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Diabetes: Types, Symptoms, and What to Do About It

India has one of the largest diabetic populations in the world, with around 77 million people living with the condition and another 25 million with prediabetes. The numbers keep rising as urban lifestyles change. What used to be considered a disease of older adults now affects people in their 20s and 30s with worrying frequency.

The frustrating part is that diabetes often develops silently. By the time symptoms become obvious, the disease has often been present for years and may have already caused damage. The encouraging part is that diabetes is highly treatable, and many of its complications are preventable with proper management.

This is a practical guide to what diabetes is, its types, how to recognise it, and how it is managed.

What diabetes actually is

Diabetes is a condition where blood sugar (glucose) levels stay too high. Normally, the hormone insulin, made by the pancreas, helps cells take in glucose from the blood for energy. In diabetes, either the pancreas does not make enough insulin, or the body's cells do not respond properly to it, or both.

Persistently high blood sugar damages blood vessels and nerves throughout the body. Over years, this leads to complications affecting the eyes, kidneys, heart, brain, feet, and other organs.

The main types

1. Type 1 diabetes

The immune system attacks the insulin-producing cells in the pancreas. The body cannot make insulin. About 5 to 10% of all diabetes cases.

• Usually diagnosed in children, teenagers, or young adults
• Symptoms develop relatively quickly
• Treatment is insulin from the start, lifelong
• Not preventable

2. Type 2 diabetes

The body's cells become resistant to insulin, and over time the pancreas cannot keep up with the demand for more insulin. The most common type, about 90% of cases.

• Usually develops in middle-aged adults but increasingly seen in younger people
• Linked to weight, lifestyle, family history
• Symptoms often subtle or absent
• Treatment ranges from lifestyle changes to oral medications to insulin
• Largely preventable through healthy lifestyle

3. Gestational diabetes

Diabetes developing during pregnancy. Usually resolves after delivery but increases risk of type 2 diabetes later. Affects 10 to 18% of Indian pregnancies.

4. MODY (Maturity Onset Diabetes of the Young)

A genetic form of diabetes. Less common.

5. Secondary diabetes

Caused by other conditions like pancreatic disease, certain medications (especially steroids), hormonal disorders.

Why diabetes is so common in India

Indians are particularly prone to type 2 diabetes for several reasons:

• Genetic predisposition (Asian Indians develop diabetes at lower BMI than Western populations)
• Higher proportion of visceral (belly) fat for any given BMI
• Sedentary urban lifestyles
• Diet high in refined carbohydrates and sweets
• Higher rates of insulin resistance
• Stress and sleep issues
• Higher rates of gestational diabetes
• Insufficient physical activity

The combination has been called the "Asian Indian Phenotype" or "thin-fat Indian" pattern.

Symptoms to watch for

Early symptoms are often subtle. Many people have diabetes for years before diagnosis.

Classic symptoms (often when blood sugar is already very high):

• Increased thirst (constantly drinking water)
• Frequent urination (especially at night)
• Increased hunger
• Unexplained weight loss
• Fatigue and weakness
• Blurred vision

Subtle symptoms (often present earlier)

• Slow-healing wounds and cuts
• Frequent skin infections
• Recurring fungal infections (yeast infections, athlete's foot)
• Tingling or numbness in hands or feet
• Frequent urinary tract infections
• Dark patches on neck, armpits, or groin (acanthosis nigricans)
• Erectile dysfunction in men
• Irregular periods in women
• Recurring gum infections

In children and young adults with type 1 diabetes

• Rapid onset symptoms
• Significant weight loss
• Severe thirst and urination
• Sometimes diabetic ketoacidosis at presentation (vomiting, abdominal pain, fruity-smelling breath, confusion)

Many people are diagnosed during routine blood tests or when complications start to appear (eye problems, kidney issues, heart symptoms).

Who should get tested

Get blood sugar tested regularly if you have any of these risk factors:

• Family history of diabetes
• Age over 35 (even without symptoms)
• Overweight, especially with abdominal weight
• High blood pressure
• High cholesterol or triglycerides
• PCOD
• History of gestational diabetes
• Previously diagnosed prediabetes
• Sedentary lifestyle
• Heart disease or stroke

Even without risk factors, annual blood sugar testing from age 35 makes sense in the Indian population.

How diabetes is diagnosed

The standard tests:

1. Fasting plasma glucose (FPG):

• Normal: less than 100 mg/dL
• Prediabetes: 100 to 125 mg/dL
• Diabetes: 126 mg/dL or higher

2. Postprandial plasma glucose (PPG) (2 hours after meal):

• Normal: less than 140 mg/dL
• Prediabetes: 140 to 199 mg/dL
• Diabetes: 200 mg/dL or higher

3. HbA1c (average blood sugar over 2 to 3 months):

• Normal: less than 5.7%
• Prediabetes: 5.7 to 6.4%
• Diabetes: 6.5% or higher

4. Oral Glucose Tolerance Test (OGTT):

• Used in some situations, especially in pregnancy
• Blood sugar measured fasting and 2 hours after 75 g glucose
• 2-hour value ≥ 200 mg/dL = diabetes

5. Random blood sugar above 200 mg/dL with classic symptoms also confirms diabetes.

Usually, two abnormal tests on different days confirm the diagnosis.

Prediabetes

Many people have prediabetes, where blood sugar is higher than normal but not yet in diabetes range. This is a crucial window:

• Without intervention, many progress to type 2 diabetes within 5 to 10 years
• With lifestyle changes, progression can often be prevented or delayed
• Some people return to normal blood sugar levels

If you have prediabetes

• Lose 5 to 10% of body weight if overweight
• 30 minutes of moderate exercise most days
• Reduce refined carbohydrates and sweets
• Increase fibre, vegetables, whole grains
• Reduce stress
• Sleep adequately
• Regular monitoring (every 6 to 12 months)
• Sometimes metformin is prescribed for high-risk prediabetes

The diabetes prevention research shows lifestyle changes work better than medication alone for preventing progression.

Managing type 2 diabetes

Treatment has several components:

1. Lifestyle changes

Diet, exercise, and weight management are the foundation. A separate blog in this series covers diabetes diet in detail.

Key principles

• Smaller portion sizes
• Regular meal timing
• Complex carbohydrates over refined
• More vegetables, fewer sweets
• Adequate protein
• Healthy fats
• Reduced fried food
• More fibre
• Adequate water

Exercise

• 30 minutes of moderate activity most days
• Mix of cardio and strength training
• Avoid prolonged sitting
• Even short walks after meals help

Weight management

• Loss of 5 to 10% of body weight significantly improves glucose control
• Belly fat reduction is particularly important

2. Medications

Many medications are available. A doctor chooses based on individual factors.

Metformin: usually the first medication. Improves insulin sensitivity. Generally safe and effective.

Sulfonylureas: stimulate insulin production. Risk of low blood sugar.

DPP-4 inhibitors: enhance the body's own insulin response.

SGLT2 inhibitors: cause excess glucose to be excreted in urine. Also help heart and kidney.

GLP-1 receptor agonists: improve insulin response and reduce appetite. Some are injectable.

Insulin: when oral medications are not enough, or in special situations.

Other: thiazolidinediones, alpha-glucosidase inhibitors, and others.

Combinations are often used.

3. Monitoring

Self-monitoring of blood glucose at home is helpful, especially for those on insulin or sulfonylureas.

HbA1c every 3 to 6 months tracks long-term control.

Blood pressure, cholesterol, kidney function, and eye exams are part of comprehensive diabetes care.

4. Target levels

For most adults with diabetes:

• HbA1c below 7%
• Fasting blood sugar below 130 mg/dL
• Postprandial blood sugar below 180 mg/dL
• Blood pressure below 130/80 mmHg
• LDL cholesterol below 100 mg/dL (lower for those with heart disease)

Targets are individualised based on age, other conditions, and life expectancy.

Managing type 1 diabetes

Treatment requires insulin from diagnosis:

• Multiple daily injections, or insulin pump
• Continuous glucose monitoring devices
• Careful carbohydrate counting
• Adjustment of insulin based on food, activity, illness
• Regular medical follow-up

Modern technology has transformed type 1 diabetes care. People with type 1 diabetes can live full lives with good management.

Complications of poorly controlled diabetes

These usually develop over years:

1. Eyes: diabetic retinopathy, cataracts, glaucoma. Leading cause of preventable blindness.

2. Kidneys: diabetic nephropathy. Leading cause of kidney failure in India.

3. Nerves: diabetic neuropathy. Pain, numbness, weakness, especially in feet.

4. Feet: diabetic foot. Combined nerve and circulation problems lead to ulcers, infections, sometimes amputation.

5. Heart: significantly increased risk of heart attack and stroke.

6. Brain: increased risk of dementia.

7. Skin: various skin problems, infections.

8. Gum disease.

9. Erectile dysfunction.

10. Decreased immunity to infections.

Good control prevents or delays most complications. Regular screening catches problems early.

Living well with diabetes

Beyond medication, several habits help:

• Take medications as prescribed
• Monitor blood sugar as advised
• Eat balanced meals at regular times
• Exercise daily
• Manage stress
• Sleep adequately
• Maintain healthy weight
• Annual eye exam
• Annual kidney function tests
• Regular foot examination
• Daily foot care (especially if neuropathy is present)
• Dental check-ups twice a year
• Flu vaccination annually
• Address mental health (depression and diabetes often coexist)
• Carry diabetes ID and emergency contacts

Diabetes management is a long-term partnership with your medical team. Active participation makes the biggest difference.

Common myths

"Eating too much sugar causes diabetes." Not directly. Excess sugar contributes to weight gain, which is a risk factor. The bigger problem is overall poor diet and lifestyle.

"You will need insulin if you have diabetes." Many people with type 2 diabetes manage with oral medications and lifestyle changes. Insulin is needed in some cases.

"Diabetes is not serious." Untreated or poorly controlled diabetes leads to serious complications.

"Thin people do not get diabetes." Indians develop diabetes at lower BMI than Western populations. Body composition matters more than BMI alone.

"Diabetes medications damage the kidneys." Most do not. Some need adjustment in kidney disease. Untreated diabetes is the main cause of kidney damage.

"You can stop medication once sugar is normal." Most people with type 2 diabetes need long-term medication, though some can reduce or stop with significant lifestyle changes.

"Fruits should be completely avoided." Whole fruits in moderation are fine. Fruit juices and dried fruits in large amounts are problematic.

"Bitter gourd cures diabetes." May help slightly but cannot replace standard treatment.

"Once you have diabetes, you cannot have sweets ever." Occasional small portions of sweets are usually fine with proper planning. Moderation matters more than complete avoidance.

Care at Prakash Hospital Noida

At Prakash Hospital Noida, our diabetologists and physicians provide comprehensive diabetes care including diagnosis, medication management, nutrition counselling, complications screening (eyes, kidneys, feet, heart), insulin management, and gestational diabetes care. Diabetic foot care and other specialised services are available.

Whether you live in Sector 18, Sector 62, Greater Noida West, or anywhere nearby, Prakash Hospital Noida is a trusted name for diabetes care and endocrinology in Noida.

To book a consultation, call the number.

A practical takeaway

Diabetes is common in India and often silent in early stages. Get tested if you have risk factors. Early diagnosis allows much better long-term outcomes.

Type 2 diabetes is largely preventable through healthy weight, regular exercise, balanced diet, and avoiding tobacco. Even prediabetes can often be reversed.

For people with diabetes, the goal is good control through medications, lifestyle, monitoring, and regular check-ups. Complications are largely preventable with proper management.

The diagnosis is not the end of normal life. Many people live decades with diabetes, with good health and quality of life, when the condition is managed well. The first step is honest assessment of your risk and getting tested if you have not done so.

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Tags: #Diabetes #DiabetesManagement #PrakashHospitalNoida