Type 2 diabetes is a long-term condition in which the body cannot use insulin properly, so the level of sugar in the blood stays too high.
Overview
Insulin is a hormone that helps sugar move from the blood into the body's cells, where it is used for energy. In type 2 diabetes the cells stop responding to insulin properly, and over time the body also makes less of it.
The result is a steady build-up of sugar in the blood. Left uncontrolled, this slowly damages the blood vessels, nerves, eyes, kidneys and heart.
India has one of the largest numbers of people living with diabetes in the world. Indians tend to develop it around ten years earlier than people in Western countries, and often at a lower body weight.
It develops gradually. Many people have it for years without knowing, which is why screening matters if you have risk factors.
Symptoms of Type 2 Diabetes
- Feeling thirsty much more than usual
- Passing urine often, including waking at night to do so
- Feeling very hungry
- Losing weight without trying
- Feeling tired or low on energy
- Blurred vision
- Cuts and wounds healing slowly
- Repeated infections, including skin and urinary infections
- Tingling or numbness in the hands or feet
- Many people have no symptoms at all in the early years
What causes it
- Insulin resistance — the body's cells stop responding properly to insulin
- A gradual fall in the amount of insulin the pancreas can produce
- Excess fat around the abdomen, which worsens insulin resistance
Who is at higher risk
- A parent, brother or sister with diabetes
- Being overweight, especially around the waist
- Little physical activity
- South Asian ancestry — risk begins at a lower body weight than in other populations
- High blood pressure or abnormal cholesterol
- Diabetes during a past pregnancy, or having a baby over 4 kg
- Polycystic ovary syndrome (PCOS)
Tests and diagnosis
These are the tests doctors commonly use. Which ones you need depends on your symptoms.
- Fasting blood sugar — 126 mg/dL or higher on two occasions suggests diabetes
- HbA1c — 6.5% or higher; this shows the average blood sugar over about three months
- Oral glucose tolerance test — 200 mg/dL or higher two hours after a glucose drink
- Random blood sugar of 200 mg/dL or higher along with clear symptoms
- Your doctor confirms the diagnosis using the result together with your symptoms, usually repeating the test.
Treatment
- Food and activity changes are the foundation, and they work — for some people in the early stage they are enough on their own.
- Metformin is usually the first medicine doctors prescribe.
- Several other classes of tablets are available, and some people need insulin injections. The choice depends on your sugar levels, weight, kidney function, heart health and cost.
- Regular monitoring matters as much as the medicine: HbA1c every three to six months, plus yearly checks of the eyes, feet, kidneys, blood pressure and cholesterol.
- Never change or stop a diabetes medicine on your own.
Prevention
- Keep your waist size in a healthy range — this matters more than weight alone
- Aim for at least 150 minutes of moderate activity a week, such as brisk walking
- Replace refined carbohydrates — white rice, maida, sugar — with whole grains, millets, dal and vegetables
- Cut down sugary drinks and packaged snacks
- Avoid tobacco in every form
- Get your blood sugar checked if you have any risk factor, even without symptoms
When should you see a doctor?
See a doctor if you notice increased thirst, frequent urination, unexplained weight loss or persistent tiredness. If you have a family history, high blood pressure or a large waist, ask for a blood sugar test even if you feel completely well.
Frequently Asked Questions
What are the early symptoms of diabetes?
The earliest symptoms are usually increased thirst, passing urine more often, unusual tiredness and blurred vision. Many people have no symptoms at all early on, so a blood test is the only reliable way to know.
What is a normal fasting blood sugar level?
A fasting blood sugar below 100 mg/dL is considered normal. From 100 to 125 mg/dL is prediabetes, and 126 mg/dL or above on two occasions suggests diabetes.
Can type 2 diabetes be reversed?
Some people, particularly those diagnosed recently, can bring their blood sugar back into the normal range through significant weight loss and sustained changes to diet and activity. This is called remission. It is not a cure — the condition can return, so continued follow-up is needed.
Do I have to stop eating rice if I have diabetes?
Not necessarily. Portion size and what you eat alongside it matter more than removing rice completely. Smaller portions, choosing hand-pounded or brown rice or millets, and adding dal and vegetables all reduce the effect on your blood sugar. A dietitian can help you plan this around meals you actually eat.
Questions to ask your doctor about Type 2 Diabetes
Pick the three that matter most to you and write them down before your appointment. Consultations are short, and almost everyone forgets at least one.
- What is my HbA1c, and what number are we aiming for?
- How often should I check my sugar at home, and at what times?
- What should I do if a reading is very high or very low?
- Which of my yearly checks are due — eyes, feet, kidneys, cholesterol?
- Can I still eat rice and roti, and in what quantity?
- Does this medicine need to be taken before or after food?
- What early signs of complications should I watch for?
What this costs, and what is free
Government hospitals and health and wellness centres provide screening and treatment for blood pressure, diabetes and common long-term conditions at little or no cost.
Eligible families are covered up to ₹5 lakh per year for hospitalisation under Ayushman Bharat PM-JAY. Day-to-day medicines are not covered by PM-JAY, but Jan Aushadhi Kendras sell them at much lower prices.
Generic versions are sold at Jan Aushadhi Kendras at substantially lower prices than branded packs of the same medicine.
The main long-term cost is medicines taken daily for years, not the consultation. Asking your doctor to write generic names, and buying at a Jan Aushadhi Kendra, is usually the single biggest saving available.
Source: Ayushman Bharat PM-JAY, National Health Authority, Pradhan Mantri Bhartiya Janaushadhi Pariyojana (PMBJP)
Prices and scheme rules change. Confirm current details with the hospital or Kendra before you rely on them.