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Harish is 50 and retired early from a bank in Faridabad. For the past few months he has been getting up twice a night to pass urine and keeping a bottle of water by the bed. He blamed the summer and his age. Then his feet began to tingle in the evenings, and a cut on his shin from the scooter stand took a month to heal. His walking friends told him to get his sugar checked, and he wants to know which of these signs actually point to diabetes. Harish is a composite of the readers who ask this, not a real patient.
The classic symptoms of diabetes are thirst, passing urine often, especially at night, tiredness, blurred vision, slow-healing cuts, repeated infections and weight loss without trying. Many Indians with type 2 diabetes have no symptoms for years, so a blood test is the only reliable check. HbA1c or fasting sugar confirms it.
What are the most common symptoms of diabetes?
When sugar runs high, the kidneys pass it into the urine and take water with it. That is why the first signs are often passing urine more often, getting up at night to do so, and feeling thirsty enough to keep water by the bed. Tiredness, a dry mouth and blurred vision that comes and goes can follow.
Harish has the first two. He also noticed he was hungrier than usual and that his trousers had loosened by a notch, without any change to his diet. Weight loss without trying happens when the body cannot use sugar properly and starts burning fat and muscle instead. Together with the night-time trips to the bathroom, that pattern is a strong reason for a blood test the same week.
Sources: [1]
Why do many people with diabetes have no symptoms?
Because type 2 diabetes builds slowly. Sudesna Chatterjee's review in The Lancet describes a long phase, often years, in which sugar rises gradually and the body adapts, so nothing feels wrong. Symptoms usually appear only when levels are already quite high.
The national ICMR-INDIAB survey found that a large share of Indians with diabetes did not know they had it until they were tested. Harish's walking friend Kuldeep found out by accident, when a routine check before a knee operation showed an HbA1c of 8.2. He had felt perfectly well. For most people over 35, or younger with a family history, waiting for symptoms means waiting too long.
What are the skin and infection signs?
High sugar feeds germs, so infections come more often and hang on longer. Itchy fungal rashes in the groin or under the breasts, repeated urine infections, boils and bleeding gums are common early clues. Women often notice repeated vaginal thrush before anything else.
Some skin signs point to insulin resistance rather than diabetes itself. Dark, velvety patches on the back of the neck, in the armpits or over the knuckles, called acanthosis nigricans, are one. An Indian expert group led by Rashmi Tyebkhan describes these patches as a marker linked with prediabetes, diabetes and PCOS. Harish's daughter-in-law Pooja, 29, has had them since college and scrubbed them for years thinking they were dirt or tanning. A sugar and fasting insulin test would tell her far more than a new scrub.
Sources: [5]
What does tingling in the feet mean?
It usually means high sugar has started to affect the nerves. The longest nerves, the ones running to the toes, are hit first. So the change starts in the feet: pins and needles, burning, numbness, or a feeling of walking on cotton wool, often worse at night.
Harish's tingling tells his doctor that his sugar has probably been high for some time, maybe years, before the thirst began. Numb feet get hurt without the owner noticing, and the shin cut that took a month to heal shows how slowly his skin is repairing. Until his sugar is under control, he checks the soles of his feet with a hand mirror each night and wears chappals with a back strap at home. He has stopped soaking his feet in hot water, which could burn them without his feeling it.
Sources: [1]
Are diabetes symptoms different in women?
The core symptoms are the same, with a few extra clues. Repeated vaginal yeast infections and urine infections are common early signs in women. Women who had diabetes during pregnancy carry a high risk later; Eleni Vounzoulaki's meta-analysis found almost ten times the risk of type 2 diabetes compared with women who did not.
PCOS also raises the risk, through insulin resistance. Harish's wife Sudha had gestational diabetes with their second son twenty years ago and was told it went away after delivery. It did, for a while. She has had no check since. Her history alone is reason enough for a yearly HbA1c, whether or not she ever feels a symptom.
Sources: [6]
Which blood tests confirm diabetes?
The American Diabetes Association's standards, used widely in India, diagnose diabetes at an HbA1c of 6.5% or more, or a fasting glucose of 126 mg/dL or more. A two-hour value of 200 or more on a glucose tolerance test also counts. A random value of 200 or more with classic symptoms also counts. Results are usually confirmed on a second test.
Prediabetes sits below that: an HbA1c between 5.7% and 6.4%, or a fasting sugar between 100 and 125. The WHO cautions that HbA1c can mislead in people with anaemia or unusual haemoglobin, which is common in India, so a fasting sugar alongside it helps. Harish booked both at a lab near his house, with a fasting sample taken at 8 am after his evening meal at 8 the night before.
When are diabetes symptoms an emergency?
When they come on fast, over days or a few weeks, especially in a younger or slim person. Rapid weight loss, intense thirst, vomiting, stomach pain, drowsiness or deep, fast breathing can mean the body has started making acids called ketones because it has almost no insulin. That is a medical emergency and needs a hospital the same day.
This picture is more typical of type 1 diabetes, which can start at any age. Kuldeep's nephew, a 23-year-old engineering student in Pune, lost seven kilos in a month, drank water all night and then collapsed with vomiting before his exams. He spent three days in intensive care. Type 2 diabetes in someone like Harish usually creeps up more slowly, but the same warning signs apply to anyone.
Sources: [1]
Why do Indians get diabetes earlier?
South Asians tend to develop diabetes younger and at lower body weights than Europeans, partly because more fat is stored around the organs. An Indian expert consensus led by Ashok Kumar Das notes that prediabetes is very common in India and tends to move on to diabetes faster among Asian Indians.
So screening starts earlier here, from about 30 or 35, and sooner with a family history, a large waist, PCOS or diabetes in pregnancy. Harish's father and elder brother both have diabetes, and he was never tested before 50. His elder son Rohit, 28, works in IT, has a 96 cm waist and sits for ten hours a day. For Rohit, losing the belly now is the most powerful protection he has.
Sources: [4]
What can you do if your sugar is high?
See a doctor within the week, and start the changes that help whatever the number is. Harish's HbA1c came back at 7.4, and his doctor started treatment and asked for three changes. He now walks for 15 minutes after dinner, has dropped the sugar from his four daily cups of tea, and eats two rotis with extra dal at lunch instead of white rice.
Weight matters most for his son Rohit, whose sugar is still normal. In the US Diabetes Prevention Program, Richard Hamman's analysis found that weight loss was the strongest single predictor of who avoided diabetes, with the risk falling by about a sixth for every kilo lost. Rohit carries twelve extra kilos around his middle. Losing them while keeping his muscle would do more for his future sugar than anything else he could change.
We should say where we stand, since you are reading this on our site. Metaboliq is a doctor-led weight programme, and the aim we set with members is "Lose up to 20% of your body weight — and keep your muscle". Results vary; your doctor decides what is right for you. It starts with a home blood test that a doctor reads, covering HbA1c, fasting sugar and insulin, so Rohit starts from his own numbers.