What is diabetes

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What is diabetes?

A plain-English guide for South African families.

About one in fourteen adults in South Africa is living with diabetes — that's roughly 2.3 million people, and the real number is almost certainly higher. Most of them have family members watching, worrying, and trying to help. If that's you, this guide is for you.

We're going to explain what diabetes actually is, in plain language, without trying to sell you anything. By the end you'll understand what's happening in the body, what the warning signs are, how it's diagnosed, what it does if you leave it alone — and what you can do to live well with it.

Before you read on

This is information, not medical advice. If you think you or someone you love has diabetes, see a clinic nurse or doctor for diagnosis and treatment.

What diabetes actually is

Your body runs on a type of sugar called glucose. Every time you eat — pap, bread, fruit, rice, samp, anything starchy or sweet — your body breaks the food down into glucose and sends it into your blood.

That glucose can't just float around in your blood; it needs to get inside your cells to be used as energy. The thing that lets it in is a hormone called insulin, which is made by your pancreas — a small organ that sits behind your stomach.

Think of insulin like a key. Your cells have doors that are locked. Insulin unlocks the doors so glucose can enter and feed the cell.

Diabetes is what happens when this system breaks down. The keys stop working, or the body stops making them. The glucose can't get into the cells where it's needed, so it builds up in the blood. That high blood sugar is what causes the symptoms — and what eventually damages organs if it isn't brought under control.

So when you hear diabetes, think: too much sugar staying in the blood for too long.

The two main types — and a third worth knowing

There are three main kinds of diabetes. They sound similar but they're actually quite different.

Type 1 diabetes

The body's own immune system attacks the cells in the pancreas that make insulin. The pancreas stops producing insulin altogether.

• Usually starts in childhood or as a young adult, though it can happen at any age

• Not caused by anything you ate or didn't do

• People with Type 1 need insulin injections every day for life

• Roughly 5–10% of people with diabetes have Type 1

Type 2 diabetes — the most common kind

The body still makes insulin, but the cells stop responding to it properly — they become “insulin resistant”. The pancreas tries to compensate by making more, but eventually it gets exhausted and produces less.

• Usually starts in adulthood, but is increasingly being seen in teenagers and even children

• Strongly linked to weight, diet, exercise, family history, and stress

• Often controllable with food, movement, and medication (usually tablets)

• About 90% of people with diabetes have Type 2 — this is the kind most South Africans should be aware of

Gestational diabetes

A form that develops during pregnancy, usually around the second trimester. Most cases resolve after the baby is born, but the mother is at higher risk of developing Type 2 later in life. This is why pregnant women are screened for it.

The warning signs to listen to

Diabetes is sometimes called “the silent killer” because it can develop slowly, without obvious symptoms, until real damage has already been done. But there are signs to watch for. If two or more of these have been going on for a few weeks, please see a clinic.

• Thirst that won't go away — drinking water all day and still feeling parched

• Frequent urination — getting up several times a night to use the toilet, peeing more than usual during the day

• Unexplained weight loss — losing kilos without trying

• Constant hunger — eating well but still feeling hungry

• Tiredness that doesn't lift — feeling exhausted even after a full night's sleep

• Blurred vision — things going out of focus, sometimes coming and going

• Wounds that heal slowly — small cuts taking weeks to close

• Frequent infections — bladder infections, thrush, skin infections

• Tingling or numbness in the hands or feet

• Dark, velvety patches of skin — usually around the neck or armpits

An urgent note about children

Children with undiagnosed Type 1 can become very ill quickly. If a child is drinking constantly, losing weight, exhausted and has fruity-smelling breath, go straight to a hospital. This is an emergency.

Who's at risk in South Africa

Anyone can develop Type 2 diabetes — but some factors make it more likely.

• Family history. If a parent, brother or sister has Type 2 diabetes, your risk is higher.

• Weight, especially around the middle. Extra weight around the belly is the most consistent risk factor.

• Age. Risk goes up after 40, but more and more young South Africans are being diagnosed.

• A history of gestational diabetes. If you had it during pregnancy, your risk of Type 2 later is much higher.

• High blood pressure or high cholesterol. These three conditions cluster together.

• A sedentary lifestyle. Office work, lots of driving, little movement.

• A diet heavy in refined starches and sugar. Lots of white bread, white rice, white pap, sugary cold drinks, juice, sweets.

• Ethnicity. South African Indians have the highest rates, followed by white and coloured populations. Rates among Black South Africans are rising fastest.

• Smoking. Increases risk and makes complications worse.

This doesn't mean you're doomed if these apply to you. It means you need to know your numbers and act early.

How it's diagnosed — and how to get tested for free

Diabetes is diagnosed with a blood test. The clinic will use one of three:

Test What it measures What it means Fasting glucose Sugar after at least 8 hours without food 7.0 mmol/L or higher = diabetes HbA1c Average sugar over the past 2–3 months 6.5% or higher = diabetes Random glucose Sugar at any time of day, plus symptoms 11.1 mmol/L or higher = diabetes

There's also a “pre-diabetes” range — blood sugar that's higher than normal but not yet diabetes. People with pre-diabetes can often reverse course with food, weight loss and movement. About 30 to 50% of people with pre-diabetes will develop full Type 2 within 5 to 10 years if nothing changes.

Where to get tested

Any public clinic will test your blood sugar for free. A finger-prick test takes two minutes and gives an instant result.

If it's high, the nurse will order a follow-up fasting test or HbA1c.

Pharmacies (Clicks, Dis-Chem and others) also offer walk-in testing, usually for around R30–R50.

What happens if it's not treated

This is the part that gets serious. High blood sugar over years quietly damages blood vessels and nerves all over the body. Untreated or poorly controlled diabetes is one of the leading causes of:

• Heart attacks and strokes — diabetes roughly doubles the risk of both

• Kidney failure — leading to dialysis or transplant

• Blindness — from damage to the blood vessels in the eyes

• Foot problems — from nerve damage and poor circulation; serious cases can lead to amputation

• Erectile dysfunction

• Slow wound healing — even small foot wounds can become dangerous

• Frequent infections

This is not meant to scare you. It's meant to be honest about what's at stake — because the good news is that almost all of this is preventable with proper management.

The good news: it's manageable

Type 2 diabetes especially is one of the most controllable serious conditions in modern medicine. With reasonable lifestyle changes and the right medication where needed, most people can live full, long lives.

Three things drive control:

• 1. Food. Smaller portions of refined starch and sugar. More vegetables, beans, lentils, eggs, lean meat or fish, plain dairy. Slower-release foods that don't spike blood sugar.

• 2. Movement. Walking after meals — especially after the biggest meal of the day — drops blood sugar measurably. So does any regular exercise.

• 3. Medication where the clinic prescribes it. For Type 2, the most common first medication is metformin — cheap, effective, on the public hospital formulary. For Type 1, insulin. Take medication exactly as prescribed and don't stop without speaking to the clinic.

For some people with early Type 2 — especially if they're carrying extra weight — significant weight loss, food changes and movement can put diabetes into “remission”. Blood sugar returns to normal and medication may not be needed. It's not a cure (the underlying risk remains), but it can mean years of life without symptoms or medication.

Living well with diabetes — the everyday basics

If you've been diagnosed (or someone in your family has been), the basics are simple to remember:

• Eat from a smaller plate. Half vegetables, a quarter protein (eggs, beans, fish, chicken), a quarter starch.

• Cut sugary cold drinks completely. A single 500 ml soft drink can spike blood sugar dangerously.

• Walk after the biggest meal of the day. 15–30 minutes is enough.

• Don't skip meals. It leads to overeating later and unstable sugar.

• Take medication at the same time every day so it becomes habit.

• Check your blood sugar regularly with a glucose meter. Your clinic can usually provide one, or pharmacies sell affordable ones.

• Look after your feet. Wash daily, dry between toes, check for cuts. Wear comfortable shoes.

• Go for your check-ups — every 3 to 6 months. Eyes once a year. Kidneys once a year.

When to see a clinic urgently

Some symptoms need same-day medical attention. Don't wait if you experience:

• Blood sugar over 15 mmol/L with vomiting, abdominal pain, or fruity-smelling breath (can be diabetic ketoacidosis — a life-threatening emergency, especially in Type 1)

• Blood sugar under 3 mmol/L with confusion, sweating, or trembling (low blood sugar — needs sugar fast)

• A wound on your foot that isn't healing

• Chest pain, sudden one-sided weakness, or sudden vision changes (signs of stroke or heart attack)

You're not alone

Almost 2.5 million South Africans are walking this same road. Many of them are doing it well — going to work, raising families, running businesses, taking holidays, growing old healthily. Diabetes does not have to be a death sentence or a life lived in fear. It does have to be managed honestly, daily, with support.

If you've recognised yourself or someone you love in this article, the next step is a clinic visit. The information costs nothing. What you do with it can change everything.

Where to get more help

Diabetes South Africa — diabetessa.org.za · 011 792 9888 (information, support, finding a registered dietitian)

Your nearest public clinic — free screening and treatment

Phila Today Diabetes Series — the next article looks at Type 1 vs Type 2 in more depth

Phila Today · Article 1 of 17 in the Diabetes Series