The Metabolic Time Bomb: Why Diabetes Is More Than Just High Sugar

World Diabetes Day: For decades, Type 2 Diabetes has been viewed primarily as a disorder of the pancreas – a problem that causes insufficient insulin secretion or reduced insulin action. However, according to experts, this conventional understanding grossly oversimplifies the compounded and systemic nature of the condition, which has no cure but can only be managed. “In reality, type 2 diabetes represents the end stage of a prolonged, multifactorial process involving widespread metabolic dysfunction across multiple organs and tissues. It is not merely a disease of glucose imbalance but a systems disease, a manifestation of deep-rooted disturbances in metabolism, inflammation, and energy regulation,” Dr Piyush Lodha, Endocrinologist, Ruby Hall

Clinic, told Times Now. According to Dr Lodha, diabetes is not the beginning of the problem, but the final symptom of an exploding “metabolic time bomb”.

What is the core of dysfunction in diabetes?

Experts believe that the epicenter of this metabolic crisis with diabetes is insulin resistance, in which your body’s cells – especially in the muscle, adipose tissue, and liver - fail to respond effectively to insulin. The pancreas then attempts to compensate by producing more insulin, resulting in hyperinsulinemia, which temporarily maintains normal glucose levels. However, over time, this compensation fails, leading to sustained hyperglycemia and clinical diabetes. Many interlinked factors contribute to the development of insulin resistance, a few of which include:

Visceral obesity

Visceral fat is deposited around internal organs and is biologically active and metabolically harmful. It secretes adipokines, pro-inflammatory cytokines like TNF-α, IL-6, and CRP, along with free fatty acids - all of which disrupt insulin signaling pathways.

Diet

Modern dietary patterns in India are dominated by refined carbohydrates, sugary beverages, and processed foods – all of which accelerate the metabolic burden on the pancreas. “Frequent spikes in blood glucose and insulin cause the pancreatic beta cells to overwork, leading eventually to beta-cell fatigue and apoptosis. Over time, the pancreas loses its capacity to maintain glycemic control,” said Dr Lodha.

Sedentary lifestyle

Skeletal muscle plays a pivotal role in glucose utilization, accounting for nearly 80 per cent of insulin-mediated glucose uptake. Not working out diminishes this capacity, allowing blood glucose and insulin levels to rise, further reinforcing insulin resistance.

Stress and sleep deprivation

Emerging evidence links elevated cortisol and disrupted circadian rhythms to increased insulin resistance, visceral fat accumulation, and altered glucose metabolism.

Why is diabetes a systemic disease?

Dr Lodha says if you view diabetes through a systemic lens, it would highlight how multiple organs contribute to, and are damaged by, the disease process. It includes:

Liver

In insulin-resistant states, the liver fails to suppress gluconeogenesis, continuously releasing glucose into the bloodstream even when it’s not needed.

Adipose tissue

Healthy adipose tissue stores fat safely. In metabolic syndrome, however, it becomes dysfunctional, releasing free fatty acids and inflammatory mediators into circulation.

The pancreas

Initially, your pancreas would respond to insulin resistance by secreting more insulin. But chronic hyperinsulinemia and glucotoxicity lead to beta-cell exhaustion, mitochondrial damage, and cell death.

The vascular system

Doctors say it is always the silent victim as elevated glucose and lipid levels damage the endothelium, initiating atherosclerosis and microvascular injury. “Thus, diabetes must be understood not as a singular endocrine disorder but as a multisystem inflammatory and metabolic failure,” said Dr Lodha.

The Indian context of diabetes is frightening

India is at the epicenter of the global diabetes epidemic, home to over 100 million diabetics - a number projected to spike sharply in the coming decades. This phenomenon is fueled by what researchers call the Asian Indian phenotype, which includes genetic susceptibility, central adiposity, diet and lifestyle, and environment and socio-economic factors – all of which contribute to rising insulin resistance, especially in urban centers.

Management of diabetes needs a tough rethinking

Doctors say understanding diabetes as a systems disease demands a paradigm shift in management – from a glucose-centric treatment to addressing the broader metabolic dysfunction, which includes:

• Aggressive lifestyle interventions like changing diet, exercising, and reducing stress levels
• Targeting insulin resistance pharmacologically with medications like metformin, GLP-1 receptor agonists, and SGLT2 inhibitors
• Comprehensive risk factor management where the treatment should extend beyond blood sugar to include control of hypertension and obesity.
• Preventive and public health approach through early screening, especially in young adults and even teenagers.