Understanding Diabetes – it’s not about sugar in the diet…

In South Africa, an estimated four to six million people have diabetes and most of them are unaware of it. Considering that the incidence of diabetes is rising at a rate of 11% per annum, it is time to wake up and do something to stop the wave of this epidemic.


Diabetes is a condition in which the amount of glucose in the blood is too high. Type 1 diabetes is an auto-immune disease with destruction of the insulin-producing cells in the pancreas, it usually develops at a young age and it is treated with insulin injections. The more common form of diabetes, Type 2, typically develops in adults over age 40, but it can appear earlier.


In Type 2 diabetes, the body’s cells develop a resistance to insulin, making it more difficult for glucose to enter the cells. As a result, cells don’t get enough energy and glucose build up in the blood vessels, causing damage to all body organs.


Having a first-line relative (a parent or sibling) with Type 2 diabetes is the biggest risk factor and the second biggest risk factor is excess weight, particularly around the waist, the so-called ‘apple figure’. (For a male a waist circumference of more than 94cm is a risk and more than 102cm calls for high action. For a female a waist circumference of more than 80cm is a risk and more than 88cm is regarded as high risk.) Eating too many calories, combined with too little exercise, over time, will result in weight gain and eventually obesity. Research over many years has shown that all calories count, not only calories from sugar!


Obesity has become a global epidemic and a direct correlation exists between the prevalence of Type 2 diabetes and obesity. In South Africa the two conditions are closely linked across both genders and all ethnic groups. Reducing fat stores by losing weight, improves insulin sensitivity, resulting in lower blood glucose levels and better control.


It is a myth that healthy foods don’t raise blood glucose. All carbohydrates matter and have to be taken into account in the diabetic meal plan, not only sugar. Most of the carbohydrates in the diabetic eating plan should come from whole grain and unrefined sources, fruit, low fat dairy and starchy vegetables, but sugar in moderation makes the diabetic diet more palatable and easier to follow. This is in line with the SA Food Based Dietary Guidelines recommending that food and drink containing sugar be used sparingly.


Good diabetes management is essential to good health and a long life. This includes monitoring one’s blood glucose levels, going for regular tests, eating a balanced diet, exercising regularly and taking appropriate medication. People living with diabetes can include sugar in moderation as part of this management plan. Flexibility, along with a variety of food choices, are the keys to ensuring a healthy eating plan that is sustainable and enjoyable.