Diabetes
Type 2 diabetes
The common form — and the one most likely to have been present for years before anyone looked.
What happens in type 2
Two things go wrong together. The body's tissues stop responding properly to insulin, so more insulin is needed to do the same job. To compensate, the pancreas produces more. For a while this works and glucose stays normal. Over years the pancreas cannot keep up, output falls behind demand, and glucose begins to rise.
This is why type 2 is usually silent at the start and why it is progressive: by the time glucose is high enough to be diagnosed, a substantial part of insulin-producing capacity has often already been lost. It is also why treatment usually needs to be adjusted over time — not because you have failed, but because the underlying process continues.
Why this matters more here
South Asians develop type 2 diabetes at a younger age and at a lower body weight than white European populations. Fat is carried more centrally and insulin resistance appears earlier, which means the weight thresholds used in Western guidance underestimate risk in Pakistani patients.
The World Health Organization recognises this with lower cut-offs for Asian populations: a BMI of 23 rather than 25 is the point at which risk starts to rise meaningfully, and 27.5 rather than 30 marks obesity. Someone told their weight is fine by a Western chart may still be at real risk. Waist measurement is often more informative than BMI.
How it is treated
Almost everyone starts with two things at once: changes to eating and activity, and metformin, unless there is a reason not to use it. Metformin is inexpensive, long established, does not cause hypoglycaemia on its own, and is available everywhere in Pakistan.
What is added after that depends on you rather than on a fixed sequence. Established heart disease or chronic kidney disease shifts the choice towards particular drug classes with proven benefit for those problems. Significant excess weight shifts it towards agents that help with weight. Cost and reliable supply matter, because a medicine you cannot obtain or afford every month is not a treatment.
Blood pressure and cholesterol are treated alongside glucose. In type 2 diabetes, most of the harm that eventually comes is cardiovascular, and glucose alone is not the whole of the risk.
What to watch for over time
Screening is part of treatment, not an extra. That means an annual check of kidney function and urine protein, a dilated eye examination, and a proper look at the feet including sensation and pulses. Most complications are far easier to slow than to reverse, and most are silent until they are not.
Common questions
- I am not overweight. How do I have type 2?
- It is common in South Asians. Insulin resistance relates to where fat is stored — particularly around the abdomen and in the liver — more than to total body weight. A normal BMI does not exclude it, and a family history raises risk independently.
- Is metformin hard on the kidneys?
- No. Metformin does not damage kidneys. It is cleared by them, so the dose is reduced or the drug stopped when kidney function falls below defined levels — which is a dosing rule, not evidence of harm. Kidney function should be checked at least yearly.
- Why does my treatment keep changing?
- Because type 2 diabetes progresses. Needing more or different medicine after some years is expected and is not a sign that you did something wrong.
Important