For years, Type 2 Diabetes has been widely regarded as a condition caused primarily by pancreatic dysfunction — either the pancreas doesn’t produce enough insulin or the body becomes resistant to it. But experts now warn that this narrow view fails to capture the complex, systemic nature of the disease, which has no cure and can only be managed.
“Type 2 diabetes is actually the final stage of a long, multi-organ metabolic process. It is not just about high blood sugar but a deeper disturbance involving metabolism, inflammation, energy regulation, and multiple organs,” said Dr. Piyush Lodha, Endocrinologist, Ruby Hall Clinic.
He describes diabetes as the “last visible symptom” of an exploding metabolic time bomb.
What Lies at the Core of Diabetes Dysfunction?
Experts identify insulin resistance as the root cause of the metabolic crisis. In this condition, cells—especially in the liver, muscles, and adipose tissue—no longer respond well to insulin. To compensate, the pancreas produces increasing amounts of insulin, leading to hyperinsulinemia. This keeps blood sugar stable temporarily, but gradually, the pancreas becomes exhausted, resulting in chronic high blood glucose and clinical diabetes.
Several interconnected factors fuel insulin resistance:
1. Visceral Obesity
Fat stored around internal organs is metabolically active and harmful. It releases pro-inflammatory cytokines like TNF-α, IL-6, and CRP, along with free fatty acids—all of which disrupt insulin signaling.
2. Diet Rich in Refined and Processed Foods
Indian diets increasingly rely on sugary beverages, refined carbs, and fast food. “Repeated spikes in blood sugar force the pancreas to overwork, eventually leading to beta-cell fatigue and cell death,” explained Dr. Lodha.
3. Sedentary Lifestyle
Skeletal muscle accounts for nearly 80% of insulin-driven glucose uptake. Lack of exercise reduces this ability, causing glucose and insulin levels to rise further, worsening resistance.
4. Stress and Poor Sleep
Elevated cortisol and disturbed sleep cycles contribute to visceral fat accumulation, impaired glucose metabolism, and progressive insulin resistance.
Why Diabetes Is a Full-Body Disease
Viewing Type 2 Diabetes as a systemic disorder highlights how multiple organs both contribute to—and are damaged by—the disease:
Liver
With insulin resistance, the liver continues producing glucose even when unnecessary.
Adipose Tissue
Instead of storing fat safely, dysfunctional fat tissue releases inflammatory chemicals and free fatty acids into the bloodstream.
Pancreas
In the early phase, it produces excess insulin to counter insulin resistance. Over time, constant pressure leads to beta-cell exhaustion, oxidative stress, and cell death.
Blood Vessels
The vascular system suffers silently as chronically high sugar and lipid levels damage the endothelium, triggering atherosclerosis and microvascular complications.
“Diabetes is not a single endocrine disorder — it is a multi-system inflammatory and metabolic failure,” Dr. Lodha emphasized.
India’s Diabetes Burden Is Growing Rapidly
India now has over 100 million diabetes patients, making it one of the global hotspots for the disease. Researchers attribute this to the Asian Indian phenotype, where genetic susceptibility, central obesity, dietary habits, lifestyle changes, and environmental factors collectively accelerate insulin resistance, especially in urban populations.
Why Diabetes Management Needs a New Approach
Experts say diabetes treatment must shift from glucose-centric care to a holistic metabolic strategy that includes:
1. Intensive Lifestyle Modifications
Healthier eating patterns, daily exercise, stress reduction, and proper sleep management.
2. Medications That Target Insulin Resistance
Drugs such as metformin, GLP-1 receptor agonists, and SGLT2 inhibitors address deeper metabolic dysfunctions, not just blood sugar numbers.
3. Broader Risk Factor Control
Managing hypertension, obesity, and cholesterol should be integral to diabetes treatment.
4. Early Screening
Early detection—especially among young adults and teenagers—is essential to prevent long-term complications.