Diabetes and CDE and Discovery 2019

This year from around next week, the various options excluding keycare of discovery will join the CDE family. Why this is exciting is that CDE has always provided comprehensive holistic care to diabetic patients and by managing a disease like this in a team approach it is simply put better managed.

What that means “downstream” so to speak is less cost to med aid, better health to patient. Greater longevity with more quality.

We are super excited at this development and though teething problems will certainly occur the benefits will outweigh the initial stumbles.

THe swtich over for diabetics on discovery is automatic you don’t have to do anything. Ok so top 2 plans nil to do, other plans register on health ID it seems with your GP/doctor. 🙂

 

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Today is a new day…

Chronic illness like diabetes especially type 1 diabetes where your life depends on testing your sugars and injecting insulin can become fatiguing to say the least. The drain and strain of this burden gets you down no matter how positive the patient and the family.

But what can be done?

I have a few tips for diabetes and other chronic disease burnout :

1.) Every day is a new day, forget the past, forgive yourself for the mistakes, highs lows etc and begin afresh almost like today is the first day

2.) Give yourself a mental break, have a week off mentally of driving strict control

3.) “allow” yourself to cheat now and again making sure you do it safely-ie inject to cover the carbs accurately

4.) See a psychologist or a life coach or similar profession regularly through state or privately – you owe it to yourself.

5.) Take anti-depressants where indicated, don’t feel guilt about it, if it has been prescribed to you for burnout, depression take them.

6.) Get together with other type1’s or people with a similar diagnosis both for sharing the good tips and debriefing about the bad stuff, no-one can commiserate like someone going through the same thing.

 

FEel free to add your tips 🙂 Today is a new day! Indeed

Discovery and CDE

So this year all Discovery patients(excluding keycare) with diabetes will be covered on the CDE programme. This is super exciting.

What is CDE ?

Cardiovascular Diabetes and education – the brain child of Dr LArry Distiller which has been running for many years across south africa out of Houghton Johannesburg. It is a programme by which diabetes is managed holistically and by a team of professionals each focusing on an area of speciality : feet, eyes, diet, exercise, medication etc.

What makes it great for control of diabetes and general wellness is that all members talk the same language in terms of diabetes management and work towards a goal of control individualised for each patient.

For any queries phone : Romae 0832898351 or email drleesecretary@gmail.com or drleethegp@gmail.com

The CDE programme runs according to international and national guidelines to give the best outcomes longterm, that means looking to have less heart attacks, less amputations, less renal failure and dialysis, less hospital admissions for diabetes due to better control and the programme achieves it year after year.

Reasons our country is great …

1.) app of the year and its success story – well done MTN

2.) Jordan Peterson’s book – 12 rules for living and the impact it could have on us if we applied it 🙂

3.) a world widely connected and the availability of gems to all

4.) Gareth Cliff and his vision and content and joy bringing en masse

feel free to add to my list

End of year madness … or is it gladness?

Another year 2018 has come and gone in the literal blink of an eye. I find myself looking back aghast at 8 years gone by in a jack flash. So much joy and so much agony. A kaleidoscope really. A train smash storm born delight. So much and yet so little.

Life is a lesson if nothing else. And I guess right now I am just terrified that I have too little time left here, now, deep in the poison garden to borrow some words from one of my favourite poems ever ever.

To recap 2018, it started with a transkei soul filler in January at Zithulele and interestingly in november topped off with a similar soul collide. I do love it when souls collide, slip and slide and joy errupts.

February the month of love seemed full of long hard days of work and figuring out pain.

March and easter arrived too soon, a lovely camping trip with friends in the cobham berg marked the kind of first quarter’s end and did a lot to boost the love tank.

April, well a month of decisions and immense pain one I shall sooner forget.

May, my birthday month had some snippets of great support by friends and reflection.

June and July the winter of the year, also just seem to full of work. But a wonderful wonderful time in the snowy mountains learning to ski, putting a hole in a sump and finding treasures in Barkley East of all places as well as the most exquisite mountains – the guardians in Elliot of even more strange and wonderful and undiscovered unrecognised places.

August was yesterday more great work. September the air filled with spores and pollen, we sneezed and bloomed. October too.

November and here we are December!

Shoo, looking back I am excited to look forward. Right now it’s hard to lift my foot even 10 cm and I feel that a good hibernate sleep of 2 weeks would not be enough. But I vow to be back in Jan2019 rejuvenated, joyous and full of brimming life for the little bit of time (hopefully at least 50 years) that I have left :):)

At this time o’ joy – I shall be joyous

2020 vision – what is your response? South africa …

There is a goal to eradicate blindness by cataract by the year 2020. Perfect vision is 20/20 or 6/6. A world health organisation WHO initiative from 1999 that aims to address multiple issues around vision and avoidable blindness it has taken off beautifully in some parts of the world and yet is sadly lacking in others.

Interesting to me the case of the eastern cape government, happy to jump on the band wagon of an NGO like Grace Vision and “claim” it’s successes but not even vaguely interested in helping fund a very worthy and well run cause.

I used to work in the government sector for 8 years. There is every single excuse not to work thought up by the staff nursing and other -like not enough staff (they require 4 nurses in order to operate), out of stock of something, too hot, too cold etc etc. Possibly some vaguely plausible but almost always overcomeable with will.

I find it sad that as humans when we are part of a big machine like government sector the vast majority of us default to the lowest energy setting.

Challenge to government health sector – partner with the NGO’s financially and see the gain/win and delight of YOUR people – the people of south africa.

WEll done mediclinic!

A chicken in the clinic …

I spent last week doing cataract surgery MCSIS at Zithulele hospital and more specifically Grace Vision (NGO). This is an amazing NGO doing phenomenal work in a very rural and poor community. They have managed since inception to alleviate blindness in their immediate vicinity.

THis means that according to the world 2020 vision target they have already done in by 2018 !!

That is simply amazing and unheard of in this part of the world – the eastern cape.

But then Zithulele at large is not your average place either.

Run by inspirted staff at large it’s a place of many miracles daily. Zithulele is a government hospital just off the road to coffee bay, transkei, which has managed things that few such institutions have been able to through sheer hard work and lots of prayer and mindful action.

Tell the truth or at least don’t lie …

We are all spiritual beings and have intrinsic innate plumb lines.

We all also have unbearable ignorance in us. There is actually much to navigate in this life. And choices present themselves and when they do the choices potentially direct or re-direct the rest of our lives.

So really we actually do have some control over the path.

I guess what I am trying to say is that life is as simple or as complicated as you choose to make it and within us lies a lot of intrinsic value as well as rubbish and we somehow have to sift out the rubbish and learn to trust the truth the internal plumbline that longs to direct our hearts and souls in a direction of fulfilment.

And to this end, we can really only be true to self if we are willing to be honest.

We celebrated world diabetes day this past wednesday and Diabetes in essence, especially type 1 offers and real deal opportunity for a whole family to get honest about a lot. A curse in essence which sometimes turns into a blessing in relation to facing challenges and rising in a dignified way above them.

In daily confronting a disease like diabetes that challenges you to eat healthily and responsibly, inject correctly, pre-empt highs and lows and at the same time fight the chronic disease fatigue.

The irony is if you manage your diabetes well you outlive the rest of the population due to preventing things like heart disease etc. I wish it were so simple with our psyche. Diabetes is a special challenge to the psyche and so many patients battle this daily and win.

 

 

 

 

 

 

Fear can be overcome by humour, there is indeed no other way…

Of two choices you can be certain – to choose love or to choose fear. What do you choose?

One of the best ways to combat fear is humour – Pieter-Dirk Uys said this in an interview with Gareth Cliff on Cliff central …http://cliffcentral.com/ – an awesome place to find cool pod casts.

Another thing that struck me is how as humans when there is a big internal fear of big feelings like for example homosexuality or being abused etc, that we someone turn our focus to self-loathing. That shadow self, the “unacceptability” thereof then turns into a great fear and we operate frozen out of contempt for this. This is not healthy.

Another thing I learnt yesterday is that depression is fear turned inward, internalised.

Not a good thing.

And yet there is freedom, there is joy, there is dancing.

IN humour, in letting go, in acceptance of self. In naming the emotion and confronting the fear in a gentle accepting way. Sitting in the mud with it. Alongside it.

We are complex individuals who crave, long for and desire connection. Empathy is the key to that connection. Without empathy connection is nearly impossible. Empathy.

 

 

 

 

Mental health …the big taboo

Tell someone you have breast cancer at the very least they have sympathy for you. Tell someone you have broken your arm they will say I am so sorry. However let it be : depression, or drug addiction or any mental dis”order” shoo but the judgement, the “look” and the opposite of support.

Like a sausage, by and large every time.

Even amongst colleagues. Even amongst loved ones.

Why? Why such stigma, such judgement, such vile poison?

Are we afraid? Is it fear? Is it selfish?

I don’t know, I only know the reaction is sad.

We are all physical, emotional and spiritual beings who battle multiple fronts on any given day. We all have spots in all of these areas. And yet in the strangest way we are all connected. And deeply so. Believe it or not. Your choice. But the truth is we are.

Think on this today. Perhaps you have such a person in your life. It would mean the world to them to even just be accepted by you.

Halloween …

What is halloween?

It is a festival that started more than 2000 years ago, this is before Christ. They were pagans in what we know as England today – celts.

It is a festival marking the end of the harvest season and has a long history.

I was trying to figure out why it is so offensive to the christian religion but even after researching I am confused.

If we really think back to 2000 years ago, and that is hard to comprehend. Life as we know it was very very different. They were as we call it pagans but really they were just trying to survive and using the sun, wind and stars to get them through the year.

As with all of these traditions like father Christmas and the easter bunny – do children really know the significance of the holidays we celebrate?

What does halloween mean for children – sweets, pumpkins, trick or treating, dress up. They certainly don’t channel anything.

I actually find it quite interesting that as humans in 2018 we still have followed a lot of customs from more than 2000 years ago, fairly “religiously”.

My personal feeling is that it is what you model daily, preach without words that has the biggest impact.

Also perhaps I am cooked in the head but “broad minded ness” in my book includes exposure to things rather than hiding them under a mushroom however this is just my personal opinion.

 

Scraps of affirmation…

Peter and John went to pray one day, they met an old man on the way ay ay, silver and gold have I none said he, but such as I have give I unto thee. Rise up and walk.

Yesterday I was privileged to listen to a sermon on this very encounter. The man in the story did not have faith for healing. He had faith for what he had encountered for many years -scraps. Scraps of money, time, affirmation, food.

And yet that day he was healed. Leaping and jumping and praising God.

So much of many of our lives are lived much like this. Hoping for scraps. And really that is not what we were destined for.

There is so much more.

We have a mindset sometimes that we lock into for years and years. And then all of a sudden sometimes the light breaks in. And we can see.

And there is a time of feasting.

Being lame is innate to my name, Claudius – the lame one. Wounded healer.

What an absolute joy and jump to be able to gift healing in the physical sense. And sometimes even the emotional.

But true healing is a much deeper process that requires divinity.

And the amazing thing is that it IS available. And also one does not have to be ok with scraps, now put that in your peace pipe and take a long hard inhale.

Claudius was a very interesting fellow, conquered Britannia – the UK basically. To sojourn from Rome to Britannia in those days was quite a sojourn.

 

The aqueduct of sylvius…

Oh my word the brain is just so absolutely fascinating and phenomenal.

I had to explain the brain’s mop up operations to a patient today and was suddenly struck by wonder …

This extremely intricate system “cycles” cerebrospinal fluid 3-4 x a day. I had never really thought about this before. One learns neuroanatomy in second year and it is really just all part of a web of knowledge about the body that has never been debated philosophically before (by myself I mean).

“The windings of the brain (which I first learnt of Franciscus Sylvius, a great anatomist) if you diligently examine the matter you shall find to descend a good depth and that the brain doth gape on each side, over and above that same middle division made by the Sickle, with a winding clift, which begins in the forepart, about the roots of the Eyes, whence according to the bones of the temples, it goes back above the root of the spinal marrow, and divides the upper part of the brain from the lower part.” -written by Caspar/Thomas Batholinus from a book F Sylvius neuroanatomical work.

How beautifully described. I am in awe just of the description. And that is how they communicated in those days 1500’s – with care and deliberation.

Much similar to the brain’s care and deliberation of itself.

A slow wash 4 times a day : fluid formed by choroid plexus within the lateral ventricles which then feeds through the system into the third ventricle via the aqueduct to the 4th then via 3 small foramina into the subarachnoid space and spinal column.

The brain bathing itself, soothing itself, slowly like a water feature – tranquil and clean and clear.

We have much to learn about self care from this amazing washing lesson by the brain. WE are generally our own worst enemy. Learn from your brain and cleanse, dream, bath today.

The aqueduct 🙂 one of my favourite parts of anatomy.

 

 

Roaring 20s party …

So we are throwing a fund raiser towards the cause of Shap Shap cinemas – can be found on Facebook … doing a wonderfully good job in terms of a lot of community education at large.

We are going to dance, party and just have a lot of fun. WE have DJ Queen G who is phenomenal playing, food from Copperfields which is delectable, a cash bar. And all of the money raised goes straight to Shap Shap.

I heard about these amazing individuals/NGO listening to Gareth Cliff during his interview with them last year.

Please support us, this is a tangible way to turn our SA around – just do it man, pay for a ticket. Dress up is optional and I guess so is dancing but will be encouraged 🙂

Life is short, times are tough, have fun and support change.

Diabetes type 1 is no one’s fault, don’t be ignorant

Daily I hear very interesting “lies” about diabetes. I heard a classic last week. Someone’s mom who had had a stroke was told her mom has the kind of diabetes that CAN NOT be controlled. God’s truth!!!

Another common lie is that this is a disease “you do to yourself” i.e. you behave/eat in a certain way and your “punishment” is diabetes. Well I am afraid that is NOT TRUE.

Especially in type 1 diabetes. This scourge has been with us for a long time. However up until the 1920’s there was no “cure” or “treatment” so to speak i.e. you generally died from it. And the consequence being the “genes” or genetic inheritance died with that. Since the 1920 s we have had insulin and now one can live very “normally” yes ~I said normally with type 1 diabetes. Yes it involves checking sugars and injecting insulin but other than that you can eat mostly what you would like to and get on with life as you would like to.

So to the diabetes that can not be cured I say : Lord have mercy. There is so much lack of knowledge especially in public sector about diabetes. That added to the corruption. Ie meters, strips, insulin being sold on the black market meant for the poorest of the poor free as part of a the dismal service being provided is a scourge.

Any form of diabetes can be treated and controlled. Is it easy ? No but is it do-able even for the poorest of the poor. YES!!!

There is so much corruption in this country and it always affects the poor more. Let’s at grass roots level tackle this with the power of words, peace, and the truth. Join us to contribute to both awareness and funds for shap shap doing this very task daily excellently : roarin 20s party 27 oct 2018 …see Facebook drleethegp and shap shap

Love, what is that?

Life, love, chemicals, spiritual being ? What are we?

We meet, we relate, we may even marry. We miraculously and seamlessly produce children who are part of both of us. They are quite a lot of work to bring up. Moms generally bear the brunt of this “work”. But is it work? Is it not also love, life, chemical, spiritual interaction?

We fight, we break up, we subject the parts of us to separation.

In this crazy process is there not a better way?

Communication of sorts, sharing of sorts ?LIfe, chemicals, spiritual interaction, I am sorry please forgive me, I love you. The breaking down of barriers?

Just too sad to even contemplate why not? Why it’s not possible ? Love life chemistry, spiritual connection? Perhaps if it never existed it can not be resurrected? Is that a fair way of analysis or is there a deeper thought? Love is certainly a conundrum and perhaps it is just way simpler and we make it way complicated.

The power of words

My daughter of 5 and I listened to a sermon on sunday about essentially the power of words and the impact they can have on relationship reconciliation.

It is indeed profound to me at how she just got it : “I love you mommy” , ” I am sorry, please forgive me”. So easy for a 5 year old to snap and seemingly so impossible for older folk to get this simple simple concept.

The power of the spoken word is immense. As the preacher said God said of His own son : “this is my son whom I love”. If the God of the universe and of creations feels the need to speak such an obvious statement and was able to speak the universe into being how much more should we not speak out loud affirmation and love to our loved ones.

The sermon has literally come up at least 10 x since sunday in her little head and in such a positive way.

Words are tools- power tools. Most days I really underestimate them.

Three hands or four

This morning I had a hospital patient in the little part of the world I live in called howick and then had to get kids to school. I had decided that I definitely was doing pilates this am not matter what and I did. Unfortunately I had no petrol in my car (well almost none). Made it to pilates. Left early to put petrol in and go and buy the food for my 5 year olds heritage day celebration. The shop I was hoping to buy fish pops from for mauritius – the country my little one chose, was closed. NO problem went next door to the trusty spar and got chicken pops instead -I am sure they eat these in mauritius too?

At the check out I had too much to carry so I said to the lovely teller – don’t you sometimes wish you had 3 hands – she said “even four, even four”.

I agree even four.

 

See here : above this pilates pic personifies the average mom, no none of us bar Julia Musgrave can do that but we try 🙂

Type 1 managed at home from the start

Outside of a patient arriving in a DKA (diabetic ketoacidosis) one can actually manage them at home from the offset. Yes this may well be a bit controversial, however, in my opinion subjecting a whole family to hospital admission of 10 days at the start of such a huge ordeal is controversial too.

There are many arguments for both sets of management.

My personal feeling is that a hospital is a very traumatic place to be. To subject an entire family to 10 days in an institution with bad food and light far away from home is akin to a concentration camp.

Trauma is also about how it is managed and the calmer, better slept “managed” parents and children do better I believe.

Type 1 diabetes is an absolute lack of insulin. There need to be multiple mind shifts that occur and this requires calmness and astuteness. It is very easy to manage in this day and age what with excellent new insulins as well as cheaper CGM availability.

We currently have an epidemic of type 1 diagnoses. If I learnt anything from Larry Distiller (guru and endocrinologist) it was step back, take a deep breath and apply the knowledge you have calmly. This is the dictum I follow with great success.

Venus and Mars and the stars beyond thars,…

So I feel that I should have a little say about the whole Serena debacle which is far from Serene to say the least.

There is unfairness for sure.

There is discrimination for sure.

Osaka is both gracious and amazing to have beaten Serena.

Trevor Noah hits it on the button – watch his clip on this.

Google it on YOU tube …:) go on I dare you

 

Open source diabetes technology

All I am going to say is watch the Carte blanche clip : 9-9-18 on Diabetes type1 from last night, you can literally google it on you tube and go!!! Jaco Cronje and co as well as shout out to Dave Segal, my guru 🙂

OPEN SOURCE CLOSING THE LOOP  for the benefit of all at a lower cost

Life as a mom/woman/werker

So I often say to my kids “mommy has at least 700 jobs to do every day”. And I often feel that perhaps that’s underestimating it. I also wish for, long for 3 or 4 hands rather than 2. It would honestly solve problems like : multiple trips to and from the car, packages as well as carrying kids etc, etc etc.

Just saying.

The average mom/woman/werker regardless of stay at home of frikken run off your feet business person wakes early, starts the day with a pretty limitless list of tasks which get interrupted on average about 1000X that specific morning. Attempts during this first mini-war of the day to shower and dress. Sometimes this process gets hijacked and one finds oneself naked in the kitchen consoling an inconsolable child about something that may actually be causing world war three in their mind but actually just can’t find it’s pink jersey.

The journey to the car is often interrupted by a request to poo and we are already 10 minutes late. And trust me this process in a young un is not a quick one.

Drop off is sometimes fraught with yet another battle of sorts from tears to tantrums and all shades of different coloured moods in-between. yes them young uns are humans with moods and lots of them.

On arrival at work one really needs a tequila but generally that does not happen. Unless your secretary spots a look of absolute failure in your eyes and merrily produces one – joking – I wish!!

Then the day begins, most feel much like a whirlwind. In my world every day is different and I end up literally donating my spleen and kidneys to most patients in terms of empathy and attempting to listen in an in-depth way a healing way.

Well then 3 pm hurtles around and usually signifies children who are either hypo-glycemic or grumpy or tired or all 3. It’s a special time of day as most mums will know which generally lasts until bed time and the routine of that is sometimes a breeze and just when you think you are bloody mom of the year a week arrives where they turn into the spawn of satan and literally behave like aliens born of people you don’t know from adam.

And on the note of adam. Well God had a special sense of humour when he created him.

How anyone gets through the average day without a glass of wine totally totals me. And I was a “tea totaller” before I had children. Despite being wise (i.e. older).

Spare a thought, if you are a women on your way to motherhood, prepare yourself -though nothing really can, just saying, sorry.

If you happen to be a caring adam then spare 2 thoughts perhaps buy some flowers and have a conversation along the lines of I love you, I appreciate you you are amazing :), just saying.

From the heart …art

The heart is a fragile thing in most, and yet a hard nasty thing in some. The arts and art is a thing like beauty – in the eye of the beholder and the eye is the window to the soul.

The soul – now there’s a concept. What is that?

What are we? Chemicals, chemical reactions on millions of different levels? Hard physical hardware ? A mixture? What makes one man soft and one man hard? Or woman. Let’s not go all porn here we are talking the insides right, the chemicals.

One day when you die does your soul live? And how do we know that for sure this side of death?

Musings on a wednesday …

Suicide, yes I said suicide

A subject we all seem to shy away from. And yet I am guessing it has been around for a long time and seems in my observance to be on the increase. Certainly amongst the medical field.

The root word is from latin sui – self and cidiim – killing, not even really a fair description.

What bugs me more is the judgement. The condemnation, never mind of some. I feel that to a large degree is it because we are not connected any more and that the lack of true “support” across the board reigns. It seems we are all islands.

And yet it could be different. We could “support” people at large more and actually “be” there for people at large.

We have become shallower in our dealings with humans. Human to human is a connection we don’t seem to have anymore. And it is sad.

Suicide is a comment on our society and it is sad.

Not long ago I thought it was dentists that had the highest rate of all professions, medical doctors seem to have taken the lead and how very very sad this is. The healing profession seems unable to heal itself and yet is it as simple as that? What lurks beneath the murky surface of this awful predicament that has surfaced. Ego ? Burn-out? The eternal yearning to be the best? Denigration ? Putting people down? Army style? Again and again? Relentless hours? Death witnessed firsthand uncountable times and the expectation that you walk out the room and have a cuppa????

Many things.

Surely we can find the roots, and deal with them? Academia at large are seemingly unaccountable – should that not change?

Lives being lost as we speak – fathers, mothers, sisters, brothers.

Sad, sad. Is there something YOU can do today? Or will you choose to remain silent and impotent.

Silent heart attack

What is a silent heart attack. An acute myocardial infarct where the patient feels no pain whatsoever. Diabetics are very prone to this. Particularly poorly controlled diabetics. If the average sugar is consistently above 10 mmol/l then the nerves to the various organs actually stop working. Which means in essence you don’t feel pain like you should.

The problem with not feeling the pain is that you don’t realise what is happening. So generally the patient presents later. Sometimes with confusion (acute), sometimes with electrolyte disturbances or unfortunately death.

Control of sugar is key.

A1c – three month average of the glucose must be performed in diabetics at least every 6 months and attended to if too high.

Controlled sugars prevent heart attacks. Controlled blood pressure prevents them too 😉

Tit bits and chunks of useful diabetes info

I was privileged to attend the Lilly summit 2018 in Durban this weekend with top notch speakers who literally infused my brain with a lovely soup of new information and better ways to help diabetics.

I posted most of the pearls on my face book feed – Claudine LEe/drleethegp.

There are few things more tantalising to a diabetes nerd that a day full of information soup, its like gourmet food for the brain and has the capacity to transform patients lives.

Thanks so Lilly for a lovely and well organised event. So wonderful too, to have Kenyan and Namibian continent there too.

 

Sticky mess 2

So when the sugar goes above 10 mmol/l (different values and way of measuring in the US and UK), the blood vessels : arteries and veins in the : eyes, heart, kidneys and feet and also EVERYWHERE (yes that includes the reproductive organs) SHUT – the sticky mess shuts them and so the cells can not get oxygen and they “starve” and can die.

That is when you have episodes like : stroke, heart attack or a black foot requiring amputation.

Or when you go blind, need dialysis or need to have a heart bypass/stent.

So what is the answer ? More meds, better meds ?? Maybe BUT mostly, more exercise, better eating habits, more exercise etc, consulting the team you know about re your diabetes : dietician, podiatrist, biokineticist, doctor, etc at least once a year.

If you keep the sticky mess away, did you know you live longer and better quality of life than your non-diabetic counterpart?

Diabetes college …

Should we open up a college to teach folk about diabetes. The diabetes man. Yeah.

A touch of sugar, my doctor says I have a little bit of sugar.

So much of confusion out there. Yes diabetes is here in a big way. Yes it’s logarithmically growing. Yes is perfectly preventable (type2). Yes there are massively big differences between being insulin dependant (type 1) and insulin deficient (varying degrees) type 2.

So yes maybe we need diabetes night school or even day school to tutor folk.

Yes you can not stuff endless amounts of carbs in your mouth. Yes that includes beer. It’s a carb. Yes it is.

Whiskey and water is better but in the quantity of one drink.

Yes fruit is full of carbs – sugar. Yes it is. No it is not great for diabetics. Does that mean you can’t eat fruit at all? No but the quantity and the type count.

Can a dietician help you ? Yes very much so.

Will exercise help ? Indeed, at least one hour though and a few times a week.

Do you have to run ? No, walking is actually better exercise.

Bottom line when your sugar goes above 10 in the blood stream things stick together. A Sticky mess.

Kana Uchema …

Karen Zoid and Yvonne Chaka Chaka have recently done this song, written in Venda Shona , what a beautiful language ….what beautiful words.

I had never even heard it spoken until the day I downloaded the song, I actually had to google it. And I have lived here in south africa since I was born. We have such huge talent in the beautiful land.

Karen is amazing at showcasing that. An amazing singer, human.

(Verse 1)
Iwe Neni
Ngatingova neyi nyika
Ndochido changu
Kugona uchinyemwerera

(Verse 2)
Ganda rako raka svibirira
Vhudzi rako raka fanana nerangu
Hukama hunoti batanidza
Newe makore akawanda

(Chorus)
Kana uchema
Ndinonzwa mwoyo wangu kurwadziwa x2

(Verse 3)
Mai nemwana
Varere wakafa musango
Apo mumwe murume aripa dambudziko
Muzita rehondo

(Ad-libs)
Taridza rudo rushoma
When you cry
When you cry
Don’t you cry brother
Don’t you cry sister

I feel it
I feel the cry

Karen Mashed this with the lyrics of linger into it – truly inspired. We are able to do so much more in this country. Love Karen, Love the queen of africa, go ladies and all talented people of south africa.

Taridza rudo rushoma …

 

Back in the office

After the most special trip to the eastern cape we returned full of love joy and hope and I am back in the office : 0832898351 🙂

Some amazing spots : The henry barkley bnb in Barkley East, the alpine swift in Rhodes and the Guardians lodge in Elliot – special amazing, reasonable, divine !!! Time out is really awesome.

Diabetes is not a myth -so why do we pretend it is???

So funny to me how there is still a lack of acknowledgment as well as a bit of head in the sand when it comes to this massive diabetes epidemic. WE seem to think we are all fairies in a fairy tale and bad things will never happen to us despite our bad behaviour.

We are currently in a pickle. A sticky soup mess of diabetes by the gazillions and yet you see no REAL action. Why?

Confusing really.

Especially problematic to have this many children “suffering” mostly silently from undiagnosed disease.

So much knowledge available and yet so little interest even.

Until the day it hits you or your family. In terms of type 2 especially in children there is so much we can do as well as reverse this if found early. So why are we not going out and actively diagnosing it?

Unfortunately in type 1 in children through no fault of their own, their bodies have attacked their pancreas and essentially killed the pancreas. And without insulin they would die.

More awareness, less scaremongering, less head in the sand, more action. More at least attempt to slow the log curve of growth. Why don’t we at least try to slow the log.

Comrades – the real joy of south africa

Oh to sit at the half way mark and watch both the beauty of south africa as well as the glory of our people both running and spectating. We are in truth a rainbow nation that deeply cares for each other across colour and culture and language and on comrades this is on display for the whole world to both see and experience. What a spine chilling, tingling and emotional few hours that really filled my tank with pure joy.

I then went and had lunch with my folks and watched some of the live footage on tv. The interview with Bruce Fordyce about Ann Ashworth was so heart rending. They were only expecting/hoping for the last gold medal and on the day she came out guns blazing and surprised even herself. To see his enthusiasm for her race and the joy of what transpired on the day, beautiful.

Our country is amazing and whilst we still have a lot to work through we are actually working through it. We are not pretending there is no elephant in the room. We are tackling daily life in south africa on a daily basis and working for the good of all.

Comrades day is our commitment to that process in action. Proud to be south african. And wow what a lady is our Ann.

 

 

What is a cough and what is a cold?

The definition of a cough : Middle English: of imitative origin; related to Dutch kuchen ‘to cough’ and German keuchen ‘to pant’, Expel air from the lungs with a sudden sharp sound, kuchen : cough, hack, kuch: fit of coughing,.

A cough is a sound we make that has a deeper cause, like a post-nasal drip, a pneumonia or a bronchitis (blockage in the passageways), a problem with the nerve supplying the lining of the lung, asthma, smoking, a lung tumour, gastric reflux etc. So in my humble opinion cough syrup as such is a little bit like using an antibiotic to treat a viral infection. One needs to treat the cause of the cough. Once one gets to the root of the problem and treats that the kuchen will go away.

🙂

What is a cold? A cold usually implies a viral infection of milder intensity that the “flu”. So many people say I have the flu please give me an antibiotic. Well! Antibiotics DO NOT touch viruses for starters and “the flu” is not the common cold or a bacterial infection like a sinusitis or a bronchitis.

Cold viruses :

• human parainfluenza virus.
• Human metapneumovirus.
• coronaviruses adenovirus.
• human respiratory syncytial virus.
• enteroviruses.

A virus is a tiny little living thing of genetic material that infects you. It is vastly different to a bacteria.

(yes do not confuse your google search with 27 years of study…)

Cold viruses generally do not kill you.

However the flu viruses of which there are also many amongst them swine flu and the influenza virus CAN kill you. So that is why we have a flu vaccine. It is so that you don’t get one of the virulent viruses that can kill you. Yes you may still get a cold virus or a bacteria (that is not part of the flu vaccine) …but it will NOT KILL you. Get it???

spekboom tours…www.spekboomtours.co.za

I spent the past 3 days on a slack pack through the Dargle forests with Julia Colvin and Jonathan (Italian surname) and a few other SNAFU’s that greatly help her with all the organisation it takes. Spekboom is a relatively new company but Julia is not new to traversing beautiful ground.

We had the absolute best “bathing in the forest” adventure possible. Nine ladies on the hike and what a wonderful time of awe and wonder (and a lot of blood sweat and sore feet) but how worth it – can not be quantified what this kind of thing does for the soul.

The sole on the other hand – she takes a beating. (Especially when you discover on the friday that your boots have literally gone walking and you now realise that the old pair of running shoes will have to suffice).

If you are in need of soul food, a little piece of heaven for the soul I would highly highly recommend this. The food was phenomenal, the company was glorious, the views breathtaking and the general injection of delight into ones being simply unquantifiable.

http://www.spekboomtours.co.za

 

 

a very old boom

spekboom tours

the view from up above

2000 year old boom

 

New insulins

Is it not a joy and a delight to be able to know that these days we can prescribe an insulin that is far more predictable and sticks to the rules than ever before.

If you are not a type 1 diabetic or parent of one you will never understand how easy it is to either over or under dose on this medication. Add to the fact that sometimes 10 u behaves a certain way and other days it behaves in another way.

So to have both Toujeo and Tresiba – true long acting analogues with SMOOTH delivery available in SA at a price that is competitive fills my whole being with delight. I can prescribe knowing that what I am hoping the insulin to do will ACTUALLY happen 🙂

By the way this lovely awesome cellist is also a type1 – no-one can deny his talent and poise. Just saying ! Type 1’s ROCK!!!! Honestly sometimes diabetes type 1 can actually be the spur that spurs you on. This phenomenal talent (recognised by Megan Markle -now the princess) rocks my world!!

Royal Wedding what a splendiferous treat!

So rarely in one lifetime is one treated to 2 royal weddings as spectacular as that of Diana and that of Meghan the Marvellous Markle.

My heart shon with joy all day long.

What absolutely divine presence of God during the entire day!

The love -pure love between Harry and Meghan is something that God desires for all of us. The fact that it is so rare is sad and a travesty.

NEVER under-estimate the power of love. That reading from Song of Solomon personifies what God intended for love and the outflow and the overflow of love.

Yes I am lyrical. Indeed. This is what my heart has always told me quietly and boldly.

Also the fact that I discovered a beautiful example of love quite by chance. I had always just assumed that Harvey (Gabriel Macht) was a player. Wow what a lovely special gift to see he’s been married for 14 years and #Ilovemywife, was his comment – it made! my day.

Yes LOVE does exist. Indeed.

Meghan you are a diamond and Harry the way you love is how every gentleman on earth should!

We are all people, we share the “commons”” of man of human kind so to speak. And yet we make it all so complicated. God ordained for us to love each other as we love ourselves. Yet so little self love in this world and so little love for one another – despite creed, culture or colour. Be the love today. Thanks Meghan and Harry and Diana for your shining example with NO words of pure redeeming LOVE.

 

Ek wil he jy moet saam sing …. My hearts deepest desire for you my darling is for you to sing when the music plays

Hulle se ons moet glo net soos die kinders …

They say we should believe, just like the children

So is hierdie lewe dan net vir beginners?

So is this life, just for beginners?

Little boys become men and then

sit in a pub and be bored …(look tired)

my boy, listen please,

one day you will have to fight with your whole being,

sometimes it will feel like the goal is a whole heap of shit,

enough is enough

but! I want you to sing when music plays, and dance in the summer rain.

Search for the rainbows my darling,

run into the sea with your jeans on

and search for the mermaids

take part in discussions about all the beauty along the coastline

stay conscious

of yourself

Not too much, but also not too little, just really not too much

Please sing when music plays and dance in the summer rain

Look for the rainbows on the road

my darling

and when you feel that this life is just one big suffering suffer!

reach out and help someone with less

and make someone happy -true joy

because then you will always be able to sing when the music plays and dance in the summer rain, search and find the rainbow,

run into the sea fully clothed,

if you find that mermaid my heart will be filled with joy because two dreamers is so much better than one …

 

karen zoid – I just love your philosophy and trying my best to impart to my girls 🙂

Alles van jou …

Lyrics for Alles Van Jou by Karen Zoid

Is daar iets wat jy wou he Is daar iets wat jy wou se Ek dag ek hoor jou stem

As ek lag wanneer jy kwaad is As ek lag wanneer jy laat is Is dit net omdat dit snaaks is Baby, ek wil jou net omhels Jy is something else Vreude ongekend Jy’s my beste geskenk Oor sensitief Ek het jou altyd lief Dit moet jy onthou Ek’s mal oor alles van jou Alles van jou. Jou behoefte om te red Die vertroue wat jy het Telefoon ettiket Ek kan jou hart bedaar Met n simpel boks-guitar Jy’s al wat ek wil he Baby, ek wil jou net omhels Jy is something else Vreude ongekend Jy’s my beste geskenk Oor sensitief Ek het jou altyd lief Dit moet jy onthou Ek’s mal oor alles van jou

Afrikaans poetry is just my best,

Via jou :

Vra my wysheid Ek verwys jou Ignoreer my Ek upstage jou My meningspyling onderskei jou Jy speel saam want ek verlei jou Ek wil vertaal in waterverf dimensies Ek wil verdwaal en nooit weer hoef te wens nie As ek naby is aan jou As ek naby is aan jou Deur die skare soek ek net na jou Jaar na jaar, jy’s al wat ek onthou Al die kitare speel weer net vir jou Serenade, sang en dans vir jou Ek gaan nooit verloor nie Ek gaan nooit wen nie Jou ten volle verstaan Of ken nie Maar ek is useless sonder jou Ek is useless sonder jou Ek lewe klein en uncomplicated Die een fout is so underrated As ek naby is aan jou As ek naby is aan jou In n kroeg of in n kerk As ons slaap of as ons werk Ons is swak maar ons is sterk Ons is vry maar in geveg Sonder liefde het ons niks Sonder liefde is daar niks Sonder liefde is ek niks Sonder liefde Deur die skare soek ek net na jou Jaar na jaar, jy’s al wat ek onthou Al die kitare speel weer net vir jou N serenade, sang en dans vir jou Ooh ooh ooh Net vir jou

 Hard to translate because the words themselves are enriched with a meaning that is really almost untranslatable – certainly with word for word. One needs a whole sentence to try and impart the deep deep meaning.

Just felt I had to share, anyone who has not heard any of our richly talented artists. There is honestly a treasure chest full of delights to delve into.

Abbott Francis Pfanner

What a lovely story of a man who gave his life for others. The founder monk of Marian- hill Monastery whose handiwork still stands today in testament.

Apparently a sickly young man who ministered in albania and europe and then come out to “africa”, landing in PE after having vomitted for most of the sea journey. He made his way up to durban and then established the monastery at marian hill. He had a different way of working to the vatican and ended up being dismissed.

He was passionate in his faith and demonstration of it, yet differed from his superiors on some of the doctrines which seemed to be deal breakers at the time.

Yet his work, handiwork, leadership etc still stands for all to see. He died feeling a great sense of injustice which I feel is so terribly sad and yet I am fairly sure that once he arrived on the other side his joy would be complete.

My own mind still boggles at the strangeness of man, I can only imagine how God’s must.

 

Diabetic feet …

So what a hugely ignored region of the body feet are. The very base of us. The very instrument of motion. Disregarded at large by most. Diabetic and non-diabetic.

Why do some diabetics have problems ? The long and the short is that largely this area can be protected, well taken care of as well as preserved.

Diabetes is a systemic disease that affects the whole body, including the feet. The blood vessels and nerves going to the feet are tiny calibre vessels, easily damaged. Think of coke rushing through your arteries and veins and what stickiness that would cause?

An ulcer on a foot is a serious thing. In fact any break in the skin is something that has to be dealt with asap. The thing with diabetic feet is that often the nerves are damaged first and there is no proper feeling and damage occurs much more easily and worse damage due to no feeling.

The human body is an amazing thing and can do spectacular processes of healing.

There are so many awesome wound treatments these days, no amputations should be taking place if the correct care at the correct time takes place.

If in doubt ask a caring practitioner to take a look.

Don’t leave a foot injury even for one day.

0832898351

2 Quarry road

Eva Mackenzie : Prins Alfred street and in hilton

Toujeo or not to jeo?

Yes folks we have a new insulin and the best best news is that it is priced affordable – R590 SEP for a long acting insulin that almost guarantees NO hypos!!!

What great great news !!!

I can barely contain my excitement as I scribble out scripts for gazillions of patients for whom this means a huge leap up in quality of life living with type 1 diabetes or diabetes that requires insulin injection.

What is it? Toujeo – or insulin glargine U300 – lots to figure out. In a nutshell it is the same as lantus/optisulin BUT squashed smaller. What does that mean?

Science is “fucking” wonderful – sorry I had to – I LOVE !!! science. When you make a molecule smaller you decrease the surface area and thus slow the absorption rate right down. So now you have a more concentrated molecule (U300 vs U100) that is “dissolving” or releasing much more slowly and predictably and yes you guessed it all you insulin boffins out there – no stacking of insulin, which means no HYPOS !!

Simple yet brilliant, don’t you think – or am I just a proper nerd.

Once daily dosing – truly once daily.

No hypos, predictable.

Need I say more

Toujeo or not to je o ??

😉

Gut microbiom and diabetes – of cats, kefir and insulin :)

I have a patient who is a type 1 diabetic and that patient has a cat who is also type 1. Needless to say they are both on insulin. Now if you thought that is it hard to dose a human try dosing a cat or a dog with insulin. It’s so hard and the margin for error is SO big.

These 2 patients have cut their insulin dose by half and halved their hypos by having kefir three times a day.

Then I came across an article in the Journal of Diabetes (South africa) about the gut bugs and diabetes. It mentions how important gut bugs are in terms of metabolic functioning – normal functioning as well as disease. It concludes by saying that “gut microbiota represents an exciting field with novel therapeutic potential”.

I say you have nothing to lose. Give it a try.

A peace poem

some times frogs boil

some times minds foil

sticks and stones can not hurt nearly as much as words, ever

some times I wish I lived in the land of never never

hearts beat strong

lives live long

and actually sometimes there is even a king kong

world’s collide

sometimes divide

the crashing waves of hurt subside

and peace can become the normal tide

life is a pulse

a heart beat or two

so simple yet so complex

rather not be constantly vexed

peace is a path

chosen

on purpose

our lives a tapestry recorded and finite

choices all ours and have an impact into eternity

weird to think

sometimes a heart sink

and yet a choice

let peace be your choice

 

 

Children with type2 diabetes

In the last month I have diagnosed 2 children with type 2 diabetes. This is a first for me and greatly concerning. The prediction was there but I guess I hoped I would never see it.

What does this mean?

Type 2 diabetes is where you “run out” of b cells – the ones that make insulin and run high sugars due to a bad match between carbs (too many) and insulin (too little).

This was previously only seen in adults really towards the age of 40. To see this in children is a wake-up call.

We have an epidemic of logarithmic proportions and it needs to be tackled in a multifaceted way. By governments – providing funding and facilities as well as knowledge sharing. By health practitioners – early diagnosis and implementation of turning the tide for both individuals and population groups. By society – recognition of poor eating and not enough exercise – ditch the device across the board. Go outside more often/daily for physical activity. By you and by you, yes you.

The drakensberg …

What a privilege to spend easter with divine friends in the pristine drakensberg mountains at Cobham near Underberg.

“Die heuwels fantasties”.

Easter camping on the riverside breathing in the fresh air up there, diving into streams of clear fresh water. Children playing, friending new friendies. Braais and “braai-pie” – thanks Suzette – watched your you tube clip and was indeed a crowd pleaser and so easy.

What a privilege.

Newer insulins

Are they any better ?

Yes, yes and yes, if I needed insulin I would only be on the newest latest of them. Are they for everyone?

I certainly believe individualisation is the key here. We now have so many tools in the armament of diabetes and to this end they require to be prescribed for the greatest benefit for the individual.

So, when it comes to what we call basal insulin – background insulin. The insulin that controls your sugar before a meal and overnight and in the back ground so to speak (out side of meals). We now have a lot to choose from : protophane, other long acting basals, analogue basals like : glargine, detemir, newer ultra-long acting like degludec.

In terms of the choice it needs to match the needs of the patient.

If a patient wishes to only inject twice a day we have an option for that.

If a patient prefers an insulin pump we have an option for that.

If a patient is wanting ultimate control above all else there are choices for that.

What is critical is aiming for an A1c of 7 with very little variability. I am always happy to sacrifice A1c for less variability and my most important criteria is no hypos! or as few as possible. They are “Kak” for both brain and patient.

A little video

https://www.tresibapro.com/resources-and-samples/video-library/tresiba-mop.html

Diabetes death rate a shocker

Following on from yesterday, there is so much we can do.

One of those things is : better insulins.

Arriving on the scene shortly in SA and already there all you first world folk, is degludec. Why is this an extraordinary insulin.

Well long have we hoped for these properties : less hypos, more even delivery, longer acting (thus forgiving if a dose is skipped), safe in the context of double dosing !!!

Yes yes and yes.

So why the tardiness in terms of medical aid re-imbursement?

Good question as I tell my 4 year old when she asks a good question.

Degludec in SA marketed as Tresiba – a wonderful new arrival on our market, folk I need the groundswell to convince the funders that this will SAVE them money and YOU your life and quality thereof. I can not do it by mine self 😉

 

Diabetes – the biggest killer of women under the age of 60

Shock horror indeed!

The medical people have long been warning of this tsunami and everyone has just yawned and gone – not me. and carried on munching on that way too big carb full meal.

Not me. Not today.

Only to find out 10 years down the drag that actually yes me too.

Diabetes is a tsunami and it IS happening and best we sit up and take notice. There is so!! much that can be done and also there is much to be said about early diagnosis and best management.

Which brings me to medical aids. In their best interest for good management to happen and yet so slow on the uptake. Folk, medical aids need the ground swell pressure of the people to force them to do what is actually best for them – ironically.

And yes CGMS, continuous monitoring and good insulins and newer treatments and earlier interventions actually SAVE money in the long term BIG time and death and morbidity (that’s when you suffer but don’t actually die).

So, folk, women and men folk. Really so much to do, so little time. Go out and have a blood test, if is it negative don’t just accept that as up to 30% of people will have a “normal” fasting sugar but an abnormal post meal sugar – and you guessed it – you could STILL have diabetes.

Stop reading and get a proper test.

Ek lewe – I LIVE! Annelie Van Rooyen

Dag na dag dreun ritme om my heen

Dag vir dag dreun ritme om my heen (day after day the rythym’s around me – droning)
voel die ure vol en tog alleen, (the hours feel full and Yet I am alone)
Maar jou blik verslaan my vrees (but your gaze destroys/chases away my fear)
sonsaffier lag in jou wese (sun saffire- joy of laughing in your living – no words to describe in english)
bring geluk wat lank verlore was.(brings joy that was long lost)

Ek lewe!

gemaak om na liefde te strewe
op vlerke van vriendskap te swewe (to fly on wings of friendship)
sonder vrae oor wat more mag bring (without a worry about what tomorrow might bring)
Mm … ah – ha
O ek lewe!
verstaan weer van droom en van vrede
die vreugde van leef in die hede
dat ek hier is vir ‘n rede.

Die vrae was soos skadu’s binne my
deur die ligte lag en andwoord jy.
En ek sien die sonverhale
in jou oe nuwe tale –
lees die storie van weerbegin. (reading the story of a new beginning)

Ek lewe!
gemaak om na liefde te strewe
op vlerke van vriendskap te swewe
sonder vrae oor wat more mag bring
mm … ah – ha
O ek lewe!
verstaan weer van droom en van vrede
die vreugde wat leef in die hede
dat ek hier is vir ‘n rede.
Ek lewe!