Globally, diabetes is ranked as the second most common disease, closely followed by ischaemic heart disease and stroke. It is not a new disease; diabetes was known in ancient Egypt and India as a disease that produced sweet urine and wasted limbs. Untreated, most diabetics died young in ancient times from heart or kidney disease and other complications.

There was no insulin or other diabetes medication earlier. Patients were placed on extremely restricted diets, starved of nutrients, protein and vitamins, and often died from this starvation along with disease complications. Herbal concoctions were also tried but showed no benefit.

Unfortunately, although the disease has been around for so long, a lot of people have failed to grasp the fundamental facts about diabetes.

No one in my family has diabetes. How did I get it?

In the early stages, diabetes is asymptomatic. Universal testing, master health check-ups and even health insurance are recent phenomena. Life expectancy was also much lower in the past. Your family members may not have been tested for diabetes, may not have realised they had it or may have died young from other causes such as infectious diseases like typhoid, which are treatable and preventable today.

I thought only older people had diabetes.

Diabetes can, unfortunately, start at any age. Babies can be born with it. Insulin-dependent diabetes, where the body produces no insulin at all, can appear at any age, with peaks appearing around 4-5 years and again between 10-14 years. This may follow a viral infection. It can be autoimmune, in which the body mistakenly treats the insulin-producing islet cells of the pancreas as foreign invaders and systematically destroys them. Diabetes can also suddenly appear during pregnancy.

Traditionally, diabetes was expected to appear at 45 years or older. It is now increasingly seen in younger people, even teenagers. This is due to obesity and a physically inactive lifestyle, with minimal games, sports or exercise, and large segments of the day spent seated in front of a mobile phone, television or laptop.

I don’t like sweets, and I don’t touch them. How did I get diabetes?

All foods contain carbohydrates, protein, fat and fibre. Carbohydrates are broken down into simple sugars (such as glucose) in the digestive system and then absorbed. Many foods — such as condiments or sauces but also healthy snacks like granola bars — contain high levels of hidden sugars. If you are overweight, even if you eat a sugar-free diet, obesity may cause type 2 diabetes by triggering chronic inflammation and releasing excess fatty acids. Body cells become resistant to insulin. The pancreas tries to produce more insulin to counter this but eventually fails, and blood sugar levels rise.

I don’t put white sugar in my tea and coffee. I was told that even though I am diabetic, I can use jaggery or palm sugar.

They are slightly better than refined sugar because they have a lower glycaemic index but they still contain high levels of carbohydrates and sucrose, which can cause blood sugar spikes. You will soon get used to unsweetened tea and coffee, and that may be best for your health.

If you are diabetic, you need to count the total calories in your daily diet. Requirements are 25-30 kcal per kg of ideal body weight (ideal body weight = weight divided by height in metres squared multiplied by 23) per day. The protein requirement is around 0.8g per kg of body weight. In this Internet-savvy smartphone generation, all you need to do is accurately write down everything you eat in a day. The calorie content is easily available online. Calculation and control of calories is the first step in diabetic control. Additionally, aim for 20-30 minutes of exercise daily.

The writer has a family practice at Vellore and is the author of Staying Healthy in Modern India. If you have any questions on health issues please write to yourhealthgm@yahoo.co.in