Diabetes is not a new disease, as frequently thought, precipitated by our present-day inactive, affluent lifestyles with an abundance of high-calorie, trans fat-laden food. It was described as early as 1550 BC in Egyptian literature and later in the 6th century BC by the Indian physicians Sushruta and Charaka. It was recognised as a condition characterised by increased appetite, paradoxical weight loss, frequent urination, and ‘sweet’ urine that attracted ants. This description still holds true today.
India is currently in the grip of an epidemic of diabetes, with around 100 million people affected. We have the largest number of diabetics in the world, even more than China. This figure does not include those who are undiagnosed and unaware of their condition, individuals with prediabetes balanced on the edge, or pregnant women with gestational diabetes. Alarmingly, though everyone has a relative with diabetes, a large proportion of people do not fully understand the disease or receive appropriate treatment.
The food we eat is digested and converted into glucose which is released into the bloodstream. This happens with all foods, but a common misconception relates this to only sweets or refined ‘white’ foods.
As soon as the pancreas senses a rise in blood glucose, its beta islet cells release a peptide hormone called insulin. Insulin facilitates the absorption and utilisation of glucose by the body’s cells for energy. It acts as a key metabolic regulator. Diabetes occurs when this process is disrupted. It may be because the pancreas does not produce enough insulin or because the body becomes resistant to its effects (insulin resistance).
Diabetes is diagnosed through blood tests:
Fasting blood glucose
Normal: <100 mg/dL
Prediabetes: 100–125 mg/dL
Diabetes: ≥126 mg/dL
Random blood glucose
Diabetes: ≥200 mg/dL
HbA1c
Normal: <5.7%
Prediabetes: 5.7–6.4%
Diabetes: ≥6.5%
Diabetes was once considered a disease of genetically predisposed middle-aged, overweight, sedentary urban adults. However, research has shown that it can occur at any age. There are several identified subtypes affecting people across all age groups.
Few people realise that even babies can develop diabetes within the first six months of life. In about 50 per cent of such cases, it may persist lifelong or disappear after a few months, only to reappear later in life.
Do not fear diabetes. Though not curable, it can be managed with discipline, diet, exercise, and medication. Diabetics can lead healthy, fulfilling lives.
Another subset is gestational diabetes, which develops during pregnancy. Risk factors include being overweight or obese, leading a sedentary lifestyle, having Polycystic Ovary Syndrome (PCOS), and a family history of diabetes. Many women may have no symptoms, which is why screening between 24–28 weeks of pregnancy with a glucose tolerance test is essential. If undiagnosed or uncontrolled, it can lead to complications such as a large baby, the need for a caesarean section, premature birth, and other delivery problems.
For the 3-hour glucose tolerance test:
- Fasting: <95 mg/dL
- 1 hour: <180 mg/dL
- 2 hours: <155 mg/dL
- 3 hours: <140 mg/dL
In most adults, especially the middle aged, symptoms include increased thirst, dry mouth despite adequate fluid intake, fatigue, weight loss, numbness and tingling in the feet, slow-healing wounds, and frequent skin infections. Similar symptoms can unexpectedly occur in adolescents and young adults who are then found to have Maturity Onset Diabetes of the Young (MODY). This is increasingly recognised.
Some individuals produce little or no insulin. As a result, cells cannot utilise glucose for energy, and blood sugar levels rise dangerously. This form often presents in two peaks, between 4–7 years of age and again during adolescence, but can also occur in adults. It may be genetic, follow viral infections (such as Coxsackie or mumps), or arise from an autoimmune process in which the body produces antibodies that destroy the insulin- producing cells of the pancreas.
The mainstay of diabetes management is diet. Daily caloric requirements (usually 1,500–2,000kcal in adults) should be calculated based on ideal body weight and activity levels. The diet should be rich in fibre (25–40g per day) to improve blood sugar control and lower cholesterol levels. Protein intake should be about 0.8–1g per kg body weight. A simple guideline is:
- 40% of the plate: non-starchy vegetables
- 30%: lean protein
- 30%: healthy carbohydrates
The calorific value and composition of the food consumed can be found online.
Regular exercise plays a crucial role by improving insulin sensitivity and lowers HbA1c. Aim for 150 minutes of moderate-intensity aerobic activity per week (such as walking, swimming, or cycling), along with two weekly strength training, balance exercises, and, if possible, yoga sessions.
Medication is required if blood sugar remains uncontrolled. Older drugs like metformin can be used alone or in combination with newer agents. Newer medication, including semaglutide, have shown significant benefits by reducing appetite, aiding weight loss, and improving blood sugar control.
High blood glucose levels can cause short-term symptoms such as excessive thirst and hunger, fatigue, headaches, confusion, blurred vision and skin infections. In the long term, diabetes increases the risk of heart disease, kidney failure, dementia, vision loss and nerve damage, which can lead to non-healing foot ulcers.
Diabetes need not be feared. Although it is not curable, it is highly manageable. With discipline and adherence to diet, exercise, and medication, people with diabetes can lead healthy, fulfilling lives.
The writer is a paediatrician and author of Staying Healthy in Modern India