Diabetes Update

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Chapter 1:   How the blood sugar is normally regulated in your body
Chapter 2:  What is diabetes and how is it diagnosed?
Chapter 3:  How common is diabetes and how does it develop
Chapter 4:  Acute complications of diabetes: ketoacidosis and hyperosmolar nonketotic diabetic coma
Chapter 5:  Long-term complications of diabetes: macrovascular disease, microvascular disease and neuropathy
Chapter 6:  Management of diabetes: principles and guidelines
Chapter 7:  Diabetes in special situations: pregnancy, surgery and chronic pancreatitis
Chapter 8:  Hypoglycaemia (low blood sugar)
Chapter 9:  Future trends in diabetes research
Appendix 1 Biochemical pathways of intermediary metabolism (the metabolic map)
Appendix 2 Detailed protocol for treatment of diabetic ketoacidosis
Appendix 3 Detailed food tables
Appendix 4 Sulphonylureas available in South Africa
Chapter 10:Interesting new perspectives on diet

Important contributors to Diabetes research and management.

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Diabetes mellitus has become a major health problem world-wide. The global prevalence is currently estimated at 350 million people and is set to increase, especially in 3rd world countries. It’s prevalence has more than doubled in the last 30 years. However, the impact of other diseases such as HIV/AIDS will modify the magnitude of the predicted epidemic.

In this short book, I have attempted to highlight some of the main issues in the field of diabetes that concern patients, health-care professionals and medical students – a rather wide cavern to bridge! It is certainly not a complete monograph on the subject: to do this would require a text that runs to several hundred pages.

(And many are already available). Rather, I have concentrated on practical aspects, with preventive measures being emphasised wherever possible. This is particularly relevant in view of the findings of recent major studies such as the DCCT and UKDPS.

There is little that is original in this review, but hopefully a clear exposition of existing knowledge has been presented.

Acknowledgement is readily given to the following sources: Practical Diabetes Management – Wits Diabetes Group; Clinician’s

Manual on Non-insulin-dependent Diabetes Mellitus – P Zimmet and M Cohen; Diabetes Mellitus: a fundamental and clinical text – edited by D Leroith, S Taylor and J Olefsky. Other sources have been acknowledged in the text itself. Gratitude to Mrs C Tennick for her editorial skills. I am particularly indebted to Loreine Saunders for compiling the detailed Food Tables listed in Appendix 3. They provide a comprehensive and practical guide to sensible eating and I endorse them fully! More information will be found in her own book “Know Your Diet: The Prudent Diet.”

This book is dedicated to my wife, Rebecca and our extended family.



Professor Barry I Joffe MB, FRCP, DSc, FCP(SA), Emeritus Professor of Medicine University of the Witwatersrand Medical School Consultant Endocrinologist, CDE, Johannesburg


My father died from the complications of adult-onset diabetes. Not for one moment did I ever consider that I might be at risk from the same disease. After all, I had been extraordinarily active in my adult life completing more than 70 marathon and ultramarathon races. I had also eaten the “heart-healthy” “diabetes-preventing” low fat “prudent” diet since at least 1977 when it began to be promoted for the first time. Yet in my sixty-first year I discovered that my blood glucose control was sufficiently disturbed for me to be diagnosed as a diabetic in waiting. I conclude that as a result of my genetic predisposition, far from saving me from diabetes, this high carbohydrate “healthy” diet had actively promoted the progression of my disease.

By a series of co-incidences, I decided that the most effective eating plan for me would be one that minimized the amount of carbohydrates I ate - in effect the polar opposite of the low fat, “heart healthy” “prudent” diet that I had stuck to religiously for more than 33 years. The results are nothing short of spectacular. By increasing my fat intake to 60% of my daily calories and restricting my intake of carbohydrates to less than 50-70 grams per day, not only did I lose 15kg effortlessly and without any trace of hunger, my energy levels and quality of life increased dramatically. I again felt as I had when I was a medical student. My running performances that had been in progressive decline for more than 20 years suddenly improved spectacularly. Medically every single biological and cardiological measure of my health also improved - some substantially - on this medically-incorrect low carbohydrate high fat (LCHF) “non-prudent” diet. But not everyone was happy with this dazzling transition - many thoughtfully took the time to write, warning me that I have chosen the path of contravention and am headed for an early grave.

So what has this experience taught (read more)


Professor Tim Noakes OMS, MD, DSc, PhD (hc), FACSM, (honorary) FFSEM (London) University of Cape Town and Sports Science Institute of South Africa