Do Medical Schemes Cover Diabetes Treatment?

Diabetes insipidus and diabetes mellitus types 1 & 2 are chronic diseases which fall under the medical industry’s Prescribed Minimum Benefits. The law stipulates that medical schemes have to cover the costs of tests, diagnosis and medication for your diabetes. However, before you do any testing you need to check the benefits of your particular medical scheme as pre-authorisation is sometimes required.


What is diabetes?

Diabetes is a chronic condition where the body does not produce enough insulin or cannot effectively use it to provide fuel for living and growing.The pancreas makes insulin and this hormone carries sugar in the blood to the cells. When the pancreas doesn’t produce enough insulin or the insulin doesn’t work properly then you’re diagnosed with the disease.
Thethree main types include:

  1. Type 1 – also called insulin-dependent diabetes or early-onset diabetes. It typicallydevelopsin childhood or adolescence and it’s when the body does not produce insulin because the immune system has destroyed the cells where insulin is made. People with this disease will need to inject themselves with insulin for the rest of their life.
  2. Type 2 – also called adult-onset diabetes. This is morewidespread and it generally affects people after they are 45 years old. The body either doesn’t make enough insulin or itdoesn’t use it Diabetes Treatment and Medical Scheme Covercorrectly. Patients with type 2 can often control their disease with weight loss, implementing a healthy eating plan and exercising. It is a progressive condition and medication is sometimes needed in addition to these lifestyle changes.
  3. Gestational diabetes mellitus – this affects females during pregnancy. It can generally be controlled with exercise and diet and it usually disappears after pregnancy.

Causes of diabetes

The reason why people develop diabetes is not fully understood but it’s believed that type 1 is influenced by genetic and environmental factors, while type 2 is a combination of elements like genetics, obesity, poor diet, physical inactivity, age and ethnicity.


People can live with diabetes for many years without realising it as they display no symptoms. Often the only reason that diabetes is discovered is when a person has developed a life-threatening complication like heart disease, kidney failure, loss of sight or nerve disease. Type 1 symptoms are frequently more severe than type 2 and they will regularly appear more quickly.

Warning signs include:

  • urinating often
  • being unusually thirsty
  • having intense hunger
  • abnormal weight loss
  • intense fatigue
  • being irritable
  • blurry eyesight
  • injuries that heal slowly
  • hands and feet that are numb or tingle
  • repeated infections of the skin, gum or bladder

Tests for diabetes

Because the disease can go undetected for many years it’s important to be screened regularly. Important tests include:

  • The Hemoglobin A1C test which checks your average blood sugar level for the past few months.
  • The FPG (fasting plasma glucose) test where blood samples are taken after an overnight fast.
  • The OGTT (oral glucose tolerance test) where blood samples are taken after fasting and again two hours after drinking a sugary solution.

How common is diabetes?

Globally there are about 366 million people diagnosed with diabetes. In South Africa it is estimated that 6% of the population suffers from the disease although many remain undiagnosed. There is no known cure for diabetes but it can be controlled with proper care. The first step is to get tested, it’s then important to accept that you have this chronic condition and you subsequently have to learn how to manage it through diet, exercise and medication.