Category Archives: diabetes

Diabetes non-month -we can still make folk aware ;)


Hello. Today is the first of December. November (diabetes month) officially over. “Ca dover”.

Diabetes is a growing problem. Most people do NOT choose it. More so type 1 – spontaneous destruction of all beta cells of the pancreas making you insulin dependent (like alcohol dependant only a little different (this is a little joke so don’t get too upset about this statement if you are prone to getting upset).

Type 2  can be lifestyle induced but that does not mean you should judge the person. Or that anyone has given you the power to do that. Or the right.

Insulin only comes in the injectable form. Yes that means you have to inject anywhere from one to 6 x a day. Then you also have to test your sugar – another “prick” required.

So don’t be a prick to diabetics as having dealt with so many already they can’t tolerate you too. And for that matter the moms and dads of diabetic children also fall into the category of not needing any more pricks in their lives – they are hard enough. Grow some empathy. Please? Even if just for the festive season.

So, in december, the festive season. Not everyone in this life is as blessed as you : health and wealth and mental health wise. If you only do this this festive season let it be that you are kind. To all around you. Truly kind not the falsely kind of kind.

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Myths around diabetes


November is diabetes month – awareness around what it is and treatment etc. There is actually quite a lot of strange information that circulates, “fake-news” so to speak regarding diabetes at large.

So let’s dispel some myths.

1.) Diabetes is caused by poor diet : firstly type 1 has nothing to do with diet and is bad luck essentially. It seems to be an auto-immune disease and essentially destroys the b cells of the pancreas creating an absolute lack of insulin.

Type 2 diabetes is a lifestyle related as well as genetic disease and even more complex in nature.

Insulin resistance is a condition more and more prevalent due to lifestyle as well as stress – a big factor. More about this another time.

2.) IF you eat properly you will get better : well firstly type 1 diabetes, without insulin – you die, children in the era before 1921 died. Only since 1921 and Banting and Best’s discovery do type 1 ‘s survive with normal life expectancies.

Concerning type 2 diet is critical and important (as it is with type 1) carbs are key and obviously healthy eating and exercising are key but eating 100% correctly will unfortunately not bring back b cells that have died.

3.) Type 1 diabetics should never eat carbs : whilst one should be mindful of the type and quantity of carb and dose the insulin accordingly it is by no means advised that type 1’s exclude all carbs. This is a tricky one and best discussed in consultation with a dietician.

 

Your sugars and your holidays


holidaysHow does one approach glucose control during the holidays?

Holidays are generally a time where we relax and let our hair down a bit more than at other times. Included in this are dietary relaxations like consuming more refined sugar than normal as well as alcohol in slightly greater amounts and strengths, depending on your preference and age. Also for some it may include more than normal outdoor activity and exercise.

All of these have repercussions for glucose levels.

So, obviously each person has an entirely unique set of circumstances as well as metabolism but roughly speaking here are some basic holiday guidelines.

If you are a type 1 and injecting insulins and testing :

1.) Consider testing your sugar more often if you are exercising more and possibly feeling hypo.

2.) Consider adjusting your insulin dose at meals with more carbs and simple carbs than you are used to (perhaps go through your dietician and doctor re this).

3.) Understand that if you drink a lot and sleep in the next morning this is dangerous and alcohol will at first raise your sugars and then after about 10-12 hours drop your sugars, so watch out for a “missed” hypo and make sure you tag a mate to check on you at least.

4.) If you are snacking and the carb count is more than 10-15 g of carbs you may need to bolus for this kind of snack in order to keep your sugars stable but it really depends on a number of factors other than just this.

5.) the weather plays a bigger role than you think, some people will go either high or low depending on very hot or very cold conditions so try to understand your body and rather pre-empt the rise or fall or at least be vigilant and test more often.

6.) consider wearing a type of medic alert bracelet in case of unconsciousness – it may save your life.

For type 2 diabetics on oral agents only or have additional insulin injections

1.) Most importantly holidays can mean massive weight gain, and this is very bad and hard to get rid of in the long run. Pre-empt this by seeing a dietician who could give you guidelines on how to cheat without too much weight gain. Also see it as a challenge to maintain your weight rather than a punishment and reward yourself with things other than the wrong food on the holidays. Set incentives and be kind to yourself with spoilers that blow your hair back and don’t put weight on.

2.) Make sure that you have enough medication and testing strips for the time that you are away as well as some back-up diabetes supplies.

3.) Know what carbs are and how they affect your sugars and plan accordingly.

4.) Know the carb content of the alcohol you are drinking and factor it into the daily calculation of insulin (if injecting) as well as the total effect of the alcohol and your activities (physical) or not.

5.) Try to see the holiday as an opportunity for increased movement -exercise in many different forms and find one that works for you, start the routine on holiday.

6.) Experiment with different healthy food and take mental note of how you feel and what it does to your sugars.

We all need a break, a re-set and a proper unwind. So most of all give yourself the mental  “space” and time you need to do just this. Planning for your holiday around your diabetes will aid in enjoying this time more and taking stress out of certain situations.

There are always healthcare professionals on duty, know the nearest casualty location and telephone numbers as well as ambulance and other emergency numbers before leaving home.

Mental health, impossible tasks and other musings


Why is it that when we are ill either physically or mentally and it comes to support for the person it is hard to find. In fact a very common reaction is for people by and large is to withdraw. Leaving an already vulnerable person more vulnerable and more likely to become sicker. Why do we do this as a society?

It seems we are quite cruel.

Much like being a type 1 diabetic. Once diagnosed your life depends on testing sugars and injecting insulin. People are wary, they hide, they run they disappear from your life entirely. Schools refuse to admit children with it. Kids don’t want to have them at their party. And why ?

Yes it’s different. Yes it’s a disease that requires things that some humans are uncomfortable with. But, can you not dig a little deep and conquer that fear, reach out and be a friendly face, hand , eye?

We are actually all connected and our reactions have repercussions. We have choices to make daily.

I challenge you today to not run and hide. To be present, even when it is uncomfortable. To be present. Really there. In the flesh and the mind. Present. That’s all. To be there.

Pushing past impossible is something that is actually possible.

And you know that we all – collectively benefit from that.

And the world at large can be a better place.

 

Diabetes and governments


Why is this not a more pressing issue? The diabesity epidemic threatens to ruin the whole world and yet so much of silence?

The log curve that shows no even inkling of abating rises like a tsunami and we are all “thula-msindo” – zulu for not saying a word.

Urgent action is required, yes I said action. Urgent.

Alternatively we can go with the tsunami of medical costs that are unsustainable, ill populations, knock effect to the economy due to loss of income, knock on due to high costs (medical) etc etc. It is a disaster and yet we look on.

Wake-up oh sleeper!

Now is the time to do something, its fast becoming too late.

 

Tidal wave required


Ok so life is interesting in south africa. I would like the kind of money that Manyi  has, 450 million? was it. I would use it to “fund” my patients needs.

Diabetics, type 1’s in particular have many needs. Most of these are not taken care of by their medical aids and despite the fact that patients pay a LOT of money for the privilege of being on one.

Type 1’s require tight control of glucose above a certain range and below a certain range and everything including the weather impacts on blood sugar. Thus continuous monitoring is a tool that can make a very very big difference in a patient’s life – it can also make such a difference that the medical aid is spared costs of admissions for highs and lows, for amputation, renal dialysis, heart attacks as well as costs attached to being blind.

However medical aids at large do not seem the slightest bit interested in saving themselves money.

Far rather milk the patient for all they are worth and at the same time provide the minimum service and complain about any request made by the health care provider who has studied long and hard and has a passion to save the medical aid costs.

Yes I am angry, perhaps at this time of day I am even h”angry”.

I am tired of begging, pleading for minimum standards of care.

I am tired that overseas things get “accepted” years before they do in south africa. Are we really 3 rd world? Despite having the “Manyi’s” ???

We require a tidal wave of protest in the form of intelligent debate with the stakeholders that matter in the realm of diabetes. I am just so tired of fighting.

Please from far and wide across  this beautiful country we call home join me, join the debate, write to your medical aid. Email me : drleethegp@gmail.com.

Please.

Continous monitoring is available in 4 forms in south africa : dexcom G5 and G4, libre flash abbott, medtronic standalone CGM and most new to the scene : ever sense.

Coming in at the lower end is the abbott flash R990 once off and R990 every 2 weeks. Dexcom is a cost upfront more than about 25k and then monthly around 4 k, medtronic around 15 and 2k per month and ever sense brand new so not too sure but in the ball park for the last 2 mentioned.

What is boils down to is MARD and quite frankly this is the bottom line with CGM is accuracy. The lower the MARD the more accurate. There are really only 2 in the market that a great on MARD : dexcom G5 and ever sense, however for the cost the libre is actually a very good value for money.

The other thing that helps me as a practitioner is a trend and all of the devices are good for this.

What we need is for the medical aids to realise that CGM is a tool they their patients can NOT afford to be without! FOR THEIR own sakes – the medical aid’s sakes.

Please tsunami arrive and let’s flood the medical aids with the truth.

Alternatively could the guptas or the Manyi’s or maybe Grace Mugage give me 450 million to spend on my very deserving patients.

Thanks ;).

Diabetes does not have to be


To be or not to be – TYPE 2 I mean. Lifestyle induced diabetes. This is a disease that we hardly saw 100years ago. It’s a new thing really.

A question of quality of life I believe. Both to prevent it and to “cure” it. Type 2 diabetes is essentially “toxicity of life” disease. Too much sugar, too much bad stuff, mainly sugar that causes inflammation generally but is specifically bad for the pancreas and the reason being it is like flogging a horse. Every time YOU demand insulin of the pancreas (every time you eat sugar or carbs) it has to produce it. Only it only has so many b cells to do this and the harder you flog it the harder those cells work and you literally flog your pancreas. At some point – once you have lost 50 % of those cells you become diabetic.

Now here ‘s the interesting thing. At 49.9% you are not diabetic but at 50% you are – go figure. Like with a lot of things there is a spectrum. So, surely you understand that one can “pick up ” this continuum BEFORE you qualify for type 2. SO why not find out??

Once you have type2 for real it is a matter of time before you flog those last 50% and then need insulin to save eyes, heart, limbs etc. However IF you take it seriously and “recruit” dying cells that are about to become apoptotic you can actually turn it around a bit, not back to 100% but you can slow the progress and retard the disease. So why not do that?

To be or not to be ? The choice is yours and the decision in your hands for the grab or not?