By Mbali Mapholi, Canderel Partner Dietitian.
As a dietitian, the question I hear most often after a diabetes diagnosis is not “What is diabetes?” It is “So, what can I eat now?”
That question says a great deal. Most South Africans have heard of diabetes. We know it is serious, and we know that food and lifestyle play a role. Far fewer people feel confident about what that actually means for the plate in front of them on an ordinary Tuesday evening. As November approaches and World Diabetes Month brings diabetes back into the spotlight, it is this gap between awareness and understanding that we need to close.
The numbers are closer to home than we think
Statistics South Africa’s latest mortality report, released in September, shows that diabetes mellitus was the leading underlying natural cause of death in South Africa in 2024, for the third year in a row. It accounted for 6.1% of the 474,366 deaths recorded that year, which works out to roughly 79 lives every day. Among women, it was the single leading cause of death, responsible for 7.9% of all female deaths.
Behind each of those numbers is a family, and very often a story that began years earlier with raised blood glucose that went unnoticed, or that was picked up but never properly explained.
This is why the international theme for World Diabetes Day 2026 and 2027, “Early Action on Diabetes”, is so fitting. South Africa is already strengthening early detection: the National Department of Health reported more than 44 million screenings for elevated blood glucose during the 2024/25 financial year. But a screening result is only the beginning. What happens in the kitchen afterwards matters just as much as what happens in the clinic.
Early action works, and much of it starts with food
One of the most encouraging findings in diabetes research comes from the landmark Diabetes Prevention Program in the United States. People with prediabetes who made sustained lifestyle changes, including modest weight loss of around 7% of body weight and about 150 minutes of physical activity a week, reduced their risk of developing type 2 diabetes by 58%.
The message for South Africans is a hopeful one. Type 2 diabetes is not inevitable, and for people living with diabetes, everyday eating habits remain one of the most powerful tools for managing blood glucose alongside the treatment prescribed by their healthcare team. If you have a family history of diabetes, are over 45, carry extra weight around your middle or had diabetes during pregnancy, ask for a blood glucose test at your next clinic or pharmacy visit. Knowing your numbers early gives you the most room to act.
There is no such thing as a “diabetes diet”
A persistent myth I encounter is that a diagnosis means a separate, restrictive way of eating: no more bread, no fruit, nothing sweet ever again. In reality, the eating pattern that supports healthy blood glucose levels is the same balanced pattern that benefits the whole family. Foods are not simply “good” or “bad”. What matters is the overall pattern, portion sizes, how often we eat certain foods and whether our choices are realistic enough to keep up for years, not weeks.
A simple starting point I use with clients is the plate method. Fill half the plate with non-starchy vegetables such as spinach, morogo, cabbage, green beans, carrots or tomatoes. Fill a quarter with lean protein such as beans, lentils, chicken, fish or eggs. Fill the final quarter with a high-fibre starch such as brown rice, samp and beans, whole-wheat bread or sweet potato. Carbohydrates are not the enemy. The type and the amount are what count, and fibre helps slow the rise in blood glucose after a meal. Eating at regular times, rather than skipping meals and overeating later, also helps keep blood glucose steadier through the day.
Know where sugar hides
South Africa’s Food-Based Dietary Guidelines advise us to use sugar and foods and drinks high in sugar sparingly, and the World Health Organisation recommends keeping free sugars below 10% of daily energy intake, ideally below 5%. For most adults, that lower target is about six teaspoons a day.
In practice, much of our added sugar comes from what we drink rather than what we eat. A 500ml regular soft drink can contain more than ten teaspoons of sugar. Two teaspoons in each of four cups of tea or coffee adds up to eight teaspoons before a single meal. Reading labels helps too: ingredients are listed from largest to smallest quantity, and sugar appears under many names, including sucrose, glucose syrup, dextrose, fructose, maltose and invert sugar.
Where sweeteners fit, and where they don’t
Reducing added sugar does not have to mean giving up enjoyment. For many of the people I work with, switching to a low-calorie sweetener in tea, coffee or home baking is a realistic first step. It lowers added sugar intake without the sense of deprivation that so often derails good intentions. Sweeteners approved for use in South Africa have undergone safety assessment and provide sweetness with little or no sugar.
But a sweetener is a tool, not a treatment. It will not undo an eating pattern built on large portions and refined starches, and it works best alongside gradually retraining the palate to enjoy less sweetness overall. Every person’s needs are different, which is why anyone living with diabetes should seek personalised advice from a registered dietitian or their doctor.
The goal is not perfection. It is informed, sustainable decision-making, one meal at a time.
Why the conversation cannot wait for November
By the time World Diabetes Month arrives, media platforms and social feeds will be crowded with statistics, awareness messages and health advice. That visibility is valuable, but nobody should need a designated month to start understanding their health or speaking to a healthcare professional.
For brands in the nutrition space, there is a responsibility to contribute to this conversation carefully. That means going beyond promoting products and helping consumers understand the broader context in which those products may be used.
At Canderel, our focus is on supporting informed choices around sugar reduction, while recognising that individual nutritional needs differ and that people living with diabetes should be guided by qualified healthcare professionals.
World Diabetes Month gives us an opportunity to amplify the conversation. The real opportunity is to make that conversation practical enough to continue long after November ends.
We know about diabetes. Now, we need to understand it better.