Understanding Diabetes: Prevention and Management for Indians

India's Diabetes Crisis

India has over 101 million people living with diabetes and an estimated 136 million with prediabetes — numbers that have made it the "diabetes capital of the world." The economic and human toll is staggering, and the disease continues to rise.

Understanding diabetes — what causes it, how to prevent it, and how to manage it — is no longer optional for the average Indian. It is a health literacy imperative.

Types of Diabetes

Type 1 Diabetes

An autoimmune condition in which the immune system attacks insulin-producing cells in the pancreas. The body produces little or no insulin. Type 1 requires lifelong insulin therapy. It commonly develops in childhood or adolescence but can occur at any age.

Type 2 Diabetes

The most common form (95%+ of cases). The body either does not produce enough insulin or does not use it effectively (insulin resistance). Type 2 is strongly linked to lifestyle factors and is largely preventable.

Gestational Diabetes

High blood sugar that develops during pregnancy. It usually resolves after delivery but significantly increases the mother's risk of developing Type 2 diabetes later in life.

Prediabetes

Blood sugar levels are higher than normal but not yet high enough to diagnose Type 2 diabetes. This is a critical intervention window — lifestyle changes at this stage can prevent or delay progression to full diabetes.

Why Are Indians at Higher Risk?

South Asians face unique vulnerabilities to diabetes:

• Thrifty gene hypothesis: South Asian populations may have genes adapted for environments where food was scarce, making them prone to storing energy as fat — a liability in modern, abundant food environments
• Central adiposity: Indians tend to store more fat around the abdomen (visceral fat), which is more metabolically harmful than fat stored elsewhere
• Lower muscle mass: Relative to body weight, Indians typically have less muscle — muscle is a major site of glucose disposal
• Dietary patterns: High carbohydrate diets, including white rice and refined wheat (maida), cause rapid blood sugar spikes
• Physical inactivity: Rapid urbanisation has created increasingly sedentary lifestyles
• Genetic susceptibility: Certain genetic variants are more common in South Asians and increase diabetes risk

Recognising Diabetes: Symptoms

Many people with Type 2 diabetes have no symptoms for years, which is why screening is so important. When symptoms do appear, they include:

• Excessive thirst (polydipsia)
• Frequent urination, especially at night (polyuria)
• Unexplained weight loss
• Extreme fatigue
• Blurred vision
• Slow-healing cuts and wounds
• Frequent infections (skin, gum, or bladder)
• Tingling or numbness in hands and feet

Prevention: The Powerful Role of Lifestyle

The Diabetes Prevention Program — a landmark US clinical trial — showed that lifestyle intervention (diet + exercise) reduced the risk of progressing from prediabetes to Type 2 diabetes by 58%. In older adults, the reduction was even greater.

Dietary Strategies

• Reduce refined carbohydrates: White rice, white bread (maida), sugar — these rapidly spike blood glucose
• Increase fibre: Whole grains, legumes (dal, rajma, chana), vegetables, and fruits slow glucose absorption
• Choose healthy fats: Nuts, seeds, olive oil, and avocado instead of ghee and processed oils in excess
• Control portions: Even healthy foods can raise blood sugar if consumed in large quantities
• Reduce sugary drinks: Soft drinks, packaged juices, and sweetened tea are major sources of hidden sugar

Physical Activity

• Aim for at least 150 minutes of moderate exercise per week (30 min/day, 5 days/week)
• Brisk walking is highly effective and accessible
• Strength training twice a week increases muscle mass, improving insulin sensitivity
• Even breaking up prolonged sitting with short walks improves blood sugar levels

Weight Management

Losing just 5–7% of body weight if you're overweight significantly reduces diabetes risk. For a 70 kg person, that's just 3.5–5 kg.

Managing Type 2 Diabetes

For those already living with diabetes, the goals are:

1. 1Control blood sugar — target HbA1c below 7% for most adults
2. 2Protect the heart — diabetes doubles cardiovascular disease risk
3. 3Prevent complications — eyes, kidneys, nerves, and feet
4. 4Maintain quality of life

Management involves:

• Diet and exercise — cornerstone of all diabetes management
• Blood glucose monitoring — know your numbers
• Medicines — metformin is typically first-line; many other classes available
• Regular check-ups — eyes, kidneys, feet, blood pressure, cholesterol
• Education and support — diabetes is a self-managed condition; education is essential

Know Your Numbers

Annual screening is recommended for all adults over 35, and for younger adults with risk factors (overweight, family history, sedentary lifestyle, gestational diabetes history).