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Understanding Diabetes
Diabetes is one of the most common chronic health conditions worldwide. It affects the way your body deals with glucose (blood sugar), which is one of the body's main sources of energy.
The good news is that diabetes can be managed. For many people, particularly those with type 2 diabetes, everyday lifestyle choices can make a meaningful difference to blood glucose, cholesterol, blood pressure and long-term health. But diabetes isn't simply a matter of "eating too much sugar". There are several different types of diabetes, and each has different causes and treatment needs.
What is diabetes?
When you eat, your body breaks down carbohydrates into glucose. Glucose enters your bloodstream and is then taken into your cells to be used for energy. Insulin is a hormone produced by the pancreas. It helps glucose move from the bloodstream into cells.
Diabetes develops when the body cannot produce enough insulin, cannot use insulin properly, or both. As a result, glucose builds up in the bloodstream, causing blood sugar levels to become too high.
Over time, persistently high blood glucose damages your blood vessels and nerves and increase the risk of complications affecting the eyes, kidneys, heart, brain and feet.
What are the different types of diabetes?
Type 1 diabetes
Type 1 diabetes is an autoimmune condition. The immune system attacks the insulin-producing cells in the pancreas, resulting in little or no insulin production. Type 1 diabetes often develops in children and young adults, but it can occur at any age. People with type 1 diabetes need insulin to survive.
Type 1 diabetes is not caused by eating too much sugar or by being overweight.
Type 2 diabetes
Type 2 diabetes is the most common form of diabetes. In type 2 diabetes, the body becomes less sensitive to insulin, known as insulin resistance, and over time the pancreas may also become unable to produce enough insulin to keep blood glucose within the desired range.
Type 2 diabetes is influenced by a combination of genetic, environmental and lifestyle factors. It becomes more common with age, but it can also occur in younger adults and children. Treatment may involve lifestyle changes, medication, and sometimes insulin.
Gestational diabetes
Gestational diabetes develops during pregnancy in someone who did not previously have diabetes. It usually improves after pregnancy, but having gestational diabetes increases the future risk of developing type 2 diabetes. Women who have had gestational diabetes should therefore discuss appropriate follow-up testing with their healthcare professional.
Other types of diabetes
There are also less common forms of diabetes. These can be caused by genetic conditions, diseases affecting the pancreas, certain medications and other medical conditions. This is one reason why diabetes should not be treated as a single condition. The appropriate treatment depends on the type and individual circumstances.
Understanding type 2 diabetes
Type 2 diabetes often develops gradually. Some people have no noticeable symptoms for a long time and only discover that they have diabetes after a routine blood test.
Possible symptoms include:
Increased thirst
Passing urine more frequently
Increased hunger
Unexplained weight loss
Tiredness
Blurred vision
Slow-healing cuts or wounds
Recurrent infections
However, you can have type 2 diabetes without obvious symptoms.
Regular screening is therefore important, particularly if you have risk factors for diabetes.
Why does type 2 diabetes matter?
High blood glucose over a long period of time can damage blood vessels and nerves.
Diabetes can increase the risk of:
Heart disease
Stroke
Kidney disease
Eye disease and vision loss
Nerve damage
Foot problems
The risk of complications is not determined by blood glucose alone.
Blood pressure, cholesterol, smoking, physical activity, diet and other factors also affect cardiovascular and overall health. This is why diabetes care involves much more than simply checking your glucose.
Diabetes and cholesterol
If you have diabetes, your doctor may pay particular attention to your cholesterol and other cardiovascular risk factors. Cholesterol is a fatty substance that your body needs for normal functions, but having too much of certain types in the bloodstream can contribute to the development of fatty deposits in your arteries.
LDL cholesterol is commonly referred to as "bad" cholesterol because higher levels are associated with an increased risk of cardiovascular disease.
HDL cholesterol is often called "good" cholesterol because it plays a role in transporting cholesterol away from the bloodstream.
Triglycerides are another type of fat in the blood and may also be elevated in people with diabetes or insulin resistance.
For someone with diabetes, cholesterol management is therefore part of protecting the heart and blood vessels. Depending on your individual cardiovascular risk, your doctor may recommend lifestyle changes, medication, or both.
Why is cholesterol important if my blood sugar is controlled?
Blood glucose is only one part of the picture. Someone with diabetes can have reasonably well-controlled blood glucose and still have an increased risk of cardiovascular disease.
This is why your healthcare professional may monitor:
Blood glucose or HbA1c
Blood pressure
Cholesterol
Kidney function
Weight and waist circumference where appropriate
Smoking status
Other cardiovascular risk factors
Looking after these together provides a more complete approach to diabetes care.
What should I eat if I have diabetes?
There is no single "diabetic diet" that works for everyone. You don't necessarily have to eliminate carbohydrates, and you don't have to give up every food you enjoy. Instead, think about your overall eating pattern. A balanced approach can include:
1. Choose more high-fibre foods
Fibre can help with blood glucose control and contributes to good digestive health.
Good options include:
Vegetables
Beans and lentils
Whole grains
Oats (there is some debate about this)
Nuts and seeds
Whole fruit
Where possible, choose less-refined carbohydrates such as whole-grain bread, brown rice or whole-grain cereals rather than relying mainly on highly refined carbohydrates.
2. Include plenty of vegetables
Vegetables are an important part of a diabetes-friendly eating pattern. Aim to include a variety of vegetables across your meals. Think beyond salads: cooked vegetables, roasted vegetables, vegetable soups, stir-fries and vegetable-based dishes can all contribute.
3. Choose whole fruit rather than fruit juice
Fruit contains naturally occurring sugars, but it also provides fibre, vitamins and other nutrients. Whole fruit is generally a better choice than fruit juice, because the whole fruit contains its fibre and tends to be more filling. You do not necessarily need to avoid fruit simply because you have diabetes.
4. Include a source of protein
Protein can help make meals more satisfying.
Examples include:
Fish
Chicken
Eggs
Lean meat
Beans and lentils
Plain yoghurt
Nuts and seeds
Where possible, choose less-processed protein sources.
5. Pay attention to fats
Not all fats have the same effect on cardiovascular health. Try to include more unsaturated fats, such as those found in:
Olive or other vegetable oils
Avocado
Nuts
Seeds
Oily fish
At the same time, limit foods that are particularly high in saturated and trans fats.
6. Be mindful of sugary drinks
Regular soft drinks, energy drinks, sweetened juices and other sugary beverages can provide a large amount of sugar without making you feel particularly full. Water is generally the simplest everyday choice. If you enjoy sweetened drinks, gradually reducing them is usually more sustainable than trying to stop everything overnight.
7. You don't have to completely ban your favourite foods
Diabetes management should be realistic. A birthday cake, restaurant meal or favourite dessert does not automatically "ruin" your diet. The more useful question is:
What does my usual eating pattern look like? Small, sustainable changes made consistently are generally more useful than an extremely restrictive diet that you cannot maintain.
A simple way to build a balanced meal
One practical approach is to think about your plate.
Try making half of the meal non-starchy vegetables, add a source of protein (a quarter of the meal), and make a higher-fibre carbohydrate a quarter of the meal.
For example:
Vegetables (1/2) + protein (1/4) + high-fibre carbohydrate (1/4)
This could be grilled chicken with vegetables and brown rice, fish with a large salad and a small portion of potatoes, or lentils with vegetables and a whole-grain accompaniment. This basic guideline may be adjusted by your doctor according to your individual health, medications and dietary goals.
Don't forget about physical activity
Physical activity is an important part of type 2 diabetes management. You don't have to become an athlete. Walking, cycling, swimming, dancing, gardening and other activities all count. Regular physical activity can help your body use insulin more effectively and can contribute to better blood glucose, blood pressure and cardiovascular health. If you have been inactive for a while, starting gradually is perfectly reasonable.
I generally prescribe moderate intensity activity for 30 minutes 5 times a week or for 40 minutes 4 times a week to my diabetic patients. the aim is to get at least 150 minutes of moderate intensity exercise every week.
Weight and diabetes
For people with type 2 diabetes who are above their healthy weight, even relatively modest weight loss can sometimes improve blood glucose and other metabolic risk factors. However, diabetes management should not be reduced to weight. People of different body sizes can develop type 2 diabetes, and healthy lifestyle changes can be beneficial regardless of the number on the scale. The focus should be on improving health, not pursuing an unrealistic body shape.
What about alcohol?
If you drink alcohol, moderation is important. Alcohol can affect blood glucose and may interact with some diabetes medications. It can also contribute significant calories. If you take insulin or certain diabetes medications, ask your doctor or pharmacist how alcohol may affect you.
Don't stop your medication because your lifestyle has improved
Healthy eating and physical activity are important, but they do not replace diabetes medication for everyone. Some people can improve their blood glucose substantially through lifestyle changes, while others need medication from the beginning. If your blood glucose improves, speak to your healthcare professional before changing or stopping medication. Your treatment can be adjusted safely based on your blood glucose, HbA1c and overall health.
A practical approach to living with type 2 diabetes
Rather than trying to change everything at once, start with a few realistic habits.
For example:
Eat more vegetables.
Choose whole fruit instead of juice.
Include protein with meals.
Choose higher-fibre carbohydrates more often.
Reduce sugary drinks.
Be mindful of highly processed foods.
Move your body regularly.
Don't smoke.
Take prescribed medication as directed.
Attend your regular diabetes checks.
These changes may seem simple, but they can add up over time.
When should you speak to a doctor?
See your GP if you:
Have symptoms that could suggest diabetes
Have been told that your blood glucose is elevated
Have a family history of diabetes
Have previously had gestational diabetes
Are concerned about your cholesterol
Are struggling to manage your blood glucose
Are experiencing side effects from diabetes medication
Have questions about your diet or lifestyle
Have wounds on your feet that are not healing normally
Regular diabetes care can help identify problems early and reduce the risk of complications.
Diabetes is manageable
Being diagnosed with diabetes can initially feel overwhelming. But diabetes management is not about achieving perfection. It is about understanding your condition, monitoring the important health markers, taking medication when needed, eating in a way that supports your health, staying active and working with your healthcare team. Small changes that you can maintain are more valuable than a perfect plan that lasts two weeks.
If you are concerned about diabetes, cholesterol, blood glucose or symptoms that may be related to diabetes, an online consultation with Dr Brandt can be a convenient first step. We can discuss your symptoms and medical history, review available results, advise on appropriate investigations, and help you understand the next steps in your care. You can book an online GP consultation from the comfort of your home.
Dr. Sonja Brandt is an online GP helping South Africans manage diabetes and other common conditions – conveniently and legally from home.
Please note: This article provides general health information and is not a substitute for an individual medical consultation. Diabetes treatment and dietary recommendations should be tailored to the individual. Online consultations are not suitable for emergencies or conditions requiring immediate physical examination.
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