Quick answer. Type 2 diabetes means blood sugar stays too high because insulin does not work well or the body makes too little. It is diagnosed with blood tests and treated with food changes, activity and usually medicines. ICMR advises screening every adult over 30, and earlier with risk factors.
What type 2 diabetes is
Insulin is the hormone that moves sugar from the blood into the body’s cells. In type 2 diabetes, insulin does not work properly and the body may also make too little of it. Over time, high sugar can damage nerves and blood vessels, leading to heart attack, stroke, kidney failure, vision loss and foot ulcers.
It accounts for 90 to 95 percent of diabetes and it is a progressive condition, which means treatment often changes over the years. Needing more medicine later does not mean you failed.
Why it matters in India
The ICMR-INDIAB national study of 113,043 adults, surveyed between 2008 and 2020, estimated that 11.4 percent of Indians aged 20 and over have diabetes and 15.3 percent have prediabetes.
ICMR says type 2 diabetes appears at least a decade earlier in Indians than in other major ethnic groups. At any given BMI, South Asians tend to have more body fat, more fat around the organs and more insulin resistance. So a person who does not look overweight can still be at risk.
Who should get tested
Many people with type 2 diabetes have no symptoms. ICMR says more than half have none, so testing matters. ICMR advises screening everyone over 30, and earlier for adults with any of these:
- A family history of diabetes.
- A BMI of 23 or more, or a waist above 90 cm in men or 80 cm in women.
- High blood pressure, or abnormal cholesterol or other blood fats.
- An inactive lifestyle.
- Diabetes in pregnancy, or a baby born weighing more than 3.5 kg.
- Heart disease or a past stroke.
- PCOS, or dark, velvety patches of skin (acanthosis nigricans).
If results are normal, retest after 3 years. With prediabetes, retest every year.
Symptoms to mention
These include thirst, passing more urine, tiredness, weight loss despite eating well, itching, repeated urine or genital infections and slow-healing wounds. Blurred vision is another. They often come on gradually.
Tests and what the numbers mean
These are the ICMR diagnostic criteria. Glucose figures are for plasma, from a blood sample. A result in the diabetes range should be confirmed with another test, unless the doctor has clear symptoms and a high random sugar to go on.
| Test | Normal | Prediabetes | Diabetes |
|---|---|---|---|
| Fasting plasma glucose (mg/dl) | Below 100 (ADA) or below 110 (WHO) | 100 to 125 (ADA) or 110 to 125 (WHO) | 126 or more |
| 2 hours after 75 g glucose (mg/dl) | Below 140 | 140 to 199 | 200 or more |
| HbA1c | Below 5.7% | 5.7 to 6.4% | 6.5% or more |
| Random plasma glucose with symptoms (mg/dl) | 200 or more |
HbA1c shows your average sugar over about 3 months. ICMR notes it has some limitations in India, and the RSSDI panel raises concerns about anaemia and haemoglobin disorders affecting the result. If either applies to you, ask whether another test should be used alongside it.
Treatment options
Food
ICMR advises a plan that is close to your family’s usual food, flexible and suited to your daily routine, ideally worked out with a dietitian. Its main points:
- Choose whole grains, unpolished cereals, millets, pulses, beans, vegetables and some fruits such as guava, papaya and oranges in moderation.
- Avoid fruit juices, and limit pickles, packaged namkeens and sauces.
- RSSDI advises limiting the quantity of rice, and preferring brown rice to white. You can still eat rice, in a smaller portion.
- Keep added salt under 5 g a day, and lower with high blood pressure.
- Limit vanaspati, butter and ghee when blood fats are high.
Activity
ICMR recommends about 150 minutes of aerobic activity a week, plus resistance training at least twice a week and flexibility exercises. ICMR also advises a full medical check before starting an exercise programme. Tobacco in any form should stop, and alcohol is best avoided.
Medicines
Your doctor chooses medicines based on your age, how long the diabetes has been present, other conditions, cost, weight and risk of low sugar. Here is the general order in Indian guidance:
The ICMR guideline dates from 2018 and RSSDI from 2020. Advice on newer medicines has moved on: the NHS, for instance, now offers most people a biguanide with an SGLT2 inhibitor. Ask your doctor which option suits you, and do not stop any medicine without medical advice.
Blood sugar targets
ICMR’s ideal range is HbA1c below 7%, fasting glucose 80 to 110 mg/dl and 2-hour post-meal glucose 120 to 140 mg/dl, with individual targets set by your doctor. Targets may be revised for older people and those with complications.
Regular checks
Complications can build up silently, so these checks matter even when you feel well.
| Check | How often (ICMR) |
|---|---|
| Fasting and post-meal glucose | At least monthly, more often if off target |
| HbA1c | Every 6 to 12 months, or every 3 months if off target |
| Clinic visit with foot check | At least every 3 months |
| Dilated eye exam for the retina | Yearly, with an ophthalmologist |
| Kidney tests (creatinine, urine albumin) | Yearly |
| Detailed foot exam, ECG, blood fats, blood count | Yearly |
Looking after your feet
ICMR advises checking your feet every day with a mirror, washing them in lukewarm water, and moisturising after drying. Do not walk barefoot, use hot fomentation or use corn plasters or blades. A foot wound should be seen by a doctor within a day.
When to get urgent help
- Call 112 or 108 for passing a lot of urine with great thirst, feeling sick, confusion, unusual sleepiness or shortness of breath. Very high sugar can be life threatening. Do not drive yourself.
- Low sugar can cause hunger, sweating, shaking and a racing heart. If the person is awake, give glucose, sweets or sugar.
- If someone is unconscious or not responding normally, give nothing by mouth, because they may choke, and call 112 or 108.
- Vomiting, diarrhoea or high fever while on diabetes medicine needs urgent advice from your doctor.
Who treats type 2 diabetes
A general physician usually diagnoses and manages it, and refers to an endocrinologist when control is difficult. Others join when needed: an ophthalmologist for eyes, a nephrologist for kidneys, a cardiologist for the heart, and a general surgeon or foot clinic for ulcers. Use find a doctor to look by city.
What to ask your doctor
- What should my HbA1c and sugar targets be, and why?
- Which medicine are you suggesting, what does it cost per month, and what side effects should I watch for?
- Can any of my medicines cause low sugar? What should I do if that happens?
- Which yearly checks are due now, and who will do them?
- How should I change my medicines when I am ill, or if I fast?
- Can you refer me to a dietitian who knows our usual food?
- Should my family members be tested?
Common questions
Can type 2 diabetes be reversed?
Some people reach remission with major weight loss. In the UK DiRECT trial, reported by RSSDI, 46 percent in a weight management programme were in remission at 12 months, against 4 percent in the comparison group. The trial’s participants had a BMI of 27 to 45, so results may differ for others. Never stop medicines on your own, and do not start a very strict low-calorie diet without advice.
Are herbal or Ayurvedic medicines safe with diabetes?
ICMR notes that some herbal products do lower sugar, but their action is not clearly understood, and they are not necessarily safe or non-toxic. Tell your doctor about anything you take, because they may add to the sugar-lowering effect of your other medicines.
Do I need a glucose meter at home?
ICMR calls home monitoring ideal for every patient, and indicated for everyone on insulin and those prone to low sugar. How often to test varies, so ask your doctor.
I have prediabetes. Will I get diabetes?
Not always. ICMR says studies, including some from India, show diabetes can be prevented in up to a third of people with prediabetes through diet, exercise and weight control. Retest every year.
Sources
- WHO: Diabetes fact sheet (checked 2 Nov 2026)
- ICMR Guidelines for Management of Type 2 Diabetes 2018 (MEDBOX copy) (checked 2 Nov 2026)
- Anjana RM et al. ICMR-INDIAB-17. Lancet Diabetes and Endocrinology, 2023 (checked 2 Nov 2026)
- MedlinePlus: Type 2 diabetes (checked 2 Nov 2026)
- NHS: Type 2 diabetes symptoms (checked 2 Nov 2026)
- RSSDI-ESI Clinical Practice Recommendations for the Management of Type 2 Diabetes Mellitus 2020 (checked 2 Nov 2026)
- NHS: Type 2 diabetes treatment (checked 2 Nov 2026)
- NHS: Type 2 diabetes complications (checked 2 Nov 2026)
- NHS: Low blood sugar (hypoglycaemia) (checked 2 Nov 2026)