A grip on glucose

The key to managing diabetes lies in moving beyond individual responsibility to creating supportive environments

- PUJA AWASTHI

India is the diabetes capital of the world. World Health Organisation data says there are 7.7 crore adult diabetics (type 2) and nearly 2.5 crore prediabetics in the country. More worrying is that half the population is unaware of its diabetic status.

Diabetes is a complex metabolic disorder that needs a nuanced understanding of genetics, lifestyle and modern medical management.

Layman's definition

Think of it as a problem with the body's 'sugar control system'. Usually, insulin—made in the pancreas—acts like a key, helping sugar from our food enter the body's cells to be used for energy. In diabetes, either the pancreas isn't making enough of that key, or the key doesn't fit well any more, so sugar stays in the blood.

The spectrum

Type 1 diabetes is an autoimmune condition where the body's defence system attacks insulin-producing cells. The exact cause is not known but research suggests it's a mix of genetic predisposition and certain environmental factors—viral infections being one possible trigger. This form typically appears suddenly in youngsters and requires lifelong insulin therapy.

Type 2 diabetes develops differently, with the body gradually becoming resistant to insulin's effects or the pancreas struggling to keep up with demand. Being overweight, physically inactive, having a family history, and ageing, all increase the odds. It can start with no obvious symptoms.

Gestational diabetes occurs during pregnancy when hormonal changes reduce insulin effectiveness. Women with a history of gestational diabetes, those who are overweight or who have a strong family history face higher risks.

The Indian context

India's diabetes epidemic is the result of a convergence of genetics, rapid urbanisation and changing lifestyles. Indians have a genetic predisposition to develop diabetes at lower body weights compared with western populations.