World Diabetes Day is on 14 November – a day to globally recognise one of the fastest-growing health crises of our time. In South Africa, this isn’t just a day on the calendar. It’s a wake-up call.

Diabetes is quietly becoming one of our country’s biggest killers – and too few of us are paying attention.

Four to six million people in South Africa suffer with this condition, and most of them are unaware they have the condition. The International Diabetes Federation reports that more than 2.3 million South African adults currently live with diabetes, representing around 7% of the adult population.

 type 1 or 2?

There are two types, of which type 1 cannot be prevented.

Type 1

Type 1 diabetes is usually diagnosed in children and young adults and was previously known as juvenile diabetes. It is classified as an autoimmune disease, meaning the body’s immune system “attacks” its own tissues or organs. In this case, the insulin-producing cells in the pancreas are targeted, resulting in the pancreas not being able to produce insulin. Genetics may play a role in this process, and exposure to certain viruses may trigger the disease.

Normally, type 1 has a rapid onset and is accompanied by the classic symptoms of diabetes, says Dr Christel Olivier at Diabetes Care Centurion.

Type 2

Type 2 diabetes means the body is not responding correctly to insulin. This is caused mainly by obesity and being unfit. Type 2 diabetes has a more gradual onset than Type 1.

Dr Olivier explains the concern: “With the worldwide obesity epidemic, type 2 diabetes is now also emerging in teenagers and even children under the age of 10. In my practice, I see many young adults between 18 and 30 years of age with type 2 diabetes, mostly with a family history of it and of being overweight or obese.”

Following healthier lifestyle choices can often prevent or delay type 2, as can early detection. Simple screening tests can identify elevated blood sugar levels long before symptoms appear.

For more info, read Understanding Diabetes.

 risk factors

“Type 2 diabetes is multifactorial in pathogenesis, meaning there is usually a family history of it, but lifestyle factors such as inactivity and being overweight also play a part in its development,” says Dr Olivier.

Although type 2 is in itself not life-threatening, in many ways it is more dangerous than type 1, as its onset is gradual and hard to detect.

Diabetes SA warns that undetected high blood glucose levels over a long period can cause serious damage to the body and lead to blindness, a heart attack or stroke, kidney failure, impotence and amputation.

Karen Pike, a diabetic nurse educator at the Constantiaberg Mediclinic in Cape Town, points out other risk factors. “Ethnic origins, the gestational period (your baby is at higher risk of getting diabetes when in the womb) and an impaired glucose tolerance (IGT) all can play a role in the onset of diabetes.”

When testing the incidence of type 2 diabetes in specific ethnic groups, the results revealed 5–7%, but in our Indian population, it is as high as 14%.

Dr Olivier, however, warns that the worldwide tendency is that it is on the increase in all populations.

what is IGT?

IGT (impaired glucose tolerance) is a fancy name given to those cases that fall under “pre-diabetes”. This means your blood sugar levels are higher than normal, but below the level of an individual with diabetes. The danger of being pre-diabetic is that people don’t often show the symptoms of the disease, so are unaware that they are developing full-scale type 2 diabetes. Weight loss, a change in diet, moderate exercise and early treatment can return blood sugar levels to normal.

manage and prevent

Type 1 diabetes cannot be cured, only controlled, so the rules are simple:

• take insulin
• eat healthily, count and limit carbohydrate intake
• check blood sugar levels regularly and stay active.

Dr Olivier advises that prevention of type 2 diabetes starts with acknowledging that you are in a high-risk group and getting tested annually.

According to Diabetes SA, scientists believe that lifestyle and type 2 are closely linked. Lifestyle is one area that individuals can focus on to help prevent or delay the onset of the disease. Preventative measures include:

• maintaining a healthy diet
• keeping weight under control
• exercising
• reducing stress
• not smoking.

Dr Olivier adds: “We need to prevent rather than treat only, and this needs to start from a very young age in our homes. As parents, we must set the example and teach our children to exercise regularly and eat healthily.”

Read more about diabetes in children.

complications

It’s not only your blood sugar levels or pancreas that are affected in type 2 diabetes. The following complications can also set in:

• heart and blood vessel disease
• nerve damage
• liver disease
• kidney damage
• eye damage
• foot damage
• skin problems
• brain problems.

sugar is not the only culprit

“Diabetes isn’t just about sugar; it’s about systems,” says Tania Joffe, Founder of Unu Health. “It’s about access to screening, education, healthy food and the ability to manage your health sustainably.

Modern living – long work hours, limited access to healthy food and the cultural acceptance of sugar-rich diets – all contribute to rising levels of diabetes diagnoses.

“The most powerful medicine we have is awareness,” says Joffe. “If every South African made one positive change today – whether it’s getting screened, moving more or eating better – we could change the trajectory of the disease in this country.”