Ampath Diagnostic Guide | Pathology solutions are in our DNA
What is Diabetes Mellitus (DM)?
Diabetes is a metabolic disorder marked by elevated blood glucose (sugar) levels. This happens due to:
- Insulin deficiency → Type 1 Diabetes
- Insulin resistance → Type 2 Diabetes
How it works:
- Carbs (starch/sugar) in food → broken into glucose
- Glucose enters bloodstream → needs insulin to enter cells
- If insulin is insufficient or ineffective → glucose builds up in the blood
Type 1 vs. Type 2 Diabetes
✅ Type 1 Diabetes
- Typically diagnosed under age 30
- Patients are not overweight
- Rapid symptom onset
- Ketones present in urine
- Accounts for 5–10% of diabetes cases
✅ Type 2 Diabetes
- Often diagnosed over age 40
- Increasingly seen in younger people and children
- Gradual or no symptoms
- Usually overweight
- No ketones in urine
- Accounts for 90–95% of diabetes cases
Prevalence in South Africa
- 9.5% of people >15 years have diabetes
- 45% are undiagnosed
- Highest rates among Asian Indian and Mixed Ancestry groups
- ~5 million South Africans have pre-diabetes
Contributors to rising incidence:
- Lack of exercise
- Poor diets (sugary, refined, processed foods)
- Weight gain
- Obesity epidemic
Diagnosing Diabetes
🔬 Laboratory Tests:
- Fasting glucose (after 8–12 hour fast)
- Oral glucose tolerance test (GTT)
- HbA1c (glycated haemoglobin – reflects average glucose over past 6–12 weeks)
🧪 Diagnostic Criteria:
CategoryFasting Glucose (mmol/L)2hr GTT / Random Glucose (mmol/L)HbA1c (%)Normal< 6.1< 7.8< 6.0%Pre-diabetes6.1 – 6.97.8 – 11.06.0 – 6.4%Diabetes≥ 7.0≥ 11.1≥ 6.5%
Living with Diabetes
🏃 Lifestyle Changes:
- Regular exercise
- Balanced diet (smaller portions)
- Weight loss
💊 Medication:
- Type 2: Oral tablets → Insulin if needed
- Type 1: Insulin therapy from diagnosis
Monitoring Glucose
- HbA1c Goal: < 7%
- Self-monitoring targets:
- Fasting: 4.0 – 7.0 mmol/L
- Post-meal: < 10.0 mmol/L
- Adjust based on age, health, and activity
Also monitor:
- Blood pressure
- Cholesterol
- Urine protein (albuminuria)
- Annual eye checks
- Daily foot checks + annual podiatrist visit
Short-Term Complications
🔺 Hyperglycaemia (High Blood Sugar)
Causes:
- Overeating / poor food choices
- Lack of exercise
- Insufficient or poorly timed medication
- Stress or illness
Untreated: May lead to ketoacidosis or coma, especially in Type 1
🔻 Hypoglycaemia (Low Blood Sugar)
- Mild: < 4.0 mmol/L
- Severe: < 3.0 mmol/L
Causes:
- Skipped meals
- Alcohol
- Excess activity without food
- Too much insulin or medication
- Poor timing of medication
Symptoms:
- Shaking
- Sweating
- Blurred vision
- Headache
- Irritability
- Confusion
- Numbness around lips
- Convulsions
- Coma
Must be treated immediately to avoid fainting or seizure
Long-Term Complications
Uncontrolled diabetes leads to:
🫀 Large Blood Vessel Disease (Cardiovascular):
- Stroke
- Heart attack
- Peripheral vascular disease → amputations
👁️ Small Blood Vessel Disease:
- Retinopathy → blindness
- Kidney disease → failure
- Nerve damage → foot ulcers, erectile dysfunction
Conclusion
While diabetes is a lifelong condition, it is manageable through:
- Education
- Blood sugar control
- Healthy lifestyle
- Consistent medical care
Take charge of your health — stay committed and empowered.
Support & Contact Info
🧩 Diabetes South Africa
🌐 www.diabetessa.co.za
📞 021 425 4440
📧 national@diabetessa.org.za
🏥 Centre for Diabetes and Endocrinology (CDE)
🌐 www.cdecentre.co.za
📞 011 712 6000