Diabetes Awareness Month

Type 2 diabetes can be treated when diagnosed early. If left untreated, warns Mediclinic Vergelegen endocrinologist Dr Elmo Pretorius, it can lead to kidney damage, heart disease and even stroke.

“Diabetes is a silent disease,” says Dr Pretorius. “You may not know you have it or think it’s not serious. But in the background, it’s causing damage to your blood vessels, and that can lead to a heart attack, stroke, renal failure, blindness – you could even lose a limb.”

When you eat or drink, your pancreas produces a hormone known as insulin to break food down into energy. When you have diabetes, your body is unable to produce enough insulin. The result: the sugar in your blood rises, uncontrolled, even as your cells are starved of energy.

“Your blood vessels have a non-stick coating,” Dr Pretorius explains. “Certain factors erode that coating, such as smoking and high blood pressure. Glucose is one of those factors. In that case, without the protective layer, things like cholesterol and platelets then become stuck to the lining of these blood vessels, and cause blockages.”

The bigger the vessel, the bigger the problem. While tiny vessels in the eye, for example, can lead to blindness, blockages in larger vessels that lead to the heart and brain can cause heart attacks and stroke.

By adjusting the following aspects of your health, you can take control.

Change your lifestyle

“The first thing we would do is investigate how we have arrived at this point,” Dr Pretorius explains. “Diabetes is largely a genetic malfunction, caused when you inherit poor pancreatic function. But what happens is that you then acquire obesity as you grow up.”

Early detection is crucial. “If we catch the disease too late, you may already have damage to your pancreas and organs – then it becomes a lot trickier. But if we pick it up early, we can reverse the poor lifestyle decisions that have led to being overweight, and in 90% of cases, we can cure diabetes.”

Bariatric surgery is a proven rapid weight-loss option for people who are suffering from morbid obesity. But lifestyle change is the cornerstone of type 2 diabetes management.

Dr Pretorius says most of his patients are proactive and motivated to change their lives in order to cure the condition, and he has many success stories. “It can be tough for people to change a lifetime of bad habits, but most diabetic patients are only diagnosed once they have had a heart attack or stroke, or are suffering from renal failure,” he says. “The average diabetic, by the time they are diagnosed, has had the disease for 10 years.”

Calories, not sugar

Prevention, in this case, a lot more effective than treatment. “Most medications for diabetes are designed to reduce the damage being done to blood vessels and organs, Dr Pretorius says. “This is damage control – not curative.”

Diet is the crux of this matter, he explains. Contrary to popular belief, diabetes is not a condition caused by sugar. “Diabetes is a disease caused by abdominal obesity. In that sense, it is about excess calories – whatever food you eat, sugary or not, could lead to diabetes if you eat too much.”

This is simple mathematics, Dr Pretorius says. “Diabetes is not a question of your diet. Are you taking in the energy content you need or less? Or are you taking in more calories than you need? Regularly taking in unnecessary calories, that your body doesn’t need, will lead to weight gain.”

Diet does play a role in the effect it has on the mind. “We know people find it difficult to gauge the number of calories on their plate, particularly white starches, like potatoes, rice and bread. We find people tend to overeat these ingredients, and these foods are very high in calories.”

The browner the carbohydrate, the better

Choosing low-glycaemic index foods, such as whole grains, is not so much a health decision as a fullness factor, he says. “Kilo for kilo, these will help you feel fuller for longer, without taking in too many excess calories,” says Dr Pretorius.

The next time you examine the back of a produce packet in the supermarket, pay special attention to the energy content. “I always tell my patients, the browner the carbohydrate, the better. And the lower the glycaemic index, the better. But total calories are the important part.”

Diet vs. exercise

While diet is an important factor in keeping weight under control, exercise plays a key role in helping to manage the effects of diabetes once it has been diagnosed. “As a way to lose weight, exercise is energy inefficient – it takes a huge amount of movement to lose the necessary weight, whereas dietary changes are a lot more effective,” says Dr Pretorius. “But exercise does make the muscles more sensitive to insulin. This helps them to use glucose to produce energy, and not fat. It also drops blood pressure and improves cholesterol.”

Dr Pretorius says patients who are struggling to lose weight may feel despondent if they focus too hard on exercise alone as a weight-loss technique. “It is a lot of work for people who aren’t used to it, and you don’t get the same calorie-deficit rewards as with dietary changes. But for those who already have confirmed diabetes, exercise is vital.”

The best part: “We’re not talking about major exercise. I’m not asking people to run 100 kilometres. Just half an hour of brisk walking is all it takes.”