Living with Diabetes in South Africa

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I just celebrated a decade of living Type 1 diabetes (sadly, there was no cake). I was diagnosed just after I moved to Cape Town from my hometown of Durban (both in South Africa). At the time, I knew absolutely nothing about diabetes. Which is how I ended up in ICU, days away from a diabetic coma, and with blood sugar so high the meter just said HI.

After five days in the hospital I was sent home with an armload of pamphlets and informational brochures and a deeply depressing diabetes magazine (the only one in South Africa at the time). I devoured everything, desperate for information, trying to understand this strange new world I found myself in. It all said the same thing: as a diabetic, I was now at increased risk of blindness, amputation, heart disease, kidney failure… The list went on. Nowhere in all of that literature did anyone say: or, if you take care of yourself, you can live a long and happy life with diabetes.

I was 25 when I was diagnosed, I’m 35 now. In the past decade, I’ve travelled the world: America, Thailand, Cambodia, Indonesia, Vietnam, Brazil, Argentina, Ireland, Italy, Scotland, Spain, and all over South Africa. I’ve scuba dived and hiked the Otter Trail and the Whale Trail (two multi-day hikes, one of which is known as the most challenging in SA). I’ve walked 500km across the North of Spain on the Camino de Santiago and successfully birthed two healthy babies – perhaps the biggest adventure of all!

I also started a diabetes lifestyle magazine and online community called (funnily enough) Sweet Life. We published 20 print issues of the magazine and distributed it around South Africa (for free) before moving entirely online this year – take a look at www.sweetlifemag.co.za and Diabetic South Africans.  

When I was first diagnosed, I felt like I was the only person with diabetes… The only one who had ever had to deal with learning how to eat again, and counting carbs, and injecting and testing blood sugar and figuring out what all of that meant. Our goal with Sweet Life has been not only to unite people with diabetes in South Africa, but to show how possible it is to live a healthy, happy life with the condition. Since 2011 we’ve been driving home the message that yes, the complications are serious. But if you look after yourself and take your medication and live a healthy lifestyle, there’s nothing you can’t do.

What I find odd about living with diabetes in South Africa is that I think in many ways we’re still a decade behind diabetes in the U.S. There are insulin pumps (two options – Medtronic and Roche) but they are prohibitively expensive and not covered in full by medical aid (our monthly medical insurance). Your doctor can push for you to get one, which is what often happens with children, but for the average person with Type 1 like me (middle class, working full-time, mom to two young kids) it’s not really an option. CGMs, too, are available but to an elite niche or to families who choose to spend most of their money on medical supplies as opposed to, you know, food and paying off a house and school fees and all that fun stuff…

I realized quite how laidback South African diabetes care is during both my pregnancies. I read a fair number of diabetes blogs from overseas and had an idea of what a pregnancy with diabetes in the U.S. looked like. While it was considered a high-risk pregnancy here, I still only saw my OB/GYN the same recommended number of times as those without diabetes, until the last few weeks. I saw my endocrinologist every month instead of every 3 to 4 months, and had to have a monthly HbA1c instead of a quarterly one (with results of 6.0 or under). I got an extra box of strips (200 instead of 150 a month) so I could test 7 times a day and keep my blood sugar tightly controlled (7.8mmol/l one hour after eating, which is 140mg/dl). But aside from that, I was left to my own devices. I had both of my babies at 38 weeks by C-section (it was either that or induction) and both were 100% healthy, although a few days earlier than scheduled, because right at the end my blood pressure spiked. They both had a few days of fluctuating low blood sugar right after birth, but nothing serious.

And that was it: I was in hospital figuring things out on my own. My OB/GYN popped in as she did with all her patients. My endocrinologist was available on the phone or WhatsApp. But everyone assumed (rightly) that I knew my blood sugar better than anyone and would continue to inject as and when I needed.

And I suppose it’s this somewhat cavalier approach to a high-risk pregnancy (admittedly a very smooth one) that has flavored my experience of diabetes in South Africa. Perhaps it’s why I’m reluctant to go onto a pump or a CGM. While diabetes is absolutely a huge part of my life, it’s by no means the defining part. Having a baby was the most important part of me being in hospital: daily life is the most important part of my every day. And yes, diabetes was and is a factor, but it’s by no means the biggest factor.

I now have a 1-year-old and a 3-year-old and life is busy and full and wonderful and exhausting. My HbA1c results have remained surprisingly stable this year, despite never feeling like I have a spare moment to myself to do anything. And while I don’t know what the long-term will bring, because none of us do, it’s been ten years so far without complications and I feel well. (And sleep-deprived.)

*ASweetLife.org is not affiliated with SweetLife.

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