Diabetes is a metabolic disorder where the body either does not produce enough insulin or cannot effectively use the insulin it makes. Insulin is a hormone, essential for regulating blood sugar levels, and when this process is disrupted, blood sugar 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 like poor diet and lack of exercise. If left unmanaged, it can lead to serious complications, including heart disease, kidney damage, and nerve problems. Since it can easily go unnoticed until serious complications arise, it is crucial for individuals to stay informed about the condition—how it develops, what the early signs are, and the best ways to manage it.

On this World Diabetes Day, we are diving into some of the most common questions and misconceptions surrounding the disease, with insights from Dr Rajiv Kovil, a leading diabetologist in India with over two decades of experience. Whether you are recently diagnosed or have been living with diabetes for years, Dr Kovil will help clear up your doubts and provide valuable advice on managing 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 may not be noticeable until significant damage has been done. Nearly 60–70 percent of the cases are diagnosed incidentally—meaning many people do not experience typical symptoms, such as frequent urination, excessive thirst, or fatigue, until later stages. Early screenings and regular checkups are crucial to detect diabetic complications (like kidney, eye, and heart issues) and can help prevent the long-term impact of the disease.

Q. How does the body regulate blood sugar levels and how does this process differ in individuals 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 glucose levels to meet the energy needs of your body. However, in people with type 2 diabetes, the body becomes resistant to insulin and the pancreas struggles to produce enough insulin to maintain normal blood sugar levels. Over time, this leads to chronic high blood sugar, which can cause damage to various organs.

Following a healthy diet is essential to managing blood sugar levels. Image courtesy: Adobe Stock

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

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

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

Dr Rajiv Kovil: While genetics play a significant role in increasing the risk of this condition, it is important to understand that heredity does not guarantee 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, particularly if they lead a sedentary lifestyle, are overweight, or have poor eating habits. The risk increases with age, obesity, and other environmental factors.

Q. How do you handle blood sugar spikes after eating a large meal or high-carb foods?

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

Q. Will I need to take insulin if I have diabetes?

Dr Rajiv Kovil: Not everyone living with this condition needs insulin. In fact, insulin therapy is typically reserved for individuals whose blood sugar can no longer be controlled through diet and oral medications. For those with type 1, insulin is necessary as the body produces little to no insulin. However, in type 2, insulin may be prescribed temporarily, especially if blood sugar is severely high during an illness, surgery, or acute stress. Insulin is also part of a permanent treatment plan if someone is in the advanced type 2 diabetes stage.

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

Dr Rajiv Kovil: Obesity is one of the leading risk factors for type 2 diabetes. Excess fat, especially around the abdomen, contributes to insulin resistance, meaning the cells of your body no longer respond to insulin as effectively. This leads to high blood sugar levels. Furthermore, fat deposits in the liver and pancreas can impair the function of these vital organs, exacerbating insulin resistance and eventually causing the pancreas to lose its ability to produce enough insulin. As obesity continues to rise globally, so does the prevalence of this condition, making weight management a critical factor in its prevention or management.

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

Dr Rajiv Kovil: While it affects both men and women, certain lifestyle factors make men more vulnerable. Men are more likely to have unhealthy habits such as higher rates of smoking, alcohol consumption, and poorer diet choices, all of which contribute to obesity and insulin resistance. Additionally, men are often less likely to seek medical advice or engage in preventive 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 could gestational diabetes affect my baby's health?

Dr Rajiv Kovil: Gestational diabetes (GD), which occurs during pregnancy, can have serious consequences for both mother and baby. If left uncontrolled, it can lead to complications such as premature birth, large birth weight (macrosomia), and delivery difficulties like shoulder dystocia. Babies born to mothers with GD are also at higher risk for developing 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.

Keep checking your sugar levels. Image courtesy: Shutterstock

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

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

• While 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 they are a necessary part of treatment for many people living with this condition.
• 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. While this condition has no cure, 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 exploitation online that promises the reversal of diabetes, which is misleading. The correct term is remission, not reversal. Remission can occur when a person improves their lifestyle significantly, but this does not mean the condition is cured—it is simply well-managed as long as those lifestyle changes are maintained. Once someone develops this chronic condition, it remains a lifelong condition that requires ongoing care and attention.

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

Dr Rajiv Kovil: Today, the management of both type 1 and type 2 diabetes has advanced significantly, with numerous medications now available to prevent complications and enhance 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 increasingly personalised, with medications tailored to the individual’s specific needs, such as addressing obesity, heart disease, or kidney problems. With the right medical advice and a commitment to healthy living, individuals with this condition can live full, active lives and prevent complications.

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