‘Get tested’, say doctors, as diabetes lurks

With more than four million South Africans said to have diabetes – the highest prevalence in Africa – it’s unsurprising that many in our community are also affected. Though the incidence of diabetes among Jews isn’t disproportionate, we are far from immune from the condition and its life-changing impact.

Though diabetes can be effectively managed, it requires commitment, a dramatic shift in your daily routine, and a new mindset. A chronic metabolic condition, diabetes occurs when the body is unable to produce or use insulin properly, causing elevated blood sugar levels which, left untreated, can cause serious health problems. World Diabetes Day on 14 November has brought attention to this topic.

Dr Daniel Israel, a Johannesburg-based diabetologist and family practitioner, who himself has Type 1 diabetes, says the overall incidence of diabetes today is astronomically higher than anyone anticipated. Yet there’s no increased prevalence in the Jewish community as opposed to the non-Jewish community, he stresses. However, in keeping with the demographics of his practice, a good percentage of both his Type 1 and Type 2 diabetes patients are Jewish.

“Type 2 diabetes, which represents 90% to 95% of cases worldwide, is partially genetic,” Israel says. “You can have a susceptibility to Type 2 diabetes because of family history, but most importantly, it’s a sedentary lifestyle disease that you activate with your genetic predisposition.” So, if your bobba and your father have it, you’re more likely to get it too, especially if you’re inactive. “I feel that these multiple, full meals every Shabbos and yom tov aren’t particularly helpful in stopping sedentary lifestyle diseases,” he says.

One’s culture and the lifestyle make a big difference in the development and management of diabetes, Israel says. For example, though the rate of diabetes among South Africa’s black population is high, those who work as labourers or walk long distances and eat conservatively effectively control the lifestyle aspects of the condition.

“However, in Jewish communities, where many are white collar workers and eat tons of food every weekend and drink alcohol, it makes a massive difference. We have to own our lifestyle to adjust our diabetes risk.”

Israel also stresses the importance of having regular diabetes screenings, especially since one can live with the condition and not be aware of it. “It damages a person’s body in that time and makes them feel acutely unwell,” he says. “And they think, ‘I’m just tired, I’m normal.’ The average Jewish man or woman in our community with a sometimes healthy and sometimes unhealthy lifestyle, who may be a bit overweight, really should be screening for diabetes.”

Screening through a haemoglobin A1c test (HbA1c) should became as routine as, for example, pap smears are for women, he says.

With the advent of new technology like continuous glucose monitoring and integrated insulin pumps, diabetes has become much more controllable, Israel says. “Diabetes isn’t a disease, it’s a condition, and if it’s a controlled condition, it’s unlikely to affect a person in the long run. If it’s uncontrolled, it’s an absolute disaster, causing microvascular and macrovascular complications. Ultimately, diabetes is a call to a healthier lifestyle.”

In the case of children, Israel says, a diabetes diagnosis can be harder for parents than having the disease themselves. “Adults can feel when they have low blood sugar, but there’s a lot of guesswork as a parent, especially with very young children.”

When her daughter Lital, now 18, was diagnosed with Type 1 diabetes at the age of nine, Lindie Novick was terrified. “It’s such a trauma and a shock initially,” she says. “In the beginning, I didn’t sleep through the night because inevitably, her sugar would go too low, which can be life threatening.”

Novick, her husband, and their son were connected to Lital’s continuous glucose monitor which would send them alerts if her sugar dropped. “I had to wake up and treat her, which had a huge impact on the family because I was exhausted,” Novick recalls. She would often lie in her daughter’s room to check she was okay. “The next morning, I’d be so tired, that at one stage, I lived on Concerta – generally used to treat attention deficit disorder – to wake me up during the day so that I could function.”

The impact on the entire family was significant. Novick recalls how her youngest daughter once told her she had become the invisible child. “You get all consumed by the diabetes,” she says. “It’s a trauma for the whole family.”

Novick also recalls a heartbreaking moment when she had to tell Lital that she would have the condition forever. “About two and a half weeks after she was diagnosed, she looked at me and said, ‘Mommy, when am I going to get better?’” Novick recalls. “It was so hard to say to her, ‘This is the story from now on.’”

Yet, after 18 months or so, managing the condition became a normal part of everyday life. Later, getting an integrated insulin pump that automatically adjusts insulin delivery based on blood sugar levels was also a game changer.

Support is also key. Novick lives in Cape Town, but she’s part of an online group which consists of 46, mainly Joburg-based, Jewish mothers whose children have diabetes. “There are so many people in the Jewish community,” she says. In the street where the Novick family takes its holiday in Plettenberg Bay, she says, there are four Jewish children with diabetes.

Stacey Waner*, a medical professional who has Type 2 diabetes, was diagnosed after the birth of her second child. While she had gestational diabetes during both her pregnancies before that, the permanent diagnosis came as a shock.

Today, she manages the condition with medication, insulin, exercise, and stress management. Yet she stresses prevention is better than cure. “I don’t think doctors are aggressive enough about treating glucose intolerance,” she says. “Managing lifestyle from a young age is also so important, because as soon as things slip, the risk is huge.”

* Name has been changed.