PHILA TODAY · LIVE WELL · EAT WELL · MOVE WELL
DIABETES SERIES · ARTICLE 12 OF 17
Living well with diabetes
The long view.
This article is a turning point in our diabetes series. We have spent eleven articles covering what diabetes is, how to recognise it, what to eat, how to move, how to read labels, how to test, how to handle a low, how to handle a sick day, how to protect your eyes and kidneys and heart and feet.
This article is different. It is not about a single skill or piece of knowledge. It is about how to keep doing all of those things — week after week, year after year, decade after decade. Because diabetes is not a sprint. It is a long, quiet road, and the people who walk it best are not the ones with the most information. They are the ones who have built a sustainable rhythm and a real life around their condition.
If you have read this far, you already care. That alone is most of what matters.
Before you read on
This article is more personal than the others. It draws on what we know from research, from clinical practice, and from listening to people who have lived with diabetes for ten, twenty, thirty years. The medical content is light here — by now, you have it. What we want to talk about is the harder part: how to keep going.
The first year
The first year of a diabetes diagnosis is unlike any year that follows. There is a flood of information — much of it confusing, contradictory, or written for someone in a different country with a different food culture and a different health system. There are new tablets or injections to learn. There is the shock of being told you have a chronic condition that will be with you for life. There is, often, fear.
Most people in their first year make every change at once and then exhaust themselves trying to maintain it. Three weeks of perfect eating, a month of daily exercise, religious testing — and then a slow drift back to old habits because the intensity wasn't sustainable.
This is normal. It is not failure. It is the natural response to a difficult diagnosis. The work of the first year is to find the changes that you can actually keep — not the ones that look most impressive on paper.
The first-year rule
Build one habit at a time. Make it small enough that you can do it on the worst day of your year. Then add the next one only when the first feels automatic. Three habits a year, repeated, beats twelve habits in week one and zero in week ten.
The fifth year
By year five, the new diagnosis isn't new anymore. You know what your body responds to. You have a routine — testing, medication, foods that work, the walk that fits your day. You have probably also drifted. Almost everyone does. A skipped test here, a forgotten medication there, a few months of eating less carefully. Then a clinic visit reveals an HbA1c that has crept up, and you re-commit.
This is the rhythm of long-term diabetes for most people. Periods of tight control, periods of looser control, periods of re-commitment. It is not a failure of character. It is what humans do with any long-term task that has no end date.
What helps in the fifth year:
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Regular clinic visits — every 3 to 6 months, no excuses. They are how you catch the drift before it becomes a crisis.
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A friend or family member who knows your numbers — not to nag, but to ask the right questions when you go quiet about diabetes.
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An identifiable next goal — “I want my HbA1c at 7.0 by my next visit” is more motivating than “I should be doing better”.
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Permission to be imperfect. Five years is a long time. You will not be perfect across five years. The aim is to be roughly on track, most of the time.
The tenth year
By year ten, things have shifted again. The condition is part of your identity in a way you don't even notice anymore. Testing is something you do without thinking. Medication is just part of the morning. You have probably learned, through trial and error, what your body uniquely needs.
You may also have hit the wall called diabetes burnout — the slow, accumulated weight of having paid attention to one thing for so many years. It is a real and well-documented phenomenon. It looks like:
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Stopping testing — “I just don't want to know”
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Skipping medication occasionally, then more often
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Avoiding clinic visits
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Eating without thinking about it for the first time in years
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Feeling resentful or angry about diabetes for no obvious reason
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A creeping sense of not caring
Burnout is not weakness. It is the predictable response to a decade of being “the responsible one”. The way out is not more willpower — it is rest, reconnection, and sometimes professional support. A counsellor who specialises in chronic illness, or a peer support group, can be transformative. Diabetes South Africa runs both.
If you recognise yourself in burnout
You are not alone. Surveys suggest 30 to 40% of people with long-standing diabetes experience burnout at some point.
The first step is to admit it — to yourself, to a doctor, to someone you trust. The second is to scale back temporarily on the most demanding parts of self-care while keeping the safety basics (medication, basic testing, clinic visits).
The Phila Today Mental Health tab has more on coping. Talk to your clinic. This is treatable.
The four anchors of a sustainable diabetes life
People who walk this road well for decades tend to share four anchors. Not all of them all the time, but most of them most of the time.
1. A relationship with a clinic
Not just any clinic — your clinic. A place where they know your file, where you trust the nurse or doctor, where you can ask questions without feeling rushed. If your current clinic doesn't feel like that, ask to be transferred to a different one. The relationship matters more than the institution.
2. A few non-negotiable daily habits
Pick three. Maybe it is medication at the same time every day, a walk after dinner, and checking your feet at night. Whatever you pick, the rule is: these three happen even on bad days. Everything else can be flexible.
3. People who know about your diabetes
At least one person at home, at least one person at work, at least one person socially. They don't need to fuss. They need to know how to spot a low and where the sugar is. People with isolated diabetes do worse — biologically and emotionally.
4. A reason to be well
This is the quietest but most important anchor. A grandchild you want to dance at the wedding of. A business you are building. A garden you tend. A book you are writing. A purpose larger than yourself. Without one of these, diabetes management feels like maintenance for its own sake. With one, every walk and every meal becomes an investment in something you love.
The reading list — back to the series
When something comes up that you want to think about again, here's the full Phila Today Diabetes Series for reference. Each one stands alone; together they cover most of what a person with diabetes needs to know.
Article When to come back to it 1. What is diabetes? When someone you love has just been diagnosed, or when you forget why this matters. 2. Type 1 vs Type 2 When you're confused about which advice applies to you. 3. 10 affordable SA foods When the shopping bill feels heavy or the menu feels boring. 4. Pap, samp and rice When you've been told to give up the food you grew up with. 5. 12-week walking plan When you need to start again. Many people use this multiple times. 6. Reading a food label Every shopping trip. Once read, twice as easy. 7. Blood sugar testing When a number worries you or your routine has slipped. 8. Hypoglycaemia If you're on insulin — read it again before any change in routine. 9. Looking after your feet Every time you buy new shoes. And once a year as a refresher. 10. Long-term complications Annually around your clinic check — to know what tests to ask for. 11. Sick day rules BEFORE you get sick. Print and keep on the fridge. 12. This article Whenever you need to remember why this is worth it.
A note for the people who love someone with diabetes
If you are reading this because someone you love has diabetes — partner, parent, child, friend — thank you. The single biggest factor in how someone does with diabetes is whether they feel supported. Not whether they have the best clinic or the most expensive medication. Whether they have someone in their corner.
What to do:
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Learn what a low looks like. Know where the sugar is kept.
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Don't be the diabetes police. Constant monitoring builds resentment, not health.
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Change the household, not just the person. Cook one meal, not two.
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Walk with them. Cook with them. Eat with them.
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Ask “how are you doing with all this?” at least sometimes. Not just “how was your test?”
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Be patient through the bad weeks. They will pass.
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Look after yourself too. Caring for someone with a chronic condition is heavy.
The bigger picture
Diabetes is not a sentence. It is a chronic condition that responds to consistent, kind, ordinary care. The science of treating it is the best it has ever been. The food we recommend is food South African families have been eating for generations. The exercise we recommend is walking. The most important monitoring is a clinic visit every few months and a moment of attention every day.
If you do these things, broadly and most of the time, the future you are heading toward is not the worst-case scenario in article 10. It is a long, full life with a manageable condition. There are millions of South Africans walking that road right now. Today you joined them.
Thank you for reading this far. The next article in the series turns to children and teenagers with diabetes — the unique challenges of a condition that started before adulthood, and what families need to know.
Where to get more help
Diabetes South Africa — diabetessa.org.za · 011 792 9888 — information, support groups, finding a registered dietitian
Your nearest public clinic — free chronic care, screening tests, education
Phila Today Eat tab — recipes throughout the series ingredient list
Phila Today Move tab — exercises for the days you can't get outside
Phila Today Mental Health tab — for when diabetes burnout becomes too heavy
PHILA TODAY
Live well. Eat well. Move well.
Article 12 of 17. The series continues. Your life continues.