Diabetes Warning Signs: Symptoms by Type & Why Millions of South Africans Don't Know They Have It

This is Part 2 of the Purple Cushhh 7-Part Diabetes Series. Read Part 1 for an overview of diabetes types and the South African epidemic.

The Quiet Disease

Type 2 diabetes has earned a grim nickname in medical circles: the silent disease. Unlike a heart attack or a broken bone, it does not announce itself with a dramatic, unmistakable event. It creeps in slowly, over months and years, while blood glucose levels quietly rise and damage accumulates in blood vessels, nerves, and organs.

By the time many South Africans are diagnosed, they have already had elevated blood sugar for five to ten years. The complications — early kidney damage, nerve changes, retinal changes — may already be underway.

This is why knowing the warning signs is not just useful information. It is potentially life-changing.

Why So Many South Africans Are Undiagnosed

The International Diabetes Federation estimates that approximately half of all South Africans with diabetes are undiagnosed. Several factors drive this:

  • Symptom subtlety: Early Type 2 diabetes often produces no symptoms at all, or symptoms so mild they are easily dismissed
  • Normalisation: Fatigue, thirst, and frequent urination are so common in daily life that many people don't connect them to blood sugar
  • Healthcare access: Routine screening is not universally accessible, particularly in rural and peri-urban communities
  • Stigma: In some communities, a diabetes diagnosis carries social stigma that discourages testing
  • Lack of awareness: Many South Africans simply don't know what the symptoms are or that they are at risk

Warning Signs by Diabetes Type

Type 1 Diabetes — Rapid & Unmistakable

Type 1 diabetes typically presents with a rapid, dramatic onset — often over days to weeks. Because the pancreas has stopped producing insulin entirely, blood glucose rises quickly and the body enters a state of metabolic crisis.

Classic symptoms of Type 1:

  • Extreme thirst (polydipsia): The kidneys work overtime to flush excess glucose, causing dehydration and intense thirst
  • Frequent urination (polyuria): Glucose in the urine draws water with it, dramatically increasing urine output
  • Rapid, unexplained weight loss: Without insulin, the body cannot use glucose for energy and begins breaking down fat and muscle
  • Extreme hunger (polyphagia): Despite eating, cells are starved of glucose — the body signals for more food
  • Blurred vision: High blood glucose causes the lens of the eye to swell, distorting vision
  • Extreme fatigue: Cells deprived of glucose have no energy
  • Fruity-smelling breath: A sign of diabetic ketoacidosis (DKA) — a medical emergency in Type 1
  • Nausea and vomiting: Often accompanies DKA

Important: Diabetic ketoacidosis (DKA) is a life-threatening emergency. If a child or young adult presents with these symptoms — particularly fruity breath, vomiting, and confusion — seek emergency medical care immediately.

Type 2 Diabetes — Gradual & Often Silent

Type 2 diabetes develops slowly, and many people have no symptoms at all in the early stages. When symptoms do appear, they are often mild enough to be dismissed or attributed to other causes.

Common symptoms of Type 2:

  • Increased thirst and frequent urination: Similar to Type 1 but usually less dramatic
  • Persistent fatigue: Cells cannot efficiently use glucose for energy; fatigue that sleep does not resolve
  • Blurred vision: Fluctuating blood sugar causes lens swelling and visual changes
  • Slow-healing wounds and infections: High blood glucose impairs immune function and circulation, slowing healing
  • Frequent infections: Particularly urinary tract infections, skin infections, and thrush (candida) — glucose feeds pathogenic organisms
  • Tingling, numbness, or burning in hands and feet: Early peripheral neuropathy from nerve damage
  • Darkened skin in body folds (acanthosis nigricans): Dark, velvety patches in the neck, armpits, or groin — a sign of insulin resistance
  • Unexplained weight changes: Weight gain (from insulin resistance) or, in advanced cases, weight loss
  • Increased hunger: Despite eating, cells are not efficiently absorbing glucose
  • Headaches and difficulty concentrating: The brain is highly sensitive to blood glucose fluctuations

Prediabetes — Usually No Symptoms

This is the most dangerous stage from a detection perspective: prediabetes almost never causes symptoms. The only way to know you have it is through a blood test.

This is why SEMDSA recommends routine screening for all adults over 45, and for younger adults with any of the following risk factors:

  • Overweight or obese (BMI ≥25)
  • Family history of Type 2 diabetes
  • History of gestational diabetes
  • High blood pressure (hypertension)
  • High cholesterol or triglycerides
  • Polycystic ovary syndrome (PCOS)
  • Physically inactive lifestyle
  • History of cardiovascular disease

Gestational Diabetes — Detected Through Screening

Gestational diabetes typically causes no symptoms and is detected through routine glucose screening during pregnancy (usually between weeks 24 and 28). Occasionally, women may notice increased thirst and urination — but these are also common in normal pregnancy, making symptom-based detection unreliable.

All pregnant women in South Africa should be screened for gestational diabetes as part of routine antenatal care.

The Complications That Develop in Silence

While diabetes itself may be silent, its complications are not. By the time many South Africans are diagnosed, early damage has already occurred in:

  • The kidneys (diabetic nephropathy): Diabetes is the leading cause of chronic kidney disease and kidney failure in South Africa
  • The eyes (diabetic retinopathy): Diabetes is the leading cause of preventable blindness in working-age adults
  • The nerves (diabetic neuropathy): Affecting up to 50% of people with long-standing diabetes — causing pain, numbness, and loss of sensation, particularly in the feet
  • The cardiovascular system: People with diabetes have 2–4 times the cardiovascular risk of non-diabetics — covered in depth in Part 6 of this series
  • The feet: Diabetic foot disease — a combination of neuropathy and poor circulation — is the leading cause of non-traumatic lower limb amputation in South Africa

When to Get Tested

The answer is: now, if you haven't recently. A simple fasting blood glucose test or HbA1c test at your doctor or clinic can tell you where you stand. It takes minutes. It could change your life.

Ask for:

  • Fasting plasma glucose (fast for 8 hours before the test)
  • HbA1c (no fasting required — reflects your average blood sugar over 3 months)

If your results are in the prediabetes range, Part 4 of this series covers exactly what you can do — naturally and effectively — to prevent progression to Type 2 diabetes.

Explore our blood sugar and metabolic health supplement range at Purple Cushhh SA — available online and in-store at Shop 108 Hibernian Towers, Beach Road, Strand, Cape Town.

This article is for educational purposes only. Always consult a qualified healthcare practitioner for diabetes screening, diagnosis, and management.

Sources: International Diabetes Federation Atlas 2023; SEMDSA Guidelines 2023; South African Medical Research Council; Diabetes South Africa.

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