Living with type 2 diabetes

A glucose reading only means something alongside when you took it. The same number can be good after a meal and poor before one, which is why a meter that does not record context is only half useful.

• Fasting, or before a meal — roughly 4.4 to 5.5 is the target range for most people. From 5.6 to 6.9 is raised; 7.0 and above is high.
• Two hours after a meal — up to about 7.8 is the goal. Between 7.8 and 11.0 is raised; 11.1 and above is high.
• Below 3.9 is low, at any time of day, and needs treating immediately.

Your clinic will also check HbA1c, which reflects average glucose over roughly three months. It is the number that predicts long-term complications, and it cannot be improved by being careful for the week before the test.

metformin (Glucophage) is first-line treatment for type 2 diabetes in South Africa and almost everywhere else. It lowers glucose without causing hypoglycaemia on its own, it does not cause weight gain, and it has decades of safety data behind it.

Its main drawback is stomach upset in the first weeks — nausea, cramping, loose stools. This is why doses are started low and increased slowly, and why it is taken with food. Most people settle within a few weeks, and a slow-release form helps those who do not. Stopping in week one because of stomach upset is the most common avoidable reason people end up on more complicated treatment later.

Most diabetes damage is preventable and none of it announces itself early. The routine checks exist to catch it while it is still reversible.

• Feet — look at them daily, including between the toes and the soles. Nerve damage means an injury can go unnoticed until it is infected. Never walk barefoot outdoors.
• Eyes — a retinal screening at the intervals your clinic advises. Early retinopathy has no symptoms and is treatable; by the time vision changes it is much harder.
• Kidneys — a urine and blood test to catch early damage, when medication can still slow it.
• Blood pressure and cholesterol — controlling these matters as much as glucose for preventing heart attack and stroke.

You do not need special or expensive food. The changes that matter most are about the starch portion, which is where most of the glucose in a typical local meal comes from.

• Halve the pap, rice, bread or potato portion and fill the space with vegetables. This does more than anything else on this list.
• Choose stiffer, less refined starches where you can, and add beans or lentils — they slow glucose release considerably.
• Drink water rather than sugary cool drinks and juice. A single 500 ml sugary drink can undo a careful meal.
• Eat at regular times, particularly if you take insulin or a sulfonylurea, because skipping meals on those medicines causes lows.