Every year, November 14 is observed as World Diabetes Day to raise awareness about a condition affecting millions worldwide, with India carrying one of the largest burdens. Many still believe diabetes is simply a consequence of consuming too much sugar. Cut out sweets, the thinking goes, and the risk disappears. Doctors, however, say the reality is more complicated. Prevention begins long before blood sugar levels rise. Left unmanaged, diabetes can gradually damage the heart, kidneys, eyes and nerves.
Silent early stage
According to Dr Deepak Thiriveedi, consultant endocrinologist and diabetologist at AGI Hospital and a health influencer, “Metabolic changes refer to changes in how our body processes food and uses energy.” One of the earliest changes is insulin resistance, in which the body does not respond effectively to insulin. Dr Ravi Sankar Erukulapati, consultant endocrinologist at Apollo Hospitals, Jubilee Hills, echoes this concern. “Unlike the common perception that diabetes is simply high blood sugar, metabolic dysfunction can begin years before glucose levels become abnormal,” he notes. Most early changes produce no obvious symptoms. Dr Deepak identifies increasing waist circumference, abdominal weight gain and darkening of the skin around the neck or armpits as possible warning signs. “A person may feel completely healthy despite having prediabetes. This is why regular screening is important,” he says. Type 2 diabetes develops gradually, with the body initially producing more insulin to overcome insulin resistance.
Who is at risk and how to check
Dr Deepak recommends fasting blood glucose and HbA1c tests as initial screening tools, with an oral glucose tolerance test for selected individuals. A lipid profile, blood pressure reading and waist circumference measurement can also help assess metabolic health. Dr Ravi Sankar adds that people above 35 should be screened, while high-risk individuals may require annual testing. Risk factors include family history, abdominal obesity, sedentary lifestyles, high blood pressure, fatty liver and polycystic ovary syndrome (PCOS). Indians face an additional concern. “Indians can develop diabetes at younger ages and even at lower body weights. Age increases risk, but we are increasingly seeing diabetes in younger adults,” Dr Deepak explains. Body weight alone can be misleading. “Being slim does not automatically mean being metabolically healthy,” Dr Ravi Sankar says. Some individuals have excess abdominal fat and relatively low muscle mass despite a normal BMI, a pattern sometimes described as the ‘thin-fat’ phenotype.
Prevention within reach
Lifestyle modifications remain among the most effective ways to prevent or delay type 2 diabetes. “Genetics plays an important role, but lifestyle influences whether this inherited susceptibility progresses into diabetes,” Dr Ravi Sankar points out. Studies suggest that losing 5 to 7 per cent of body weight, alongside regular exercise and a balanced diet, can significantly reduce risk among people who are overweight. Dr Deepak adds that even small, sustained changes can make a difference.
Dr Ravi Sankar recommends brisk walking or other moderate exercise, while Dr Deepak advises prioritising balanced, home-cooked meals with more vegetables, pulses and protein, and fewer refined carbohydrates and sugary drinks. Breaking up long periods of sitting with short walks can also help. “Consistency is more important than perfection,” Dr Deepak says.
Misconceptions about diabetes can also hinder prevention. Many believe it is caused only by excessive sugar consumption or affects only people who are overweight. Dr Deepak clarifies, “Portion control, balanced nutrition and regular exercise matter more than eliminating a single food.” Dr Ravi Sankar adds, “Prevention requires comprehensive lifestyle management.”