•Impaired glucose tolerance
Type 1 diabetes
Type 1 diabetes occurs less frequently than type 2 diabetes. Type 1 diabetes is caused by an absolute deficiency of insulin as a result of damage to the Islets of Langerhans in the pancreas where insulin is produced. This condition is irreversible and type 1 diabetics are often not overweight. Injections of insulin, together with a balanced diet, are important components of the treatment. Uncontrolled high blood glucose levels can in the long term contribute to damage of the blood vessels, with subsequent cardiovascular disease, kidney damage, kidney failure, diabetic retinopathy (eye damage), neuropathy (damage to the terminal nerve endings) and amputation of the lower limbs as a result of poor blood supply and gangrene. In children with poorly controlled type 1 diabetes, ketoacidosis, growth failure and delayed puberty also occur.
Type 2 diabetes
Type 2 diabetes is the most common form of the disease and there is a genetic association, which means that this condition can occur in families.
The symptoms and diagnosis of type 2 diabetes are often missed for up to seven years, during which time the malfunctioning of the beta cells in the pancreas is already present. This means that long before individuals are aware of their condition, chronically raised blood glucose levels may already contribute to damage to the blood vessels, with subsequent cardiovascular disease, stroke, kidney damage, kidney failure, diabetic retinopathy (eye damage), neuropathy (damage to the terminal nerve endings) and amputation of the lower limbs as a result of poor blood supply and gangrene in later years.
Type 2 diabetes is often associated with obesity and an inactive lifestyle, but older patients are not always obese. Type 2 diabetes often originates as the metabolic result of excess fat in the abdomen, muscle tissue and liver. This excess fat in combination with high blood glucose levels contributes to beta-cell malfunction, increased blood pressure, a typical fat profile (low HDL, increased triglycerides and LDL) and insulin resistance. HDL, which is also known as high-density lipoprotein, is the “good” cholesterol carrier, which helps to keep the arteries clean. LDL, otherwise known as low-density lipoprotein, is the “bad” cholesterol carrier, which causes fat to be deposited in the arteries.
With insulin resistance the insulin-producing beta cells of the pancreas are overstimulated to excrete too much insulin in an attempt to try to reduce the blood glucose to within normal limits. Despite the increased circulating insulin it seems the body cells react as if they have developed resistance to the normal function of insulin.
Emotional and physical stress can also be a contributing factor to type 2 diabetes. The body is exposed to increased physical stress when long working hours lead to severe exhaustion. If meals are skipped during this period, this can result in a lack of nutrients required to maintain body tissue and can also cause inflammation.
Weight loss, a healthy lifestyle, healthy eating habits and regular exercise are regarded as important aspects in the treatment of type 2 diabetes. Medications are often added depending on the patient’s blood values. Depending on the nature of beta-cell malfunction, type 2 diabetics tend to start with insulin therapy much earlier these days to prevent long-term deterioration caused by diabetes.
Whereas type 2 diabetes was previously regarded as an illness of “the aged”, nowadays the condition is increasingly being observed in children. Such children should preferably be referred to a specialist.
Gestational diabetes
Gestational diabetes originates as a result of hormone changes during pregnancy. Although the condition usually improves spontaneously after the birth of the baby, there is the possibility that a woman who had gestational diabetes will over time develop type 2 diabetes. It is important to control blood glucose during pregnancy with a balanced diet and to continue to maintain healthy eating habits after the baby is born.
Impaired glucose tolerance or pre-diabetes
People with impaired glucose tolerance have increased blood glucose values, but not to such an extent that they can be diagnosed with diabetes. This disease is also referred to as pre-diabetes. Treatment of the condition includes healthy eating habits, regular exercise and long-term weight control. Impaired glucose tolerance can be improved, remain constant or develop into type 2 diabetes.
Sugar sensitivity
During consultations I often meet people with allergies who suffer from discomfort caused by sugar or sucrose and refined carbohydrates. This discomfort can range from sudden tiredness, headache, migraine, abdominal discomfort, abdominal distension and flatulence to loose stools.
In a case of true sucrose intolerance there is a deficiency of the enzyme sucrase which is required to break down sucrose into glucose and fructose. The symptoms of this condition include diarrhoea and distension of the abdomen, which is caused by fermentation and gas production in the digestive tract. This sensitivity to sugar is not related to diabetes, but those who suffer from this condition do benefit from a sugar-free diet.
What is regarded as well-controlled diabetes?
As mentioned, blood glucose values that fluctuate or remain high over a long period can damage the blood vessels which supply blood to the heart, kidneys, eyes and nerve endings.
Although fasting blood glucose values are important, increasing emphasis is being placed on the blood glucose values two hours after a meal.
SEMDSA* provided the following ideal finger prick values for blood glucose in their 2012 guidelines:
| Younger diabetics without complications | Majority of diabetics | Older diabetics with complications | |
| Fasting | 4,0-7,0 mmol/l | 4,0-7,0 mmol/l | 5,0-8,0 mmol/l |
| Two hours after a meal | 4,4-7,8 mmol/l | 5,0-10,0 mmol/l | < 12,0 mmol/l |
A part of the red blood cell known as haemoglobin is influenced by the amount of glucose that is present in the bloodstream. It is advisable to have an HbA1c test done regularly. HbA1c is a marker which indicates how efficiently your blood glucose has been controlled during the previous three months and it should be tested every six months. It is ideal to keep the HbA1c as low as possible without causing hypoglycaemia.
SEMDSA* provided the following HbA1c values in their 2012 guidelines:
| Younger diabetics without complications | Majority of diabetics | Older diabetics with complications |
| ≤ 6,5% | ≤ 7,0% | ≤ 7,5-8% |
*SEMDSA: Society for Endocrinology, Metabolism and Diabetes in South Africa
Golden rules for controlling diabetes
•Accept and make peace with the fact that you have been diagnosed with diabetes.
•Understand what diabetes is and what its treatment entails.
•Use your medication as prescribed and talk to the members of your diabetic care team if you feel unsure.
•Know and understand the principles of good nutrition and apply them every day.
•Keep your blood glucose under control by:
–following a balanced diet according to your needs, or
–following a balanced diet and using insulin injections and/or diabetes tablets as prescribed, and
–doing regular exercise as part of your treatment.
•Keep an accurate record of your blood glucose readings, particularly if they fluctuate a lot.
•Be honest if you overstep the mark with the wrong food and don’t use the medications properly.
•Keep your body weight within 10% of your ideal weight for your height or maintain a body mass index (BMI) – an indication of healthy weight – of less than 25 kg/m2.
•Care for your feet regularly. Tell your caregivers at once if sores or grazes do not heal and only allow a responsible person to cut your toenails.
•Have your blood pressure measured regularly if you have a problem