‘It is not a death sentence’

Henriette Lamprecht – Although it is a chronic condition, it is not a death sentence. Diabetes can be controlled and long term complications can be prevented, says Charlotte Thiele, registered dietician and accredited diabetes coach.

According to her, iff diagnosed at an early stage, it may be possible to achieve remission by major adjustments in life style e.g. significant weight loss.

Explaining the different types of diabetes Charlotte says a type 1-diabetic has to inject insulin on a daily basis as the pancreas produces none. Blood sugar levels must be monitored and carbohydrates eaten counted in order to calculate insulin doses. According to Charlotte modern technology made this more user friendly with the availability of insulin pumps replacing injections and Continuous Glucose Monitoring replacing finger sting testing.

In the case of type 3-diabetes the actual cause is insulin resistance which is treated in three ways. Firstly with medication which is three different tablets of which Metformin is always the first line. Insulin may be needed after some years when the pancreas doesn’t produce enough anymore, says Charlotte. One’s food intake needs to be controlled, although there is no such thing as a diabetic diet, she says. The person needs to exercise regularly, while bllood sugar levels have to be monitored as well.

Charlotte warns it is very important for the diagnosed person to receive the correct treatment.

“Not controlling blood sugar levels can cause long term complications e.g. blindness, kidney failure, heart disease, gangrene causing amputations and erectile dysfunction. If the blood sugar levels remain high there is damage done to organs,” she explains.

One of the long term complications called neuropathy involves deterioration of the nerve end points which causes loss of feeling in especially the feet. A sore or wound might then develop without the person being aware of it and by the time they realize its there, it might already be infected.

“Poor supply of blood and other important agents in healing of wounds complicate wound healing. There are a few miracle workers called wound care nurses available to treat this and which is critical in prevention of having to amputate.”

Although diabetes it is a chronic condition, it is not a death sentence, Charlotte emphasizes.

“It can be controlled and long term complications can be prevented. If diagnosed at an early stage, it may be possible to achieve remission by major adjustments in life style e.g. significant weight loss.”

With reference to gestational diabetes, which can develop in pregnancy, it usually resolves after the birth of the baby, but might be a precursor of future type 2 diabetes as there usually is a strong family history, she warns. The condition is triggered in pregnancy due to insulin resistance triggered by pregnancy hormones.

Prevention of type 2 diabetes is straight forward – eating healthy with regular exercise to prevent weight gain and do not smoke.

Charlotte explains the managing of diabetes is a complex challenge as it involves more than a daily tablet and multiple daily decisions.

“It involves the measuring of blood sugar, making good food choices, making time to exercise, taking medication and that as part of the daily rat race that most of us run.”

If one doesn’t plan ahead and have a proper routine, it will be difficult to adhere to treatment, she warns.

“Of course it seems more difficult to take injections than any thing else. We strive to plan a realistic routine together with each individual”

According to Charlotte the concept of Diabetes Self Management Education and Support has become part of all Global Standards of Care as it ends up playing the most significant part in the management process.

Qualified and experienced educators, now rather called “coaches”, guide people with diabetes in learning the best way to manage their own diabetes as they themselves have to live with it day to day.

“Ideally the person’s care taker e.g. spouse, friend, partner and or family member accompanies them in consultations as this support is most beneficial e.g. reminding your partner to take medication and measure blood sugar.”

Steps that are imperative of a person with diabetes’ journey includes assuring blood sugar levels are controlled by eating healthy, exercising and taking medication etc. from day to day.

Regular doctor visits e.g. every three to six months includes a blood test called HbA1c which is done to monitor average blood sugar levels of the past three months. Blood pressure and cholesterol levels needs to be monitored as these usually are associated with type 2 diabetes, while body weight and waist circumference as well as kidney function needs to be regularly checked.

“All these reduce the overall risk of long term complications. Eye examinations also have to be done yearly, so that any early damage can be detected and managed.”

A person with diabetes can “absolutely” live a normal live, Charlotte emphasizes.

“By controlling the blood sugar with proper management, the person with diabetes is as normal as any other without it.”

As diabetes is a complex condition, it needs a multidiscipliniary team to take proper care of all the different factors e.g. medical and medication, diet, exercise, psychology, foot care, says Charlotte. Such a team consist of a doctor and a dietitian qualified and experienced in diabetes care, a diabetes nurse, a biokineticist, a podiatrist, a psychologist and endocrinologist (a physician who specialised in diabetes) or paediatrician in case of children with diabetes.

Currently there are no endocrinologist in Namibia , but says Charlotte, a few physicians are very experienced in diabetes care. - [email protected]