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Bite your teeth into this!

tooth-brushOral health care is extremely important in diabetes. Although, plaque is the main bad guy of gum disease, poorly controlled blood glucose levels can also be a culprit. Diabetes may weaken your mouth’s germ-fighting powers. High blood sugar levels can help the gum disease get worse. At the same time, gum disease can make diabetes harder to control.

Often gum disease is painless. You may not even know you have it until you have some serious damage. Regular dentist visits are your best weapon.

While gum disease may not hurt, there are warning signs to watch for.

  • Bleeding gums when you brush or floss. This bleeding is not normal. Even if your gums don’t hurt, get them checked.
  • Red, swollen, or tender gums.
  • Gums that have pulled away from teeth. Part of the tooth’s root may show, or your teeth may look longer.
  • Pus between the teeth and gums (when you press on the gums).
  • Bad breath.
  • Permanent teeth that are loose or moving away from each other.
  • Changes in the way your teeth fit when you bite.
  • Changes in the fit of partial dentures or bridges.

The three main steps in fighting gum disease are brushing, flossing, and seeing your dentist regularly. Brush at least twice a day and floss at least once a day. Ask your dentist or hygienist to show you the correct way to brush and floss. Here are some tips.

Brushing. A toothbrush can only clean one or two teeth at a time. Allow about 3 minutes of brushing to clean all your teeth well.

  • Use a brush with soft bristles and rounded ends. Soft bristles are less likely to hurt your gums.
  • Angle the brush against the gum line, where teeth and gums meet.
  • Move the brush back and forth with short strokes. Use a gentle, scrubbing motion.
  • Brush the outside surfaces of the teeth. Do the same for the backs of the teeth and chewing surfaces.
  • Brush the rough surface of your tongue to remove germs and freshen your breath.
  • Remember to brush your gums too.
  • Get a new toothbrush when the bristles are worn or bent, about every 3-4 months.

Flossing. Few people really enjoy flossing. But if you don’t floss, you’re only doing half the job of cleaning your teeth and gums. Flossing cleans away plaque and bits of food from between your teeth and below the gum line. It gets places your brush can’t reach. Floss once a day.

  1. Break off 18 inches of floss and wind most of it around one of your middle fingers. Wind the rest around the same finger of the other hand.
  2. Hold the floss tightly between your thumbs and index fingers. Leave about an inch between them.
  3. Use a gentle sawing motion to get the floss between your teeth. Never snap the floss into the gums.
  4. When you get the floss to the gum line, curve it into a C-shape against one tooth. Scrape up and down on the sides of each tooth to remove plaque.
  5. As floss gets worn and dirty, move to a clean section and continue. Don’t forget the backsides of your rear teeth.
  6. When you’re done brushing and flossing, rinse your mouth with water.

 

Diabetes under the knife

Surgery and diabetes

Going into hospital for surgery can fill anyone with anxiety – doesn’t matter if it’s major abdominal surgery, a broken bone or a short diagnostic procedure – it’s all “scary”! Even more so for people with diabetes as there are so many unanswered questions. Will they check my glucose levels? Will I go low? What happens if I can’t eat after the operation? Should I decrease my insulin, stop my tablets or just eat less?

Although every case is different depending on what surgery, what type of diabetes, what medication and a host of other variables, there are some basic guidelines that may reduce anxiety and make for a better surgical experience.

operation

Why does surgery cause stress in diabetes?

The peri-operative period (time surrounding and including the operation) is often associated with a decline in glucose control due to a combination of factors including the stress response of surgery, starvation, tissue damage during surgery and pain. These all lead to an increase in pro-inflammatory response mediators and stress hormone release. This, in turn, change insulin sensitivity and secretion resulting in a state of relative insulin resistance and breakdown of proteins and fats in the body. This may last for a few hours or extend into a few days after surgery all of which has a negative effect on the length of hospital stay and post-operative complications including infection and major organ damage.

So here are some basic tips to ensure during the peri-operative period:

  1. Rethink elective surgery (that which is not immediately necessarily) if your HbA1c is >8.5%
  2. Aim to keep blood glucose levels between 6.0-10.0mmol/l
  3. Speak to your diabetologist prior to surgery to help you manage your levels as well as possible
  4. Using a sliding scale of insulin in hospital is NOT recommended
  5. Aim to minimise the period of starvation as much as possible (plan surgery for early in the morning rather than later in the day)
  6. Those people who have additional risk factors (kidney disease, heart disease, lung dysfunction etc) should seek expert advice during the PLANNING phase of surgery
  7. Involve a team of healthcare professionals including your diabetologist, surgeon, anaesthetist and post-op rehab team to attain the best possible outcome

Some medications need to be reduced or completely omitted. Some of the newer oral agents don’t really have good data to guide us so individual advice may be required. Insulin requires more careful adjustment and you should seek specific advice from your doctor prior to surgery. Generally an evening dose of basal insulin should be reduced by 20% the day before surgery and restarted after surgery. Pre-mix insulin can be given as usual the night before and then reduced to 50% on the morning of the surgery, reducing with dinner. Those people using a basal-bolus regimen should reduced the night-time basal dose by 20% as above and omit bolus doses whilst fasting.

Hypoglycaemia (low blood glucose levels) is a serious risk in the peri-operative period. A reading of <6.0mmol/l should indicate imminent hypoglycaemia whilst a level <4.0mmol/l requires immediate treatment in order to prevent adverse complications. Hospitals can give intravenous dextrose if the blood glucose levels are low and continuous testing should continue every 15mins until levels return to normal.

hyperglycaemiaHyperglycaemia is not an acceptable complication of surgery however it may well be expected! Post-operative stress, infection and tissue trauma may well result in high glucose readings for some time after an operation. Consult your diabetologist and ensure you know how to manage your glucose levels during this period. Higher than normal levels will place you at an increased risk of post-operative complications such as infection, delayed healing or even a stroke or heart attack.

Those people who use insulin pumps should usually be encouraged to manage their own glycaemic control as much as possible. However, it is necessary to inform the surgeon and anaesthetist that you are using a pump and ensure they are familiar with your exact device. Remember, there are quite a few pumps in use and unless you are dealing with each device on a regular basis, individual settings and management may be difficult for someone who is unfamiliar with them. Make sure you et a print out of your daily settings from your diabetologist prior to surgery and give this vital information to the anaesthetist before your surgery.

No single solution will be adequate for every patient in every situation so it is very important to consult your multi-disciplinary team prior to surgery. Your diabetologist can give vital information to your surgeon and anaesthetist on how your diabetes is managed. Post-operatively, the surgeon can inform your diabetologist of complications expected linked to the surgery and you can then titrate your medication accordingly. The post-op rehab team including physiotherapists, occupational therapists and perhaps even psychologist will also need to interact with your usual health care team to ensure the best possible outcomes.

As with most things in diabetes, planning and being prepared is your best defence so communicate with the team and ensure the best possible outcome from your surgery.

What’s all the puff about?

The month of May is dedicated to anti-smoking awareness in the health calendar in South Africa. We’ve all heard the fuss about how smoking causes cancer, how it can harm an unborn baby not to mention the expense etc etc. But why is it an absolute no-no when it comes to people with diabetes and other cardio-vascular diseases?

Quit smoking word written with broken cigarette concept for quitting smoking

Quit smoking word written with broken cigarette concept for quitting smoking

Firstly, smokers are 30-40% more likely to develop diabetes than someone who doesn’t smoke. So, if you have a family history of diabetes or heart disease, you’re overweight or have any other risk factors for diabetes, now is probably about the right time to STOP smoking!

If you already have diabetes, you will most likely be aware of complications such as heart and kidney disease, eye disease and damage to nerves causing pain and numbness. ALL of these complications are far more prevalent in those who smoke. Poor blood flow in the limbs can result in infections, ulcers and gangrene which is a completely avoidable complication of diabetes. Eye disease can be prevented through regular screening BEFORE it manifests in poor vision and changes made to diabetic medication prior to permanent damage being done.  Those who smoke are at much higher risk of developing diabetic retinopathy and of the disease progressing much quicker than it would in a non-smoker.

Everyone knows that smoking can cause respiratory disease but for someone with diabetes this chronic cough may easily develop into an unrelenting infection that requires multiple courses of antibiotics and causes havoc with glucose control. Periods of illness can be very trying times for those with diabetes and the added burden of chronic bronchitis may be just what is needed to result in hospitalisation and ICU care.

Fertility may also be a problem for people with diabetes – both for men and women. The added negative effect of smoking on fertility may be the key to preventing normal fertility in otherwise healthy young people.

The answer is to QUIT smoking!

Unfortunately, nicotine replacement with patches, electronic cigarettes and other newer devices does not help in reducing the risk of developing diabetes. Furthermore, many of the complications of diabetes are still in play with nicotine replacement therapy so the best solution is to quit “cold turkey”.quitting-smoking-cold-turkey

Easier said than done? Here are some useful tips…

1. Put together and plan and discuss with your doctor. Think about when and how you will stop smoking. It’s a good idea to come up with a “quit date.” Your doctor can also advise on the best way for you to quit smoking.

2. Get ready to quit. Choose a day not to far in advance and mark it on your calendar. Throw away your cigarettes and ashtrays. Stock up on alternatives to keep you occupied when you get the urge to smoke (carrot sticks, gum etc)

3. Replan your days. As smoking is a habit, it becomes part of everyday life. eg: with coffee in the morning, during a break at work etc. Make other plans for during these times. You may even need to rethink your social life and the people that you spend time with who smoke.

4. Consider using nicotine replacement therapy (NRT) in the short-term. This can be in the form of patches, gum, nasal sprays and provides a controlled amount of nicotine to gradually reduce  your dependence. It may not be a long-term solution but it may certainly ease the transition.

5. Consider medication. Various pharmaceutical products are available that can help reduce nicotine craving and withdrawal. Initially, they may be used for up to 3 months but a doctor mat consider an extended period if necessary. Side effects may need to be considered as well.

6. Seek help. Many experienced therapists and groups are available that can assist people in quitting smoking. Therapists may be able to address individual needs and circumstances whereas groups may offer the support and real-life tips and tricks that others can’t provide.

7. Get connected. Several cellphone apps exist that can help to monitor your progress and support you in quitting smoking. Some are available for free whereas others require a joining fee. Some that have been suggested are QuitGuide, quitSTART, Craving to Quit, Kwit, and Smoke Free.

Make a decision to live a healthier lifestyle and you won’t regret it!

The Sweet Truth

sugar Sweeteners are divided into nutritive sweeteners (NS) and non-nutritive sweeteners (NNS). As the names suggest, the first group provides energy as well as taste and the second group are artificial and provide virtually no taste. Regular sugar provides about 4kcal or 17kJ per gram. These are found in all fruits, dairy products etc and are also added by food manufacturers as “added sugar”. Other nutritive sweeteners include mannitol, xylitol, sorbitol etc. These provide very little energy per gram but can cause side effects such as diarrhoea and abdominal discomfort due to their slow and incomplete absorption. Foods containing these substances can be labelled as “sugar free”.
 
The WHO (World Health Organisation) recommends that no more than 25g (6tsp) of sugar be consumed per day. These sugars include glucose, fructose, sucrose, added sugars (by the manufacturer or consumer) and naturally sweet foods such as honey, syrup, fruit juices etc. Fruits and dairy products are excluded from this allowance.
 
Recent studies have shown that up to 10% of Type 2 Diabetes onset (independent of weight) may be induced by sugar-sweetened beverages. Do I really need to give examples of these? In other words, a person who regularly consumes these drinks is placing himself at additional risk of diabetes even if he is not obese! Rather consider tea, coffee, water or if you absolutely have to, artificially sweetened beverages. But please see read the next paragraph very carefully.
 
Artificial sweeteners (NNS) have virtually no energy content and are usually sweeter than sugar per gram. These may include aspartame, sucralose and advantame. HOWEVER, more recent evidence suggests that these sweeteners interfere with our body’s learned responses and sweet taste receptors which, in turn, may also affect glucose metabolism and insulin secretion. Furthermore they may also interfere with gut microbes and lead to glucose intolerance. Bottom line is – there’s more to diet drinks than meets the eye!

World Kidney Day

DID YOU KNOW that 8th March 2018 is World Kidney Day?

What is kidney disease?kidneys

Kidneys are those two small little organs in your abdomen that remove waste products from the blood. Diabetes can damage the kidneys especially if blood glucose levels are too high. This causes filtration of waste products to be impaired. Diabetic kidney disease is almost entirely preventable through good blood glucose and blood pressure control.

How can it be prevented?

One of the main problems with kidney disease is that it is virtually asymptomatic until almost all kidney function is lost. This means that you cannot wait until you feel different to check your kidney function. At least every 6 months, people with diabetes should have their kidney function monitored and small deteriorations in function should prompt a change in medication or tighter control of blood glucose and blood pressure. Targets for blood pressure control and flags for kidney disease are much stricter in people with diabetes than in the general population.

Can it be treated?

Mild and moderate disease may be treated with a change in medication and lifestyle. Dietary changes can also offer some protection. Some hypertensive medications can offer protection to the kidneys as well. Once end stage renal disease is established, the only treatment is regular dialysis or a kidney transplant. Both of these options are costly and demand a dramatic lifestyle change so rather speak to your doctor about how to prevent and protect your kidneys.

Physiotherapy & pregnancy-related conditions

 

Pregnancy is a joyful, spiritually awakening experience but does not come without a few bumps along the way. There are many conditions that may arise within the first few months with your newborn ~ the good news is, we can help you!

 

young mother does fitness exercises together with kid boy isolated

As physiotherapists there are many pregnancy related conditions that we treat. Our most common conditions that we see include cracked nipples, mastitis, incontinence, C-section scars and pelvic floor weakness.

Cracked nipples usually occur when your baby is not latching correctly during breastfeeding. This will result in redness followed by small cracks on the nipple that can lead to a small (or larger!) sore. One of our most effective treatments we use for this condition is low level laser therapy which promotes tissue regeneration alongside a few other benefits. We also use nipple massage as well as chatting about self-care tips at home and checking that your latching technique is effective.

Mastitis is a redness and swelling of the breast that is usually by blocked milk ducts. This results in an infection of the breast tissue and if severe, you will have a general feeling of unwellness with fatigue and fevers. It is a very uncomfortable ordeal but fortunately we have many treatments that are known to be highly effective for mastitis – these include ultrasound, nipples massage, self-care tips and latching technique correction.

Incontinence affects most pregnant women at some stage of their pregnancy, whether it be during, after or both. If you do experience incontinence, it is important to get it treated before it worsens. As physios, we assist with individualized pelvic floor exercises both during and after pregnancy. We also use a treatment known as percutaneous tibial nerve stimulation which is a minimally invasive procedure that has shown excellent results.

Many women who have undergone a caesarean section often forget about their scar and may end up with complications further on in life as a result. Proper care of your C-section scar is vital in preventing thickening of the scar tissue. We will teach you effective scar massage to ensure your scar looks beautiful both inside and out. Another effective treatment we use is low level laser therapy to break down the scar tissue further and promote new cell formation in the area.

Last, but not least, a huge part of what we do both during and after pregnancy is pelvic floor strengthening. If a weak pelvic floor is left untreated, it may lead to incontinence, painful intercourse or even organ prolapse. Our treatment includes not just everyday superficial strengthening, but extremely vital deep core strengthening.

So be proactive – if you suffer from any of the above problems, see your physiotherapist. Both you and baby will be thankful for it!

 

Diabetes in pregnancy

Not much attention has been paid to gestational diabetes in the past. But recent scientific evidence has shown the importance of monitoring and managing diabetes with increased vigilance at this important time in a woman’s (and her baby’s) life.

New guidelines were introduced in South Africa in 2017 that define what is meant by gestational diabetes and diabetes in pregnancy. Please make sure that if you do have a family history of diabetes that you are pro-active in detecting diabetes during your pregnancy.

pregnancy healthy eatingFirstly, it is important to set health eating and lifestyle habits PRIOR to conception. It has been shown that optimum weight management and diet at this stage is very important in preventing diabetes occurring. If you already have diabetes before your pregnancy, you want your HbA1c to be as well controlled as possible. Also consider seeing a diabetologist and dietitian whilst planning a pregnancy so that your medication can be reviewed and your diet optimised. Other medications taken for blood pressure or cholesterol control may also need to be altered prior to conception.

During pregnancy, you want to keep your blood glucose levels within a very narrow range. This is to ensure that adverse harm is not done by exposing the fetus to high or low blood glucose levels. Sometimes continuous blood glucose monitoring may bpregnant insuline necessary to achieve these targets. Speak to your diabetologist about what type of monitoring may be best for you.

Very often, insulin is necessary during pregnancy although needs may vary during the various trimesters. With good monitoring and regular review, you can adjust your insulin to meet the changing requirements of your body.

Timing of delivery is also vitally important in order to ensure the baby is adequately developed but is not too big. Larger babies may make for a difficult and prolonged labour which may itself result in complications for the mother and baby.

pregnant yummy

Breastfeeding is a part of pregnancy that is often neglected. Don’t be swayed by pressure to supplement your baby’s feeds with formula just because you are diabetic. The more a baby breastfeeds, the more milk the mother produces. Breastmilk is ideally suited to your baby and provides many, many additional benefits that formula milk is unable to. Seek the advice of a trained professional and with adequate support and encouragement, most mothers should be able to provide enough milk for their newborns.

Foot care in diabetes

foot careFoot care is essential in diabetes management. Limb amputations are NOT necessary! They are   a complete failure of diabetes management and can be completely prevented through adequate care and education.

The most important part is to ensure you inspect your feet on a regular basis. Look for changes in skin colour or for any areas of tenderness. Look for scratches or cuts and report any sign of infection to your doctor as soon as possible.

walk barefootMake sure you dry between your toes after a shower or bath and always wear protective foot wear especially when walking on sharp or uneven surfaces.

small shoes

 

Wear proper fitting shoes and socks. Socks should be dry and not too tight. Inspect shoes before putting them on and look to see if there are any foreign objects that may cause damage to the feet. Change your footwear regularly to avoid abnormal pressure points developing.

 

Moisturise and massage your feet regularly to improve circulation and make sure you keep foot massageyour toenails short and straight. Do not cut them into the corners. Don’t treat corns or calluses yourself but rather seek professional help.

 

All people with diabetes should ensure that they have their feet examined at least every 6 months to prevent any damage or detect deterioration. These simple steps can really make a difference in preventing unnecessary complications!

Insulin injection technique

injection techniqueInjection technique is an extremely important part of diabetes management. There are a few key issues that you need to pay attention to in order to ensure that medication delivery is efficient and effective.

  1.  Please change your needles regularly! Most people should be changing their needles every 3-5 injections. For some that may be about once a week, for others it may mean every day. Also, ensure that you use the smallest effective needle to prevent skin and subcutaneous tissue damage. Usually the 4mm (green) or 5mm (purple) needles are perfectly adequate.
  2.  Never inject through clothes as you will immediately bluninjection rotationt the needle and cause damage to your skin and underlying tissues.
  3. Inject slowly and steadily and hold the pen against your skin for 5-10 seconds after injecting to ensure the last few drops of insulin are all delivered. Gently pull the needle out replace its protective cap.
  4. Rotation of sites is also very important to ensure that you do not get lipodystrophy at the site.

 

Usually, the abdomen is the best place to inject insulin but other sites can also be used. Please consult your diabetologist and discuss other options.

injection sites

Women and Diabetes – International Diabetes Day 2017

Women and Diabetes is the theme for the IDF celebration of International Diabetes Day on 14th November 2017. This day marks the birthday of Frederick Banting who was born in 1891. At the age of 32 he won the Nobel Prize for his discovery of insulin which revolutionalised diabetes management of the 20th century. Almost 100 years later, insulin is still the best option that we have to offer to our patients with diabetes. However, new drugs are being developed, new technologies available and new insights in the future! These are exciting times that we live in!!

Read more on this website about some of the latest developments and read more over the next few weeks about how diabetes affects women in our society. Perhaps it is due to some of the influence of women in health care that diabetes management has moved from a purely medical focus to encompassing all aspects of life and building a team-approach that empowers and educates people with diabetes.

We pay tribute this month to the women who have diabetes, the women who care for those with diabetes and the women who contribute daily to the advancement of diabetes management.

Image result for not all of us can do great things