A Pretoria GP's Guide to Managing Diabetes Day to Day

Diabetes in South Africa is no longer a quiet problem. The 2024 International Diabetes Federation Atlas estimates that 2.3 million South African adults are living with the condition, and we sit fourth highest in Africa for total cases (IDF, 2024). In the same year, Statistics South Africa confirmed what many doctors had been seeing in their consulting rooms for some time. Diabetes has overtaken every other non-communicable disease as the leading cause of death in our country (Stats SA, 2024).

If you have type 2 diabetes, or you love someone who does, those numbers can feel heavy. We understand. But there is also good news, and it is the same news your doctor has probably given you before. Day-to-day management works. Real change in your blood sugar comes from the small things, done consistently, far more than from any single appointment or prescription.

This is the practical Pretoria guide.

Know your numbers, but do not become a slave to them

The Society for Endocrinology, Metabolism and Diabetes of South Africa, or SEMDSA, sets our local standard. Their 2017 guidelines, still the reference most of us work from, recommend a general HbA1c target of 7 percent or lower for most adults with type 2 diabetes (SEMDSA, 2017). Your doctor may adjust that target for you. Older patients, or those with complications, may have a slightly higher target. Younger patients, especially those newly diagnosed, often aim a little lower.

What is HbA1c exactly? It is a blood test that measures your average blood sugar over the past three months, give or take. You should be having this test at least twice a year, more often if your sugar is not yet well controlled.

For home blood glucose monitoring, the story is more nuanced than it used to be. If you are on insulin, daily testing is essential. But if you are managing your diabetes with tablets only, daily finger pricks may not actually improve your control, and can add anxiety without adding benefit (AAFP, 2013). Talk to us about what your monitoring schedule should look like, given your specific situation. There is no point in turning yourself into a pin cushion if it is not changing your numbers or your decisions.

Food: what actually moves the needle

If there is one place where daily choices matter most, it is on your plate. In our community, food is love. We share it across generations and across long Sunday afternoons in the garden, and asking someone to change how they eat can feel like asking them to change who they are.

So let us be practical. You do not need to give up pap. You do not need to never have a koeksister again. What you need is to understand which foods raise your blood sugar quickly, and how to balance them.

Carbohydrates such as white rice, white bread, mealie meal, samp, pasta, potatoes, sugary cooldrinks, and most fruit juices raise blood glucose fast. Whole grain options, beans, lentils, vegetables, and most fresh fruits raise it more slowly. Protein and healthy fats slow things down further. So a plate that contains pap is not the enemy. A plate that is only pap, with a sweet cooldrink alongside it, is a problem.

A good working guide is this. Half your plate should be vegetables or salad. A quarter should be lean protein, things like chicken, fish, eggs, beans, or lean beef. The remaining quarter is for your starch. Replace cooldrinks with water, rooibos, or unsweetened sparkling water. If you take sugar in your tea, start dropping it slowly. Most people lose the taste for it within a few weeks.

Some easy swaps. White bread for low GI brown bread or seed bread. White rice for brown rice, samp, or barley. Sugary breakfast cereals for oats with cinnamon and a few nuts. A late-afternoon biscuit habit for an apple with peanut butter. Small swaps, done day after day, are what change your HbA1c at the next visit.

Movement: 150 minutes is the magic number

The American Diabetes Association recommends at least 150 minutes of moderate intensity exercise per week for people with type 2 diabetes, spread across at least three days, with no more than two days between sessions (ADA, 2022). They also recommend two to three resistance training sessions per week on non-consecutive days.

That sounds like a lot until you break it down. Thirty minutes, five days a week. A brisk walk in your neighbourhood. A turn through the Union Buildings gardens. Climbing the koppie at Klapperkop on a Saturday morning with a friend. Resistance training does not mean a gym membership. It can be bodyweight squats while waiting for the kettle, push-ups against the kitchen counter, or carrying full shopping bags up the stairs instead of taking the lift.

What matters is consistency. Twenty minutes on most days will do far more for your blood sugar than two hours on a Saturday and nothing for the rest of the week.

Medication: take it like you mean it

If you have been prescribed metformin, or any other diabetes medication, the most important thing you can do is take it as prescribed. Skipping doses, doubling up after a missed day, or stopping when you feel fine are common patterns we see, and they all undermine your control. If a medication is giving you side effects, do not just stop it. Come and talk to us. There are almost always alternatives.

If your doctor has spoken to you about insulin, please do not delay because of fear. Insulin is not a punishment. It is not a sign you have failed. For many people, it is the most effective tool to bring blood sugars back into range and prevent the complications we work so hard to avoid.

What about alcohol?

Alcohol and diabetes have a complicated relationship. Beer and sweet wines raise blood sugar quickly. Spirits do not, but they can cause low blood sugar hours later, especially if taken on an empty stomach or while on insulin or certain tablets. The general guidance is moderate intake at most, ideally with food, and never as a substitute for water during the day. If you find your social life leaning heavily on alcohol, please come and have a conversation. We do not judge. We just want to help you protect your health.

Sick day rules

When you are unwell, even with something ordinary like a flu or a stomach bug, your blood sugar can swing in unexpected ways. Some basic rules help. Keep taking your diabetes medication unless your doctor tells you otherwise. Drink plenty of water. If you are vomiting and cannot keep food or fluids down for more than 24 hours, or your blood sugar is unusually high or low, please contact us promptly. Sick days are when small problems turn into hospital admissions if they are not managed early.

The complications worth preventing

Uncontrolled diabetes is dangerous because it works quietly. The damage to your blood vessels, kidneys, eyes, and nerves often does not announce itself until it is significant. This is why we ask you to come in for the things that feel less urgent. An annual eye exam with an optometrist or ophthalmologist. A foot check. Kidney function tests. Blood pressure and cholesterol monitoring.

Each of these checks is a small investment that protects something bigger. Your sight. Your feet. Your kidneys. Your independence in your later years.

The mental side, because nobody talks about it enough

Living with a chronic condition is tiring. There are days when you do not want to think about your blood sugar, or what is on your plate, or whether you took your tablet this morning. That is not weakness. That is being human. Studies in the WHO African Region have shown that diabetes self-management education and peer support meaningfully improve both glycaemic control and quality of life (WHO Africa, 2025). You do not have to do this alone.

Talk to us. Talk to your family. Look into local support through Diabetes South Africa, which has chapters across Gauteng. If you are feeling persistently low or hopeless, please tell your doctor. Depression and diabetes often travel together, and they are both treatable.

The bottom line

You can live a long, full, joyful life with type 2 diabetes. We see it every week. The people who do best are not the ones with perfect numbers. They are the ones who show up for themselves a little bit, every day. Who walk after dinner. Who keep a water bottle in the car. Who take their tablets without drama. Who come for their check-ups even when nothing hurts.

Dr Setlogelo and the team at Kelebogile Medical Centre are ready to support you through every step. If you are newly diagnosed, or feeling lost in the routine, please book a consultation. We will work the plan with you.

References

• American Diabetes Association. (2022). Standards of Medical Care in Diabetes. Diabetes Care, 45(Suppl. 1). Available at: https://diabetesjournals.org/care
• American Academy of Family Physicians. (2013). Choosing Wisely: Do not routinely recommend daily home glucose monitoring for patients with type 2 diabetes mellitus not using insulin. Available at: https://www.aafp.org
• International Diabetes Federation. (2024). IDF Diabetes Atlas, 11th Edition. Available at: https://diabetesatlas.org/data-by-location/country/south-africa/
• Society for Endocrinology, Metabolism and Diabetes of South Africa. (2017). SEMDSA 2017 Guidelines for the Management of Type 2 Diabetes Mellitus. JEMDSA, 22(1) Supplement 1: S1 to S196. Available at: https://www.semdsa.org.za
• Statistics South Africa. (2024). Mortality and Causes of Death in South Africa. Pretoria: Stats SA. Available at: https://www.statssa.gov.za
• World Health Organization African Region. (2025). Effectiveness of diabetes self-management education and support interventions on glycemic levels among people living with type 2 diabetes in the WHO African Region: a systematic review and meta-analysis. Frontiers in Clinical Diabetes and Healthcare. Available at: https://www.frontiersin.org/journals/clinical-diabetes-and-healthcare