Understanding Diabetes
Diabetes Mellitus (DM) is a metabolic disorder marked by high blood sugar levels. It occurs due to:
- Type 1: Insulin deficiency
- Type 2: Insulin resistance
When we eat foods with starch or sugar, they break down into glucose. This glucose enters the bloodstream and needs insulin (produced by the pancreas) to enter cells and provide energy. Without enough insulin or if insulin doesn’t work properly, glucose builds up in the blood.
Types of Diabetes
Type 1 Diabetes
- Diagnosed under 30 years
- Slender body type
- Rapid symptom onset
- Ketones in urine
- 5–10% of diabetes cases
Type 2 Diabetes
- Diagnosed over 40 years (but increasingly younger)
- Usually overweight
- Gradual or no symptoms
- No ketones in urine
- 90–95% of diabetes cases
Prevalence in South Africa:
- 9.5% of people over 15 have diabetes
- 45% are undiagnosed
- Highest rates in Asian Indian and Mixed Ancestry populations
- 5 million have pre-diabetes
Diagnosis
Tests used:
- Fasting glucose (after 8–12 hour fast)
- Oral Glucose Tolerance Test (GTT)
- HbA1c (glycated haemoglobin – shows average blood sugar over weeks/months)
Diagnostic Criteria
Plasma Glucose (mmol/l), HbA1c (%)
Normal: < 6.1
Pre-diabetes: 6.1–6.9
Diabetes: ≥ 7.0
Living with Diabetes
Lifestyle is key:
- Healthy eating
- Regular exercise
- Weight management
Treatment:
- Type 2: Lifestyle → Medication → Insulin (if needed)
- Type 1: Insulin from diagnosis
Monitoring:
- HbA1c goal: < 7%
- Self-testing:
- Fasting: 4.0–7.0 mmol/l
- After meals: < 10.0 mmol/l
Also monitor:
- Urine protein
- Annual eye exams
- Foot care & podiatrist visits
Short-Term Complications
Hyperglycaemia (High Blood Sugar)
Causes:
- Overeating
- Lack of exercise
- Missed or mistimed medication
- Stress
- Illness
Untreated can lead to ketoacidosis and coma, especially in Type 1.
Hypoglycaemia (Low Blood Sugar)
Defined as:
- < 4.0 mmol/l (mild)
- < 3.0 mmol/l (severe)
Causes:
- Skipped meals
- Changed mealtimes
- Alcohol
- Increased activity
- Too much medication
Symptoms:
- Shakiness, confusion, blurred vision
- Irritability, anxiety
- Fatigue, weakness
- Hunger
- Palpitations
- Sweating
- Seizures, coma
Treat immediately to avoid serious outcomes.
Long-Term Complications
Uncontrolled diabetes can lead to:
Large Blood Vessel Disease
- Stroke
- Heart attack
- Amputation
Small Blood Vessel Disease
- Eye disease/blindness
- Kidney failure
- Nerve damage
- Foot injuries
- Erectile dysfunction
Conclusion
Diabetes is a lifelong condition, but complications can be prevented with:
- Knowledge
- Responsibility
- Lifestyle changes
- Medical treatment
Consider joining a support group for guidance and motivation.
Contact Information
Diabetes South Africa
🌐 www.diabetessa.co.za
📞 021 425 4440
📧 national@diabetessa.org.za
Centre for Diabetes and Endocrinology (CDE)
🌐 www.cdecentre.co.za
📞 011 712 6000