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How one South African advocate is re-designing equity in CGM
When a sixteen-year-old Kirsten de Klerk heard the words “you’ll have to do this every day for the rest of your life” , it felt like a life sentence. Years later, that moment became her motivation to fight for fair, safe, and affordable access to continuous glucose monitoring (CGM) across South Africa.
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Sections
00:10 – 01:00 The Glucose Never Lies® mission — translating science into real-world action.02:47 – 04:00 Diagnosis at 16 and the moment reality hits.08:25 – 09:19 Burnout and self-blame — “keeping diabetes in the boot.”09:19 – 12:00 #LetterToMyDiabetes — the spark that rebuilt connection.14:19 – 17:49 Two-week CGM trial that changed everything.17:49 – 22:00 From privilege to purpose — realising access inequality.22:00 – 31:29 Building South Africa’s advocacy network and petition (14 000 signatures).31:29 – 37:23 Negotiating with funders — turning frustration into progress.37:23 – 49:24 CGM accuracy and global standardisation — why 70 % doesn’t always mean 70 %.52:46 – 54:00 Redirection, not rejection — hope as a strategy.
Episode Summary
In this powerful episode of The Glucose Never Lies® Podcast , John Pemberton is joined by Kirsten de Klerk — a Cape Town–based type 1 diabetes advocate whose story captures both the personal and political dimensions of living with diabetes in an unequal healthcare system. Diagnosed at sixteen, Kirsten’s journey begins with the innocent question every teenager might ask: “How long do I have to do this for?” Her doctor’s reply — “Every day for the rest of your life” — marked the start of a lifelong negotiation between reality and resilience.
Supported by a devoted mother who organised meal plans, carb charts and glucose logs, Kirsten initially thrived. But the transition to adulthood exposed a gap that exists in diabetes care worldwide: the abrupt hand-over from parental supervision to independent self-management. University life brought late nights, skipped meals and denial. As she puts it, “Diabetes was in the boot of the car — always there, but never a priority.” Eventually, she stopped testing altogether, saying, “If I don’t prick my finger, I won’t see the numbers — so I won’t be disappointed in myself.” This was the beginning of burnout — not laziness, but emotional overload, guilt, and silence.
Her recovery began unexpectedly. While working in the corporate sector, Kirsten felt numbness in her toes — an early warning of long-term complications. Sitting on a Cape Town beach soon after, she wrote a #LetterToMyDiabetes and experienced what she calls a moment of truth: “I realised diabetes isn’t going anywhere.” That letter became the start of her advocacy work. She opened an Instagram account, began sharing honestly about her condition, and built a small but growing online community that evolved into South Africa’s first in-person diabetes meet-ups.
From Burnout to Blueprint
Kirsten’s story unfolds in stages that reflect the human side of system change:
From Control to Collapse: Learning that burnout isn’t failure — it’s an unspoken part of long-term diabetes care.From Avoidance to Acceptance: Using writing and community as tools for healing and accountability.From Isolation to Advocacy: Turning private struggle into public purpose.
Her discovery of continuous glucose monitoring (CGM) marked another pivotal chapter. A two-week trial using a CGM changed everything — “One device. Two weeks. No going back.” But it also exposed injustice. While the technology gave her back control, she saw how few people in South Africa could access it. Eighty-five per cent of the population rely on public healthcare, where most patients with type 1 diabetes are given just three blood glucose test strips per day — and only if supplies are available.
Building the CGM Access Blueprint
Kirsten decided that awareness wasn’t enough; policy had to change. Alongside Bridget McNulty , she co-founded SA Diabetes Advocacy , creating an online petition, mentorship programme, and free four-week Advocacy Course to teach others how to campaign effectively in their communities. What started as a small initiative grew into a national movement.
Advocacy milestones:
Over 14,000 signatures gathered for the national CGM access petition.
Support letters secured from endocrinology units across South Africa.
Direct negotiations with major medical aid funders.
Early success: funding secured for children under 18 to receive CGM sensors on a tiered plan.
John and Kirsten reflect on how this mirrors global progress in the UK and elsewhere — a shift “from research to reality.” They also discuss the “Step to the Line” video used in leadership training — a visual metaphor for privilege and equity. It demonstrates why some people start further back, and why fair access means providing different levels of support to achieve the same outcome.
The Accuracy Debate
Kirsten’s advocacy soon intersected with John’s own area of expertise: CGM accuracy and comparator bias . As cheaper sensors entered the market, she noticed that many devices lacked proper testing or transparency. Some were inaccurate enough to cause harm — “We had reports of children going into DKA because the sensor didn’t detect lows,” she recalls.
Together they outline three truths that every policymaker, clinician, and person with diabetes should understand:
Not all CGMs are created equally. Inaccuracy harms you now. Inaccuracy harms you later. “70% time-in-range on one device might be 60% on another.”
This led to a wider discussion on the need for a global standard of CGM testing , ensuring all devices are compared under the same laboratory conditions. “Access without accuracy is false progress,” John summarises — a sentiment that now defines both GNL’s advocacy and Kirsten’s next chapter.
Redirection, Not Rejection
Despite resistance, delays, and limited resources, Kirsten’s determination has not wavered. “There’s no such thing as rejection, only redirection,” she says — a philosophy that underpins all her advocacy work. She describes how every setback led to a new partnership, a new idea, or another petition. Her next goal is to bring the same petition model into public healthcare , with letters of support from all provincial endocrinology units to the South African Department of Health .
For Kirsten, South Africa is more than a battleground for access — it is a test case for the world . By proving that equitable CGM access can work in a middle-income country, her model could be adapted globally. As John concludes, “If it can happen here, it can happen anywhere.”
Key Takeaways
Burnout is not weakness — it’s a predictable outcome of chronic self-management without emotional support.
Advocacy starts with acceptance: connection before correction.
CGM access without accuracy creates a false sense of safety.
Global standardisation of CGM testing is essential — 70% must always mean 70%.
Hope and persistence are strategic tools: “There’s no such thing as rejection, only redirection.”
The CGM Access Blueprint begins with South Africa — but its lessons apply everywhere.
This episode follows her journey from diabetes burnout to national advocacy. What began as one person’s story of survival has become the blueprint for CGM access — combining community, clinical evidence, and courageous persistence. Together, we explore how lived experience can shape policy, and how accuracy and equity must rise side by side.
Call to Action
Sign the CGM Access PetitionShare the DSN Forum comparison chart Read the FIND Diagnostics accuracy factsheetForward this episode to one clinician and one person living with T1D.Remember: equity starts with evidence — and evidence starts with you.
“Step to the Line”
During the episode John and Kirsten reference the powerful short film Step to the Line (Soul Pancake, YouTube). It visualises privilege and opportunity: two groups stand behind a line and step forward if statements apply to them. By the end, those who started furthest back remain far behind — a metaphor for why equity means meeting people where they start, not where we stand .
Evidence & Resources
Connect with Kirsten de Klerk
