Diabetes: how to spot it, treat it, and live well with it

Diabetes is when the sugar (glucose) in your blood is too high. Over time, high blood sugar damages your eyes, kidneys, nerves, and blood vessels — but with the right care most people with diabetes live a full, active life.

Diabetes is becoming more common in Ethiopia, especially in cities. Getting tested and started on treatment early is the single most protective thing you can do.

On this page

• The two main kinds of diabetes
• Early signs
• Getting tested
• Managing diabetes — diet
• Managing diabetes — activity
• Medicines and insulin
• The 4 checks every person with diabetes needs each year
• When to get help urgently

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The two main kinds of diabetes

Type 1 — the body cannot make insulin at all. Usually starts in children and teenagers. Needs insulin injections for life.

Type 2 — the body makes some insulin but does not use it well. Usually starts in adults over 40. Often manageable with diet, exercise, and tablets; sometimes needs insulin.

There is also gestational diabetes — high blood sugar during pregnancy — which usually goes away after birth but raises the mother’s future Type 2 risk.

Most diabetes in adults in Ethiopia is Type 2.

Early signs

Early diabetes often has no symptoms — that is why testing matters. When symptoms do appear, they include:

• Passing urine more often than usual (especially at night)
• Feeling very thirsty
• Losing weight without trying
• Feeling very tired
• Blurred vision
• Cuts and wounds that heal slowly
• Frequent skin or urine infections
• Numbness or tingling in the hands or feet

::: urgentAdvice severity=“urgent”

Urgent advice: go to a health facility today if you also have:

• Fruity smell on your breath
• Rapid, deep breathing
• Vomiting that will not stop
• Extreme drowsiness or confusion
• Very frequent urination with strong thirst that will not go away

These can be signs of diabetic ketoacidosis — a life-threatening emergency. Do not wait. :::

Getting tested

Ask for a blood sugar test at any health centre if you have any early symptoms, or as a routine check if you are:

• Aged 40 or older
• Overweight, especially around the waist
• Have a parent or sibling with diabetes
• Had gestational diabetes in a previous pregnancy
• Have high blood pressure

Fasting blood sugar (no food for 8 hours before the test):

• Under 100 mg/dL — normal
• 100-125 mg/dL — pre-diabetes (a warning — lifestyle changes now can prevent Type 2)
• 126 mg/dL or higher, on two different days — diabetes

Random blood sugar (any time of day):

• 200 mg/dL or higher, with symptoms — diabetes

HbA1c (measures the past 3 months) — the best long-term measure:

• Under 5.7% — normal
• 5.7-6.4% — pre-diabetes
• 6.5% or higher — diabetes

Government health centres offer fasting blood sugar tests free or at very low cost.

Managing diabetes — diet

Food is your most powerful medicine. You do not need special “diabetic” foods. You need normal food, in the right amounts, at regular times.

::: doList

Do

• Eat at set times — 3 meals + 1-2 snacks per day
• Base each meal on vegetables — half your plate
• Choose whole grains — barley, teff, whole wheat, brown rice — over white rice and white bread
• Include a protein — lentils, beans, eggs, milk, fish, or lean meat
• Small portions of injera — one at a time, not several
• Drink water — 6-8 cups a day
• Read food labels for hidden sugar (in “healthy” biscuits, packet drinks, condensed milk)
• Weigh yourself monthly if you are trying to lose weight :::

::: dontList

Don’t

• Do not skip meals — this causes blood sugar swings
• Do not drink soft drinks, packet fruit juices, or sweetened tea — one 500 ml bottle can have 10 spoons of sugar
• Do not add sugar to coffee or tea (or use much less)
• Do not eat large amounts of sweets, cakes, or biscuits — small portions, occasionally
• Do not smoke — smoking doubles the risk of complications
• Do not drink more than 1-2 alcoholic drinks a day, and never on an empty stomach :::

::: factBox

A simple plate rule

Half your plate: vegetables (cooked or raw). One quarter: protein (lentils, beans, fish, chicken, eggs, cottage cheese). One quarter: whole grains or starchy vegetables (small amount of injera, barley, potato, sweet potato).

Do this at every meal and half your work is done. :::

Managing diabetes — activity

30 minutes of brisk walking, most days. That is the target. Even 10 minutes helps.

Activity moves sugar out of the blood and into the muscles. It also helps you lose weight and lowers blood pressure.

Ideas:

• Walk to the market instead of taking transport
• Get off the taxi one stop earlier
• Household activity — carrying water, sweeping, gardening — all count
• If you have a friend to walk with, you will keep it up longer

If you have not been active for a long time, start small and build up. If you have foot problems or heart problems, ask a health worker before starting anything strenuous.

Medicines and insulin

If diet and exercise are not enough to bring your blood sugar into range, you will be started on a tablet.

The most common first-line medicine in Ethiopia is:

• Metformin — 1 or 2 tablets a day with meals

Metformin does not cause low blood sugar on its own, does not cause weight gain, and is available cheaply. Most people tolerate it well. If it upsets your stomach, take with food.

If tablets are not enough, other medicines (sulfonylureas, DPP-4 inhibitors) may be added, or you may be started on insulin injections. Insulin is not a failure — it is the most powerful tool we have.

If you take insulin:

• Learn how to check your blood sugar at home if you can
• Learn the signs of low blood sugar (shaking, sweating, confusion) and always carry a snack
• Never skip an insulin dose without talking to a health worker
• Rotate injection sites to prevent lumps

The 4 checks every person with diabetes needs each year

1. Eyes — an eye examination at a hospital eye clinic (diabetic retinopathy can be treated if caught early)
2. Feet — every visit: check for cuts, wounds, numbness. Get shoes that fit properly.
3. Kidneys — a urine test for protein
4. Blood pressure and cholesterol — every visit

Also: keep vaccinations up to date (flu yearly if available; pneumococcal after 60).

When to get help urgently

::: urgentAdvice severity=“emergency”

Emergency: go to a hospital now if:

• Confusion, extreme drowsiness, or unconsciousness
• Rapid, deep breathing with fruity breath
• Vomiting that will not stop
• Severe abdominal pain
• A foot wound with red streaks, pus, or foul smell (can lead to amputation if untreated)
• Chest pain or shortness of breath (higher heart-attack risk in diabetes) :::

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Reviewed by Dr. Hanna Alemayehu, MD, MPH — Family medicine, Addis Ababa Last reviewed: 5 September 2026 · Next review due: 5 September 2028

Sources:

1. World Health Organization. Diabetes fact sheet. November 2024.
2. Federal Ministry of Health, Ethiopia. National Non-Communicable Disease Strategic Plan. 2021.
3. International Diabetes Federation. IDF Diabetes Atlas, 10th edition. 2021.

Content adapted from WHO diabetes guidance, Ethiopian MoH NCD strategic plan, and the IDF Diabetes Atlas. Reviewed for Ethiopian context by Dr. Hanna Alemayehu.

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Draft notes (delete before publish)

• Word count: ~1,150
• Grade 7
• isTimeCritical: false; urgentAdvice for DKA + foot infection + heart attack
• Uses both urgentAdvice severities, doList, dontList, factBox (plate rule)
• Ethiopian dietary context: injera, teff, barley, restraint on injera portions is culturally realistic
• Chat (khat) not mentioned here — noted in hypertension instead to avoid duplication
• Metformin as first-line matches Ethiopian NCD formulary
• Dr. Hanna Alemayehu is placeholder — B2B-22