Understanding Diabetes: Type 1, Type 2, Prediabetes & the South African Crisis

This is Part 1 of the Purple Cushhh 7-Part Diabetes Series. Over seven articles we cover everything South Africans need to know about diabetes — from understanding the condition to prevention, management, complications, nutrition, and natural support.

A Silent Epidemic in Our Midst

According to the International Diabetes Federation (IDF) Diabetes Atlas 2023, approximately 4.2 million South Africans are living with diabetes. An estimated equal number remain undiagnosed — walking around with dangerously elevated blood sugar, silently accumulating damage to their blood vessels, nerves, kidneys, and eyes.

The Society for Endocrinology, Metabolism and Diabetes of South Africa (SEMDSA) reports that South Africa has one of the highest diabetes prevalence rates in sub-Saharan Africa, with Type 2 diabetes accounting for over 90% of all cases. The condition is the second leading cause of premature death in South Africa after HIV/AIDS, and a major driver of cardiovascular disease, kidney failure, blindness, and amputation.

Yet despite its scale, diabetes remains profoundly misunderstood. Many South Africans don't know they have it. Many who do don't fully understand what is happening in their bodies. And many don't know that Type 2 diabetes — the most common form — is largely preventable, and in its early stages, potentially reversible.

This series is about changing that.

What Is Diabetes?

Diabetes mellitus is a group of metabolic diseases characterised by chronically elevated blood glucose (blood sugar), resulting from defects in insulin production, insulin action, or both.

To understand diabetes, you first need to understand insulin.

How Insulin Works

When you eat carbohydrates, your digestive system breaks them down into glucose, which enters the bloodstream. Rising blood glucose signals the pancreas to release insulin — a hormone produced by beta cells in the pancreatic islets of Langerhans.

Insulin acts like a key: it unlocks the doors of your cells, allowing glucose to enter and be used for energy. Without insulin — or when cells stop responding to it — glucose accumulates in the bloodstream. This is the defining feature of all forms of diabetes.

Chronically elevated blood glucose is toxic to blood vessels and nerves. Over time, it causes the devastating complications that make diabetes one of the leading causes of blindness, kidney failure, heart attack, stroke, and lower limb amputation worldwide.

The Four Main Types of Diabetes

Type 1 Diabetes

Type 1 is an autoimmune condition in which the immune system mistakenly destroys the insulin-producing beta cells of the pancreas. The result is an absolute deficiency of insulin — the body produces none at all.

  • Onset: Usually in childhood or young adulthood, though it can occur at any age
  • Cause: Autoimmune destruction of beta cells; genetic and environmental triggers
  • Management: Lifelong insulin therapy is non-negotiable — Type 1 cannot be managed without insulin
  • Prevalence in SA: Approximately 5–10% of all diabetes cases
  • Key distinction: Type 1 is not caused by lifestyle and cannot be prevented or reversed

Type 2 Diabetes

Type 2 is a metabolic condition characterised by insulin resistance — cells throughout the body stop responding normally to insulin — combined with progressive decline in the pancreas's ability to produce enough insulin to compensate.

  • Onset: Usually in adulthood, but increasingly in younger people and adolescents in SA
  • Cause: A combination of genetic predisposition and lifestyle factors — particularly excess body weight, physical inactivity, poor diet, and chronic stress
  • Management: Lifestyle modification, oral medication, and in advanced cases, insulin
  • Prevalence in SA: Over 90% of all diabetes cases
  • Key distinction: Type 2 is largely preventable and, in its early stages, potentially reversible through intensive lifestyle intervention

Prediabetes

Prediabetes is the critical warning stage — blood glucose levels are elevated above normal but not yet high enough to meet the diagnostic criteria for Type 2 diabetes. SEMDSA estimates that millions of South Africans are in this stage without knowing it.

  • Fasting glucose: 5.6–6.9 mmol/L (normal is below 5.6; diabetes is 7.0 and above)
  • HbA1c: 39–47 mmol/mol (5.7–6.4%)
  • Risk: Without intervention, approximately 15–30% of people with prediabetes will develop Type 2 diabetes within 5 years
  • Opportunity: With lifestyle intervention, progression to Type 2 can be prevented or significantly delayed — this is the most important intervention window

Gestational Diabetes

Gestational diabetes develops during pregnancy in women who did not previously have diabetes. It occurs when pregnancy hormones cause insulin resistance that the pancreas cannot fully compensate for.

  • Affects approximately 7–14% of pregnancies in South Africa
  • Usually resolves after delivery, but significantly increases the mother's lifetime risk of developing Type 2 diabetes
  • Requires careful management during pregnancy to protect both mother and baby

Why South Africa Is So Vulnerable

The South African diabetes epidemic is driven by a convergence of factors that are deeply embedded in our social, economic, and cultural landscape:

  • Dietary transition: Rapid urbanisation has shifted diets away from traditional whole foods toward ultra-processed foods high in refined carbohydrates, sugar, and unhealthy fats
  • Physical inactivity: Sedentary work and urban lifestyles have dramatically reduced physical activity levels
  • Obesity: South Africa has one of the highest obesity rates in Africa — a primary driver of insulin resistance
  • Genetic predisposition: Certain South African population groups have higher genetic susceptibility to insulin resistance and Type 2 diabetes
  • Chronic stress: Poverty, inequality, unemployment, and social instability drive chronic cortisol elevation — a direct contributor to insulin resistance
  • Healthcare access: Limited access to screening and early intervention means many cases are diagnosed late, when complications have already begun

Know Your Numbers

SEMDSA recommends that all South African adults over 45 — and younger adults with risk factors — be screened for diabetes and prediabetes. The key diagnostic markers are:

  • Fasting plasma glucose: Normal <5.6 mmol/L | Prediabetes 5.6–6.9 | Diabetes ≥7.0
  • HbA1c (3-month average blood sugar): Normal <39 mmol/mol | Prediabetes 39–47 | Diabetes ≥48
  • 2-hour glucose tolerance test: Normal <7.8 mmol/L | Prediabetes 7.8–11.0 | Diabetes ≥11.1

If you have not been screened recently — particularly if you have a family history of diabetes, are overweight, or have high blood pressure — make it a priority. Early detection is everything.

What's Coming in This Series

  • Part 2: The Warning Signs — Symptoms by Type & Why SA Has So Many Undiagnosed Cases
  • Part 3: The Blood Sugar Rollercoaster — How Glucose Spikes Damage Your Body
  • Part 4: Prevention & Natural Support — Can Type 2 Be Reversed?
  • Part 5: Living Well With Diabetes — Daily Management & Natural Supplements
  • Part 6: Diabetes & Your Heart — The Cardiovascular Connection
  • Part 7: The Diabetes Nutrition Guide — What to Eat, What to Avoid, Your Supplement Stack

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 and does not constitute medical advice. Always consult a qualified healthcare practitioner for personalised diabetes management guidance.

Sources: International Diabetes Federation Atlas 2023; Society for Endocrinology, Metabolism and Diabetes of South Africa (SEMDSA); South African Medical Research Council; Statistics South Africa.

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