World Diabetes Day: 10 frequently asked questions about diabetes

Diabetes is a metabolic disease in which the body does not produce enough insulin or cannot effectively use the insulin it does make. Insulin is a hormone that is essential for regulating blood sugar levels. When this process is disrupted, blood sugar levels can rise to dangerous levels. There are two main types: type 1, which is typically diagnosed in childhood or early adulthood, and type 2, which is more common and often linked to lifestyle factors such as poor diet and lack of exercise. If left untreated, it can lead to serious complications, including heart disease, kidney damage and nerve problems. Because it can easily go unnoticed until serious complications arise, it is crucial that individuals stay informed about the condition: how it develops, what the early signs are, and the best ways to manage it.

This World Diabetes Day, we dive into some of the most common questions and misconceptions surrounding the disease, with insights from Dr. Rajiv Kovil, a leading diabetologist in India with more than two decades of experience. Whether you have recently been diagnosed or have been living with diabetes for years, Dr. Kovil will help you clear your doubts and provide valuable advice on dealing with this lifelong condition.

Excerpts from the interview:

Q. Diabetes is often considered a silent disease: how can individuals detect early signs and prevent long-term complications?

Dr. Rajiv Kovil: Diabetes is often referred to as a silent disease because its symptoms and complications are not noticeable until significant damage has been done. Nearly 60-70 percent of cases are diagnosed incidentally, meaning that many people only experience typical symptoms such as frequent urination, excessive thirst or fatigue at a later stage. Early screenings and regular checkups are crucial to detect diabetes complications (such as kidney, eye and heart problems) and can help prevent the long-term effects of the disease.

Q. How does the body regulate blood sugar levels and how does this process differ in people with diabetes?

Dr. Rajiv Kovil: In a healthy body, blood sugar levels are regulated by a number of hormones, including insulin and glucagon, which are secreted by the pancreas. This process helps maintain stable blood sugar levels to meet your body’s energy needs. However, in people with type 2 diabetes, the body becomes resistant to insulin and the pancreas has difficulty producing enough insulin to maintain normal blood sugar levels. Over time, this leads to chronic high blood sugar levels, which can cause damage to various organs.

Q. If my blood sugar levels become normal, do I still have diabetes?

Dr. Rajiv Kovil: Once diagnosed, the condition is lifelong. Even if blood sugar levels normalize and medication is no longer necessary, a person remains diabetic. A person may be able to control the condition with insulin and medication, or in some cases – especially with type 2 diabetes – without medication. However, not taking medication does not mean that the disease is cured; the underlying condition still exists and requires proper monitoring and treatment.

Q. Is diabetes hereditary or can it develop without a family history?

Dr. Rajiv Kovil: Although genetics play an important role in diabetes risk, it is important to understand that heredity does not guarantee that you will develop the condition. Think of heredity as loading the gun, while lifestyle choices – such as diet, exercise and stress levels – pull the trigger. Even individuals with no family history of the condition can develop it, especially if they lead a sedentary lifestyle, are overweight or have poor eating habits. The risk increases with age, obesity and other environmental factors.

Also read: World Diabetes Day 2024: 5 ways to detect diabetes quickly

Q. How do you deal with blood sugar spikes after eating a large meal or high-carb food?

Dr. Rajiv Kovil: Large spikes in blood sugar levels are often observed after consuming a heavy or carbohydrate-rich meal. To manage this, it is best to aim for a balanced meal with a mix of carbohydrates, fiber-rich vegetables, proteins and fats. For people with type 1 diabetes, additional insulin doses are usually required to control these spikes. For people with type 2 diabetes, a gentle walk after meals and medications can be effective. Additionally, many newer diabetes medications can help reduce these spikes, and continuous glucose monitoring (CGM) devices can provide real-time insight into how your blood sugar responds to different foods.

Q. Should I use insulin if I have diabetes?

Dr. Rajiv Kovil: Not everyone with diabetes needs insulin. In fact, insulin therapy is generally reserved for individuals whose blood sugar levels can no longer be controlled through diet and oral medications. People with type 1 need insulin because the body produces little or no insulin. However, in type 2, insulin may be prescribed temporarily, especially if blood sugar levels are severely high during illness, surgery or acute stress. Insulin is also part of an ongoing treatment plan if someone is in the advanced stages of type 2 diabetes.

Q. Obesity appears to be one of the biggest risk factors for diabetes. How does it affect blood sugar levels and increase risk?

Dr. Rajiv Kovil: Obesity is one of the major risk factors for type 2 diabetes. Excess fat, especially around the abdomen, contributes to insulin resistance, which means your body’s cells no longer respond to insulin as effectively. This leads to high blood sugar levels. In addition, fatty deposits in the liver and pancreas can impair the function of these vital organs, worsening insulin resistance and ultimately causing the pancreas to lose its ability to produce enough insulin. As obesity continues to rise worldwide, so does the prevalence of this condition, making weight management a crucial factor in its prevention or management.

Q. The prevalence of diabetes is increasing in both sexes. But what are the main factors that make men more susceptible?

Dr. Rajiv Kovil: Although it affects both men and women, certain lifestyle factors make men more vulnerable. Men are more likely to have unhealthy habits, such as increased smoking, alcohol consumption and poorer food choices, all of which contribute to obesity and insulin resistance. In addition, men are less likely to seek medical advice or take preventative health measures. In some regions, such as India, increased stress levels, poor sleep patterns and a lack of physical activity further exacerbate these risks, making men more susceptible to developing diabetes.

Q. How can gestational diabetes affect my baby’s health?

Dr. Rajiv Kovil: Gestational diabetes, which occurs during pregnancy, can have serious consequences for both mother and baby. If not controlled, this can lead to complications such as premature birth, large birth weight (macrosomia) and delivery problems such as shoulder dystocia. Babies born to mothers with gestational diabetes are also at greater risk of developing diabetes type 2 diabetes later in life. Pregnant women should be screened for the condition early in their pregnancy, especially if they have risk factors such as obesity or a family history of the condition. Maintaining blood sugar levels during pregnancy is essential to reduce risks and ensure a healthy delivery.

Q. What are some common misconceptions or myths about diabetes that you often encounter in your practice, and how would you like to dispel them?

Dr. Rajiv Kovil: There are many myths surrounding the condition that can cause confusion. One of the most persistent myths is eating sugar.

• Although excessive sugar consumption can contribute to weight gain and insulin resistance, diabetes is a complex condition influenced by genetics, lifestyle and other factors.
• Another common misconception is that insulin is harmful, painful, or a sign of disease progression.
• In fact, modern insulin therapies are safe and cause minimal discomfort, and are a necessary part of the treatment for many people with diabetes.
• Some people also believe that medications are unsafe if you have the condition, preferring natural remedies instead.

However, diabetes medications undergo rigorous testing and are proven to be both effective and safe when used under medical supervision. Although diabetes cannot be cured, it is a manageable condition!

Q. Can diabetes be cured, or is it a lifelong condition?

Dr. Rajiv Kovil: It is a lifelong condition that cannot be cured or reversed. Unfortunately, there is significant marketing activity online promising the reversal of diabetes, which is misleading. The correct term is remission, not reversal. Remission can occur when a person significantly improves their lifestyle, but this does not mean the condition is cured; the condition is simply managed well as long as lifestyle changes are maintained. Once a person develops diabetes, it remains a lifelong condition that requires constant care and attention.

Q. What tips would you give people with diabetes to manage it?

Dr. Rajiv Kovil: Today, the treatment of both type 1 and type 2 diabetes has advanced significantly, and numerous medications are now available to prevent complications and improve quality of life. For type 1 diabetes, the development of continuous glucose monitors and insulin pumps has revolutionized treatment. For type 2 diabetes, treatment is becoming increasingly personalized, with medications tailored to the individual’s specific needs, such as tackling obesity, heart disease or kidney problems. With the right medical advice and a commitment to healthy living, people with this condition can live full, active lives and avoid complications.