Diabetes Type 2

Type 2 diabetes is the most common form of diabetes. In India, it now affects over 100 million adults, and most develop it about a decade earlier than Europeans — often in the 30s and 40s, at BMI values that look "normal" by Western cut-offs but are obese by Asian ones. It's a manageable, partly reversible condition — if caught early and acted on.

The South-Asian pattern

• Onset 10 years earlier than in Europeans.
• "Thin-fat" phenotype — diabetes can develop at BMI as low as 22–23, with more visceral fat and less muscle.
• Strong family clustering — a first-degree relative with diabetes raises your risk sharply.
• Cardiovascular risk is much higher — Indians with diabetes have heart attacks earlier and more often. Blood pressure and cholesterol control matter as much as sugar control.

How it presents

• Often no symptoms — picked up on routine testing.
• Excessive thirst and urination, tiredness, blurred vision, slow-healing wounds, recurrent urinary or fungal infections.
• Sometimes found late — already with complications (eye, kidney, nerve, heart).

The four pillars of treatment

• 1. Food — see Diabetic Diet. Shift to millets (ragi, jowar, bajra), whole grains, pulses, vegetables, protein at every meal; cut sugar-sweetened drinks, sweets, refined flour, fried snacks. Portion matters as much as choice.
• 2. Movement — 150+ minutes a week of brisk walking or equivalent, plus strength training twice a week. Reduces blood sugar independently of weight loss.
• 3. Weight — 5–10% loss is genuinely transformative; can normalise sugars in early type 2, especially within 6 years of diagnosis.
• 4. Medicines — the major classes your doctor may use are: biguanides (first-line), SGLT2 inhibitors (heart/kidney-protective), GLP-1 receptor agonists (weight loss + heart protection), DPP-4 inhibitors, sulfonylureas, thiazolidinediones, insulin. Modern combinations target sugar, weight, heart, and kidney together.

Targets (individualised)

• HbA1c around 6.5–7% for most adults; higher (7.5–8%) for frail older adults.
• Blood pressure under 130/80 mm Hg for most people with diabetes.
• LDL cholesterol under 70 mg/dL (high cardiovascular risk).
• Quit tobacco — the single biggest cardiovascular risk in Indian diabetes.

Annual checks — non-negotiable

• Dilated retinal exam (see Diabetic Eye Problems).
• Kidney function (eGFR) + urine albumin for kidney disease.
• Foot exam — feel, pulses, any ulcer (see Diabetic Foot).
• BP, lipid panel, HbA1c every 3–6 months depending on control.
• Dental check, flu shot annually, pneumococcal vaccine as advised.

Avoid

• Unregulated "diabetic cures" and Ayurvedic powders promising HbA1c reversal — many contain undeclared sulfonylureas or steroids. Cause real harm.
• Stopping medicines because "sugars are normal" — talk to a doctor before any change.
• Crash keto diets if on SGLT2 inhibitors (DKA risk) or sulfonylureas (severe hypoglycaemia) — tell your doctor.