India is the diabetes capital of the world. World Health Organisation data says there are 7.7 crore adult diabetics (type 2) and nearly 2.5 crore prediabetics in the country. More worrying is that half the population is unaware of its diabetic status.
Diabetes is a complex metabolic disorder that needs a nuanced understanding of genetics, lifestyle and modern medical management.
Layman’s definition
Think of it as a problem with the body’s ‘sugar control system’. Usually, insulin—made in the pancreas—acts like a key, helping sugar from our food enter the body’s cells to be used for energy. In diabetes, either the pancreas isn’t making enough of that key, or the key doesn't fit well any more, so sugar stays in the blood.
The spectrum
Type 1 diabetes is an autoimmune condition where the body’s defence system attacks insulin-producing cells. The exact cause is not known but research suggests it’s a mix of genetic predisposition and certain environmental factors—viral infections being one possible trigger. This form typically appears suddenly in youngsters and requires lifelong insulin therapy.
Type 2 diabetes develops differently, with the body gradually becoming resistant to insulin’s effects or the pancreas struggling to keep up with demand. Being overweight, physically inactive, having a family history, and ageing, all increase the odds. It can start with no obvious symptoms.
Gestational diabetes occurs during pregnancy when hormonal changes reduce insulin effectiveness. Women with a history of gestational diabetes, those who are overweight or who have a strong family history face higher risks.
The Indian context
India’s diabetes epidemic is the result of a convergence of genetics, rapid urbanisation and changing lifestyles. Indians have a genetic predisposition to develop diabetes at lower body weights compared with western populations.
Regional variations
Urban south Indians show particularly high diabetes rates, partly because of genetics and dietary patterns. Certain ethnic groups, like Punjabis and Gujaratis, are also more vulnerable. While rural areas had lower rates, prevalence is rising rapidly as lifestyle changes penetrate these regions.
Our relationship with food
Food occupies a central place in Indian social life, which creates unique challenges for diabetes prevention and management. White rice, deep-fried snacks and sweets feature prominently in both daily and festive meals, and refusing food can be seen as rude in social settings. Many Indians also eat dinner late, which affects blood sugar control. There can be workarounds such as switching to brown rice or millet and reducing portion sizes.
The sugar misconception
Complete sugar avoidance isn’t necessary—moderation and overall dietary balance matter more. You might get diabetes even without eating a grain of sugar in your life. White sugar, brown sugar and jaggery all affect blood sugar similarly. While jaggery might contain trace minerals, the amounts are insignificant from a health perspective.
Artificial sweeteners
Most approved artificial sweeteners have undergone extensive testing and are generally safe in moderation. Research is ongoing about their effect on gut health and metabolism, so the key lies in using them as part of a broader strategy to reduce cravings rather than as a magic solution.
Recognise warning signs
Several classic signs warrant attention—unusual thirst, frequent urination (especially at night), unexplained weight loss and persistent fatigue. Some people notice their vision becoming blurry or wounds taking longer to heal.
Beyond obvious symptoms
More subtle changes can also hint at diabetes. Frequent skin infections, particularly in skin folds, can provide early clues. Some people develop dark, velvety patches on the neck or underarms—acanthosis nigricans—often linked to insulin resistance. Women might notice recurrent yeast infections, while men might have erectile dysfunction.
Modern diagnosis and screening
While fasting glucose, post-meal glucose, and HbA1c (which shows average blood glucose level over two to three months) tests remain the diagnostic backbone, screening approaches have become more proactive. For people at higher risk, doctors now recommend earlier and more frequent screening, sometimes starting in the 20s. Continuous glucose monitoring, once reserved for diabetics, is increasingly used to spot slight increases in blood sugar levels that routine tests might miss.
The ripple effect
Over the years, high sugar levels quietly damage the small blood vessels and nerves that keep organs healthy, explaining why no organ system remains unaffected.
The heart connection
Blood vessels can develop blockages earlier in diabetics, increasing the risk of heart attacks and strokes. Blood pressure and cholesterol monitoring are as crucial as glucose control in diabetes management.
Kidney complications
The microscopic filters that clear waste from the blood can thicken and scar, allowing protein to escape into the urine—an early sign that can progress to kidney failure if left untreated.
Eye problems
The fine vessels feeding the retina might start to leak or develop fragile new branches that break easily, threatening vision over time. Regular eye exams can detect these changes.
Nerve damage
Reduced blood flow and chemical changes from persistently high blood sugar levels interfere with nerve signalling, leading to tingling, burning or numbness, most commonly in the feet.
Emergency situations
Hypoglycaemia (low blood sugar) is one of the most immediate diabetes-related dangers. It can cause sweating, trembling, confusion or even brief loss of consciousness, requiring immediate correction with something sugary.
Diabetic ketoacidosis occurs more often in people with type 1 diabetes when the body has too little insulin and begins breaking down fat rapidly, producing harmful acids in the blood. This causes nausea, vomiting, rapid breathing and drowsiness, requiring immediate treatment.
Be vigilant
Family members should be able to recognise when something is off—for example, if the person suddenly seems quiet, confused or starts sweating. Many clinics now encourage caregivers to attend sessions to practise real-life emergency situations.
Gender and age
Men are often diagnosed earlier, sometimes during heart health check-ups, while women may have menstrual irregularities or recurrent infections as early warning signs. Women with diabetes face a relatively higher risk of heart disease. Blood sugar control influences fertility and pregnancy outcomes, with poorly controlled diabetes increasing chances of miscarriage or premature delivery.
Schools need to develop support systems
While some urban schools have begun implementing support measures—such as staff trained to help with glucose monitoring or emergency responses—this is far from standard practice. In many cases, parents still have to explain the child's needs to teachers and classmates. Wider awareness, clear school policies and basic health training for staff would make a significant difference.
Management targets
For most diabetics, home glucose monitoring involves checking fasting and post-meal levels several times weekly, while HbA1c testing occurs every three to six months in clinical settings. Generally, HbA1c below 7 per cent indicates good control for adults, though children, elderly patients and those with other medical conditions may have adjusted targets.
Beyond glucose monitoring, diabetes care includes annual eye examinations, kidney function tests, foot checks for nerve damage, blood pressure and cholesterol reviews, and dental visits.
Exercise is medicine
At least 150 minutes of moderate activity weekly—such as brisk walking, cycling or swimming—provides significant benefits, while strength training twice weekly offers additional advantages. Ask your doctor what exercise is best for you.
Common management mistakes
Skipping glucose checks allows gradual changes to go unnoticed until they become serious. Many people make medication adjustments based on single readings without consulting health care providers, while others eliminate all carbohydrates instead of practising portion control or lean on ‘diabetic-friendly’ packaged foods that still raise blood sugar levels.
Misconceptions
Dangerous misconceptions include believing that starting insulin means the situation is hopeless, or that herbal remedies alone can cure diabetes. While some traditional practices may support overall health, they cannot replace established medical treatment.
The technology revolution
Continuous glucose monitoring provides real-time information, helping reveal patterns that occasional finger-stick tests might miss. Automated insulin pumps can adjust delivery based on glucose readings, while smartphone apps help track food intake, exercise and medication adherence. These technologies are particularly valuable for young adults and those with variable schedules.
Looking ahead
Early detection through improved screening, better understanding of genetic and environmental risk factors, and advancing treatment options provide hope for millions. The key lies in moving beyond individual responsibility to create supportive environments—from schools that accommodate children with diabetes to workplaces that encourage healthy eating and physical activity. Health care systems must provide culturally sensitive education while families learn to balance tradition with health needs.
Research frontiers
Artificial pancreas systems combining continuous glucose monitoring with automated insulin delivery are transforming Type 1 management. Stem cell research aims to replace destroyed insulin-producing cells. Personalised medicine approaches recognise that diabetes isn’t identical in everyone. Gut microbiome research may reveal new prevention and treatment targets.