Type 2 diabetes – managing it day to day in South Africa
What the glucose numbers mean, why metformin is almost always first, and the daily habits that decide how the next twenty years go.
Reading your own glucose numbers
A glucose reading only means something once you know when you took it. The same number can be good after a meal, but poor before one. A meter that does not record this context is only half useful.
- Fasting, or before a meal: the general self-monitoring target for someone on treatment is 4.0 to 7.0 — not the tighter range used to diagnose diabetes in someone who does not have it. Your clinician sets your actual target, since it is adjusted for your medicines, age and other conditions, so ask what yours is rather than assuming.
- Two hours after a meal: the general self-monitoring target for someone on treatment is up to about 10.0. Again, this is a target your clinician sets and adjusts for you, not a fixed line — ask what applies in your case.
- Below 3.9 is low, at any time of day, and needs treating immediately.
Your clinic will also check your HbA1c. This reflects your average glucose over roughly three months, and it is the number that predicts long-term complications. You cannot improve it just by being careful for the week before the test.
Why metformin is nearly always the starting point
metformin (Glucophage) is the first medicine doctors try for type 2 diabetes, in South Africa and almost everywhere else. On its own, it lowers glucose without causing hypoglycaemia. 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. That is why doses start low and increase slowly, and why you take it 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.
Medicines commonly added when one is no longer enough:
Gliclazide — Diamicron, Diamicron MR, Adco-Gliclazide, Glical
Type 2 diabetes mellitus — sulphonylurea with lower hypoglycaemia risk
Empagliflozin — Jardiance, Synjardy (with metformin)
Type 2 diabetes; heart failure with reduced ejection fraction; chronic kidney disease
Sitagliptin — Januvia
Type 2 diabetes — as add-on to metformin or other agents
Insulin Isophane (NPH) — Protaphane, Humulin N, Insuman Basal
Type 1 and Type 2 diabetes — intermediate-acting basal insulin
The checks that prevent the complications
Most diabetes damage is preventable, and none of it announces itself early. The routine checks exist to catch it while it can still be reversed.
- Feet: look at them every day, including between the toes and the soles. Nerve damage means an injury can go unnoticed until it gets infected. Never walk barefoot outdoors.
- Eyes: get a retinal screening at the intervals your clinic advises. Early retinopathy has no symptoms, and it is treatable — once vision changes, it is much harder to treat.
- Kidneys: a urine and blood test catches early damage, while medication can still slow it down.
- Blood pressure and cholesterol: controlling these matters as much as glucose does for preventing heart attack and stroke.
Eating well on a South African plate
You do not need special or expensive food. The changes that matter most are about your starch portion — that is where most of the glucose in a typical local meal comes from.
More of these:
- Vegetables — fill the space you free up by halving your starch portion. This does more than anything else here.
- Stiffer, less refined starches, where you can.
- Beans or lentils — they slow glucose release considerably.
- Water.
Less of these:
- Pap, rice, bread or potato — halve your usual portion.
- 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.
Common questions
- Can type 2 diabetes be reversed?
- Some people achieve remission — normal glucose without medication — usually through substantial, sustained weight loss relatively early after diagnosis. It is genuinely possible but it is not the expected outcome for everyone. Type 2 diabetes is progressive: the pancreas produces less insulin over time regardless of how well it is managed, which is why remission still needs ongoing monitoring, since glucose can rise again even after it improves.
- Why is my morning reading the highest of the day?
- The body releases glucose overnight to prepare for waking, so a raised fasting reading is common and does not necessarily mean you ate badly the night before. A single reading also does not tell the whole story — your clinic's HbA1c test reflects your average glucose over roughly three months and is a better guide to how things are really trending. Bring the morning pattern to your clinician rather than adjusting medication yourself — the fix depends on the cause.
- Do I still need medicine if my readings are good?
- Good readings on treatment mean the treatment is working, not that the underlying condition has gone away. Stopping usually sends glucose back up over the following weeks, because type 2 diabetes does not reverse itself just because it is currently well controlled. Any reduction in your medicines should be planned with your clinician, with testing to confirm it holds.
Sources
- SEMDSA Guideline for the Management of Type 2 Diabetes MellitusSociety for Endocrinology, Metabolism and Diabetes of South Africa
- Adult Hospital Level and Primary Healthcare Standard Treatment Guidelines and EMLNational Department of Health, South Africa
Sources last checked 4 August 2026.