Diabetes is one of the most common health conditions in South Africa. Estimates by the International Diabetes Federation predict about 7.2% of adults in SA and around the world have diabetes. Many people live with this condition for years without realising it, because it often develops gradually and may not cause obvious symptoms in the early stages. It is a growing concern worldwide and in South Africa, with the predicted number of patients increasing each year.

When diabetes is not diagnosed or managed properly, it can increase the risk of serious health problems such as heart attacks, strokes, kidney disease, vision loss, and nerve damage. The good news is that with early diagnosis and proper treatment, most people with diabetes can live long and healthy lives.

This article explains what diabetes is, why it matters, and how it can be managed effectively.

What is Diabetes?

Diabetes is a condition where the body has difficulty controlling the level of sugar (glucose) in the blood.

Glucose is an important source of energy for the body. After we eat, our body breaks down carbohydrates into glucose, which enters the bloodstream. A hormone called insulin, produced by the pancreas, helps move glucose from the blood into the body’s cells where it can be used for energy.

In diabetes, this system does not work properly.

There are two main problems that can occur:

• • The body does not produce enough insulin
  • The body becomes resistant to insulin and cannot use it effectively

As a result, glucose builds up in the bloodstream instead of being used by the body.

Types of Diabetes

Type 1 Diabetes

Type 1 diabetes occurs when the body stops producing insulin completely. It usually develops in childhood or young adulthood and requires lifelong insulin treatment.

Type 2 Diabetes

Type 2 diabetes is the most common form of diabetes and accounts for the majority of cases. It occurs when the body becomes resistant to insulin and gradually cannot maintain normal blood sugar levels.

Type 2 diabetes is strongly associated with several risk factors, including:

• • Excess body weight
  • Physical inactivity
  • Family history of diabetes
  • Increasing age
  • High blood pressure or abnormal cholesterol levels

Other types of diabetes include gestational diabetes and type 5 diabetes (Malnutrition related.

Why is Diabetes Important?

Diabetes is not only about high blood sugar. It is also a major risk factor for heart and blood vessel disease.

People living with diabetes have a much higher risk of developing:

• • Heart attacks
  • Stroke
  • Heart failure
  • Kidney disease
  • Nerve damage
  • Vision problems

Modern diabetes care therefore focuses not only on controlling blood sugar, but also on protecting the heart, kidneys, and blood vessels.

Symptoms of Diabetes

Many people have no symptoms in the early stages. When symptoms do occur, they may include:

• • Increased thirst
  • Frequent urination
  • Unexplained weight loss
  • Fatigue
  • Blurred vision
  • Slow healing of wounds
  • Recurrent infections

Because symptoms may be mild or absent, regular screening is important, particularly for people with risk factors.

Who Should Be Tested?

Testing for diabetes is recommended for people who:

• • Are overweight or obese
  • Have high blood pressure
  • Have a family history of diabetes
  • Have high cholesterol
  • Are over the age of 40
  • Have previously had gestational diabetes

Diagnosis is usually made with a blood test measuring glucose levels or HbA1c, which reflects average blood sugar levels over the previous three months. Occasionally, when results are indeterminate, we may do a oral glucose tolerance test to measure your bodies response to glucose.

How is Diabetes Treated?

Treatment depends on the individual, but most management plans include several key components.

Lifestyle Changes

Healthy lifestyle habits are the foundation of diabetes care:

• • Maintaining a healthy weight
  • Eating a balanced diet
  • Regular physical activity
  • Avoiding smoking
  • Limiting excess sugar and refined carbohydrates

Even modest weight loss can significantly improve blood sugar control.

Medication

Many people with type 2 diabetes require medication to help control blood sugar. These may include tablets or injectable medications.

Some newer medications have been shown not only to improve blood sugar control but also to protect the heart and kidneys, which has become an important focus of modern diabetes treatment.

Managing Other Risk Factors

Because diabetes increases cardiovascular risk, treatment often also includes:

• • Blood pressure control
  • Cholesterol-lowering medication
  • Regular screening for complications

Managing these factors significantly reduces the risk of long-term complications.

Monitoring and Follow-Up

People living with diabetes usually require regular medical follow-up to monitor their health.

This may include:

• • Blood sugar or HbA1c testing
  • Cholesterol levels
  • Kidney function tests
  • Eye examinations
  • Foot checks

These checks help detect complications early, when they are most treatable.

The Role of a Diabetes Counsellor and Dietitian

Managing diabetes is about much more than taking medication. A diabetes counsellor and dietitian can play an important role in helping patients understand their condition and develop practical strategies for long-term success.

A diabetes counsellor provides education about blood sugar monitoring, medications, lifestyle changes, and preventing complications. They can also help patients overcome common challenges such as adjusting to a new diagnosis, managing stress, and building confidence in self-care.

A dietitian helps patients develop an individualised eating plan that fits their lifestyle, cultural preferences, budget, and health goals. Rather than focusing on restrictive diets, a dietitian can provide practical guidance on portion sizes, meal planning, carbohydrate choices, and weight management. For many patients, dietary changes are one of the most effective ways to improve blood sugar control and reduce the risk of future complications.

Early Warning Signs of Prediabetes

Before someone develops type 2 diabetes, blood sugar levels often become slightly elevated. This stage is known as prediabetes.

Prediabetes usually causes no symptoms, but it is an important warning sign that the body is beginning to struggle with glucose control.

Common risk factors include:

• • Being overweight
  • Lack of physical activity
  • Family history of diabetes
  • High blood pressure
  • High cholesterol

The encouraging news is that prediabetes can often be reversed. Lifestyle changes such as weight loss, improved diet, and increased physical activity can significantly reduce the risk of developing diabetes. Early testing allows these changes to be made before complications develop.

Frequently Asked Questions

What is HbA1c and why do we measure it?

HbA1c (also called glycated haemoglobin) is a blood test that reflects the average blood sugar level over the previous two to three months.

When glucose circulates in the blood, some of it attaches to haemoglobin inside red blood cells. The HbA1c test measures how much glucose has attached to these cells.

This makes HbA1c a very useful test because it provides a long-term picture of blood sugar control rather than a single reading at one moment in time.

Doctors use HbA1c to:

• • Diagnose diabetes
  • Monitor how well treatment is working
  • Guide adjustments to medication if needed

For many people with diabetes, the target HbA1c is below 7%, although this can vary depending on the individual.

Can diabetes be cured?

Type 1 diabetes currently has no cure and requires lifelong insulin treatment.

Type 2 diabetes can sometimes go into remission, particularly with significant weight loss and lifestyle changes, but it still requires ongoing monitoring.

Is diabetes caused by eating too much sugar?

Sugar alone does not cause diabetes. However, diets high in calories, processed foods, and sugary drinks can contribute to weight gain and increase the risk of developing type 2 diabetes.

Can diabetes be prevented?

In many cases, type 2 diabetes can be prevented or delayed. Maintaining a healthy weight, exercising regularly, and following a balanced diet can significantly reduce the risk.

Do people with diabetes have to avoid all carbohydrates?

No. Carbohydrates are an important source of energy. The key is choosing healthier carbohydrates, such as whole grains, vegetables, and legumes, while limiting refined sugars and highly processed foods.

If I start medication, will I need it forever?

Not always. Some people can reduce or stop certain medications if they achieve significant improvements in weight, diet, and physical activity. However, many people require long-term treatment to keep their blood sugar under control.

How often should someone with diabetes see their doctor?

Most patients benefit from a review every three to six months, depending on their blood sugar control and treatment plan. Regular follow-up helps ensure that treatment remains effective and that complications are detected early.

How much does this all cost?

In South Africa, diabetes is a prescribed minimum benefit (PMB) condition which means that medical aid schemes are required by law to pay for your appointments, tests and medications. This includes hospital plans. The exact benefits will differ depending on which medical aid/hospital plan option you have. Please note that some medical aid options require you to go to a state clinic for your treatment if that is in your contract. You can check with your broker/scheme to get more information.

The Good News

Although diabetes is a serious condition, it is also very manageable. With the right combination of healthy lifestyle choices, appropriate medication, and regular medical care, most people with diabetes can lead full and active lives.

Early detection and consistent treatment are the key to preventing complications and protecting long-term health.

If you are concerned about your risk of diabetes or would like to discuss screening, speak with your doctor at HMCD.

References

1. ESC Guidelines on Cardiovascular Disease in Patients with Diabetes. European Society of Cardiology.
2. World Health Organization. Diabetes Fact Sheets and Global Health Estimates.
3. International Diabetes Federation. IDF Diabetes Atlas.

High blood pressure – known as hypertension – is one of the most common health conditions in South Africa, occurring in about 38% to 48% of our country’s population. Many people have it without knowing, because it often causes no symptoms.

Untreated high blood pressure increases the risk of stroke, heart attack, kidney disease, and heart failure. These conditions occur younger in South Africans than in other countries due to poor screening and awareness.

The good news is that hypertension is easy to detect and very treatable and this article will help you understand what hypertension is, how we diagnose it and how we manage your condition.

What Is Blood Pressure?

Blood pressure is the force of blood pushing against your arteries as your heart pumps. It is measured using a sphygmomanometer which traditionally uses mercury – hence the unit of measurement is millimetres of mercury (mmHg).

It’s written as two numbers, for example 130/80 mmHg:

• • Top number (systolic): pressure when the heart beats
  • Bottom number (diastolic): pressure when the heart relaxes

How Is Blood Pressure Classified?

Normal Blood Pressure

• • Equal to or below 120/70

Elevated Blood Pressure

• • 120–139 systolic and/or 70–89 diastolic

Elevated blood pressure is a newer term you may hear your doctor mention that allows us to identify at risk patients or even start treatment on certain patients with other illnesses such as diabetes or kidney disease.

High Blood Pressure (Hypertension)

• • 140/90 or higher

This usually requires treatment.

Why Is High Blood Pressure So Important in South Africa?

South Africa has very high rates of stroke and heart disease, with current statistics showing us that these affect patients 15 years younger on average than in countries in Europe/North America.

Factors that increase risk locally include:

• • High salt intake (especially from processed foods and seasoning powders)
  • Obesity
  • Physical inactivity
  • Smoking
  • Diabetes
  • Limited access to regular healthcare for many communities

Because high blood pressure often has no symptoms, many people only discover it after a serious complication like a stroke. Hence the need to increase screening in our communities.

How Is Blood Pressure Diagnosed Properly?

Most of the time your doctor will want to take a series of blood pressure readings to make a diagnosis of hypertension to avoid overdiagnosis.

Doctors recommend:

• • Home blood pressure monitoring using a validated blood pressure machine and a diary, or
  • 24-hour blood pressure monitoring known commonly as a holter BP where a special BP machine is attached to you and gives us your average BP over 24 hours (this is something we commonly do for our patients in our practice).

These methods help avoid:

• • White-coat hypertension (high readings only when you see the doctor or nurse)
  • Masked hypertension (normal when we measure but high at home)

If home monitoring isn’t possible though, repeating the measurements at our practice will still help us make a diagnosis.

Your doctor may also order blood tests when working you up for hypertension to check for any potential causes and complications of hypertension and to make sure they choose the right medication for you.

What Should My Blood Pressure Target Be?

For most adults on treatment, the recommended goal is a Systolic blood pressure between 120 and 129
Lowering blood pressure into this range reduces the risk of strokes and heart attacks.

Targets may be adjusted if you:

• • Feel dizzy or light-headed
  • Are over the age of 85
  • Have other medical conditions

Your doctor will work with you to individualise your target to best suit you.

Lifestyle Changes That Really Make a Difference

Lifestyle changes are recommended for everyone with raised blood pressure.

Key steps include:

• • Reducing your salt intake (avoid adding salt at the table; limit stock cubes, processed meats, packet soups, and sauces)
  • Exercising regularly if you can (simple exercise such as going for a 30-minute walk once a day will help with your blood pressure control)
  • Maintain a healthy weight
  • Eat more vegetables and fruit
  • Limit alcohol
  • Stop smoking

These changes often reduce the need for higher doses of medication.

When Is Medication Needed?

Medication is usually recommended if:

• • Blood pressure is 140/90 or higher, or
  • Blood pressure is elevated and you have other risks (such as diabetes, kidney disease, or previous stroke)

The current recommendations are that we start on a combination of medications instead of just one to improve control of blood pressures. This is done by using pills containing multiple medications in them to make it easier for patients to use.

Unfortunately, these combination tablets aren’t currently available at public hospitals and clinics, but the individual medications used are the same as in private. Some medical aids also require us to follow a stepwise approach to treatment and may only pay for combination medications after we have tried an individual medicine first.

Frequently Asked Questions (FAQ)

Can I feel high blood pressure?

Usually not. Most people feel completely normal — which is why hypertension is called the “silent killer.”

Do I need to take tablets for life?

Often, yes. High blood pressure tends to return if medication is stopped.
However, good lifestyle changes may reduce the number or dose of tablets needed.

How much does this all cost?

In South Africa, hypertension is a prescribed minimum benefit (PMB) condition which means that medical aid schemes are required by law to pay for your appointments, tests and medications. This includes hospital plans. The exact benefits will differ depending on which medical aid/hospital plan option you have. Please note that some medical aid options require you to go to a state clinic for your treatment if that is in your contract. You can check with your broker/scheme to get more information.

Is stress the main cause of high blood pressure?

Stress can raise blood pressure temporarily, but long-term hypertension is usually caused by a combination of genetics, diet (especially salt), weight, and physical inactivity.

Are traditional or herbal medicines safe for blood pressure?

Some herbal remedies may interfere with prescribed medication or affect kidney function.
Always tell your doctor or nurse if you are using traditional remedies.

What blood pressure machine should I use at home?

Use an upper-arm cuff machine that has been clinically validated. Wrist and finger machines are less reliable.

What if my blood pressure is high at the clinic but normal at home?

This is common and is called white-coat hypertension. Home or 24-hour monitoring helps clarify this.

How often should I check my blood pressure?

• • If normal: at least twice a year
  • If elevated or treated: as advised by your healthcare provider, often weekly or monthly

What can we do for you at HMCD

Making an appointment with one of our doctors will allow them to screen you for hypertension, go through your medical history, identify risk factors for heart disease and strokes and order any special tests that may be necessary to ensure an accurate diagnosis.

At HMCD we also have the facilities and equipment to do electrocardiograms, fundoscopy photographs (a special photo of the back of your eye that allows us to identify any potential risk or disease) and 24-hour home blood pressure monitoring.

Our doctors are equipped with up-to-date knowledge to guide your treatment, and when necessary, our established relationships with local specialists allow for ease of referral if there are any complications with your condition.

Take-Home Message

High blood pressure is common, serious, and often unnoticed — but it is one of the most treatable risk factors for heart disease and stroke.

Regular checks, healthier daily habits, and the right treatment can protect your heart, brain, and kidneys for years to come.

If you haven’t checked your blood pressure recently, make an appointment with one of our doctors at HMCD.

References:

John William McEvoy et al, ESC Scientific Document Group , 2024 ESC Guidelines for the management of elevated blood pressure and hypertension: Developed by the task force on the management of elevated blood pressure and hypertension of the European Society of Cardiology (ESC) and endorsed by the European Society of Endocrinology (ESE) and the European Stroke Organisation (ESO) European Heart Journal, Volume 45, Issue 38, 7 October 2024, Pages 3912–4018, https://doi.org/10.1093/eurheartj/ehae178 Woodiwiss, A.J., Orchard, A., Mels, C.M.C. et al. High prevalence but lack of awareness of hypertension in South Africa, particularly among men and young adults. J Hum Hypertens 39, 111–119 (2025). https://doi.org/10.1038/s41371-023-00873-3

From left: Dr Jonathan Cook, Dr Peter Vogts, Dr David Peiser, Dr Piero Jonck and Dr Len de Kramer.

The Howick Medical Centre Doctors has come a long way over the course of the last 33 years. A passionate group of doctors, we continue to serve the Howick and greater Midlands community with care and compassion.

We celebrated a new milestone in our journey with the official opening of our new consulting rooms in Howick on August 1, 2023. Thirty-three years ago, Dr David Peiser moved to The White House Centre in Howick, from Manguzi in Northern KwaZulu-Natal. He was joined by Dr Robin Stevenson and his son Chris, and then by long-time friend Dr Peter Vogts. Dr Mark Stead joined Drs Peiser and Vogts in 1993 and then Dr Frank Berry became a part of the team.

Howick has been blessed by excellent doctors in the past, with the late Dr John Hyslop being the biggest driver of healthcare in the town. He was much loved in Howick and it was in early 2002 when his vision was realised and a community hospital was built in the town.

In 2005, Dr Peiser and Associates moved to the Howick Medical Centre (where they are currently situated) and joined forces with Dr Jonathan Cook. Dr Piero Jonck joined the practice a year later in 2006. In 2018, Dr Len de Kramer joined the practice and together they formed the Howick Medical Centre Doctors practice.

Six general practitioners, with various special interests, ranging from diabetes to travel medicine, family medicine, and a large economic clinic, soon meant that there was a shortage of space in the existing facility. This was solved in 2023 with the expansion into the new facility. The new rooms boast state-of-the-art facilities and are a source of pride for all who work there. There are six consulting rooms, which are fully equipped with the necessary tools, and side room facilities for patients. Four minor theatres allow the team to deal with general practice procedures and trauma cases.

There is also a dedicated resuscitation room equipped with a state-of-the-art defibrillator, oxygen and ECG monitoring to ensure a rapid and effective response to emergencies. In addition, the rooms offer patients lung function tests, standard and stress ECGs, diabetic monitoring, ultrasound facilities and a travel clinic licensed to dispense Yellow Fever vaccines. They also have a fundoscope for easy detection of systemic diseases.

The nurse’s clinic has four full-time registered nurses on stand-by. All our nurses have diplomas in wound care and are well trained in paediatric and adult vaccinations.

The economic clinic is a community project of the Howick Medical Centre Doctors that caters for patients without medical aids or hospital plans. We offer great service, with medication, at an affordable fee on a first-come, first-serve basis.

Dr Sam Lindsay, a local GP, runs our female health clinic on Thursday afternoons. Dr Shaun Nischk, has recently joined forces with the HMCD. We are excited to have him among our ranks as his caring nature and brilliant work ethic have proved invaluable to our practice.

The future looks bright for healthcare in Howick and the Howick Medical Centre Doctors are proud to celebrate this growth.