When 39-year-old Lesang Modutwane was diagnosed with diabetes in 2022, she thought her health would finally improve once she began treatment.
Instead, what followed was a relentless battle for survival, marked by medical negligence, misdiagnosis and patient abandonment.
Her story shines a light on the deepening crisis within South Africa’s public healthcare system, where patients living with chronic conditions such as diabetes are often left to navigate the system alone, and sometimes at great personal cost.
Modutwane was one of the speakers at the Diabetes Summit held in Kempton Park, east of Johannesburg, on Wednesday, where experts and policymakers gathered to discuss the country’s escalating diabetes burden. South Africa has more than 4-million adults living with the condition, which is now the main cause of death among women.
‘Everything changed that day’
“I walked into a doctor’s office after being extremely ill for months, and that consultation changed my life forever,” says Modutwane, recalling the day her life took a devastating turn on November 19 2022.
At the time, she weighed just 45 kilograms and was in diabetic ketoacidosis (DKA), a life-threatening emergency caused by dangerously high blood sugar levels. She was admitted to a small clinical eye hospital, which she later discovered, had no endocrinology department to manage diabetes patients properly.
Despite showing clear signs of type 1 diabetes, she was incorrectly diagnosed as type 2 and discharged without insulin. Within 48 hours, she was back in the hospital in an even worse condition.
“I was attended to by a lovely dietitian, but she was clearly not trained in type 1 diabetes and reluctant to provide the information I desperately needed,” she said.
From that point, her health spiralled.
“I began having medical emergencies more often than not. I was struggling to sit upright. I lost everything, my work contracts, my car, my phone, my life as I knew it,” Modutwane said.
‘I was a walking medical emergency’
By September 2024, Modutwane had moved back home to Pretoria, realising that being close to family might be her only chance for survival. Bedridden and weak, she sought care at ODI District Hospital in Mabopane and later at Dr George Mukhari Academic Hospital.
But instead of healing, she says, she encountered further neglect and mismanagement.
“At ODI, I was once too sick to wake up and eat. No one fed me, yet the insulin injections continued because they were written in the doctor’s orders. I had more emergencies in the hospital than I ever did at home.”
She recalled being served high-sugar, high-carbohydrate meals, peanut butter, potatoes and white rice — foods detrimental to a diabetic patient’s condition.
In South Africa, over 13% of adults have diabetes, that’s roughly one in nine South Africans. A significant portion of cases remain undiagnosed, with one 2019 estimate suggesting that more than half of people with diabetes are unaware they have it.
— Prof Ntobeko Ntusi, president of the SAMRC
On one occasion, she was handed the wrong medication after a nurse confused her bed with another patient’s. When she asked for clarification, the nurse became defensive and irate.
Eventually, ODI referred her to George Mukhari Hospital, citing her “many complications”. But there, too, she encountered no beds, no medication, no specialist care and no accountability.
“Nurses didn’t know how to measure saline in syringes. Doctors rarely checked on us. It was pure abandonment,” she said.
After years of near-constant illness, Modutwane eventually discovered through painful trial and error that it was the insulin itself that was causing her severe fatigue.
Today, she is slowly recovering, but her journey stands as a stark reminder of how vulnerable patients with chronic illnesses remain in a strained public healthcare system.
South Africa’s silent epidemic
At the summit, Professor Ntobeko Ntusi, president of the South African Medical Research Council (SAMRC), warned that diabetes remains a national health emergency.
“In South Africa, over 13% of adults have diabetes, that’s roughly one in nine South Africans. A significant portion of cases remain undiagnosed, with one 2019 estimate suggesting that more than half of people with diabetes are unaware they have it,” he said.
He added that 65% of deaths in South Africa are due to cardiovascular disease, with diabetes being a critical risk factor.
Despite these grim statistics, Ntusi said there are reasons for hope.
“There is compelling evidence that we may be closer to a cure, with promising research into beta cell regeneration and new immunotherapies that could one day restore pancreatic function,” he said.
‘This is more than a health issue, it’s an economic one’
Gauteng health MEC Nomantu Nkomo-Ralehoko said the province’s urban districts, especially Johannesburg and Tshwane, have some of the highest numbers of insulin-dependent patients in the country.
“In Gauteng, between 23,720 and 25,000 patients rely on insulin, many presenting at advanced stages of the disease,” she said. “This should move us from words to action.”
Nkomo-Ralehoko added that diabetes is not just a health issue. “It’s an economic issue, a family issue and a productivity issue. With 70% of people living with diabetes being of working age, the impact on our workforce, household income and healthcare system is profound.”
She called for a life-course approach to tackling the epidemic, from childhood obesity and poor diets in schools to adult stress, inactivity and the complications faced by older people, such as blindness and kidney failure.
“This summit must not just be a dialogue. It must be a catalyst for change,” she said.
National goals, but a long way to go
South Africa’s National Strategic Plan for the Prevention and Control of Non-Communicable Diseases (2022–27) outlines ambitious targets for diabetes:
- 90% of adults should know whether they have raised blood glucose levels;
- 60% of those with raised levels should receive interventions;
- 50% of those receiving interventions should have their blood sugar levels under control.
However, Dr Patrick Ngassa Piotie, chairperson of the Diabetes Alliance, said the country is still falling short.
“When the strategy was adopted, we implicitly acknowledged our failure in screening, linkage to care and management,” he said.
According to Stats SA’s 2025 report, diabetes remains the leading natural cause of death, responsible for 32,863 deaths in 2022.
“The economic toll is equally alarming,” added Ngassa Piotie.
“When diagnosed cases are included, the total cost of diabetes is estimated at R21.8bn in 2023, projected to reach R35bn by 2030,” he said.
For Modutwane, the fight is far from over, but she hopes that by sharing her story, she can help ensure others don’t have to endure what she did.
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