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Diabetes in South Africa

The two main role players in diabetes are glucose and insulin.

Glucose and Insulin

Glucose is an essential energy source but it cannot be used by our bodies’ cells without the hormone, insulin, which is produced in the pancreas. It helps to transport glucose from the bloodstream across cell membranes and into the cells where it is used as energy.

Healthy Blood Glucose Levels

Glucose is an essential energy source but it cannot be used by our bodies’ cells without the hormone, insulin, which is produced in the pancreas. It helps to transport glucose from the bloodstream across cell membranes and into the cells where it is used as energy.

Diabetes in South Africa

Unhealthy Blood Glucose Levels

If the cells become less responsive to insulin, or if the pancreas cannot produce enough insulin to keep blood glucose levels within the normal range, it may lead to a condition known as Diabetes Mellitus Type II (DMII or Type II Diabetes).  This is a progressive process, from insulin resistance to pre-diabetes, to non-insulin-dependent DMII and eventually insulin dependant DMII if left unmanaged.  It can be explained as follows:

Diabetes in South Africa
  1. Insulin Resistance and Hyperinsulinemia

If the body’s cells become less responsive to insulin (insulin resistance), more and more insulin is required to maintain healthy blood glucose levels, resulting in high blood insulin levels known as hyperinsulinemia. Blood glucose levels, however, remain within the normal range. If left unmanaged, this can lead to pre-diabetes.

  1. Pre-Diabetes

Prediabetes means your blood glucose levels are higher than normal, but not high enough to be diagnosed as DMII. It usually occurs in a person who already has some form of insulin resistance, or whose pancreas is not making enough insulin to keep blood glucose in the normal range. Without enough insulin, extra glucose stays in your bloodstream without entering your cells. Blood glucose levels of between 7.8 mmol/l and 11 mmol/l is considered pre-diabetes. If left unmanaged, it can progress to DMII

Diabetes in South Africa
  1. Diabetes Mellitus Type II – non-insulin dependent

In this most common form of diabetes, your body does not use insulin properly (insulin resistance) and your pancreas can no longer cope with making enough insulin to keep your blood glucose at normal levels, which then rise (hyperglycaemia). Blood glucose levels above 11 mmol/l is considered DMII. If left untreated, this can progress to insulin dependent DMII, whereby the pancreas can no longer produce insulin and insulin injections are required.

Risk Factors

Age is becoming less of an indication as the risk in children, adolescents and young adults is increasing. Other factors include:

  • Obesity
  • A BMI (body mass index) of ≥ 25 kg/m2
  • Inactivity
  • High blood pressure (hypertension) ≥ 140/90 mmHg
  • A family history of diabetes
  • High cholesterol (dyslipidaemia)
  • A history of cardiovascular disease
  • A high-risk ethnic group such as those of South African Asian descent

What are the Signs and Symptoms of Type II Diabetes?

Diabetes in South Africa
  • Unusual tiredness
  • Frequent urination (day and night)
  • Changes in appetite
  • Unexplained weight loss
  • Increased thirst
  • Blurred vision
  • Abdominal pain, nausea
  • Unusually sweet-smelling breath
  • Tingling in the limbs
  • Itchy skin, slow healing of cuts and wounds

Diagnosis

At least two blood glucose tests need to be done and it is recommended that the same test is done on two separate days.

  • A fasting blood glucose reading of ≥7 mmol/l, a random blood glucose level of ≥11 mmol/l, or a two-hour post glucose ingestion reading of ≥ 11 mmol/l is required for diabetes to be confirmed.
  • One HbA1c (this test shows the average blood glucose levels over 3 months) level of ≥6,5% would also be adequate to confirm the diagnosis.

Continuous Monitoring of Blood Glucose Levels

Once the diagnosis of DMII has been confirmed, regular blood glucose monitoring tests are required to confirm that the condition is under control.

The following methods can be used:

  • Regular finger prick tests (can be done at home)
  • Your HbA1c may need to be checked every six months if your blood glucose levels are on target and if your treatment has changed. If you are not on target or your treatment has changed, you may need your HbA1c checked every three months
Diabetes in South Africa

Management

Type II Diabetes often responds positively to a combination of lifestyle changes, weight loss, dietary management and medication, such as Metformin.

More About Metformin

Metformin is renowned as the first choice of anti-diabetic medication in the treatment of DMII (Type II Diabetes).

  • Metformin effectively reduces the danger of complications from diabetes, such as cardiovascular disease and even death.
  • It is recommended that metformin therapy continues even when other treatments are added at a later stage

Complications of Unmanaged Type II Diabetes

If DMII is not adequately managed and blood glucose levels remain high over long periods of time, certain complications may occur, including:

  • Blindness
  • Kidney failure
  • Nerve deterioration
  • Stroke
  • Heart disease
  • Dehydration
  • Coma
  • Brain damage

Diabetic Lifestyle

Diabetes in South Africa

Lifestyle changes include:

  • Healthy eating – eliminating sugars and refined carbohydrates
  • Resistance training along with cardiovascular exercise
  • The aim of losing 10-15 % of your body weight and maintaining the weight loss
  1. Grossman SP, The role of glucose, insulin and glucagon in the regulation of food intake and body weight, Neurosci Biobehav Rev. 1986 Fall;10(3):295-315
  2. Global Diabetes Community, Blood Glucose Care, 2018
  3. Vivian A. Fonseca, Defining and Characterizing the Progression of Type 2 Diabetes, Diabetes Care. 2009 Nov; 32(Suppl 2): S151–S156
  4. Adam G. Tabák, Prediabetes: A high-risk state for developing diabetes, Lancet. 2012 Jun 16; 379(9833): 2279–2290
  5. Prelipcean, MD, Diabetes Risk Factors, Health Line Newsletter, Jul 3, 2018
  6. Suzanne Falck, MD, Recognizing Type 2 Diabetes Symptoms, Health Line Newsletter, Jul 2, 2018
  7. Kristin Della Volpe, Who Should Be Tested for Diabetes, and How is Diabetes Diagnosed?, Endocrineweb, April 1, 2017
  8. Type 2 Diabetes Treatments, WebMD, Sept 10, 2016
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Diabetes in South Africa

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