Diabetes
Diabetes care
Diagnosis, medication review and the daily decisions in between — for type 1, type 2 and prediabetes.
Which one applies to you
Type 2 diabetes
The common form. Often silent for years, and in South Asians it appears at a lower weight and a younger age.
Type 1 diabetes
The immune system stops insulin production. It is not only a childhood condition — around half of new cases begin in adulthood.
Prediabetes
Glucose above normal but below the diabetes threshold. The stage where the outcome is still genuinely reversible.
What diabetes actually is
Diabetes is a condition in which the level of glucose in the blood stays higher than it should, because the body either does not make enough insulin, cannot use the insulin it makes, or both. Insulin is the hormone that moves glucose out of the blood and into cells where it is used for energy.
The type matters because the mechanism differs, and so does the treatment. In type 1, the immune system destroys the cells that make insulin, so insulin has to be replaced from the day of diagnosis. In type 2, the body becomes resistant to insulin and, over years, the pancreas gradually falls behind demand. Prediabetes sits in between: glucose is above normal, but not yet at the level that defines diabetes.
What all three share is that the day-to-day management happens at home, not in the consulting room. That is the part this clinic is built around.
Diabetes in Pakistan
Pakistan has the highest rate of diabetes of any country in the world. The International Diabetes Federation puts age-standardised prevalence among adults aged 20 to 79 at 31.4% for 2024 — close to one adult in three — with 34.5 million people living with the condition, the fourth largest number of any country on earth.
Roughly 26.9% of them, about 9.3 million people, do not know they have it. Undiagnosed diabetes is not harmless: damage to the eyes, kidneys, nerves and arteries accumulates quietly through those years, which is why so many people here are found to have a complication already present on the day they are diagnosed.
On current projections the number reaches 70.2 million by 2050. Read the other way round, these figures are an argument for testing rather than for alarm. If you are over 30, carry weight around the middle, or have a parent or sibling with diabetes, a fasting glucose and an HbA1c once a year is a reasonable thing to ask your doctor for.
Figures: International Diabetes Federation, IDF Diabetes Atlas, 11th edition, 2025.
How it is diagnosed
Diagnosis is made on a blood test, not on symptoms. Any one of the results below is enough, and unless glucose is unequivocally high with classic symptoms, the test is repeated to confirm before a diagnosis is made.
Both mg/dL and mmol/L are given. Laboratories in Pakistan usually report glucose in mg/dL and HbA1c as a percentage.
Symptoms — and why their absence proves nothing
The classic symptoms are passing urine frequently, being persistently thirsty, unexplained weight loss, tiredness, blurred vision, and cuts or infections that take longer than usual to settle. In type 1 these usually come on over weeks and are hard to ignore.
In type 2 there may be no symptoms at all for years. It is common for the diagnosis to be made on a routine test, or after a complication has already started. Feeling well is not evidence that glucose is normal, which is why testing matters if you have risk factors — a parent or sibling with diabetes, raised weight around the waist, high blood pressure, a history of gestational diabetes, or polycystic ovary syndrome.
What treatment involves
Treatment is built around three things: the medicines that suit your type and your other conditions, the way you eat and move, and the readings that tell you whether the plan is working.
For type 2, that usually starts with lifestyle change and metformin, with further medicines added according to your glucose, your kidney and heart status, your weight and what you can realistically afford and sustain. For type 1, it means insulin from the outset, matched to what you eat and what you do. In every case the plan is only as good as your ability to follow it in an ordinary week.
Targets are individual. A commonly used goal for adults is an HbA1c below 7% (53 mmol/mol), but a higher target may be safer if you are older, live alone, have significant heart or kidney disease, or have had severe hypoglycaemia. Anyone who gives you a single number without asking about your circumstances is not treating you, they are treating an average.
The diagnostic thresholds
These are the American Diabetes Association criteria, which are the ones used in most Pakistani practice.
| Test | Normal | Prediabetes | Diabetes |
|---|---|---|---|
| Fasting plasma glucose | Below 100 mg/dL (5.6 mmol/L) | 100–125 mg/dL (5.6–6.9 mmol/L) | 126 mg/dL (7.0 mmol/L) or above |
| HbA1c | Below 5.7% (39 mmol/mol) | 5.7–6.4% (39–47 mmol/mol) | 6.5% (48 mmol/mol) or above |
| 2-hour glucose, 75 g OGTT | Below 140 mg/dL (7.8 mmol/L) | 140–199 mg/dL (7.8–11.0 mmol/L) | 200 mg/dL (11.1 mmol/L) or above |
| Random glucose with symptoms | — | — | 200 mg/dL (11.1 mmol/L) or above |
Fasting means no food or caloric drink for at least eight hours. The World Health Organization uses a slightly narrower fasting range for prediabetes (110–125 mg/dL), so a result in the low 100s may be labelled differently depending on which criteria your laboratory follows. HbA1c is unreliable in anaemia, haemoglobinopathies, pregnancy, recent blood transfusion and chronic kidney disease — in those situations it should not be used alone.
Common questions
- Can diabetes be reversed?
- Type 1 cannot. Type 2 can go into remission — meaning HbA1c stays in the non-diabetic range without glucose-lowering medicine — most often after substantial weight loss and most reliably when it is attempted within a few years of diagnosis. Remission is not the same as cure: the tendency remains, and glucose needs to keep being checked.
- Do I have to take insulin forever once I start?
- In type 1, yes. In type 2, not necessarily. Insulin is sometimes started temporarily to bring very high glucose down quickly, or during illness, surgery or pregnancy, and can often be reduced or stopped afterwards.
- My sugar is fine when I check at home. Do I still need HbA1c?
- Yes. A meter reading is one moment; HbA1c reflects the average over roughly the previous three months. Two people with the same HbA1c can have very different patterns, and two people with the same morning reading can have very different HbA1c.
- Can I fast in Ramadan?
- Many people with diabetes can, but not everyone, and it depends on your type, your medicines, your kidney function and whether you have had hypoglycaemia. It needs an assessment before Ramadan, not a decision on the first morning. Doses often have to be changed and the timing of medicines moved.
Important