Taking Control of Your Blood Sugar

World Diabetes Day is commemorated on the 14th of November every year. This day is an opportunity to raise awareness about the impact of diabetes on people’s health. It also seeks to highlight the opportunities to strengthen the prevention, diagnosis, and treatment of diabetes.

This year, the theme is “Education to Protect Tomorrow”. Improved access to quality education on diabetes (for the health team and for people living with diabetes, their caregivers, and society in general) is needed. The number of people living with diabetes has increased from 108 million to 463 million in the last thirty years, globally. The prevalence of diabetes in South Africa (SA) has almost tripled from 4.5% in 2010 to 12.7% in 2019. Diabetes was the second leading underlying cause of death in SA in 2017, behind Tuberculosis (latest data). Shockingly, it was found to be the number one leading underlying cause of death for females. In 2016, 67% of both males and females were found to be pre-diabetic. Despite these figures, the scary reality is that just under half (45.4%) of people living with diabetes in SA are undiagnosed.

What is the difference between diabetes and pre-diabetes (according to the World Health Organisation)?
● Blood glucose levels below 5.5mmol/l are normal.
● Blood glucose levels above 7mmol/l are considered diabetic.
● Blood glucose levels between these two cutoff points lie in the prediabetic range: 5.5 to 7mmol/l.

Individuals with pre-diabetes have a high risk of developing Type 2 Diabetes and if left untreated, can lead to serious health complications. The good news is that pre-diabetes is reversible with diet and lifestyle changes, and Type 2 Diabetes can be well-controlled and sometimes reversed.

The key to taking control of blood sugars is to get tested regularly. During the month of November, many South African pharmacies offer free blood glucose testing. You will need to do a fasting blood glucose test to be diagnosed, which is often followed by a second test. Remember, this is not a test you can cheat. Doctors often also perform an HbA1c test that measures your average blood sugar levels over the past 3 months (so you really can’t cheat the system). Being diagnosed can be a very emotional experience for you and your loved ones, but the sooner you are diagnosed, the sooner you can prevent complications, and prevent becoming reliant on insulin (as seen in Type 1 Diabetes).

What is the difference between Type 1 Diabetes and Type 2 Diabetes?
● In Type 1, your pancreas doesn’t make any insulin which means you need to inject it from an external source.
● In Type 2, your pancreas doesn’t make enough insulin, and/or the insulin it is making doesn’t always work as it should, which means you will need to take oral medication to improve the way it works (e.g. Glucophage). Type 2 diabetics may need to inject insulin if poorly controlled.
● Both types are forms of diabetes mellitus, meaning they lead to hyperglycemia (high blood sugar) and if not controlled, serious medical complications.

Because SA was named the “unhealthiest country on earth” in 2019 (according to the Indigo Wellness Index), the Government was obligated to implement steps to improve health on a national level. A sugar tax was implemented in 2018, where sugar-sweetened beverages are now subjected to a tax based on their sugar content. This was done in an effort to curb the overconsumption of sugar, which is linked to the increased prevalence of diabetes. Whether this has helped is questionable, because many South Africans are still exposed to rapidly increasing obesogenic environments, and unsafe environments (which discourage physical activity). Many individuals also lack access to fresh nutritious foods and education to make healthy food choices.

Furthermore, there are many complex underlying causes of diabetes, which makes it a difficult disease to eradicate. If you have been diagnosed with pre-diabetes or diabetes it is vital that you receive adequate support from healthcare providers, community members and loved ones. However, it is also your responsibility to ensure the necessary steps are taken to receive support and change your lifestyle.

If you’re undiagnosed, make sure to test your blood sugars twice a year, or immediately if you have any of the following symptoms:
● Increased urination, often at night
● Increased thirst
● Unintentional weight loss
● Increased appetite
● Blurred vision
● Numb or tingling hands or feet
● Increased fatigue
● Very dry skin
● Slowly healing sores
● Increased infections
● Nausea, vomiting, or stomach pains

Treating and managing diabetes should be individual-specific using a multi-disciplinary approach, but here are three general lifestyle guidelines to get you on track:

1. Eat nutritious foods in correct quantities, regularly throughout the day
Eat the right kind of food, the right amount (portion size) and regularly (don’t skip meals). This has a huge impact on your blood sugar. You will need to cut back on sugary food, junk food and refined carbohydrates (such as white bread, pasta and rice, cakes, sweets and fast food). You do not need to cut out carbohydrates from your diet, but you will need to focus on portion size and eating complex carbohydrates that are high in fibre (such as whole grains, legumes, starchy vegetables etc). Fibre helps prevent a rapid spike in blood sugar levels. Also, make sure you are following the South African Food-based Dietary Guidelines (see below).

2. Exercise daily
Physical activity is extremely important in managing blood sugar levels. You don’t have to join a gym, but you do need to be more active (include more walking, climbing stairs, cleaning, gardening or you can follow online workouts). Always get clearance from your doctor first as intense exercise can result in low blood sugar which is also dangerous. The doctor may also need to adjust your medication dose.

3. Lose weight, if you need to
Excess fat, especially around the tummy often causes insulin resistance and leads to Type 2 diabetes. Therefore, losing the necessary weight can lower your reliance on medication. It is always best to have a realistic goal in mind and aim to lose ½ kg per week so that it is sustainable and will stay off in the long run.

South African Food-based Dietary Guidelines
Enjoy a variety of foods.
Be active!
Make starchy foods part of most meals.
Eat plenty of vegetables and fruit every day.
Eat dry beans, split peas, lentils and soya regularly.
Have milk, maas or yoghurt every day.
Fish, chicken, lean meat or eggs can be eaten daily.
Drink lots of clean, safe water.
Use fats sparingly. Choose vegetable oils rather than hard fats.
Use sugar and foods and drinks high in sugar sparingly.
Use salt and food high in salt sparingly.

By Lauren Walsh