Living with
Diabetes

What is Diabetes?

When you have diabetes, it means your blood glucose levels are too high. Glucose is the main sugar used by the body for energy. Therefore, you might hear other people say that your blood sugar levels are too high or that you have hyperglycaemia.

With type 2 diabetes – the more common type – your body does not use insulin properly. Insulin is an important hormone that helps glucose enter your cells, where it will be used for energy. Without insulin, glucose cannot get into cells and remains in the bloodstream.
Type 2 diabetes is usually lifestyle-driven and can typically be managed with healthy eating and exercise.

Type 1 diabetes is usually genetic and occurs when the pancreas does not make insulin in the first place. To manage their blood glucose levels, a person with type 1 diabetes will have to inject insulin when they eat.

Diabetes is a chronic disease that might require long-term management to avoid serious complications.

How do you know you have diabetes?

The symptoms of type 2 diabetes usually appear slowly. Some people do not notice symptoms at all and are only diagnosed during routine testing at the doctor or healthcare facility.
Common symptoms are:

• Being very thirsty
• Urinating often
• Feeling very tired
• Having sores that heal slowly
• Having blurry eyesight
• Frequent infections (like the flu, bronchitis or thrush)
• Unexplained weight loss
• Increased hunger
• Tingling or numbness in the hands or feet
• Itchy skin.

What do blood glucose measurements mean?

Tests that measure the amount of glucose in your blood can show if you have diabetes.

The numbers to know:
Blood glucose readings are measured in millimoles per litre (mmol/l). Normal blood glucose measurements are between 4.0-6.9 mmol/l.
A doctor can choose to measure blood glucose levels in different ways to determine if you have diabetes:

• Fasting blood glucose test: This test is usually done in the morning after not eating or drinking throughout the previous night (a continuous eight-hour period).
  A normal fasting blood glucose reading would be 5.6 mmol or less; however, if two random fasting tests, on two separate days in a two-week period, show a result of 7.0 mmol/l or greater then you will be diagnosed as having diabetes.
  A result of 6.0-6.9 mmol/l indicates that you are “pre-diabetic” or “insulin-resistant” and are at risk of developing diabetes.
• Random blood glucose test: This is a test done at any period in a non-fasting state (when you have eaten in the eight-hour period preceding the test).
  A normal random blood glucose reading is 5.6 mmol or lower, while any reading of 5.6-11.1 mmol would be considered “insulin resistant”.
  A result of greater than 11.1 mmol/l will indicate you have diabetes.
• Oral glucose tolerance test: This test is done after fasting for a night and then drinking a sugary fluid. The original fasting blood glucose level will be tested before ingesting the fluid and, thereafter, levels will be measured at intervals over a following two-hour period. Readings below 7.8 mmol/l are normal.
  If the reading is 11.1 mmol/l or greater after two hours, then you will be diagnosed as having diabetes, while results between 7.8 and 11.0 mmol/l indicate that you are “pre-diabetic” or “insulin resistant”.

Once diagnosed, you will be asked to measure your blood glucose levels regularly by yourself using an affordable blood glucometer.
It is important that you measure your blood glucose levels before and after eating, or at certain periods following meals, or as your doctor instructs. You must also record your measurements so that you and your doctor can refer back to them to adjust your treatment and assess how you are managing your condition.

Another type of test, the HBA1C (average blood sugar level over three months), can determine whether you have diabetes and can also review how well you are managing your blood sugar levels over a longer period (a normal value is 6.5 percent or lower).

What is the difference between type 1 and type 2 diabetes?

Unlike patients with type 1 diabetes, patients with type 2 diabetes do not usually have to inject insulin and can often manage their condition with healthy lifestyle behaviours, like eating healthily and exercising regularly.

You might have also heard types 1 and 2 referred to as “insulin dependent” and “non–insulin dependent” diabetes. Type 2 diabetes or “non-insulin dependent” diabetes is lifestyle-driven while type 1 diabetes is usually genetic.

What is gestational diabetes?

Gestational diabetes refers to high blood glucose levels detected for the first time during pregnancy. It is a result of increased hormone production by the placenta that causes insulin resistance.
While it can occur any time during pregnancy, it is more common in the second or third trimesters.

Gestational diabetes is typically only temporary, resolving after pregnancy ends. However, women diagnosed with gestational diabetes are more likely to develop type 2 diabetes after pregnancy and are more likely to experience high blood glucose levels in subsequent pregnancies.
Additionally, untreated gestational diabetes increases the risk of complications during pregnancy, such as pre-eclampsia, and can cause harm to the foetus, resulting in preterm birth or stillbirth if blood sugar levels are not managed.
The condition also increases the risk of excessive birth weight (when a newborn weighs more than 4 kg, which can cause delivery problems and require caesarean section), as well as increasing the risk that the newborn will have hypoglycaemia after birth (low blood glucose levels which can lead to the newborn feeding poorly or experiencing dangerous seizures).

Women with gestational diabetes can eat healthily and exercise to manage their blood glucose levels; however, sometimes, medication might also be needed to reduce blood sugar levels.

What causes diabetes?

The Heart and Stroke Foundation of South Africa (HSFSA) estimate that one in 10 adult South Africans have diabetes, while one in five have impaired glucose tolerance.

You have a higher risk of type 2 diabetes if you are over 45 years old, have obesity, have a family history of diabetes, or do not exercise. However, type 2 diabetes can be diagnosed in children as young as 2 years old, especially in those who have a family history of diabetes.
Additionally, due to modern, unhealthy lifestyles, type 2 diabetes has now become more common than type 1 among children with newly diagnosed diabetes.

The major risk factors for type 2 diabetes are the following:

• Age greater than 45 years (although, as noted above, type 2 diabetes is occurring with increasing frequency in young individuals)
• Overweight or a BMI greater than 25 (‘BMI’ stands for Body Mass Index, and is the relation of you weight in kilograms to your height in meters).
• Family history: You are at increased risk if a first-degree relative (e.g., parent or sibling) has diabetes.
• You have had a previous impaired glucose tolerance or impaired fasting glucose test result when your doctor tested you: Your doctor may have said you are “glucose intolerant,” insulin resistant” or “pre-diabetic.
• Other conditions that form part of metabolic syndrome: These include hypertension (this is a repeated blood pressure reading of greater than 120 mmHg systolic blood pressure and 90 mmHg diastolic blood pressure) or high cholesterol (a total cholesterol level less than 5 mmol/l or a bad cholesterol/LDL level more than 3mmol/l and good cholesterol/HDL level less than 1.2 mmol/l), which can form part of metabolic syndrome.
• A history of gestational diabetes: This is a high blood glucose level experienced during pregnancy. Risk is also greater if you have ever delivered a baby with a birth weight of 4 kg or more.
• Polycystic ovarian syndrome: This condition results in insulin resistance.

Genetic Influences:

The genetics of type 2 diabetes are complex and not yet completely understood. Evidence supports the involvement of multiple genes in pancreatic beta-cell failure and insulin resistance.

Living and managing

Many people can manage their diabetes through healthy eating, physical activity and blood glucose testing. Some people also need to take metformin or other medications or inject insulin when they eat.

By working closely with your doctor, you can manage your diabetes by focusing on five specific key changes in your daily life:

1. Eat a healthy diet
   This is crucial when you have diabetes because your blood sugar levels depend on what you eat.
   Limit foods that are high in sugar and fat. Remember that carbohydrates turn into sugar in the body, so watch your carb intake and chose low GI and whole-wheat grains with more complex sugars for sustained glucose release. You will need to eat these “good carbohydrates” regularly to avoid your blood sugar levels dropping too low (hypoglycaemia), especially if you take insulin.
   However, sweets and deserts containing lots of sugar or high-fructose corn-syrup should be avoided as much as possible or should be strictly restricted. Focus on eating food to provide only as much energy as your body needs.
   Additionally, eat plenty of low-sugar and high-fibre vegetables and fruits. Choose non-fat or low-fat dairy and lean meats (chicken and fish).
   Try to keep your food intake roughly the same from meal to meal if you take insulin or other medication to control your blood sugars. You can also keep a blood sugar log to write down what you eat, when you eat, and how it affects your glucose levels. In order to do this, check your blood sugar levels one-hour hour after eating.
   You can refer to the Cooking from the Heart recipe book volume 3 for healthy and delicious recipes adapted for the proper dietary management of diabetes.
2. Exercise
   Try to keep as active as possible. You don’t have to join a gym do this; instead, just take regular walks, ride a bike or dance along to the music on the radio.
   Your goal should be 30 minutes of moderate activity (makes you sweat and your heart beat a little faster) most days of the week. An active lifestyle helps you control your diabetes by bringing down your blood sugar levels. Regular physical activity also reduces the risk of heart disease and stroke and helps alleviate stress.
3. Get regular check-ups
   Aim to see your doctor at least twice a year. Diabetes raises your risk of heart disease and other conditions so it’s important to know your numbers for blood pressure, cholesterol and HBA1C that your doctor will regularly test for.
   Get a full eye exam every year and check your feet often for signs of sores.
4. Manage stress
   When you’re stressed, blood sugar levels go up. Furthermore, you might not manage your diabetes well and forget to exercise, eat right or take your medicines when you are anxious. Therefore, find ways to relieve stress.
5. Stop smoking
   Talk to your doctor about ways to quit smoking, as diabetes increases your risk for heart disease, stroke, kidney disease, nerve damage, and foot ulcers. If you smoke, your chance of getting these problems is even higher.

A diabetic friendly Chicken & Broccoli Bake Recipe 

Chicken & broccoli bake

A delicious diabetic friendly chicken & broccoli bake recipe for your family.

What treatment is available for type 2 diabetes?

If exercise and healthy diet alone don’t work to keep your blood sugar levels within a normal range, your doctor may prescribe oral medication to take.
The most common types of oral medication you may be prescribed for diabetes include, but are not limited to:

• Biguanides: This group is the most commonly used to treat diabetes and includes metformin. These drugs work to reduce the amount of glucose produced and released by the liver, and, to a lesser extent, increases the sensitivity of cells to insulin, as well as limiting the amount of glucose absorbed by the small intestine during digestion.
• Meglitinides and sulfonylureas: These are also a common type of diabetes medication, including gliclazides, which help to stimulate the pancreas to produce and release more insulin.
• DPP-4 inhibitors: Also known as gliptins, these drugs reduce the breakdown of hormones that stimulate the pancreas to release insulin. This means more insulin is available to better manage the glucose in your blood after digestion of a meal.
• Thiazolidinediones (TZDs) or glitazones: These medications help insulin work better on cells; thereby, lowering insulin resistance and meaning your pancreas does not have to work so hard.

Your doctor will talk to you about which type of medication is suitable for you to use and about any possible side-effects and how and when to take your medication.
While metformin is usually taken before each meal, gliclazide is normally taken before the first and last meals of the day, and different TZDs have different instructions for usage.

Your doctor may also prescribe a combination of drugs to manage your blood glucose levels.

Importantly, oral medication is not a replacement for exercise and good diet, but should rather be used in combination with lifestyle measures to assure good blood glucose control.

Do you need to use insulin?

Type 2 diabetes is a progressive disease with declining insulin production in the pancreas over time. Eventually, your pancreas may not be making enough insulin for your body.

If you do not manage your blood glucose levels properly, the progress to this point will be more rapid. However, on average, 50 % of people with type 2 diabetes will need to start injecting insulin into their bodies within 10 years of being diagnosed as having type 2 diabetes.

People with type 1 diabetes have to inject insulin into their bodies as their pancreas does not produce any.

Typically, insulin comes in the form of injections (a syringe and needle). Learning to give injections to yourself may seem daunting at first, but it is much easier than you think.

Some people with diabetes may use a computerized insulin pump, connected to a tiny needle under their skin, to provide a steady stream of insulin throughout the day, without having to continuously inject. You and your doctor can program the pump to deliver a certain dosage of insulin throughout the day.

Injectable insulin comes in five types, of which your doctor may prescribe different combinations:

• Rapid-acting (takes effect within a few minutes and lasts 2-4 hours)
• Regular or short-acting (takes effect within 30 minutes and lasts 3-6 hours)
• Intermediate-acting (takes effect within 1-2 hours and lasts up to 18 hours)
• Long-acting (takes effect within 1-2 hours and lasts beyond 24 hours)
• Ultra-long-acting (takes effect within 1-2 hours and lasts 42 hours).

How and when should you take insulin?

The place on the body where you inject the insulin is important.

Injecting into the stomach, just below the umbilicus (belly button), will achieve the best and most consistent insulin absorption; however, you can also inject into your arms, thighs and buttocks. Try to make a habit of injecting in the same general location (like the legs or stomach) each time but change the exact needle insertion spot, as this will help lessen the chance of scarring under the skin.

When you inject depends on the type(s) of insulin you use.
You generally want to time your injection so that the glucose absorbed during the digestion of a meal gets into your bloodstream at about the same time that the insulin starts to work. This will help your cells to use the glucose optimally and will avoid low blood sugar levels (hypoglycaemia).
So, for example, if you use a rapid-acting insulin, you should aim to inject 10 minutes before, or directly with, your meal; while if you use regular or intermediate-acting insulin, you should generally inject about an hour before meals.
If you use long-acting insulin, on the other hand, you should inject it only once or twice a day; this should be at the same times every day usually in the mornings and evenings; no matter what you eat. Eating an appropriate bedtime snack if you take long-acting insulin in this way can help you avoid hypoglycaemia during the night.

The best way to take your insulin is to follow your doctor’s instructions.

What are the complications of diabetes?

If you do not manage your diabetes and experience high blood glucose levels over a prolonged period, you will get damage to different parts of your body, the most common being:

• Coronary artery disease (disease in the blood vessels that bring oxygen and nutrients to the heart muscle) and hypertension (high blood pressure). These will increase you risk for heart attack and stroke.
• Eye damage, which may lead to reduced eyesight or even blindness.
• Kidney disease and kidney failure.
• Infections – commonly ulcers or gangrene in the feet which could lead to amputation or sepsis.

What is diabetic hypoglycaemia?

Diabetic hypoglycaemia occurs when the glucose in the bloodstream of someone with diabetes is too low and the body, particularly the brain and muscle cells, don’t receive enough glucose to produce energy.
It is medically diagnosed as a blood glucose level of less than 4.0 mmol/l in someone with diabetes.
Try to test your blood sugar levels regularly and do not skip meals or delay scheduled snacks to avoid hypoglcaemia.

Severe hypoglycaemia can cause serious problems, such as seizures or coma, that require emergency care. Make sure your family, friends and co-workers know what to do in case of such an emergency.
You and they will have to be able to identify the signs of hypoglycaemia and know how to quickly raise low blood glucose levels. You can raise your blood sugar levels quickly if you are hypoglycaemic by eating or drinking something high in simple sugars, such as glucose tablets, sweets, fruit juices and sugared beverages.

The early signs and symptoms of hypoglycaemia to watch out for include:

• Shakiness or tremors
• Dizziness and disorientation
• Sweating
• Extreme tiredness
• Palor
• Hunger
• Fast heartbeat
• Inability to concentrate
• Confusion
• Irritability or moodiness
• Headache.

If diabetic hypoglycaemia isn’t treated fast enough, signs and symptoms of severe hypoglycaemia can occur, which include:

• Clumsiness or jerky movements
• Inability to eat or drink
• Muscle weakness
• Difficulty speaking or slurred speech
• Blurry or double vision
• Drowsiness
• Confusion
• Convulsions or seizures
• Unconsciousness/coma
• Death, rarely.

If you have severe hypoglycaemia, the emergency services must be contacted immediately. People around you can do the following to help, especially if you are losing consciousness or have become unconscious:

• Do NOT inject insulin as this will only cause blood sugar levels to drop further
• You can try to use a dextrose mouth gel on the tongue or inside of cheeks (the dextrose will be rapidly absorbed into the blood vessels in the oral cavity and converted into glucose)
• Inject glucagon, a hormone that stimulates the release of sugar into the blood.

If you experience episodes of hypoglycaemia more than once a week, see your doctor as you may need to change your medication dosage or timing.