Karate athlete Graham Chamberlain, 35, is from South Africa. Diagnosed with type 1 diabetes in Pretoria at the age of 16, Graham feels that only recently in his life with diabetes he has received more supportive medical care having moved to Cape Town and been fortunate enough to have got an insulin pump, which meant for the first time being able to see an endocrinologist, Dr Christel Olivier from the Diabetes Care Centurion branch. In this #DiAview, Graham shares his journey with an insight to diabetes care in South Africa in addition to recently taking on a World Diabetes Day challenge which involved abseiling down the highest abseil peak in the world!

  1. What do you recall about your initial reactions to being diagnosed with type 1 diabetes, and how much of a change was it for you to suddenly take all this ‘diabetes info’ into your life at that time? 

“I was diagnosed in my teenager years and my initial thought was that it was not so bad: I just need to remove sugar from my diet and I will be fine. This initial thought was due to lack of knowledge and quickly changed. The more I read up on diabetes and the more information I received from my mom, whom is a registered nurse in South Africa, the more I realised that this illness is not something to take lightly.

The shock definitely came late for me and when it actually hit me, I felt overwhelmed, scared and lonely.

It felt for me that no one understands me and that I am facing this illness by myself and it was very overwhelming. Looking back now to my early years of diabetes, I wish I had a support group for teenagers with diabetes, someone I can relate with and share the mental burden diabetes can have on a person.”

2. In your opinion from experiences, Graham, in regards to the approach towards diabetes education, what works and what does not work for you? 

“When I was 17, I experienced an intense hypoglycaemic incident, I was skateboarding with my best friend throughout the whole day and when we went back home for dinner, I injected my set bolus amount as per instruction from my doctor at that time. This resulted in my blood glucose level dropping to a very low level and I was going in and out of consciousness. Fortunately, my father got hold of some glucose and I managed to raise my blood glucose just in time before I was completely unconscious. I was never told that I need to take physical activity into account when injecting insulin, also I was injecting the same set amount of insulin for every meal which definitely was a big mistake. If I was better educated, I would have known that my body requires different amounts of insulin at different times and that there are so many factors playing a role in order to inject the correct amount of insulin. Diabetes education is very close to my heart because lack of knowledge can be fatal. I am very active due to my Karate training and I still need to be very careful when I inject pre/post my training sessions; but what helps me is analysing my blood glucose patterns regularly. This allows me to make informed decisions and better understand my blood glucose readings.”

3. You are an athlete, and congrats on turning pro in karate! Can you talk us through how you typically prepare for a karate competition? What decisions do you tend to make regarding your diabetes?

“I divide my Karate training into two parts when it comes to my diabetes management in relation to training. One is my daily training which include instructing of students and the other is our National senior training which happens on selected Saturdays throughout the year. The training which happens daily is shorter and more intense, this takes a lot of energy in a short space of time and I usually keep my insulin pump connected to my body but is also dependent on what my blood glucose is before and during training.

When we do our National training sessions which is 3 to 4 hours at a time; then I usually disconnect my insulin pump because it is not so high in intensity and we have a break in between where I usually eat a snack and inject very little insulin for. My coaches and fellow instructors also understand that I have special requirements and they allow me to manage my diabetes accordingly.

Competition day is a whole different ball game, stress and adrenaline raises my blood glucose and I usually need to inject insulin 30min before competing, I also eat a banana 10 to 15min before I do Kata or fighting (kumite) this helps me to boost my energy for the duration of my performance. This being said, every day I train and every competition I compete in requires a different approach because our blood glucose fluctuates so much and so often. It is all about managing diabetes on the day and the only way to do that is to know what your blood glucose readings are.”

4. So… this year’s World Diabetes Day. Tell us all what you did in November – and why?!

“This year I wanted to do something special for World Diabetes Day, I wanted to create awareness of diabetes by challenging myself. I wanted to inspire others with diabetes to get out of their comfort zone and not let diabetes stop them from living a full life, so I set out to do 5 challenges in 5 days.

The first day I went for my first ever surfing lesson. Day two was a stand-up paddling (SUP) lesson. On day three I went for a hike up Elsies’s peak, which resulted in a hypoglycaemic incident – this was dangerous because I ran out of glucose and my blood sugar was dropping rapidly, my legs became weak and my vison blurry; I remember telling my sister that I was in trouble and that I needed to get back to our vehicle where I had more glucose. I stumbled a couple of times and thought I was going to pass out and fall down the steep embankment of the mountain; luckily, I managed to get to our vehicle safely and recover from my hypo. In a sense I was happy that I went through this hypo because my sister could then see how quickly a medical emergency can happen, I also documented and shared each day on social media, which helped to create awareness of the challenges we face as type 1 diabetics. Day four was a gruelling 5-hour trail run combined with karate training up Helderberg Mountain and in contrast to the hypo incident the day before, my blood glucose was absolutely perfect throughout the entire run and training sessions. I left the grand finale for day five… I abseiled off Table Mountain, which is the highest commercial abseil in the World; it is 1000m above sea-level and you abseil 112m down the mountain.”

5. On that final part of your WDD Challenge – The Abseil – what was going through your mind?(!) and what impact on your blood sugars did you notice?? From the experience of these challenges, what would you like to share to others living with type 1 diabetes?

“Abseiling off of Table Mountain was one of the scariest things I have ever done in my life. I have a fear of heights… and combining that with diabetes and the fact that I was facing unknown circumstances really got to me, my blood glucose reading reflected that. The drive to Table Mountain was when it really hit home; I stared to hyperventilate and my legs felt like jelly. My blood glucose reading started in range at 5.7mmol/l and quickly raised to above 10mmol/l. You take a cable car up the mountain in order to reach the summit and by then my blood glucose were hitting the 14mmol/l mark, my heart was pounding followed by shortness of breath and feeling weak in the legs, not just from the fear but also because of the increase of glucose in my blood stream.

Through breathing exercises which my sister Ilze taught me and have been joining me on each challenge including this one, I managed to calm my self down just enough to feel that I could do this. The abseil instructor gave us a brief safety induction and explained the procedure. This was all a blur to me because all I could think about was the height I was about to face. Once you are strapped in your harness and standing on the edge of the rock face, the instructor commands you to let go of the rope and high five your abseil partner whom is a good friend of mine named Ian. We started our decent and I looked down the face of the mountain, feeling anxious but for some reason also enjoying not just the breath-taking view but also because I knew I was doing this challenge for the right cause and felt proud of myself.

When I reached the landing point, I checked my blood glucose reading and it went up to 16mmol/l. I quickly injected one unit of insulin as I knew there was still a 30min hike left back up the mountain in order to use the cable car to get down to where my vehicle was parked. Overwhelmed with joy and excitement my friend Ian, my sister Ilze along with her husband Carel hiked back with smiles accompanied with disbelief that we overcame this mental challenge.”

6. Final question. Is it fair to say that South Africa is a beautiful country but also one with a number of contrasts, especially in regards to healthcare accessibility? – One one hand, looking at other nations across Africa south of the Sahara, South Africa has positives, being viewed as a nation where health industries will target to market advanced tech such as the latest pumps and CGMs, with perhaps more hospitals and pharmacies established to distribute, and yet on the other hand, there are also large volumes of financial hardships for those diagnosed with type 1 diabetes who may not be able to afford the advanced treatments or the more reliable insulins and testing strips. Would you be able to give an insight into the healthcare situation for people living with type 1 diabetes in South Africa, and in your view, what can change and/or improve?

“We as South Africans are definitely fortunate in this regard, it is a lot tougher in other African countries when it comes to resources, availability and support. I saw that when my wife and I travelled to Botswana, Namibia and Zambia in 2018. This being said, poverty, the high unemployment rate and difficult social and economic circumstances is a huge problem. It has a snowball effect and rolls into poor medical facilities as well as a limited level of education when it comes to diabetes and diabetes management. Another problem we as South Africans face is that majority of us cannot afford medical aid, thus it makes it almost impossible to enjoy the much needed CGM technology and or insulin pump. This breaks my heart because I know how much I struggled and failed to manage my blood glucose for 16 years prior to me being able to afford an insulin pump and CGM. I still struggle to pay the bills due to my hefty monthly medical aid bills which is equivalent to a monthly rental payment on a 2-bedroom house in South Africa.

I would love to see our medical aids and our Government step up to the plate and realise that at least a CGM should be considered as an essential part of managing diabetes and that it should be included in chronic medical options. The only way we can manage our diabetes is by knowing what our blood glucose readings are. We simply can not test our blood glucose 288 times a day which is what my CGM currently does. With it, I can have immediate access to what my blood glucose levels are doing 24 hours a day. In an ideal world, this is what we all need in order to not only survive but to thrive with diabetes.”