Overview#
Type 2 Diabetes Mellitus (T2DM) is a chronic metabolic condition in which the body either does not produce enough insulin or becomes resistant to its effects, leading to persistently elevated blood glucose levels. India is home to over 101 million people with diabetes, earning it the label "diabetes capital of the world" (ICMR-INDIAB study, 2023). The condition disproportionately affects South Asians due to genetic predisposition, central obesity, and dietary patterns rich in refined carbohydrates.
Causes & Risk Factors#
- Insulin resistance – cells in muscle, fat, and liver respond poorly to insulin.
- Family history – having a first-degree relative with T2DM doubles the risk.
- Obesity & central adiposity – waist circumference > 90 cm (men) or > 80 cm (women) in Indians increases risk significantly.
- Sedentary lifestyle – physical inactivity reduces glucose uptake by muscles.
- Dietary factors – high intake of white rice, refined flour (maida), sugary beverages, and low fibre intake are key contributors in the Indian diet.
Signs & Symptoms#
- Frequent urination (polyuria), especially at night
- Excessive thirst (polydipsia)
- Unexplained weight loss despite normal or increased appetite
- Fatigue and general weakness
- Blurred vision
- Slow-healing wounds or frequent infections
- Tingling or numbness in hands and feet (peripheral neuropathy)
- Darkened skin patches on the neck or armpits (acanthosis nigricans)
Diagnosis#
Early detection is critical. The following tests are used to diagnose and monitor T2DM:
- Fasting Blood Sugar (FBS) – values ≥ 126 mg/dL indicate diabetes. Book FBS test
- HbA1c (Glycated Haemoglobin) – reflects average blood sugar over 2-3 months; ≥ 6.5 % is diagnostic. Book HbA1c test
- Oral Glucose Tolerance Test (OGTT) – 2-hour post-load glucose ≥ 200 mg/dL confirms diabetes.
- Random Blood Sugar – ≥ 200 mg/dL with classic symptoms is diagnostic.
Treatment Options#
Medications: Metformin is the first-line drug. Other classes include sulfonylureas, DPP-4 inhibitors, SGLT2 inhibitors, and GLP-1 receptor agonists. Insulin therapy is used when oral agents are insufficient.
Lifestyle modifications:
- Follow an Indian-plate method: half the plate with vegetables, a quarter with whole grains (brown rice, ragi, jowar), and a quarter with protein (dal, paneer, fish).
- Aim for at least 150 minutes of moderate-intensity exercise per week.
- Maintain healthy body weight (BMI < 23 for Indians per ICMR guidelines).
Prevention#
- Replace white rice with millets or brown rice at least in one meal daily.
- Walk for 30-45 minutes after dinner to lower post-meal glucose spikes.
- Get screened annually if you are over 30 with a family history of diabetes.
- Reduce intake of sugar-sweetened beverages, fruit juices, and processed snacks.
- Manage stress through yoga, pranayama, or meditation.
When to See a Doctor#
Seek medical attention if you experience persistent thirst, unexplained weight loss, frequent infections, or if your fasting blood sugar exceeds 100 mg/dL (pre-diabetes range). If you already have diabetes, consult your doctor urgently for blood sugar readings above 300 mg/dL, signs of diabetic ketoacidosis (fruity-smelling breath, nausea, confusion), or any new foot ulcers.