Type 2 diabetes, commonly known as “sugar” in Pakistan, has quietly become one of the most serious public health emergencies in the country. Almost every family is affected with this problem including parents, khala, phupo, chacha and some very young people as well. It is discussed casually, yet the consequences are anything but.
When both direct medical costs and indirect costs are considered, diabetes is estimated to cost Pakistan up to USD 8-9 billion annually, as much as our national defence budget. Pakistan now ranks amongst the countries with the highest diabetes burden globally. Current figures from the World Health Organisation suggest that one in three Pakistanis are living with diabetes. This means a large proportion of people discover the disease only after complications such as heart disease, kidney failure, vision loss, or nerve damage have already developed. This late diagnosis is not just a clinical failure, it is a systemic one. Diabetes in Pakistan has moved beyond being an individual health issue and has become a population-level crisis.
What is Type 2 Diabetes?
Type 2 diabetes occurs when there is too much sugar (glucose) in the bloodstream. This happens because the body either does not produce enough insulin or becomes resistant to it. Insulin is the hormone responsible for moving sugar from the blood into the body’s cells to be used as energy. When this process fails, sugar builds up in the blood over time, damaging blood vessels, nerves, and vital organs such as the heart, kidneys, eyes, and brain. Type 2 diabetes is not just a blood sugar problem, it is a whole-body disease.
Despite how common it is, diabetes in Pakistan is poorly controlled and rarely brought into remission. The real question is, why are we still getting it so wrong, despite knowing so much about it?
“Doctor, I don’t eat sugar”
This is one of the most common statements doctors hear. Many people believe diabetes is caused only by eating sweets. While sugary foods do raise blood sugar, they are not the main culprit. Carbohydrates are broken down into sugar during digestion. This means everyday foods like naan, roti, white rice, bread, parathas, biscuits, and bakery items all raise blood sugar levels, sometimes as much as, or more than, table sugar.
This does not mean these foods must be eliminated entirely. The key is portion control and smarter choices such as having one roti instead of three, brown or wholegrain bread instead of white, smaller rice portions, more vegetables, lentils, eggs, fish, and lean meats. This results in consuming the same foods but a lot better balance. What you eat most days matters far more than what you eat occasionally.
“It is in my family - Everyone has it”
Genetics do play a role. South Asians are genetically more prone to developing type 2 diabetes, often at a younger age and lower body weight than other populations. But genetics are not destiny, lifestyle factors such as diet, physical activity, smoking, sleep, and stress, all have a powerful influence. According to the Centres for Disease Control and Prevention, losing just 5-10% of body weight can significantly improve blood sugar levels and insulin sensitivity. Small, consistent changes can produce life changing results.
“I walk for 30 minutes after eating - Isn’t that enough?”
Walking is an excellent start, and it does help. But for many people, walking alone is not enough to bring diabetes into remission. The body needs activities that raise the heart rate, cause light breathlessness and build muscle. Although still healthy, a normal walk is seldom going to bring any results to put diabetes in remission. Muscle acts like a storage unit for sugar, pulling glucose out of the bloodstream and improving insulin sensitivity.
The most effective approach combines cardio (brisk walking, stair climbing, cycling), strength training (bodyweight exercises, resistance bands, light weights 2-3 times a week).
Simple additions can make a big difference:
- Take the stairs and repeat a few rounds every day.
- Add short bursts of faster walking
- Use household items as weights and lift them regularly
- Follow short home workouts online
- Start small, progress slowly
- Consistency matters more than intensity.
Exercise is one of the most powerful medicines for diabetes and it is free. You don’t have to go to the gym to start exercising, it can be done at home as well.
Why is Diabetes so dangerous?
Diabetes often causes silent damage before symptoms appear. Over time, uncontrolled diabetes can damage vision and cause blindness, slow wound healing and increase infections, damage nerves leading to numbness in hands and feet, cause kidney failure and increases the risk of heart attacks and strokes. By the time symptoms are obvious, significant damage may already be done.
The earlier diabetes is brought under control, the greater the chance of preventing or even reversing these complications.
Due to south asians having a genetic predisposition to diabetes, the UK NICE guidelines suggest getting a risk assessment as early as 25 years of age.
So, what is the real lesson?
Pakistan’s diabetes crisis cannot be solved with medications alone or occasional clinic visits.
The scale of the problem demands:
- High intensity of public education
- Early screening and detection
- Long-term lifestyle change
- Community-level action
Diabetes is not simply a medical condition, it is deeply tied to culture, food habits, urbanisation, and inactivity. Pakistani food is not the enemy- portion size, frequency, and balance make all the difference. Remission is possible, not through extreme diets, but through sustainable lifestyle change.
With education, early diagnosis, regular physical activity, and healthier eating patterns, type 2 diabetes can go into remission for many people. The power to stay healthy or to control diabetes does not lie in medication alone- it lies within our homes, our routines, and our communities.
The author is a British-Pakistani physician working with the NHS UK