Health fairs are fascinating. There will be a banner, a blood-sugar machine and somebody explaining that prevention is better than cure. People will queue for a finger-prick test, collect a leaflet and promise to cut down on sweet drinks. What happens afterwards is the problem.
This year’s World Diabetes Day theme is “Early action on diabetes”. It is an excellent instruction, provided it also applies to governments and health services.
The International Diabetes Federation estimates that 589 million adults aged 20 to 79 were living with diabetes in 2024. About 252 million did not know they had it. The kidneys, eyes, nerves and blood vessels may be exposed to high blood sugar levels for decades.
Type 2 diabetes can develop gradually, with few obvious symptoms.
Even the word “sugar” encourages us to underestimate the disease. “I have a trace of sugar” sounds rather safe. It hardly conveys the possibility of dialysis, blindness, a heart attack or a wound that will not heal.
Insulin, produced by the pancreas, helps the body use glucose and regulates its supply. In Type 1 diabetes, the immune system usually destroys the cells that produce insulin. Insulin treatment is essential for survival. This disease is not caused by eating sweets.
In Type 2 diabetes, the body becomes less responsive to insulin, and the pancreas cannot produce enough to compensate. Genetics, age, body fat distribution, physical activity and other factors influence risk. It can occur in people who are not visibly overweight. Gestational diabetes develops during pregnancy and warrants follow-up after delivery.
A family history, excess abdominal fat, high blood pressure, abnormal cholesterol levels, polycystic ovary syndrome (now polyendocrine metabolic ovarian syndrome) or previous gestational diabetes should prompt a discussion about screening.
Persistent thirst, frequent urination, blurred vision, recurrent infections or unexplained weight loss require assessment. A child or adult who develops these symptoms rapidly needs prompt attention. Vomiting, abdominal pain, deep breathing or drowsiness may indicate a dangerous metabolic emergency.
Diagnosis requires proper testing. A laboratory fasting glucose level of at least 7.0 mmol/L, or 126 mg/dL, or an HbA1c of at least 6.5 per cent meets a diagnostic threshold. Unless there is unequivocal hyperglycaemia, confirmation is usually required.
What is the blood pressure? Does the person need cholesterol-lowering treatment? Have the eyes been screened? Have the feet been examined? Have the kidneys been checked with both a blood test and a urine albumin-to-creatinine ratio? Small amounts of albumin leaking into the urine can reveal kidney or heart damage before obvious symptoms develop.
Modern treatment offers more than lower glucose readings. For appropriate patients, certain SGLT2 inhibitors and GLP-1 receptor agonists reduce important heart or kidney risks; some also help substantially with weight management. These are not interchangeable medicines, nor are they suitable for everyone.
Patients do not need a supermarket aisle labelled “diabetic”. Beans, lentils, vegetables, whole fruit and suitable portions of staple foods can form part of a sensible eating pattern. Rice and roti are not moral failures. Portion size, preparation and the overall meal matter.
Water is a better everyday drink than soft drinks, sweetened juices or heavily sweetened tea. Most adults should work towards at least 150 minutes of moderate physical activity weekly, adapted to their health, with strengthening activities where appropriate. Starting with a manageable walk is more useful than prescribing an ambitious programme that never begins.
People using insulin or medicines that can cause hypoglycaemia need specific advice about exercise, meals and monitoring. A reading below 3.9 mmol/L, or 70 mg/dL, requires action. Sweating, shaking, hunger, confusion or unusual behaviour may be clues. For an alert adult who can swallow safely, take about 15 grams of fast-acting carbohydrate, such as an appropriate amount of glucose tablets, and recheck after 15 minutes. Repeat if the reading is still low.
An unconscious person, someone having a seizure or someone unable to swallow safely needs emergency help. Give nothing by mouth. Use glucagon if available and someone knows how to administer it. Never try to pour a sweet drink into an unconscious person.
Diabetes requires difficult decisions, including on days when the patient is grieving, exhausted, broke or simply tired of being a patient. Diabetes distress is recognised, and depression may coexist.
Taxes on sugary drinks deserve serious consideration as part of that work. Evidence from countries including Mexico shows reductions in purchases of taxed drinks.
The Diabetes Association of Trinidad and Tobago, patient advocates and community groups have a vital role. Their efforts deserve sustained support, but volunteers cannot be expected to compensate indefinitely for weaknesses that require a functioning public system.
More than a century after insulin was first used to treat a person with diabetes, we have better knowledge, better monitoring and better medicines. None guarantees a good life without reliable access and the support to use them.
And before we congratulate ourselves on another successful World Diabetes Day, let us ask one uncomfortable question: what became easier for the person who has to live with diabetes tomorrow?
