Sugar and Survival
Once considered a disease of affluence, diabetes now cuts across every social, economic, and age barrier. The country faces a metabolic crisis shaped by genetics, modern lifestyle, and rapid urbanisation.
By Amresh K. Tiwary
It is often said that if left unchecked, India will soon be crowned the world’s capital of diabetes — an unenviable title that mirrors both progress and peril. As lifestyles evolve and urban stresses multiply, diabetes has become a defining health challenge of our times, creeping silently across generations and geographies. The World Health Organization (WHO) calls it one of the leading global causes of death and disability, responsible for an estimated 6.7 million deaths annually worldwide.
Across India, diabetes is now visible in every segment of society — rural or urban, rich or poor, young or old. The disease no longer belongs to the middle-aged elite; it is fast becoming an intergenerational epidemic. According to the latest ICMR-INDIAB study (2023), more than 101 million Indians currently live with diabetes, while an additional 136 million are pre-diabetic — a staggering pool of nearly 240 million people at direct metabolic risk. The figures speak to a looming crisis that demands urgent and sustained medical, social, and policy-level intervention. To contain this rising tide, government initiatives must converge with citizen awareness and responsible corporate action.
Causes and Risk Factors
There are many causes of diabetes, but the most formidable remains our lifestyle. Being overweight, physically inactive, and chronically stressed leads to insulin resistance — the physiological gateway to type 2 diabetes. The modern Indian lifestyle — characterised by long sedentary hours, excessive screen time, high intake of refined carbohydrates, and declining physical activity — has dramatically altered the nation’s metabolic profile.
Childhood obesity has emerged as one of the most alarming trends. Children who are overweight early in life are far more likely to develop type 2 diabetes as adults. The National Family Health Survey (NFHS-5, 2019–21) indicates that more than 14 percent of Indian adolescents between ages 15 and 19 are overweight or obese, setting the stage for early metabolic disorders.
Dr Arvind Garg, Senior Child Specialist at Apollo Hospital, Noida, observes that obesity is among the major risk factors for diabetes, yet India still lacks comprehensive longitudinal studies that map this relationship across regions. Intriguingly, despite having lower average body-mass indices (BMI) than Western populations, Indians exhibit a much higher prevalence of diabetes. This suggests that diabetes manifests at a lower BMI threshold among South Asians — a phenomenon linked to genetic predisposition, visceral fat accumulation, and reduced muscle mass. As Dr Garg points out, a “lean-looking” Indian may carry just as much risk as an overweight European due to hidden fat around vital organs, a phenomenon researchers call the “thin-fat” Indian phenotype.
Understanding Diabetes and Its Effects
Diabetes is fundamentally a disorder of the endocrine system. The pancreas — a small but vital organ — produces the hormone insulin, which regulates blood sugar. In type 1 diabetes, the insulin-producing beta cells are destroyed, leading to absolute deficiency. In type 2 diabetes, insulin production continues, but the body’s cells become resistant to its action, causing glucose to accumulate in the blood.
Over time, chronic hyperglycaemia can damage virtually every organ in the body. The kidneys, eyes, heart, nerves, and even the skin suffer the consequences. The World Kidney Day 2024 report estimates that nearly 30 percent of chronic kidney disease in India stems from poorly controlled diabetes. Patients should regularly monitor blood parameters such as urinary albumin, serum urea, and creatinine, and avoid unnecessary painkillers that can strain kidney function. Swelling of the feet, persistent fatigue, and breathlessness are red flags that must never be ignored.
In India, roughly 17 million people already live with diabetic nephropathy, yet access to dialysis and transplants remains beyond the financial reach of many. Preventive action — including early detection and lifestyle regulation — is therefore the most cost-effective and humane response.
Diabetes in Numbers
India today has more diabetics than any other country in the world. Once considered a disease of affluence, it now affects more than 11 percent of the nation’s adult population — a figure that continues to rise. A decade ago, the number was about 62 million; today it exceeds 101 million. Nearly one million Indians die each year due to diabetes and its complications.
The average age of onset is falling alarmingly — from the mid-40s to the mid-30s in urban populations. The dual forces of genetic susceptibility and lifestyle transition — from traditional diets and physical labour to processed foods and sedentary routines — have accelerated the epidemic. The World Bank estimates that diabetes will cost the Indian economy over USD 150 billion in lost productivity and healthcare expenditure by 2030.
If the trajectory continues unchecked, India will see over 130 million diabetics by 2045 — an increase unmatched anywhere in the world. The disease is no longer a matter of individual health but of national development and demographic destiny.
Complications and Symptoms
When diabetes remains uncontrolled, the consequences extend far beyond high blood sugar. The immune system weakens, wound healing slows, and organs begin to deteriorate. Among the most common and dangerous complications are diabetic foot ulcers — open wounds that can lead to gangrene if neglected. Recent research shows that nearly one in four diabetics globally will develop a foot ulcer during their lifetime.
Other complications include cardiovascular disease, kidney failure, retinopathy, and neuropathy. Early symptoms — frequent urination, excessive thirst, sudden weight loss, fatigue, blurred vision, or tingling in extremities — often go unnoticed or misattributed to stress. This delay in diagnosis is particularly common in India, where nearly half of diabetics remain undiagnosed until complications appear. Awareness of these signs can literally save lives.
Expert Insights
According to Dr N.P. Singh, Senior Consultant at Max Superspeciality Hospital, Vaishali, diabetes — regardless of its type — results in excessive glucose in the bloodstream, though the underlying causes vary. Glucose, the body’s primary energy source, becomes toxic in excess, damaging blood vessels and nerves. Chronic hyperglycaemia accelerates ageing, compromises immunity, and predisposes to stroke and heart attack.
Worryingly, diabetes is now diagnosed in individuals as young as 15. Sedentary living, processed diets, and irregular sleep patterns are key drivers. With more than 17 million Indians already battling diabetes-related kidney disease, Dr Singh stresses that the focus must shift from cure to prevention — “exercise, education, and early screening are our best medicines.”
He notes that even modest lifestyle changes — a 5–7 percent weight loss and 30 minutes of brisk walking daily — can reduce diabetes risk by nearly 60 percent, as confirmed by the Diabetes Prevention Program and subsequent global studies.
Genetics and Family History
Heredity undoubtedly plays a role in diabetes. Dr Anup Mohta, Director of Chacha Nehru Bal Hospital, East Delhi, observes that children born to diabetic parents are several times more likely to develop the disease as adults. However, he adds that inheritance is not destiny. While type 2 diabetes is often familial, its expression depends heavily on lifestyle and environment. A healthy diet, regular exercise, and weight control can effectively “switch off” the genetic vulnerability, proving that nurture can override nature.
Stages of Diabetes
There are two primary forms — type 1 and type 2 diabetes — both caused by inadequate insulin activity. Type 1, usually emerging in childhood or adolescence, requires lifelong insulin therapy and rigorous dietary management. Type 2, far more common, develops gradually and often goes unnoticed for years until routine tests reveal elevated glucose levels.
In addition, prediabetes represents a critical intermediary stage where blood sugar is higher than normal but not yet diabetic. This stage offers an invaluable window for intervention through lifestyle modification. Gestational diabetes, appearing during pregnancy, often resolves postpartum but significantly increases the mother’s future risk of type 2 diabetes. Regular screening during pregnancy is therefore essential for both maternal and neonatal health.
Eye, Nerve, and Hearing Complications
Dr Shishir Narayan, Shroff Eye Hospital, New Delhi, warns that diabetes demands vigilant eye care. Prolonged hyperglycaemia can damage the retina, cause early cataract, and lead to vision loss. Regular ophthalmic check-ups are vital. Long-standing diabetics are also prone to neuropathy — nerve damage causing pain, numbness, or weakness — and diabetic foot, where infections may become limb-threatening.
Recent studies have revealed a less-known complication — hearing loss. Research published in Diabetologia (2024) suggests that diabetics are nearly twice as likely to experience hearing impairment compared to non-diabetics, due to microvascular damage in the inner ear. Screening for hearing issues should begin earlier among diabetics, as untreated impairment can contribute to depression and dementia. These findings reinforce the need for multidisciplinary management — endocrinologists, nephrologists, ophthalmologists, and ENT specialists working in tandem.
Education and Awareness
Education is the foundation of diabetes prevention. Understanding early warning signs — excessive thirst, frequent urination, fatigue, numbness, recurrent infections, slow-healing wounds — can prompt timely medical attention. Mass education campaigns, workplace wellness programmes, and school-based health checks must be integrated into public policy.
Community participation is equally critical. Self-monitoring, regular testing, and adherence to medication form the triad of effective management. As Dr Tedros Ghebreyesus of WHO recently remarked, “No single intervention can stop diabetes, but informed citizens can.”
The Ayurvedic View
In Ayurveda, diabetes is known as Madhumeha — Madhu meaning honey and Meha meaning urine — classified under Vataj Meha, a disorder rooted in imbalance of the Vata dosha. Vata represents movement and dryness; when aggravated, it leads to tissue degeneration and metabolic depletion. Ayurveda sees diabetes not as an isolated disease but as a systemic disorder of energy imbalance and digestive impurity (ama).
The Ayurvedic approach aims to rejuvenate rather than merely regulate. Herbs such as Gudmar, Karela, Neem, Methi, and Vijaysar have demonstrated hypoglycaemic properties. A 2024 CCRAS clinical study under the Ministry of Ayush showed that an integrative regimen combining Ayurvedic formulations with yoga and diet counselling improved HbA1c levels by up to 0.7 percent over six months. Unlike modern drugs that target sugar control alone, Ayurveda strives to restore digestive fire (agni), cleanse metabolic channels, and enhance vitality.
Thus, Ayurveda complements modern medicine by addressing the psychosomatic roots of disease — balancing the body, calming the mind, and reinforcing immunity. In the Indian context, where lifestyle, stress, and nutrition converge to shape health, this integrative approach holds great promise.
Daily Regimen and Lifestyle Discipline
A diabetic’s best medicine is consistency. Rising early — ideally by sunrise — activates metabolism and synchronises circadian rhythms. Drinking a glass of lukewarm water with lemon aids detoxification. Exercise is indispensable: morning walks, yoga, cycling, or swimming improve insulin sensitivity and cardiovascular fitness. Meditation helps reduce stress, a silent trigger for high sugar.
Breakfast should be wholesome yet light — whole-grain bread, milk, and seasonal fruit in moderation. Lunch may include lightly cooked vegetables, lentils, brown rice or chapatis, and buttermilk with cumin and coriander. Avoid heavy, oily, or spicy meals that tax digestion. Daytime sleep, though tempting, should be avoided as it increases Kapha and impairs metabolism. In the evening, opt for light snacks — fresh juice or roasted chickpeas. Dinner should be simple and taken at least two hours before bedtime — boiled vegetables, sprouts, cottage cheese, or salad. A glass of warm milk before sleep promotes relaxation and metabolic balance.
Ayurveda calls this daily rhythm dinacharya — a structured lifestyle that aligns with nature’s cycles and sustains inner harmony. When followed consistently, it not only stabilises blood sugar but also restores energy, mood, and clarity.
Takeaways
Diabetes today represents not just a medical condition but a mirror of modern civilisation — of abundance, imbalance, and inattention. India stands at a crossroads: to either succumb to its projected destiny as the diabetes capital of the world or to rewrite that narrative through awareness, prevention, and holistic health. By blending scientific precision with traditional wisdom, and personal discipline with public policy, the nation can indeed reclaim its metabolic balance.
The battle against diabetes begins not in hospitals but in homes — in every meal cooked, every step walked, and every habit changed.