On World Diabetes Day, provincial health authorities have emphasised the need for early detection, treatment and education, to reduce diabetes complications.

South Africa has more than 4 million people with diabetes, which is about 1 in 9 adults. But many people are going undiagnosed. It’s also the second leading cause of death in South Africa, behind Tuberculosis.

Worryingly, increasing numbers of children are being diagnosed with the condition. The Red Cross War Memorial Children’s Hospital sees around 3 to 5 newly diagnosed patients per month in its diabetes ward following referrals to the facility.

After admission, young diabetes patients will receive follow-up appointments to visit the hospital’s diabetes clinic. Most children present with type 1 diabetes, often in a critical condition.

Dr Michelle Carrihill, a paediatric endocrinologist and head of the diabetes and endocrinology department at the hospital says over the last six years, they have averaged around 50 new patients per year.

“However, this number can vary significantly, with as few as three or as many as 12 new cases in a single month. Our primary concern is that many young patients with diabetes arrive very sick, sometimes requiring ICU admission, which can be traumatic for both the children and their families.”

Dr Carrihill has stressed the importance of recognising the warning signs of diabetes in children and seeking urgent help from a clinic.

Common symptoms include:

• Sudden bedwetting or frequent urination
• Increased thirst
• Weight loss or not picking up weight
• Difficulty concentrating at school
• Vision problems
• Vomiting

“If your child exhibits any of these symptoms, please access your clinic for a test. If you can make a diagnosis before they become very sick, they will be much better off. Early detection is crucial in preventing severe illness. Our patients don’t need to be very sick when they’re in the ward. They can be newly diagnosed, and it allows for our team to provide education and counselling to the patient and their family.”

The hospital also provides care to children presenting with type 2 diabetes.

“Obesity is a concern in children and children can develop type 2 diabetes. We are seeing more type 1 diabetic children presenting earlier because they’re overweight or obese and need more insulin, which their pancreas can’t produce. Some of our patients are as young as six or seven years old. About 10% of our patients present with type 2 diabetes. We are also seeing cases of ‘double diabetes’, where children have both type 1 and type 2 diabetes.”

She has emphasised one of the most important factors in reducing the risk of childhood diabetes is early detection, treatment and education.

“Type 1 diabetes is autoimmune with a genetic risk and is not preventable at this stage. It’s important to understand that it doesn’t happen because anyone did anything wrong.”

She added, “Prevention begins in utero with healthy pregnant mothers. Antenatal care should include education on healthy eating, which continues with healthy feeding and breastfeeding after birth which can reduce the risk of diabetes. Families need to be educated on nutritious meals and the dangers of processed foods, starting in schools and extending beyond.”

Similarly, Tygerberg Hospital offers a comprehensive service to children and adults at its diabetes clinics.

Dr Marli Conradie-Smit, head of Endocrinology, says their adult diabetes clinics treat between 109 (Type 1) to 190 (Type 2,) patients per month, with 5-6 new cases each week.

“These clinics aim to enhance the care of people living with diabetes. Patients have access to a specialised team focused on patient-centered care in diabetes mellitus. Often, we evaluate patients and then refer them back to their local clinic with a clear care plan. Additionally, we have access to specific medications, like insulin analogues, that only specialists can initiate. Patients are also educated to manage diabetes mellitus effectively, live well, and stay active in their communities.”

In adults, the most common type of diabetes is type 2, which occurs when the body becomes resistant to insulin or does not produce enough insulin. Type 2 diabetes can lead to long-term damage to your body, so an early diagnosis is crucial.

Untreated or badly controlled diabetes can result in amputations, kidney failure and blindness.

Groote Schuur Hospital conducted 456 retinal operations between January 2023 and June 2024, of which 256 (57%) involved diabetic eye problems. At this advanced stage of the disease, diabetic retinopathy is theoretically preventable with primary and secondary prevention strategies.

Dr James Rice, head of the Eye Department’s retina service at Groote Schuur Hospital says eye screening is an important part of managing diabetes.

“As diabetic retinopathy does not show any symptoms in the early stages when they are most treatable, it can become quite advanced before you start to notice it. Going to your routine eye screening at a clinic can help you spot and treat diabetic retinopathy early, which should prevent it from progressing to a stage when it is more difficult to treat.”

Experts agree that a healthy lifestyle is crucial to managing the condition. This includes staying physically active, eating mindfully and nurturing mental well-being.

Tygerberg Hospital also shared the story of one of their patients, Angelo Plaatjies, who was just five when he was diagnosed with Type 1 diabetes.

Now 33, he says he has navigated a lifetime of managing his condition, learning how to balance his health and well-being.

“Living with diabetes hasn’t been easy, especially when I was invited to children’s parties as a child,” Angelo recalled.

“There were always sugary treats, and I had cravings, especially for the sweet stuff.”

But he added with the right care and support from healthcare workers and his family, he has learned how to manage his condition and live his life fully.

Some tips for helping to manage diabetes:

• Eat foods like vegetables, whole grains, lean proteins, and healthy fats. Avoid refined carbohydrates such as sugary drinks, and manage portion sizes
• Aim for at least 150 minutes of moderate aerobic activity each week such as walking, swimming, or cycling. Strength training exercises, even a couple of days a week, can further boost insulin sensitivity
• Stress too can raise blood sugar levels, so be mindful of situations that can elevate stress levels
• Maintain a regular sleep routine of seven to eight hours of quality sleep a night
• Consistent blood sugar monitoring is important to stay in control. Follow the medication plan designed by a healthcare provider and adjust the diet and exercise as needed based on diabetes readings.

Premier Alan Winde, himself a diabetic, has shared words of encouragement:

“It is a manageable condition, and one can live a perfectly normal life if you take the necessary steps to keep it under control. At first this may be difficult, but it will eventually come naturally to you. I exercise as often as I can and eat a balanced diet. Equally as important is the support my family and friends gives me and I also always follow the advice of my doctor, this is crucial. And you must always remember, you are not alone; there is always help available.”