Diabetes symptoms and types: what is diabetes, and type 1 vs type 2
Diabetes means blood sugar stays too high because the body makes too little insulin or cannot use it well. Common symptoms are frequent urination, thirst, tiredness, blurred vision and slow-healing wounds, but type 2 often has no symptoms at all. The main types are type 1, type 2 and gestational diabetes. A blood test (fasting sugar or HbA1c) is the only way to know.
Diabetes in Pakistan
Pakistan has one of the highest rates of diabetes in the world: the International Diabetes Federation estimated that about 1 in 4 adults (around 33 million people) had diabetes in 2021, and many do not know it. South Asians develop type 2 diabetes at a younger age and a lower body weight than Europeans, so testing should start earlier.
Symptoms of diabetes (sugar ki alamat)
- Frequent urination, especially getting up at night
- Strong thirst and a dry mouth
- Tiredness and weakness
- Weight loss without trying (more typical of type 1, or of very high sugar in type 2)
- Blurred vision
- Slow-healing cuts and wounds, and repeated skin, gum, urine or yeast infections
- Tingling or burning in the feet (a sign that sugar has been high for a long time)
- Dark, velvety skin on the neck or armpits, a sign of insulin resistance; see the insulin resistance page
Type 2 diabetes is often silent for years. Many people in Pakistan are first diagnosed during a test for something else, or only after a complication.
Types of diabetes: type 1 vs type 2 vs gestational
| Feature | Type 1 | Type 2 | Gestational |
|---|---|---|---|
| Who gets it | Usually children and young adults, but any age | Mostly adults over 30; in Pakistan increasingly in people in their 20s | Pregnant women, usually found at 24 to 28 weeks |
| Cause | The immune system destroys the insulin-making cells | The body resists insulin and slowly makes too little of it | Pregnancy hormones raise insulin needs |
| Onset | Fast, over days to weeks | Slow, over years; often no symptoms | No symptoms; found on a glucose test |
| Body weight | Often thin, with weight loss | Often overweight or with belly fat, but not always in South Asians | Any |
| Treatment | Insulin from the start, for life | Diet, activity and weight loss, then tablets, injections or insulin if needed | Diet and activity; some need insulin or tablets |
| Can it go into remission? | No | Yes, in some people with weight loss | Usually goes after delivery, but the risk of type 2 later is high |
Other types are less common: prediabetes (sugar higher than normal but below diabetes; the best time to act), LADA (a slow type 1 in adults, often mistaken for type 2), MODY (a genetic type that runs strongly in families) and diabetes caused by pancreas disease, steroids or other medicines.
Sugar levels that mean diabetes
| Test | Normal | Prediabetes | Diabetes |
|---|---|---|---|
| Fasting sugar (mg/dL) | Below 100 | 100 to 125 | 126 or more |
| HbA1c | Below 5.7% | 5.7 to 6.4% | 6.5% or more |
| 2 hours after 75 g glucose (mg/dL) | Below 140 | 140 to 199 | 200 or more |
More detail on the normal sugar level and HbA1c normal range pages.
What to do after a diagnosis
Type 1 diabetes always needs insulin, and food is planned around it. In type 2 and prediabetes, food and activity are the foundation of treatment: losing 5 to 10 percent of body weight, regular meals with measured roti or rice, half the plate sabzi, no sugary drinks and a walk after meals. Start with the diabetic diet chart, or ask a dietitian for a plan built around your reports and medicines.
See a doctor first if
- You have vomiting, belly pain, deep fast breathing, fruity-smelling breath or drowsiness with high sugar: this can be diabetic ketoacidosis, go to hospital now
- Your child or teenager suddenly drinks and urinates a lot and loses weight (same-day test)
- Your sugar is above 300 mg/dL, or below 70 mg/dL with shaking, sweating or confusion
- You are pregnant and have not had a glucose test at 24 to 28 weeks
Common questions
What is diabetes?
Diabetes is a long-term condition in which blood sugar (glucose) stays too high, because the body does not make enough insulin, cannot use it properly, or both. Insulin is the hormone that moves sugar from the blood into the cells. Over years, high sugar damages the eyes, kidneys, nerves, heart and blood vessels.
What are the first signs of diabetes?
Passing urine often (especially at night), feeling very thirsty, tiredness, blurred vision, slow-healing wounds and repeated infections such as urine infections or thrush. Many people with type 2 diabetes have none of these, which is why a test is the only way to know.
What are the early signs of diabetes in women?
The same as in men, plus repeated vaginal yeast infections (itching and white discharge) and urine infections. Women with PCOS, a history of diabetes in pregnancy, or a baby over 4 kg at birth have a higher risk and should be tested regularly.
What sugar level means diabetes?
Diabetes is diagnosed with a fasting sugar of 126 mg/dL or more, an HbA1c of 6.5% or more, a sugar of 200 mg/dL or more 2 hours after a glucose drink, or a random sugar of 200 mg/dL or more with symptoms. Without symptoms, the result is confirmed with a second test. See the normal sugar level page for full ranges.
Can type 2 diabetes be cured?
It is not "cured", but it can go into remission: normal sugar without diabetes medicines for at least 3 months. This is most likely with significant weight loss early after diagnosis. Never stop medicines on your own; reduce them only with your doctor as your sugar improves.
Does eating sugar cause diabetes?
Sugar alone does not cause type 1 diabetes. For type 2, the main drivers are extra weight (especially belly fat), inactivity, family history and South Asian genes. Sugary drinks and a diet high in refined flour raise the risk mainly by adding weight and stressing insulin.
Who should get tested for diabetes in Pakistan?
Every adult from age 35, and earlier if you are overweight (BMI 23 or more for South Asians) with another risk: a parent or sibling with diabetes, high blood pressure, high cholesterol, PCOS, diabetes in pregnancy, or an inactive lifestyle. If normal, repeat at least every 3 years.
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Sources
- American Diabetes Association. Standards of Care in Diabetes, Section 2: Diagnosis and Classification
- International Diabetes Federation. IDF Diabetes Atlas, 10th edition, 2021
- Riddle MC et al. Consensus report: definition and interpretation of remission in type 2 diabetes. Diabetes Care, 2021
- NHS. Diabetes
- NHS. Diabetic ketoacidosis