What is Diabetes Mellitus?

Diabetes Mellitus is a group of chronic conditions characterized by high blood glucose (sugar) levels resulting from insufficient insulin, lack of insulin, or the body’s inability to use insulin effectively.

Insulin, a hormone produced by the pancreas, has many functions in the body. It also plays a central role in regulating blood glucose. Think of insulin as a conductor in an orchestra—it coordinates various cellular activities that maintain metabolic balance. One of its functions is to facilitate the movement of glucose from the bloodstream into cells, where it can be used for energy. When this finely tuned system falters, glucose builds up in the blood, setting the stage for Diabetes Mellitus.

Previously known as Insulin-Dependent Diabetes Mellitus (IDDM), Type 1 is an autoimmune condition in which the immune system destroys the insulin-producing cells in the pancreas. People with type 1 diabetes produce little to no insulin and require lifelong insulin therapy, usually administered through injections or insulin pumps. Blood glucose is typically monitored through continuous glucose monitoring (CGM).

This form of diabetes is distinct from Type 2 and usually presents earlier in life. Public figures such as Wasim Akram, Nick Jonas, and Sonam Kapoor have openly shared their journeys with Type 1 Diabetes.

Previously called Non-Insulin-Dependent Diabetes Mellitus (NIDDM), Type 2 is far more common, accounting for 90–95% of all diabetes cases.

In its early stages, the body becomes insulin resistant—cells no longer respond efficiently to insulin, requiring more of it to maintain normal glucose levels. Over time, the pancreas cannot keep up with this demand, and blood sugar levels begin to rise.

Insulin resistance is at the heart of Type 2 Diabetes. It often develops silently over many years before blood sugar abnormalities are detectable by standard diagnostic tests.

A significant number of individuals are being diagnosed with Type 2 diabetes that rapidly progresses to exhibit characteristics of Type 1 diabetes. These cases are often observed in individuals with normal or below-normal body weight. A growing body of research, particularly emerging from India, is shedding light on this phenomenon.

This type occurs during pregnancy and typically resolves after childbirth. However, it increases the mother’s risk of developing Type 2 Diabetes later in life.

Prediabetes is a warning state—blood sugar levels are higher than normal but not high enough to be classified as diabetes. It indicates the presence of insulin resistance and represents a critical opportunity to prevent the onset of Type 2 Diabetes.

• Advancing age
• Family history of diabetes
• Ethnic background (higher risk in South Asians, African Americans, and Hispanics)
• Overweight and obesity
• Physical inactivity
• Chronic stress
• Excessive alcohol consumption
  
  

• Excessive thirst and hunger
• Frequent urination
• Fatigue and irritability
• Blurred vision
• Slow-healing wounds
• Tingling or numbness in the hands and feet
• Unexplained weight changes
• Fruity odor on the breath
• Skin darkening, particularly in body creases
  

Some individuals may experience no noticeable symptoms, with abnormalities discovered only during routine health screenings.

The diagnostic thresholds for prediabetes and diabetes are well established and widely used in clinical practice:

Normal Range

• Fasting Blood Sugar (FBS): 70–99 mg/dL (3.9–5.5 mmol/L)
• HbA1c: 3.9% to less than 5.7%
  

Prediabetes

• FBS: 100–125 mg/dL (5.5–6.9 mmol/L)
• HbA1c: 5.7% to less than 6.5%
  
  

Diabetes Mellitus Type 2 (DM2)

• FBS: ≥126 mg/dL (≥7.0 mmol/L)
• HbA1c: 6.5% or higher
  

Additional diagnostic tools include Random Blood Glucose Testing and the Oral Glucose Tolerance Test (OGTT).

While a range of new and effective medications are available for the treatment of DM2, the ultimate goal should be prevention. The pathological process underlying diabetes begins long before clinical diagnosis, often in the form of insulin resistance—a condition in which cells become less responsive to insulin. By the time fasting blood glucose or HbA1c values reach diagnostic thresholds, insulin resistance may have been silently progressing for several years.

This provides a critical window of opportunity: diabetes can often be predicted—and potentially prevented—through early detection of insulin resistance. If identified early and managed appropriately, the development of Type 2 diabetes may be entirely avoidable.

Scientific research continues to identify promising avenues for early detection. Insulin assays have become more accessible, although they are not yet part of the formal diagnostic criteria. Dr. Joseph Kraft was a pioneer in advocating for the use of insulin assays to detect early diabetes. Newer tools are also on the horizon and may become clinically mainstream. As a result, the very definition of Type 2 diabetes is evolving.

There is also growing optimism around dietary interventions, particularly low-carbohydrate diets, which are gaining traction as effective tools for managing insulin resistance and DM2. Diets high in fat, such as the ketogenic diet, have long been used in medical settings—for example, in treating intractable epilepsy. While powerful, ketogenic diets should be undertaken only under the supervision of qualified healthcare professionals, as improper use can be harmful.

Early diagnosis and proactive management remain central to effective diabetes care.

If you have Type 2 diabetes or have been diagnosed with prediabetes, it's essential to take these conditions seriously and work closely with your healthcare provider. Managing diabetes involves a comprehensive plan that includes a balanced diet, regular physical activity, weight management, and—when necessary—medication. Each of these elements is crucial to preventing complications that can significantly reduce quality of life and lifespan.

Even if you have not been diagnosed with diabetes or prediabetes, it’s wise to assess your risk for insulin resistance and take preventive steps. Lifestyle modifications—such as regular exercise, healthy eating, and maintaining a healthy weight—can significantly reduce the likelihood of progressing to DM2.

The healthcare system and scientific community are increasingly equipped to support prevention and early intervention, but ultimately, the responsibility for your health starts with you.

Wishing you a life of health and vitality.