the gum margins and in the grooves between the margins and the teeth. The bacteria and their products have direct inflammatory effects and provoke immunological (defence) responses by the body.

Periodontal disease, a chronic inflammatory disease that destroys the bone and gum tissues supporting the teeth, is a major cause of adult tooth loss.

People with poorly controlled diabetes are more likely to develop periodontal disease than well-controlled patients and those without diabetes. This is probably related to an increased susceptibility to infections because of chronic hyperglycaemia (high blood glucose levels).

It has also been shown that severe periodontal disease can also contribute to hyperglycaemia. When this becomes chronic, there is an increased relative risk of developing some diabetes-related complications.

Those with poorly controlled diabetes have increased levels of small signalling proteins called cytokines in their gum tissues, causing destructive inflammation of the gums. Furthermore, beneficial growth factors are reduced, interfering with the healing response to infection. The increased cytokine production with chronic inflammation has been linked to the development of accelerated atherosclerosis (progressive thickening and hardening of the walls of the arteries, which carry oxygenated blood from the heart to the body), coronary artery disease and stroke.

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Although acute inflammation has a protective role, if it goes untreated, chronic inflammatory changes develop, leading to dysfunction of the affected tissues, and to poor oral health.

Meticulous oral hygiene may reduce the risk of other associated medical conditions. Good glycaemic control prevents oral thrush, xerostomia (dry mouth), mouth ulcers and cavities that may be found in people with uncontrolled diabetes. The management of gingivitis includes a healthy meal plan and exercise; good glycaemic control; correct and regular brushing (at least twice daily) and flossing of the teeth; avoidance of smoking; daily cleaning of dentures and regular periodic assessments by a periodontist /dentist.

The benefits of flossing

We may have heard that we should floss our teeth at least once a day, but how many of us really understand the range of flossing benefits? Using dental floss not only keeps our teeth clean and healthy looking but it also prevents tooth decay between our teeth, and plays a role in preventing gum disease and bad breath. It is an integral part of good oral hygiene that most of us don’t pay enough attention to.

One of the most obvious benefits of daily flossing is that it enables us to remove acid-producing plaque and particles of food trapped between the teeth. Left between the teeth, in contact with the tooth surface, this can foster tooth decay and cavity formation. Flossing benefits the gums similarly, by removing trapped food that might contribute to gum disease.

The key factor in bad breath are bacteria that can live in the spaces between the teeth and use trapped food particles as a food supply. Flossing benefits your breath by limiting the food supply of these organisms and dislodging many of those that do get established. These bacteria can also play a role in inflammation of the gums, and eventual gum disease - gums begin to recede and pull away from the teeth, bacteria get into the little pockets that are formed and multiply, making the situation worse. When you consider this unpleasant scenario, the benefits of flossing clearly outweigh any inconvenience.

The correct way to floss

Here are a few simple steps to making sure your teeth are getting the most out of their daily cleaning session.

Always floss before brushing your teeth, as •floss will loosen plaque that you won’t want rolling around in your mouth. Start with the back molars on one side and •work your way all the way around. Glide the floss gently back and forth between your teeth. Make sure that you get all the way up to your gums and go a little under the gum line on both sides. Be very gentle and don’t snap your floss up between your teeth as it’s traumatic for your gums.Angle the floss around the tooth so that it kind •of hugs it. This will help you to make sure you clean both sides of the tooth and both gum lines.Work around your teeth, unwinding and •rewinding the floss so that you have a new, clean section to use for each tooth. Always finish by brushing your teeth and •

rinsing out your mouth with water or mouthwash.A regular flossing routine can save your teeth from gingivitis and contact cavities. It’s a habit that’s worth building, especially with proper technique. Lastly, if you take a night snack, make sure that you floss, brush and rinse after and not before your snack so that you sleep with a clean mouth. Like your feet, your teeth should last a lifetime!

Breakfast is the most important meal of the day especially for those with diabetes

Maintaining a healthy blood glucose level starts with the first meal of the day and can often set the tone for the rest of the day. It is important to

get a proper balance of proteins, fats and carbohydrates.

Today’s schedules often mean people rush out the door, sometimes skipping breakfast. This is not a good idea for a person with diabetes because skipping a meal can result in extremely low blood glucose (hypoglycaemia).

In addition, eating the wrong foods - those too rich in sugar or the wrong type of carbohydrates - can result in high blood glucose (hyperglycaemia). A balanced breakfast can help to keep blood glucose stable throughout the morning hours.

Make time

It really doesn’t take long to eat a meal; the preparation is what requires time. The trick is to establish a routine and have a plan. It’s okay to eat the same meal repeatedly; in fact, many people rotate two basic meals, depending on how much time they have in the morning.

If you need to leave your house without eating, prepare an ‘on the go’ breakfast the night before that you can eat either as you travel or on a break. Meal

replacements are also helpful on those rushed mornings so speak to a registered dietician about the right choice for you.

Some people don’t like eating traditional breakfast foods like cereal but there is no rule that says you can’t eat whatever you enjoy. Eat leftovers or heat up some soup, beans on whole-wheat toast, chicken salad, pasta, or a peanut butter and thinly-spread jam sandwich.

Certain foods however should not be included. Canned fruits may contain unneeded sugars. While fats are needed for healthy body function, they should be poly or monounsaturated. Breakfast meats such as bacon or sausage are typically loaded with saturated fats, so think about substituting healthier meats like lean ham or beef, chicken (without the fat) or fish.

Blood glucose and breakfast

Even if your blood glucose is too high, you need to eat a healthy breakfast. By learning to adjust your short or rapid-acting insulin to match your blood glucose and the carbs you plan to eat, you can enjoy a healthy breakfast and bring down your blood glucose levels to a more optimal level. If you do not take insulin or oral medications, it will take time for your blood glucose to come down unless you are able to walk or do some physical activity. You may find that by eating more protein than carbohydrates, your blood glucose will decrease more quickly and you will still be satisfied.

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Losing weight the healthy way…

Reducing your weight and sustaining at your new healthier level is not an easy goal to achieve

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Ria Catsicas RD (SA) in Private Practice

Numerous factors contribute to gaining weight, and these factors must be taken into consideration in our search for a sensible

solution in achieving successful weight loss.Despite the vast number of ‘solutions’ on the market varying from ‘food combining’ to ‘eating for your blood type’, the fundamental physiology that underlies weight gain is that our daily energy intake (type and amount of food and drink) exceeds our daily energy expenditure (what our bodies burn up). The truth is that excess calories are stored as fat in the fat cells.

Although this might sound simple, fat accumulation is a complex interaction of numerous factors which affect how our bodies will use energy from food. These factors include our activity levels, gender, age, body size and genetic differences to name only a few. Factors that affect our choices regarding the type and amount of foods we eat include our socio economic circumstances, culture, temperament and personality, response to appetite, moods and emotions, ability to cope with stress and our degree of motivation and self esteem. In addition, our expectations of our own health and perception of our body image can be powerful influences.

The benefits of weight reduction

Despite the complexity of reducing weight, there should be no doubt in your mind that this goal has a tremendous benefit to blood glucose control. Fat loss, especially around your tummy, makes your body cells more sensitive to the action of insulin and glucose is better transported from the blood into your body cells. If you are being treated for diabetes, this results in your medication functioning more effectively and lowering your blood glucose levels. The benefit of this is that you may need to use less medication (= less cost) to achieve the same results.

Type 2 diabetes is a condition of progressive failure of insulin-producing beta cells together with resistance to the action of insulin. By losing fat, insulin resistance is reduced and the improved blood glucose control helps to preserve the function and lifespan of the remaining beta cells in the pancreas.

More good news

Even a small amount of weight loss results in significant health and quality of life benefits. You will find immediate improvement in your sleep patterns, energy levels, ability to move and in your self confidence. In an extensive and ongoing US based study called Action for Health in Diabetes (AHEAD), overweight and obese patients with type 2 diabetes lost an average of 8.6% of their initial weight. These patients not only experienced a reduction in their HbA1c from 7.3 to 6.6 % but also found they needed less medication because of lowering their blood pressure and cholesterol levels.

Losing an average of only 10 kg can reduce your systolic blood pressure by between 5 and 20 mmHg.Losing fat also causes a drop in LDL (bad) cholesterol

and triglyceride levels and increases HDL (good) cholesterol levels. Losing abdominal fat will improve conditions such as gout, arthritis and atherosclerosis substantially as excess abdominal fat releases inflammatory substances that aggravate these conditions. The key to success

Although there are many ‘diets’, ‘shakes’, and appetite suppressants on the market that offer weight loss ‘solutions’, the disadvantage is they are not all nutritionally balanced (too low or high in carbohydrate) for you to control your blood glucose levels optimally. Most patients find that although they lose weight initially, once they stop taking these appetite suppressants or stop following the rigid prescriptive ‘diet’ they gain all the weight they originally lost.

The solution for success is to follow a nutritionally balanced eating plan that restricts your calorie intake (without deprivation and starvation) and controls your blood glucose and cholesterol levels optimally.

Get help

Consulting a registered dietician or joining a Weigh-Less group will have huge benefits.A dietician can develop a practical plan that takes your lifestyle in consideration. For example, do you enjoy eating lunch from the work cafeteria, do you need a packed lunch on the road or do you enjoy lunch at home? Your dietician can also calculate

the correct amount of calories (energy intake) you need taking your activity level, age, gender, and weight status as well as medication regimen into consideration. Eating different foods from the rest of your family is unsustainable in the long term so the plan must consist of normal foods everyone can and will eat.

Much more than a ‘diet’

As type 2 diabetes is a progressive chronic condition, you should therefore look beyond a quick ‘diet’ to lose weight. Understanding how different types of foods and the time and quantity of food and drink consumption affect your blood glucose levels and weight status will help you to make choices that are more informed. Vital also is the need to acquire the necessary self-awareness, attitudes, knowledge and skills to identify and change the factors that inhibit your weight loss. This process will help you choose healthier eating habits, which become part of your lifestyle in the long term.

A healthy eating plan that adds pleasure and variety

A good eating plan should allow for choices and variety. Healthy eating should be an enjoyable experience. The ideal foods to incorporate are high in fibre, low glycaemic index, carbohydrate foods such as all fresh fruit and vegetables, brown rice, stampkoring, oats, sweet potato, hi fibre cereals, and health / seed breads. Lean proteins such as fish (all types), legumes (lentils / beans) lean red meat, eggs, chicken and low fat dairy products should also be included. As all herbs, spices, condiments (just remember to watch the salt!) and cooking methods such as steaming, baking, grilling, and stir frying may be used, no meal need to be boring, bland or tasteless. Your dietician can provide you the tools to create healthy meals such as a menu, a shopping list and recipes.

Portion control and structure

Healthy foods should be eaten in controlled portions and in a structure of three meals a day with snacks being optional. It is not only the type, but also the amount and times we consume food and drink that affect our body weight and blood glucose levels significantly. Strategies to eat less without feeling hungry or deprived need to be developed.

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ED is common in men who have diabetes

Erectile dysfunction (ED) is a condition that affects a man’s ability to get and sustain an erection sufficient for satisfactory sexual performance. Although most

men do encounter trouble having an erection from time to time, the problem is not generally thought to be ED unless the symptoms are persistent for three months or more.

ED is common for men who have diabetes. Often, it may be the first symptom that men notice and the one that leads them to the doctor in the first place. Only after they have sought medical help for ED do they also receive a diagnosis of diabetes. Fifty percent of men with diabetes will experience ED within 10 years of diagnosis.

How does diabetes cause ED?

The same elevated blood glucose levels that cause blood vessel and nerve damage in other parts of the body can also lead to complications in blood flow and nerve damage to the penis.

Heart disease and diabetes are often linked together because coronary artery damage is a complication of diabetes as well. Coronary artery disease can affect sexual function on its own, but erectile dysfunction is nine times as likely in men who suffer with both coronary artery disease (CAD) and diabetes, than men who have diabetes without the addition of CAD. Erectile dysfunction is so prevalent in both coronary artery disease and diabetes, that it could be considered a risk factor for both. If a man is suffering from ED, his doctor should suggest screening for CAD and diabetes.

Factors that can lead to ED

The longer a man has had diabetes, the more likely he may suffer from ED. Also if blood glucose levels have not been well controlled, blood vessel and nerve damage will be greater. Complications of accompanying heart disease such as high blood pressure and high cholesterol can also affect ED.

Commonly prescribed medications and ED

Some common prescription blood pressure medications are known to cause ED, such as some diuretics and

beta blockers. Certain antidepressants also can cause ED. Discuss your medications with your doctor, if ED is a concern. Don’t just stop any medications without this advice. Sometimes different medications can be prescribed that do not have ED as a side effect.

The ED workup

Men who experience erectile dysfunction should consider talking to a health care provider together with their partner. The health care provider should ask about the patient’s medical history, the type and frequency of sexual problems, medications, smoking and drinking habits, and other health conditions. A focused physical examination and laboratory tests may help pinpoint causes of sexual problems.

The health care provider will check blood glucose control and possibly hormone levels and may ask the patient to do a test at home that checks for erections that occur during sleep. The health care provider may also ask whether the patient is depressed or has recently experienced upsetting changes in his life.

Treatment for ED

Often lifestyle changes such as increasing exercise and losing weight as well as addressing reversible risk factors such as smoking may be of benefit not only for improving erectile function, but also for improving overall cardiovascular and metabolic health. Counselling, particularly with your partner may help with psychological causes. In addition, there are prescription medications that can treat ED. These medications work by helping increase blood flow to the penis. These drugs may have some serious side effects in certain people, so talk over this option with your doctor, and make sure that he or she knows your entire medical history and all other medications that you take.

Talking about E.D…

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Talking about E.D…

Glucose?

glucose and cholestorol levels

Supporting Diabetes SA

Vegetarian

Halaal certified

It is well known that people who have diabetes sometimes have to deal with degrees of hopelessness,

despair, sadness or apathy

These feelings may be related to the diabetes or triggered by the diabetes, but many times these feelings can begin for reasons other than the

diabetes. Either way, the good management of the diabetes can be blocked by these feelings, especially when those feelings linger for more than two weeks.

Why would diabetes cause these feelings?

When anyone is diagnosed with diabetes, the shock is significant. Most people with diabetes will be able to tell their story of emotional upheaval when they were told that they had diabetes. The parents of children who develop diabetes will also go through shock and emotional distress. Initially all people with diabetes have so much to learn and need a lot of information, help and support.

When things don’t go according to plan, and someone experiences low blood glucose levels for the first time, or too many lows, or too many high blood glucose levels in spite of every effort to keep good control, a sense of hopelessness and despair can arise.

When it finally sinks in that this condition is for life and the management thereof is never-ending, there can be strong feelings of loss and sadness.

When the lifestyle changes that have to be made become frustrating or irritating and the person would like to give up and go back to their old way of life, apathy and depression can set in. Consider the load a person with diabetes has to carry –

Having to eat differently;•Having to exercise regularly;•Having to calculate doses or remember to take •the required medication;

Having to have invasive treatment such as finger •pricks and injections;Having to always be aware of whether blood •glucose levels are too high or too low and try to get it just right on a regular basis;Having to change treatment on sick days;•Having to lose weight;•Having to deal with other conditions that may •arise such as sleep apnoea, or complications or co-existing conditions such as cystic fibrosis or thyroid problems.

These are just some of the issues that can become frustrating and lead to depression and despair. When support is ineffective and the person feels inadequate to cope with all these daily challenges, diabetes can be a very daunting condition.

What to do about it? - that is the question

As soon as you begin to feel overwhelmed, talk to someone who understands diabetes and its demands on your life. You may manage well overall but circumstances may arise that tax your resources too heavily and you feel you are not coping effectively any more.

Find help! Whether it is medical help you need, or emotional support or information about the area of

The depression dilemmaRosemary Flynn

Clinical Psychologist, CDE Houghton

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concern, draw on the emotional and social support available to you.

Find a confidante or therapist with whom you can work through your feelings. Share feelings with others who have diabetes – they are often able to help you through the bad times.

Make sure you are getting enough sleep – if you are constantly tired, it is difficult to cope with extra demands.

If there are other relationships or circumstances that are creating these feelings for you, it is just as important to deal with those issues since they have an effect on how you handle your diabetes. Your therapist can help you work through whatever is creating distress for you.

Can depression be prevented? Yes it can!

Learn all you can about your condition to give you •the confidence you need to manage it;Get the support you need to deal with difficult •situations before they become distressing;

Reframe your negative thoughts with positive •thoughts (this is not always easy but worth the effort). Diabetes is manageable and you can still have a worthwhile life with it;Learn assertiveness to deal with ‘crazy makers’ – •you know at least one!;Learn to understand your own negative feelings •such as fear and anger and deal with them as they arise;Learn some relaxation exercises to calm down •more effectively when you start to feel fear. This will help you deal with whatever is making you afraid;Start an exercise routine. Yoga and Tai Chi are •excellent for stress relief;Learn the art of positive thinking and be grateful •for all you have;Breathe!•

If you find you cannot shake the depression, see a doctor or

psychologist. There are medications that can help you get back on track

The depression dilemmaLIVING WITH DIABETES•

A certain amount of maths is required to manage diabetes well. But you don’t have to be a maths

genius to succeed. It’s a question of balance

I am on my mountain bike at the bike park. It’s a blue route. There are two small technical up and down hills followed by a much larger even more technical steep

uphill, down and uphill again. Getting up is a bit of a balancing act similar to how I find managing diabetes. You cannot lean too far forward or the back wheel will slip, nor can you lean to far back or the front wheel lifts. You cannot go too slowly because you need momentum to get up the last part, nor can you go too fast or you won’t have enough power for when you do slow. You also need the correct line and balance. Basically everything needs to be perfect to succeed. I have done the route before but it still takes more than one attempt to get up.

Then it’s the trail around the edge of the mountain. The ground drops away on my left and I feel that sense of exposure. I love it. This is my fortnightly weekend morning getaway. Its great exercise and great for taking my mind off things. It is not working today though. I am in a deep conversation with my brother in-law who is right behind me. I am panting now because the dip with a hair-pin turn to the left is followed by an uphill. I say, “... but It’s not that hard. Why would anyone let percentages and basic addition get in the way of good health?” We are at the top now. It’s a fast series of tight massively cambered turns. Mind the rock. “You don’t get it Paul. Some people are just terrified of maths!” he says. I am lucky to have been blessed with an aptitude in maths and this is taking some time to sink in. It’s a steep downhill and I pick up speed. I need to concentrate now because of the sharp rocks. They are a bit tricky at speed and you don’t want to fall here. Regrouping on the other side I say, “... but it’s their health! What can be more important?”

My brother-in-law and I are discussing a topic that has been bothering me ever since I was diagnosed with type 1 diabetes. It started with comments like “Don’t take advice from that patient. They didn’t have the aptitude to work it out so they are on a different treatment.” or “You are

so lucky you can work these things out. Most people don’t and just suffer”. I am using a bit of poetic license here, but you get the message. Another saying “As jy dom is moet jy hard kak” comes to mind.

Initially I just accepted what I was told. Relieved that I ‘got it’ I moved on. Now that I have had diabetes for more than 2 years and know what is required to know pretty well, these early comments now haunt me. There is a lot that you need to learn, but the maths that you use daily is very basic. Managing diabetes well is more about understanding and balance than maths. I have never heard someone say “You are just not clever enough to ride a mountain bike”. Balance is instinctively learned once the problem is understood. I think the fault lies with either the teacher’s ability to teach, or the student’s willingness to learn, or access to a good teacher, or just the sheer amount needed to be learned. So find a good teacher, change your attitude and get a good book to assist your learning.

If you are not yet sold by my argument, and are ‘terrified of maths’ or struggle with your daily maths requirements, I have some other suggestions:

Get the gadget.• You can buy a scale that does carbohydrate-counting for you. You put the food on the scale, enter the food type and ... it tells you the weight of the carbs;

Phone a friend.• If you really struggle with the numbers or just want some confirmation, then ask for help. This is serious stuff and most friends are more than willing to help out;

Do the easy maths before the hard.• There is always more than one way to get to an answer. Get someone to help you find the easy way. Another example is to learn to carb-count using exchanges first. This is a lot easier than the gram based carb-counting.

What about mental maths?

Now you should obviously not try this until you are confident doing the calculations on your calculator. However if you have got the hang of it, there are many useful tips and tricks you can use that make mental maths easier. I want to share one of these tips that I use

Paul Baker

Maths, your health depends on it

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LIVING WITH DIABETES•

quite often when carb counting. I.e. how to calculate percentages in your head? Here is an example.

I am quite hungry and in a rush. I need a decent meal quickly. I grab the loaf of low glycaemic index (GI) bread. (This loaf is not really low GI, but rather ‘lower GI’ than normal bread. It is quite safe for me to eat.) I grab four slices and pop it on the scale. The scale reads 166 g. Recently I have found that the bread thickness varies too much so I prefer to weigh the food. The nutrition label on the loaf says that there are 38 g of carbs in each 100 g of bread. I read that as 38 %. This means that I need to calculate 38 % of 166 g to get the total carbs in grams of the four slices that I am about to eat.

The trick to mental maths is to change the problem slightly to make it easy. There is nothing easier than working with tens or a multiple of tens. That’s what I look for.

38 % = 40 % - 2 % = (4 x 10 %) - (2 x 1 %)

Now getting 10 % from 166 g is easy because you just

need to move the decimal point by one place to the left.I.e. 10 % of 166 g = 16.6 g and similarly 1 % of 166g = 1.66 g (move the decimal point two places to the left).

Let’s start the calculation using the answers above: 40 % of 166 g = 4 x 16.6 g

We don’t need an exact result so we can safely round to the nearest half gram.

≈ 4 x 16.5 g = 66 g

Now just subtract 2 % of 166 g = 2 x 1.66 g ≈ 2 x 1.5 g = 3 Total carbs = 66 g – 3 g = 63 g.

This meal thus contains 63 g of carbs. (As it turns out in this case the exchanges method would have got us close enough an it is a lot easier to calculate).

Mental maths requires a bit of practice before you get good at it. So try it more than once, and soon you will find this quicker than reaching for a calculator.

LIVING WITH DIABETES•

Treatment of diabetes in infants and toddlers poses unique challenges

If your child is under the age of two and has been diagnosed with diabetes, know that there are many alternatives and options available that will control this

condition and ensure your child has a happy, healthy, and normal childhood.

The number of babies and toddlers with diabetes is increasing, so know that you are not alone. When your very young child or baby has diabetes, they can’t tell you if they are “feeling low” or needs to check his or her blood glucose. But just as parents develop a sense of a “hungry cry” versus a “wet cry,” you will become attuned to the signs your child gives about how they are feeling.

Recognising Signs and Symptoms

The same symptoms that occur in older children and adults signalling the possibility of type 1 diabetes apply to infants and toddlers; the difference is that since their verbal communication skills are limited, you probably won’t recognize them as quickly. In addition, symptoms like fatigue are hard to discern in a baby who sleeps a good deal of the day anyway. The positive news is that most parents, particularly new ones, will take a “rather safe than sorry” attitude and take an inconsolable infant or toddler to the doctor to figure out what’s wrong quickly rather than waiting around for things to worsen. If your child is at risk for type 1 diabetes, you can be on the lookout for the following symptoms:

Excessive wet nappies;•

Nappy rash that doesn’t resolve quickly or keeps •recurring;

Constant hunger and/or thirst;•

Irritability or fussiness that doesn’t seem related •to colic;

Sleeping more than usual.•

Detecting Highs and Lows

Recognising blood glucose highs and lows may be hard when a diabetes diagnosis is new in your very young child. Fortunately you have the best tool for making sure things are in balance right at your fingertips—a glucose monitor. If your child is acting the least bit out of sorts, always check glucose levels first. It may not be her diabetes, but if it is you want to find out quickly and treat it fast. Talk to your child’s doctor or educator about an appropriate amount of carbohydrates to treat lows.

If you have an infant or toddler with diabetes, have an oral syringe on hand to administer a fast-acting carb like syrup if a hypo occurs and your baby refuses a bottle of juice. Cake icing in a tube and glucose gel can also work for more cooperative eaters. Never feed a child who has lost consciousness because of the risk of choking or aspiration, and never give an infant a glucose tablet or hard candy. A Glucagon injection will be your best option in this instance. Speak to your doctor about getting one and how much to give should you need to use this effective treatment for unconscious hypoglycaemia.

Glucose Monitoring

Glucose checks are a tough job for parents, especially in very young children who don’t have the capacity to understand why they must get poked and prodded. You can make the job a little easier by buying an alternate site meter, which allows you to test on less-sensitive areas like the forearm. You may also be able to stick the heel instead of the fingers. Talk to your child’s doctor for her or his specific recommendations, and try out different meters until you find one that works well for you. Don’t worry, both you and your child will eventually get used to blood glucose checks.

Eating and Insulin

Small children have notoriously unpredictable appetites. They can go for days eating very little, and then suddenly down a whole plate of food in the blink of an eye. Of course, if you don’t know what your child is going to wolf down, or push away, at the next meal, it makes giving insulin more difficult. For this reason, your doctor

Diabetes management in babies and toddlers

Sharon Dale

PARENTING•

DIABETESLifestyle38

may recommend short or rapid-acting insulin to be administered immediately following a meal to correctly cover the carbs and avoid highs or lows.

Coping with diabetes

Diabetes at any age will inevitably bring stress into the family. It’s vital for the child to feel that his or her parents display trust and confidence in diabetes management. Over-protection may lead to the child becoming anxious and clingy. At this stage your child cannot understand injections and blood-testing which can give rise to pain, anger and anxiety. The best way to handle this is to get the tests and injections out of the way as quickly as possible and with no fuss and then comfort and distract the child afterwards. Your child (and you) will soon get used to all the facets of diabetes management and it will become a way of life.

It is difficult enough to find time for everything as an

ordinary parent of a baby or toddler. A parent of a child with diabetes will sometimes wish they had more than two arms to manage blood glucose, testing, injections, meal planning, and all the other adjustments of daily life that come along with a child with diabetes. Speak to your doctor or nurse educator, or contact Diabetes SA on 011-8863765 , to find out about a support group for parents of children with diabetes. Sharing hints and tips and knowing that you are not alone can go along way to calming you down.

Helpful hints

Seek out parents of other babies and toddlers •with diabetes in your area to glean information and support from individuals who are in the same situation;

Learn as much as you can about diabetes and its •management;

Visit a nurse educator regularly;•

Stick to a schedule and test blood glucose as •often as recommended by your Diabetes Team;

With small children, consider developing a game •that will allow him or her to stick to the schedule without feeling regimented;

Since a blood glucose test typically involves a •small prick, consider various ways to make the entire process less scary and painful for your child;

If you have a toddler, speak with your child and •let him or her know the exact reason why blood glucose tests and injections need to be done;

Remember, if you properly control the diabetes, •the risks of complications or problems decrease;

Make sure that your baby or toddler’s playgroup, •day care mother or nanny is well educated in your child’s diabetes management routine and emergency procedures;

Create a special diabetes station in your home •and be sure that everyone in your home (even older children) knows how to use the equipment properly. By developing a plan, everyone will know exactly what to do in an emergency;

Always carry a test kit, your child’s insulin, •Glucagon injection, snacks, and glucose gel or sweets (for the older child).

DIABETESLifestyle 39

PARENTING•

The right insurance plan is an important investment no matter your age.

Life insurance isn’t something that you should wait on. Instead, take the time to look for a solid insurance plan so that you can be sure that everything will be taken care of if something suddenly happened to you.

Now for the first time Liberty is offering people with diabetes the opportunity to have full comprehensive cover at the most favourable and affordable rates.

In the past, insurers were not able to offer disability and critical illness benefits to people with diabetes and life cover was quite expensive if you have diabetes. Liberty has now changed all that.

Protection for people with diabetes

For the first time, Liberty now offers not only life cover but other benefits such disability and critical illness protection to people with diabetes, that are managing their health and have well controlled diabetes.

Keeping your diabetes under control

Diabetes is a condition that can be managed, leading to a long and healthy life.

In order to stay healthy and keep blood glucose levels under control, people with diabetes need to take the regular medication (insulin or oral medication) in the right doses, eat healthy and nutritious food, exercise, and visit their doctor or nurse educator regularly.

A person with well-controlled diabetes has no complications and an HbA1c level of less than 7 % and a BMI that is less than 28 kg/m2. The HbA1c is a blood test that measures the body’s blood glucose levels over the last three months and BMI (Body Mass Index), is a measurement of body weight with reference to height.

They also go for regular checkups and keep other conditions like hypertension and cholesterol under control.

Diabetes complications and life cover

There are some complications resulting from uncontrolled diabetes that may result in the rejection of life cover. Microvascular complications involve the kidneys, eyes, and peripheral nerves and macrovascular complications include peripheral arterial disease, strokes, and coronary artery disease.

Therefore, before granting you life cover benefits, Liberty underwriting will request –

Questionnaires to be completed by the •applicant and the applicant’s doctor.A short medical report which includes •measurement of height, weight, blood pressure and urine check.Blood tests including an HbA• 1c.

Making the changes

Should your diabetes be uncontrolled, you can improve your risk factors by controlling your glucose levels (thereby reducing your HbA1c), losing weight, visiting a diabetes clinic or nurse educator for regular checkups and education, improving hypertension and cholesterol control, as well as engaging in regular exercise. This would need to be maintained for at least six months for the cover to be re-evaluated.

For more information, please speak to your Liberty Wealth Adviser or contact their call

centre on 0860 237 237 or visit www.liberty.co.za

Diabetes Life

DIABETESLifestyle

42

I have had type 1 diabetes for 53 years

I was diagnosed in 1957 by a Dr Visagie in a small town called Bothaville in the Free State after an accident with my bicycle. Nobody in town knew diabetes and Dr Visagie called it a “New Disease”.

At that time it was devastating news to me as they told me I could have no more sugary foods or bread. I absolutely loved my bread. My late dad told me “Mind over matter” and this phrase had a very big impact on my life especially at that time. I think of it often even today.

I was sent to Dr. AJ Tinker, a physician in Johannesburg and he bought me a Tab cool drink (which was a new product). He took me to his house in Houghton and gave me a book called “Polly French of Witford High” (which is still in my possession). He was the first doctor to explain my “new disease” to my parents.

The tools required to remain healthy

To test my glucose levels I needed to use special drops, mixed in water and my urine. My mom then warmed it on a Bunsen burner. The mix then changed colour. From this we would estimate the glucose level in “plusses”. We did this once a week. It was very expensive and my parents couldn’t afford to test more often.

Injecting my insulin was a different story. I used Lilly products – “lente” and “semi-lente”. The insulin was in vials, I needed to mix the two different insulins by drawing them into a syringe, one after the other. It was then injected as a once a day injection in my upper thighs. I was very scared of the needle. I could not do it myself without the help of a trigger, which fitted onto the syringe.

My glucose levels were extremely uncontrolled! I had so many hypoglycaemic attacks during my school years. The doctors at home had no idea how to treat them, except by

giving me sugar water. I can remember one morning when I was 10 years old. I rode around the house on my bicycle a few times, and then collapsed. My mom rushed me to the doctor who stared at me in horror, not knowing what to do. His partner came after a while and gave me sugar water. Eventually I came around.

I then used to inject on my upper arms, and some of the kids at school would hit me on my arms to get some reaction out of me. Many kids at school thought I was abnormal. They side stepped me as far as possible, as nobody understood the condition. It was extremely difficult for me and it made me angry and moody.

Growing up and moving on

During matric in 1965, I had a stroke but still passed the examinations with the love, the will and the grace of God. I also participated in ballet, swam gala and participated in other sports.

I married my husband in 1969. A daughter was born for us in 1973 without a right leg, otherwise healthy.

In 1995 I had a severe heart attack and in the Heart Hospital in Pretoria I received a heart bypass. There were days in hospital that I felt it will be better for me to die but with the love and the special support of my husband and all the prayers I received from family and friends, I managed to “pull through”.

I have also had numerous laser treatments for both eyes and can still see well. In my later years with diabetes, my eyes went haywire and my husband calls me “My girl from South West” (one eye south, the other west). Not every day of my life is moonshine and roses but I try very hard to be positive. In this, my husband supports me unconditionally, with self-monitoring of blood glucose, my meal plan, and all decisions which need to be made.

Lastly, I am a firm believer in God. Praise the Lord, because it is only through Him that I am alive much to the wonder of my doctors.

Editors note: Thank you Martie for blessing us with your inspiring story looking back on not only your journey with diabetes, but also a history of diabetes care in general. The fact that you have lived for 53 years with type 1 diabetes serves as an example to those diagnosed today.

What we can promise those who follow you, is that your journey will be much easier if you put in the necessary effort. We now have the knowledge and tools to prevent many of the complications Martie has had to experience. Martie has left her contact details with us. If you would like to hook up with her, please e-mail me at Michael@cdecentre.co.za.

LIVING WITH DIABETES•

My life with diabetes

By Martie Steenkamp

EAT RIGHT•

The amazing health benefits of fish

abnormalities. They also have an anti-inflammatory activity.

The advantage of getting omega 3’s from sardines/pilchards rather than larger fish such as the salmon is that the smaller size of sardines makes them less likely to have accumulated toxins such as mercury, dioxane and PCB.

Another important health benefit of sardines is that they’re a naturally good source of vitamin D. As you may already know, few foods are high in vitamin D, but sardines and pilchards are one of them.

Sardines and pilchards are also high in calcium which can work with the vitamin D to help promote stronger bones. With 37 grams of protein and zero carbs per serving, it’s a low carbohydrate dream food.

The high protein content of sardines and pilchards helps to promote satiety and the lack of carbohydrates helps to keep blood glucose stable.

Buy right

When you purchase sardines or pilchards, look for ones that are packed in water or tomato sauce as opposed to oil. Oil can add significantly to the calorie and fat content. There are a variety of ways to eat sardines and pilchards such as creating a delicious salad, on pasta, in a sandwich spread, or eating them straight out of the can.

The benefits of eating fish are well known

‘Good proteins’ are found in fish, chicken breast, lean meat and low fat soy products but fish is a great choice considering many factors. Other protein foods like meat, milk and eggs are high in fats and cholesterol. Fabulous fish Sardines or pilchards are considered to be one of the healthiest fish around and they’re convenient to eat as there is no preparation required.

Probably the greatest nutritional value of sardines and pilchards resides in their high concentration of omega-3-fatty acids.

Omega 3’s have been shown to reduce triglyceride levels and play a role in preventing dangerous heart rhythm

DIABETESLifestyle

44

Occasionally, less insulin is needed if you are not eating much. This is why you should test your blood glucose more often. Your doctor or diabetes nurse may ask you to check your urine for ketones - especially if you have type 1 diabetes. If your urine shows moderate or large amounts of ketones, contact your diabetes team immediately. Editor’s Note : Members of the CDE Diabetes Management Programme have access to a 24-hour Hotline for this purpose - Please use it!

Generally speaking, if your ketones are negative, you can feel comfortable that you are not in immediate danger (unless you are using an insulin pump!), even if your blood glucose is running somewhat high.

It’s important to eat even if you don’t have an appetite. If you’re unable to eat in your normal manner, try eating six to eight lighter snacks throughout the day. Foods that may be easiest to eat include toast, crackers, cereal, mashed potatoes, rice, soup, or yoghurt.

Maintain your fluid intake

Finally, the third precaution you’ll need to take when ill is to maintain your fluid and mineral balance. This is important even if you’re not vomiting. Drink eight to ten glasses of water, black tea, or diet cool-drink. If you’re having three or more watery bowel movements, you may need even more fluids. If you can’t keep down any liquids, or if these measures don’t control your diabetes, call your health care professional immediately.

If you are battling with constant low blood glucose levels, take a glass of apple juice or non-diet cool-drink and call your health care professional. You should also check yourblood glucose levels more regularly. If they’re low, try to eat some solid food.

Sick Day Check List

Never omit or reduce your insulin dose when •you are sick. More insulin is often needed rather

When you are unwell, your body’s increased production of stress hormones will cause blood

glucose levels to rise

People with diabetes know how important it is to keep their diabetes under control. But controlof diabetes can be upset by many illnesses. For

example, certain illnesses can cause your blood glucose to rise, making you lose vital fluids and minerals. Vomiting and diarrhoea cause even further loss of fluids and minerals. This can be very serious for someone with diabetes.

When illness threatens to throw your diabetes out of control, you must act promptly and take the following three precautions:

manage the illness;•control your blood glucose level; and•maintain a good fluid and mineral balance.•

Manage the illness

If you have a mild cold or mild diarrhoea, you probably won’t have too much trouble. But if you are very ill, especially with infections of the throat, chest, ears or urinary tract, contact your diabetes team for advice and help immediately.

Manage your blood glucose level

The second precaution you’ll need to take when ill is to carefully control your blood glucose. Even mild illnesses can disrupt blood glucose levels, especially with type 1 diabetes, so you should be even more alert than usual during this period.

Continue to take your insulin or oral medication when you’re sick. In fact, your body sometimes needs more insulin during an illness, so ask your doctor or nurse educator about when you might require extra insulin doses.

Sick day management

DIABETES MANAGEMENT•

DIABETESLifestyle46

than less at this time. If your blood glucose levels remain too low and you are unable to eat, seek advice from your doctor or nurse educator as soon as possible.Contact your doctor or diabetes nurse for advice •about increasing your dose of short or rapid- acting insulin. You may also need extra doses of this insulin.Eat according to how you feel and what food you •can tolerate. If you cannot eat your usual meals, have small •low-fat snacks at regular intervals throughout the day, for example - toast, crackers, boiled rice, soup, low-fat custard or ice-cream. If you cannot eat food, have sips of fluid every •few minutes. High blood glucose levels, vomiting and diarrhoea can all lead to dehydration. If your blood glucose level is more than 10 •mmol/L, have unsweetened fluids like water, clear soups, weak tea, or diet drinks. If your blood glucose level is less than 10 (15 in •children) mmol/l, have sweetened fluids like apple juice. Test your blood glucose level more frequently, •for example - every 2 to 4 hours and record all results. Test your urine for ketones every time you pass •urine.

Contact your Diabetes Team (phone your Hotline) if:

Your blood glucose level is more than 14 mmol/L •or moreMore than a trace of ketones are present in your •urineYou are feeling nauseous or you cannot keep •down any food or fluidsYou have tummy pain or are short of breath•

Ketoacidosis

In type 1 diabetes a relative or absolute lack of insulin (usually a missed dose), can lead to high blood glucose levels and rapidly progress to a serious condition called diabetic ketoacidosis (DKA). There will be ketones in the urine. You may also notice:

abdominal pain;• nausea;• vomiting, breathlessnes and drowsiness - these • are late symptoms that will often require hospital admission.

DKA is a medical emergency. If you have these symptoms,

contact your Diabetes Team on their Hotline immediately

DIABETES MANAGEMENT•

DIABETESLifestyle

47

Andrew Heilbrunn Biokinetics Department, CDE Houghton, Johannesburg

Regular activity plays a significant role in the treatment and prevention of diabetes

We all know that regular activity plays a significant role in both the treatment and prevention of type 2

diabetes. In addition, regular exercise plays an important role in the management of type 1 diabetes, although it takes more effort and constant monitoring to get the food intake, insulin dosage and timing of exercise correct. Bearing this in mind how do we get the best out of our gym or home exercise workouts?

Your initial consultation with a Biokineticist (Exercise therapist) will provide the practitioner with the information he or she needs regarding your “diabetes” status, cardiovascular health, fitness levels, injuries, barriers to exercise and preferences for exercise. With this information, the appropriate exercises can be prescribed to improve your physical condition

The latest research suggests that a combination of resistance exercises (e.g. low-intensity resistance gym circuit for 15-30 minutes) and endurance exercises (walking, cycling, swimming or jogging at a low intensity for 15-30 minutes) is the best routine for the majority of people with diabetes. The fitter person with lower cardiac risk can also add interval training to their routine. An example of interval training would be walking one minute and then running one minute or cycling at a low resistance for one minute followed by cycling at a high resistance for one minute. This method of exercise can be added for 6-10 minutes either in the middle or at end of the routine.

How much exercise is enough?

The daily gym routine should ideally last 45-60 minutes in order to get the maximum benefit. If you cannot get to a gym daily, try get to the gym on alternate days and perform leisure activities like gardening or housework or shopping on the in-between days.

What is a safe training heart rate or intensity when walking, cycling or running?

If a person with diabetes has a cardiac condition, he or she should follow a 70/30 split of endurance to resistance training. If the person is not on a Beta Blocker (blood pressure medication that slows ones heart rate), your Physician or Biokineticist can work out a safe training heart rate.

One formula for a safe training heart rate is as follows:(220 - age - resting heart rate x 0.6 + resting heart rate) = lower training heart rate

(220 - age - resting heart rate x 0.8 + resting heart rate) = upper training heart rate

Example

If a patient is 50 years old and has a resting heart rate of 60 beats per minute, his safe training heart rate range would be 126-148 beats per minute. Numerous heart rate monitors are available on the market and most pieces of cardiovascular gym equipment have built in heart rate monitors.

Best time of day to exercise

For those people on insulin, exercising before breakfast and before supper may be more preferable. Exercise at this time may result in less hypoglycaemic episodes during activity. The reason for this is that you generally have less short acting insulin circulating at these times.

Weight loss

Exercise is not renowned for reducing large amounts of weight; however, recent research suggested that regular moderate to high intensity exercise and a lower-calorie eating plan may reduce abdominal fat percentage. Reducing abdominal fat percentage is vital in improving blood glucose levels, cholesterol and blood pressure.

How to get the most out

of your workouts

FITNESS•

DIABETESLifestyle48

THE BEST SUPPORTIVE THERAPYALONG WITH CLASSICAL HYPOGLYCAEMICS

FITNESS•

Furthermore, in order to get the best weight loss potential out of your routine, you should exercise at the highest intensity that is safe for you. In other words if you are able to get to the gym three times per week, try and exercise for just over an hour and push up the intensity of your workout as you get fitter. In order to measure your improvement, waist circumference, body weight and body fat percentage should be measured every 4-6 weeks. This should preferably be done with the same practitioner on the same scale and utilizing the same body fat percentage method.

Some researchers suggest that exercising first thing in the morning before breakfast on an empty stomach may improve your chances of weight and fat percentage loss. Exercising at this time of day is believed to kick-start ones metabolism and utilise more fat as an energy source.

Orthopaedic conditions

Exercise can play an essential role in the management of orthopaedic (neck, shoulder, lower back, knee, or ankle) conditions. Thus from a Biokinetic point of view it is essential to assess each persons orthopaedic status. If you have an injury, the correct exercise therapy needs to be prescribed as part of your workout. Rehabilitation exercises should constitute at least one third of your workout.

In order to get the most out of your workout, make a firm commitment to regular exercise, take heed of the above-mentioned factors and make exercise a positive lifestyle change and habit. The most important advice we can give you is to enjoy your workouts. Then you will want to come back for more.

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Chromium 200 mcg

Zinc 15 mcg

Magnesium 100 mcg

Selenium 100 mcg

Copper 1 mg

Manganese 2 mg

Iron 8 mg

Iodine 100 mcg

Vitamin D (200 IU) 5 mcg

Vitamin A ( 2333IU) 700 mcg

Vitamin E 30 mg

Vitamin C 120 mg

Thiamin (Vit.B1) 15 mg

Riboflavin (Vit.B2) 5 mg

Niacin 45 mg

Vitamin B6 25 mg

Folic acid 500 mcg

Vitamin B12 9 mcg

Pantothenic acid 10 mg

Biotin 200 mcg

NOTE :For essential Calcium-Magnesium therapy in Diabetes Mellitus, another innovative Vitabiotics product , OSTEOCARE Tablets is recommended.Calcium has been excluded from the Diabetone formula because of the large amount in which it is needed. It’s best if taken separately.

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LETTERS•

FeedbackA helping hand

I picked up your magazine, issue one, from my local Dis-Chem in Hillcrest. I found your mag extremely informative and beneficial, especially as I have been recently diagnosed with diabetes. At 61 years old I found this to be rather daunting, especially when the new Doctor I visited made no attempt to contact me after my blood tests. After two days I phoned him and he kindly told me I had diabetes with an HbA1c of 13.3 %, cholesterol level of 8.6 and I must pick up a script from the front desk and avoid sugar. He either lacks knowledge of the disease or has a “don’t care” attitude. Frankly, after finding out how serious this condition is, he should not be allowed to consult on the subject and should have the decency to point one in the right direction. He prescribed two types of oral medications, which he made a total botch up of and the pharmacist had to phone him to clarify which type to give me.

The following Saturday my wife and I visited Pick n Pay in Hillcrest as I needed to stock up with items with no sugar, (I had not done any research on the subject as this was only two days after my diagnosis). I went in search for a store assistant for help. A Mr. Mark Trollip came to my assistance and asked why I needed these items and told him I was “not allowed” to have sugar. He asked if I had diabetes and then proceeded to give my wife and I a tour of the store and their range of healthy foods. He then advised me to visit his Doctor. I am now under his care and on a long-acting insulin. In addition, he has organised a Diabetes Counsellor and nurse to help me further. I have also joined Diabetes South Africa.

I was appalled at the lack of knowledge from the first Doctor and recently attended the presentation on diabetes by Momentum Life and they have also indicated that Doctors are reluctant to improve their knowledge, advice and care to patients who they diagnose with the disease. To this day, I have not heard from the first Doctor.

Keith Meyer

Michael replies - We are sorry to hear about your experience, which unfortunately is that of many before you. There are however a number of diabetes practitioners in South Africa who are passionate about good diabetes care. It seems that you have found one. We trust that you will enjoy our next issue.

Readers Competition Number 2

Numeracy is vital to patients with diabetes who must apply math skills (addition, subtraction, and multiplication) to diabetes self-management activities such as, glucose monitoring, carbohydrate counting, and adjustment of insulin. We have a pair of Polaroid sunglasses (either a ladies or gents pair, valued at R550) as well as a hamper of natural vitamins from Nutrifruit labs valued at R250 for the first two respondents to send us the correct answers to the questions below:

Before working in the garden you are to decrease 1. your meal insulin by half, if the meal and garden work are two hours or less apart. You usually take 8 units for lunch. If you eat lunch at 12h30 and are going to mow your lawn at 14h00, how much insulin should you take? ANSWER = _____ units

You have been advised by your biokineticist and 2. dietician to eat 6 grams of carbohydrate for each 30 minutes you plan to walk. You are planning to walk for one hour. You have a bag with 12 whole-wheat crisp breads. Each cracker contains 4.2 grams of carbohydrate. Approximately how many crackers do you need to eat before your walk? ANSWER = _____ Crackers

E-mail the correct answers to Michael@cdecentre.co.za

before the 30th of November 2010

Motivating our readers

I have just finished reading the first issue of Diabetes Lifestyle and I must say that it is a brilliant idea to send this out to the CDE members. It is a good read and one that I am going to look forward to in the future as an adult with type 1 diabetes. With a rushed life, you sometimes forget to stay on track and there is very little out there motivating a person. I think this magazine is a good motivator with relevant information and will definitely ensure I stay on track.

My suggestion would be to add a recipe in every edition. I would also suggest a question and answer section for readers, which would make the magazine more interaactive. It is also interesting to read about problems which other people with diabetes encounter and any solutions to this. I also think that the section on carb counting was very good as we are always interested in what food and how much is allowed in our meal plan. Thank you and well done on the first edition.

Manusha Pillay

Michael replies - Thank you so much for your compliments andconstructive suggestions, especially on the ‘Question and Answer’ section. We want Diabetes Lifestyle to be a resource for the diabetes community and welcome interacting with our readers. Please send us your questions and we will answer them.

Congratulations to the CDE

I must congratulate you and your editorial team on producing this fantastic world class publication! This is yet another example of the The Centre for Diabetes providing patients such as myself with outstanding service and advice that will improv our lives.

I have had type 1 diabetes for 43 years, and have been looked af-ter by Dr Distiller and his team for 28 of those years. In spite of all my personal experience in diabetes treatment, I still learnt a great deal of practical knowledge from the first edition of your magazine.

As well as the content of the journal, the layout and illustrations are also excellent and easy to read. It is good to see that you have also secured very good support from your advertisers. A great deal of effort goes into producing such a publication, and I’m sure that I speak on behalf of many patients with diabetes in thanking you and your team for all the hard work. I look forward to the next edition.

Steve Sheldon

Michael replies - Thank you for taking the time to provide us with this feedback. We are glad that you gained something from our first foray into this medium. We still would like to improve our standard further and feedback like yours will help spur us on to achieve this.

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