It’s one of the fastest growing non-communicable diseases in South Africa, yet as many as four in ten people living with type 2 diabetes haven’t yet been diagnosed. 

“Worldwide, type 2 diabetes is a greater health burden than type 1 because it is so much more common, and there’s often the misperception that it is less serious. But type 2 diabetes can be just as damaging if it’s not properly managed,” says Dr Gregory Promnitz Snr, a specialist physician practising at Netcare Olivedale Hospital.

Type 2 diabetes involves the body becoming less effective at using the hormone insulin to regulate glucose levels. Usually, it’s diagnosed from middle age onwards and has a strong familial link.

Diabetes is a chronic disease, which means it requires long-term treatment. Type 1 diabetes is treated with insulin, while type 2 diabetes usually requires more than one type of oral medication and may progress to insulin-dependent diabetes. 

“The potential complications of uncontrolled type 1 and type 2 diabetes are similar and can include vision loss, heart and kidney problems and nerve damage. Unstable blood glucose levels can affect multiple organ systems and, in severe cases, can lead to life-threatening emergencies,” he says.

Dr Promnitz Snr notes with concern that people may be living with type 2 diabetes for years before it is diagnosed. Knowing what to watch for could prompt an earlier conversation with your doctor.

“The symptoms of type 2 diabetes can be subtle, and because a person doesn’t necessarily feel unwell, the condition can go undetected. Earlier diagnosis provides an opportunity to gain control of the condition before long-term damage occurs,” he says.

“Unfortunately, even after diagnosis, diabetes can remain uncontrolled if the person thinks of their treatment as medicine alone. Many don’t realise that diet is the mainstay of the treatment plan. Understanding the factors that influence glucose control is vital,” he says.

“Being diagnosed and learning that you will have to be on medication and make lifestyle changes for the rest of your life is hard for anyone to adjust to. Often people want a quick fix, but that’s not how diabetes management works; it’s a lifelong commitment.”

Dr Promnitz Snr points out that type 2 diabetes can occur alongside dietary factors that contribute to obesity and insulin resistance, as well as other comorbid conditions including hypertension and heart disease, requiring multidisciplinary care.

“Many patients I see have had poorly controlled diabetes for five to ten years, and the damage has already begun. I would recommend that people with type 2 diabetes have their eyes checked regularly, as one of the more severe, irreversible complications is losing your sight,” he warns.

“Uncontrolled diabetes can affect every organ system, and a multidisciplinary approach can help achieve optimal control and prevent or delay associated health risks. Many general practitioners have made a point of expanding their knowledge of diabetes to better help patients to manage this growing condition.”

Mariana Davel, a dietitian practising at Netcare Olivedale Hospital, adds that developing sustainable dietary habits to help manage or prevent comorbidities can significantly improve long-term wellbeing and quality of life for people with diabetes. 

“One of the most common misconceptions about diabetes control is that the diet is boring and does not include any treats. Rather, through individual assessment and dietary education, we help people adapt recipes and make healthier meal choices that fit into their overall eating plan,” she says.

“Following an eating plan that supports your diabetes management can be delicious and doesn’t have to be expensive. Seasonal fruit and vegetables are generally more affordable and offer an ever-changing variety of healthy fresh food,” Davel recommends.

She explains that low glycaemic index (GI) foods can support diabetes management because they provide slow-release energy. “Many low-GI recipes use common kitchen cupboard ingredients and offer healthy alternatives that do not cost more.”

Learning to read and interpret the nutritional information on food labels is an important skill for making better daily dietary choices. “Food products marketed as sugar-free can sometimes be more expensive, and often the fat and sodium content can be very high,” she says.

Top three dietary tips for diabetes control

1. Focus on balanced meals consisting of lean proteins and vegetables or salad, with smaller portions of starch
2. Plan your meals and snacks to avoid temptation when you’re hungry
3. Drink water as part of your routine

“Our metabolism, which is how our bodies use and convert energy, is influenced by a range of factors. Managing stress and getting enough regular physical activity are important aspects of diabetes control alongside diet and medication,” Davel says.

“Diabetes can seem daunting, but embracing a healthy new lifestyle can be enjoyable. Getting your diet right is the foundation for better glucose control,” she concludes.