Pretoria - Today (Thursday November 14) marks World Diabetes Day, and health experts predict that by 2030 the disease will be the seventh leading cause of death.
Diabetes South Africa says an estimated 3.5 million South Africans are diabetic, while the government estimates 6.5 million.
Estimates are that about 5 million South Africans have pre-diabetes, a condition where insulin resistance causes blood glucose levels to be higher than normal, but not high enough yet to be Type 2 diabetes.
There are three types of diabetes:
* Type 1: the body stops producing insulin, an essential hormone produced by the pancreas to convert glucose into energy.
* Type 2: develops over time where the body is unable to use insulin properly.
* Gestational diabetes occurs during pregnancy due to hormonal changes, genetics and lifestyle factors.
Type 2 diabetes is a lifestyle disease, and affects the majority of South Africans. Many cases go undiagnosed as there are few initial symptoms and people fail to recognise them as warning signs.
The major symptoms include: fatigue, excessive thirst and urination, slow wound healing and skin infections, blurred vision and regular bouts of thrush.
The complications from diabetes include heart disease, stroke, blindness, amputations and kidney failure. With early detection, most of these can be avoided entirely.
Juvenile diabetes is caused by a destruction of the insulin-producing cells of the pancreas – unrelated to sugar consumption. It cannot be outgrown, because the cells of the pancreas that produce insulin are destroyed and would never make insulin again. Children with Type 1 diabetes will always need to take insulin, or until a cure is found.
Although Type 1 diabetes in children requires consistent care, advances in blood sugar monitoring and insulin delivery have improved the daily management of thedisease.
* Diabetes SA: visit www.diabetessa.co.za or call 086 111 3913, 011 886 3721
CASE STUDY: ‘I am who I am and that makes me special’
Kay-Cee is a typical 8-year-old, who loves running around and playing, loves her pets and all animals. She is also an aspiring zoo-keeper.
Like most children her age she relishes an occasional chocolate bar or ice cream, but unlike other little girls, her sweet treats are limited.
“We do have our small indulgences, and when we have chocolate she has a couple of blocks of Canderel chocolate instead, and we use artificial sweetener instead of sugar when making pudding, like sago, but Kay-Cee’s remains syrup-free,” her mother Louise Schoeman said.
Kay-Cee’s condition means she cannot over-indulge in sugary goodies, too much salt or fatty foods. “Her diet is low carb and doesn’t include white bread, she eats brown rice and wholewheat pasta,” her mother said.
Fruit is an integral part of the six meals she eats a day – but grapes and watermelon, because of their high sugar content, are a no-no.
This energetic girl has Type 1 diabetes, an auto-immune condition, the exact cause of which is unclear. In most people with Type 1 diabetes, the body’s immune system mistakenly destroys the insulin-producing cells in the pancreas. Genetics may play a role and exposure to certain viruses may trigger the disease. In Kay-Cee’s case there is uncertainty over how the disease was triggered but her body is unable to produce insulin – a hormone needed to control the amount of glucose (sugar) in her blood. Kay-Cee’s pancreas does not work, unlike those with Type 2 diabetes, who are able to produce small amounts of insulin.
Insulin regulates blood sugar levels, and stores excess glucose in the liver for energy. Although it is a lifelong, chronic disease, diabetes can be managed with daily insulin treatments, a balanced diet and exercise.
Managing her condition has become a way of life for Kay-Cee and her family. She has lived with diabetes for a year, and has learnt to test her sugar and administer insulin injections.
“The first time I had the injection I cried and cried,” Kay-Cee said.
The experience had been frightening and sore, because “I’d never had an injection in my thigh before,” she said.
Before her diagnosis, Kay-Cee had been lethargic and had lost weight. Her family became worried and took her to two GPs last year.
“She had lost her appetite and was constantly thirsty, but both doctors missed the symptoms and told us she simply had a bug,” Schoeman said.
“She was breathing rapidly and had no energy, but the doctors gave us antibiotics and said she’d be better by the weekend, but by the weekend she was in ICU,” her aunt Renata Ford added.
Her sugar levels were extremely high and she was admitted to hospital in a state called diabetic ketoacidosis – which, if left untreated, is fatal. It causes accumulation of liquid in the brain and placed her organs under extreme stress. Ketoacidosis is the most common cause of death in paediatric diabetes. It is also often how Type 1 juvenile diabetes is diagnosed.
“I’m still so angry that she was misdiagnosed and had to go through such trauma. If only the doctors had simply checked her sugar or urine… We almost lost her,” Ford said.
Kay-Cee spent 10 days in hospital, treating dehydration and correcting potassium levels as well as providing insulin, before daily insulin injections were introduced.
Her morning routine now consists of testing her sugar levels using a glucose meter and getting a shot of insulin, followed by a healthy breakfast, which should keep her sugar levels constant through the day. In the evening, before dinner, she takes another jab of the long-acting insulin, to sustain her body through the night. She also has a snack before bedtime.
Said Ford: “We check on her during the night, to make sure she doesn’t experience a hypo, which is a drop in glucose levels which could result in a coma.”
Kay-Cee also has an insulin pen filled with short-acting insulin which can be used if her glucose reading is too high.
“We also give it to her if she attends birthday parties or has special treats which might affect her sugar levels,” Schoeman explained.
Kay-Cee carries a bag, filled with diabetic goodies wherever she goes.
“In there is a tester kit, insulin, a snack, a can of Coke, sweets, an apple and a glucagon pen,” said Schoeman.
The family’s biggest concerns are around failing to act quickly enough if she goes into a hypo, or a sugar low. The glucagon pen contains pure glucose that can be injected directly into her bloodstream if Kay-Cee becomes unresponsive because of a low. Controlling the highs are also a huge concern because of long-term damage to the nervous system, eyesight and the kidneys.
“We are currently investigating getting an insulin pump for Kay-Cee, which will help control those highs and prevent any complications later on in life. Pumps are expensive. Because it’s a relatively new technology in this country, is not as readily affordable as it is in the UK and the US,” Ford said.
Exercise too is an integral part of a diabetic’s life, and Kay-Cee is an active child, who enjoys being outside and intends joining the swimming and softball teams next year.
A proud Ford said: “Kay-Cee is dealing with a complicated disorder, and I have great pride in her. She is responsible for her age but is still just a little girl, who occasionally questions why she has this disease. But she has a bright outlook on life.”
“I am who I am and that makes me special,” said Kay-Cee.
The family said education was the biggest key in managing juvenile diabetes, and diabetes in general.
Knowing the symptoms of diabetes and catching it early is key, as is encouraging children to eat more balanced meals, and cut out sugar and fat.
CASE STUDY: Living with a disorder and loving her life
Major advances have been made in diabetic treatment technology over the 45 years Clare Braun has been diabetic.
To name a few, the needles have become smaller and easier to handle, injections have moved from glass syringes to disposable dial-up dose pens; and the methods of testing have become quicker, easier and more convenient.
“The machines were massive and cumbersome; they are now pocket-sized,” she said. And for years testing entailed mixing five drops of urine with 10 drops of water in a test tube, into which a pill was dropped and the mixture shaken gently, before it was compared with a colour to a chart after a few minutes.
And to learn all this, Braun had to be admitted to hospital and taught the regime over a week.
“It would be quite a sight when all of us trooped to the toilet to get the drops of urine,” she said, adding that the wonders of technology are that testing is now instantaneous. The modern tester lets a diabetic know their sugar levels in all of five minutes.
Being diagnosed with Type 1 diabetes when she was barely out of her teens was a traumatic experience for Braun. She was 19 – an age when trips to get an ice cream and coke were frequent.
She was forced to learn how to hold back: “Everyone around me was so carefree and didn’t have to watch what they ate…”
It led to feelings of loneliness. “I felt alone and different until I discovered that one young man in our group of friends was also diabetic.”
They were able to share and discuss problems, which were many and varied, ranging from the number of times they could eat to learning not to pull the syringe out too fast. “The insulin would spill out, which meant re-injecting yourself.”
The young woman had been unaware of diabetes and its symptoms, and had rushed to hospital when her thirst levels went up; she had constant headaches and was losing up to a kilo a day.
Like many people, she had “heard about diabetes but never really knew enough about it”. Her diagnosis began an education that continues to this day.
She said: “I learn something new every day by talking to other people and reading newspapers and magazines.”
When Braun got married and had children, she incorporated her diabetic eating habits into carefully thought-out meals, to give her children healthy eating habits and to make sure they enjoyed their food.
“I also let them have sweets, in moderation though, and when they were old enough to understand I talked to them about diabetes and allowed them to familiarise themselves with my needles.”
Braun later developed insulin resistance, a condition where the insulin injected into her system didn’t work as well as it had. She has been taking tablets as a booster ever since.
She admitted she is often so busy that she misses signs that her sugar levels are changing. The support of family and friends ensures that she ingests her “quick fixes” of a coke, sweets and/or sandwich, which allow her to feel better pretty fast.
She said she feels she escaped lightly in that she didn’t develop many of the complications associated with diabetes, although losing her eyesight in the one eye some years ago rendered her half blind, and unable to drive, among other things. However, with the help of her doctors, she regained her sight and was certified fit to drive again.
The most important lesson is that diabetes is not a killer. “Here I am, alive and kicking and functional, 45 years after I was diagnosed.”
She emphasised the importance of education and awareness, and catching diabetes early.
“Diabetes is manageable, and once people understand that they must follow their diet, exercise regularly and test as often as they have to, to avoid getting into a hypo (low sugar) or hyper (high sugar), they will be fine.”
“No one should be a prisoner of their disease,” she said, adding that diabetics lead normal, active lives like the rest of society.
Being part of groups, forums and support organisations ensured diabetics are kept up to speed with changes. And this also helps them understand better what they have gone through, so joining them, she said, should be encouraged.
Insulin pumps are the latest in diabetic technology, and they are small, hi-tech electronic devices meant to make the management of Type 1 diabetes more flexible.
The pump is a small battery-operated electronic device which continuously delivers insulin into the body through a catheter. The catheter is inserted into through the skin into the fatty tissue and is taped in place, and it can be worn 24 hours a day, detached for bathing, swimming and other activities.
It is used to:
* Improve blood glucose fluctuations
* Have more flexibility
* Have a better quality of life
*Eliminates individual insulin injections
* Delivers insulin more accurately than injections
* Allows diabetics flexibility about when and what they eat
* Reduces severe low blood glucose episodes
* Eliminates unpredictable effects of intermediate-or long-acting insulin
* Allows users the freedom to exercise without having to eat large amounts of carbohydrates. - Pretoria News