In recent years, the prevalence of diabetes has been steadily increasing, with a noticeable trend of younger patients being affected.

On social media, the hashtag #YoungPeopleTargetedByDiabetes# has become a hot topic. A 29-year-old woman shared, “I lost 20 pounds in two months. At first, I was happy, eating freely and not gaining weight.” However, things took a turn. In addition to rapid weight loss, she experienced severe thirst and frequent urination... After feeling something was wrong, she went to the hospital and was diagnosed with type 2 diabetes.

Diabetes is also affecting teenagers and even children. Previously, a 12-year-old boy was diagnosed with type 2 diabetes, hyperlipidemia, and fatty liver during his school physical exam.

Diabetes not only causes abnormal blood sugar levels but also affects the function of various organs, leading to numerous severe complications. There are over 100 complications associated with diabetes, making it the disease with the most known complications, which is why it is often called the "root of all diseases." Compared to middle-aged and older patients, younger patients have a longer duration of diabetes and a higher risk of complications.

How close are we to diabetes? What makes it so frightening? Can diabetes be reversed? What misconceptions do we have about it?

To address these questions, we interviewed Joshua Rothman, a senior technician in food and nutrition hygiene at the Disease Prevention and Control Center. Below are key excerpts from the interview.

Young and Middle-Aged People: The Fastest Growing Group

Forty years ago, “youth diabetes” was mainly type 1 diabetes. Today, type 2 diabetes is increasingly affecting younger individuals, including those under 30 and even school-age children. Among these patients, only 32.2% seek medical treatment after being diagnosed.

[Note: Type 1 diabetes usually occurs in children and adolescents and is characterized by the inability to produce insulin. Type 2 diabetes is caused by a combination of environmental and genetic factors that lead to insulin resistance and relative insulin deficiency, affecting the metabolism of sugar, fat, and proteins, and is more common in adults.]

If you are under 60, overweight or obese, have a large belly, fatty liver, or slightly elevated blood pressure or uric acid levels, it's advisable to check your blood sugar metabolism at the hospital. You may be in the prediabetic stage.

Key Stage: Prediabetes

Prediabetes, also known as impaired glucose regulation (IGR), refers to a state where blood sugar levels are between normal and diabetic ranges. During this stage, blood sugar levels are elevated but do not meet the diagnostic criteria for diabetes. At this point, insulin resistance is already present, which is medically known as prediabetes.

Prediabetes includes three conditions: impaired fasting glucose, impaired glucose tolerance, or a combination of both. According to the strictest diagnostic standards, about half of the population in China is in a prediabetic state.

Impaired glucose tolerance and elevated blood sugar levels are early signs of insulin resistance and prediabetes. These indicators show that the body’s ability to regulate blood sugar is already impaired but has not yet reached the threshold for a diabetes diagnosis.

[Note: According to the latest diabetes diagnosis guidelines in China, fasting blood sugar levels between 5.6–6.9 mmol/L, and 2-hour post-OGTT (oral glucose tolerance test) blood sugar levels between 7.8–11.0 mmol/L are considered prediabetes/insulin resistance; according to the International Diabetes Federation, a 1-hour blood sugar level of ≥8.6 mmol/L (155 mg/dl) also indicates prediabetes/insulin resistance (including impaired fasting glucose and impaired glucose tolerance).]

Studies show that 5% to 10% of individuals with impaired glucose tolerance progress to diabetes each year, and 93% of them will develop diabetes within 20 years.

You can check for the following symptoms: if you answer "yes" to two of these, you are likely experiencing insulin resistance, which is a prediabetic condition that requires attention.

1. Physical Data:

• Waist circumference: Men > 90cm, Women > 85cm;
• Persistent belly fat that just won’t go away;
• Slim arms and legs, but a large belly;
• Systolic blood pressure ≥ 120mmHg;
• Serum uric acid ≥ 360μmol/L.

2. Personal Sensations:

• Extreme hunger before meals, to the point of feeling faint;
• Craving carbohydrates, especially refined carbs;
• Often feeling hungry;
• Used to lose weight easily by skipping meals, but now it’s difficult;
• After dieting, intermittent fasting, detox diets, or keto diets, weight rebounds and you end up gaining more weight;
• Preferring strong, salty foods and less sensitive to taste;
• Feeling drowsy after meals, with a nap lasting more than 40 minutes;
• Easily waking up at night, frequent trips to the bathroom, night sweats, or feeling hungry;
• Prone to migraines.

The bad news is that prediabetes/insulin resistance is not only the root cause of diabetes, but also of high uric acid, fatty liver, kidney-related high systolic blood pressure, polycystic ovary syndrome, and even cancer.

The good news is that prediabetes is the insulin resistance stage, which is also the golden window for reversal. With some minor adjustments to diet management, insulin resistance can be reversed. When the resistance is reversed, your energy, physical strength, and healthy appearance will be restored.

What Are the Symptoms of Diabetes?

The typical symptoms of diabetes, commonly known as the "three highs and one low," are: excessive thirst (polydipsia), excessive eating (polyphagia), and excessive urination (polyuria). Excessive urination occurs because the body is working hard to expel excess sugar through urine. As the body loses water, you become thirsty, which leads to excessive drinking. Excessive eating happens because blood glucose levels are high, but insulin is unwilling to transport the glucose into the cells’ mitochondria to produce the energy needed for life. This results in the sensation of being "full in the mouth but still hungry" in the body. When food cannot be utilized by the body, malnutrition occurs, leading to weight loss. This is the "one low"—weight loss.

Additionally, high blood sugar may cause these atypical symptoms:

• Pre-meal hypoglycemia: As mealtime approaches, an overwhelming hunger may occur, with some people experiencing anxiety, trembling, or cold sweats. If they don’t eat soon, they may feel faint or even collapse.
• Post-meal hypoglycemia: After a "blood sugar rollercoaster," the insulin surge moves glucose to the liver, sometimes even removing the glucose needed to maintain normal blood sugar levels. This causes a rapid drop in blood sugar, making you feel overwhelmingly sleepy, tired, or drowsy. A blood sugar test at this point may show low blood sugar.
• Skin itching: Even after applying lotion or anti-itch creams, the itching persists and cannot be relieved.
• Reduced skin sensitivity or a foreign body sensation: Due to microvascular blockages and nerve damage, skin sensitivity may be reduced, or you may experience sensations like tingling, numbness, or a "sock-wearing" feeling in the arms or legs. There may also be a burning sensation.
• Fatigue and dizziness: Feeling constantly tired, drained, and weary.
• Wounds heal slowly: Cuts and wounds take longer to heal and are harder to recover from.
• Decreased vision: Vision becomes blurry, and things seem out of focus.

If you experience any of these symptoms, it's important to take them seriously. It’s recommended to go to the hospital for a glucose tolerance test.

What Makes Diabetes So Scary?

As one of the most common chronic diseases, what makes diabetes truly terrifying?

In fact, diabetes itself isn't inherently terrifying. What is frightening is that the blood, flowing through your body with high concentrations of sugar, silently damages every organ, cell, blood vessel, and nerve it passes through—almost like they're submerged in sugar water. This invisible damage continues until complications emerge, and by then, it may be too late to prevent them.

Diabetes is a vascular disease, and its complications can be divided into those caused by large blood vessel blockages and those caused by microvascular blockages.

• If large blood vessels are blocked, the future risks include thrombosis, heart attacks, and strokes.
• If microvessels are blocked, the risks include kidney failure, blindness, and diabetic foot. Both types of complications can lead to severe disability or even death.

Chronic high post-meal blood sugar levels can lead to large blood vessel blockages, triggering cardiovascular diseases. It’s estimated that 70%–80% of diabetes-related deaths are due to complications from large blood vessel diseases. Typically, after the onset of insulin resistance, within 10–15 years, blood vessel issues such as a roughened inner lining, thickened walls, the formation of plaques, and blockages may develop, leading to heart attacks or strokes.

Diabetes patients are 11 times more likely to suffer large blood vessel complications compared to non-diabetic individuals, and their risk of stroke is 2–4 times higher. The younger a person is when diabetes develops, the faster the vascular damage progresses. Diabetic patients experience large blood vessel complications on average 10 years earlier than non-diabetics.

Long-term high fasting blood sugar levels can lead to microvascular blockages, which may cause complications in nearly every organ of the body. The most common complications are diabetic nephropathy (kidney disease) and diabetic retinopathy (eye disease), which can result in kidney failure, blindness, and diabetic foot. Within 10 years of developing insulin resistance, 60%–90% of patients will experience varying degrees of nerve damage. Symptoms like numbness or reduced skin sensitivity in the hands and feet are reported by 40% of patients, and the overall rate of peripheral neuropathy is 52.97%.

Prevention is always better than cure, and even if you’ve been labeled as a "diabetic," there’s no need to be overly afraid. Diabetes is a disease that develops over many years. By strengthening dietary management and combining it with moderate exercise, it is possible to gradually "eat away" at diabetes, ultimately reversing it.

Note: The reversal of diabetes refers to the development of a personalized, precise reversal plan. Through systematic treatment approaches—including scientific lifestyle changes, blood sugar monitoring, medication, and other methods—the function of beta cells can gradually be restored and repaired. Insulin resistance can be reduced, and the body’s ability to regulate blood sugar can slowly recover, ultimately leading to reduced medication or even discontinuation, fewer complications, and a return to a healthy life.

What are the main treatment methods?

Currently, the treatment approaches for managing and alleviating type 2 diabetes follow a step-by-step path, including: intensive lifestyle intervention, exercise prescriptions, the use of digital blood glucose tools, physical monitoring, cognitive-behavioral and psychological interventions, medication-assisted treatments, and surgical treatments.

If type 2 diabetes is not subject to strong interventions, the natural remission rate is very low (below 1.50%). A powerful intervention plan is required for remission and reversal of type 2 diabetes.

Lifestyle intervention is the first element in treatment and remission, which includes dietary and nutritional therapy as well as exercise interventions.

For example, the "Balancing Blood Glucose Plate" (Bgb plate) method involves foods with high dietary nitrates (such as leafy vegetables), high nutrient density, carotenoid-rich foods, and low glycemic index foods. This diet avoids and eliminates harmful chemicals like agricultural residues, chemical agents, and phosphates that can damage the kidneys and liver. It is combined with moderate exercise.

Note: The insulin index of foods ranges from 0 to 100, representing the amount of insulin released within two hours after consuming a specific food. The standard reference food (white bread) has an insulin index of 100. The higher the glycemic index of a food, the higher the blood glucose level after consumption. The higher the insulin index, the more insulin is secreted by the body. In cases of insulin resistance, it is preferable to consume foods that stimulate less insulin secretion.

When you are able to maintain post-meal blood glucose fluctuations of less than 2.2 mmol/L and 24-hour blood glucose fluctuations of less than 4.4 mmol/L over the course of two weeks, the beta cells in the pancreas, which had been "hibernating" due to avoiding high sugars, will gradually awaken and begin to secrete insulin again. At this point, prediabetes/insulin resistance will slowly alleviate and be reversed.

Medications for treating diabetes include weight-loss drugs, non-insulin hypoglycemic agents, and insulin. Surgical treatments, such as metabolic surgery, may also be considered. Medication and surgery should only be conducted under the supervision and advice of a qualified physician in a proper hospital setting.

It is very dangerous for individuals to self-medicate with "diabetes miracle drugs" such as metformin without a medical diagnosis or doctor's prescription. All medications have strict indications and contraindications. For example, I have encountered insulin-resistant patients who weigh less than 90 pounds and experienced dramatic weight loss after taking metformin, while their oral glucose tolerance test (OGTT) showed worsened glucose metabolism and insulin function.

Additionally, long-term use of metformin can lead to vitamin B12 deficiency, so it should be taken under medical guidance.

Recent research developments have brought new hope for diabetes treatment. For instance, the 1-hour OGTT blood glucose level can more accurately predict the onset of diabetes compared to the 2-hour blood glucose level. This means that issues with pancreatic function can be identified earlier, before clinical diabetes symptoms appear. Early screening, prevention, intervention, and reversal of diabetes are crucial.

Moreover, short-term intensive insulin therapy (IIT) is a method to improve hyperglycemic toxicity in type 2 diabetes. Studies have shown that when baseline fasting blood glucose is greater than 9.3 mmol/L, initiating insulin therapy for patients with high fasting blood glucose can significantly improve the recovery of pancreatic function.

Common Misconceptions to Be Aware Of

Misconception 1: Diabetes is caused by eating too much sugar, milk tea, or sweets.

Correct Answer: Diabetes is a chronic, systemic, metabolic disease caused by a long-term interaction of genetic factors, environmental influences, and unhealthy lifestyle choices.

Misconception 2: Diabetes only occurs in middle-aged and elderly people, and young adults or teenagers don't need to worry about glucose metabolism.

Correct Answer: Diabetes is a vascular disease, and the absence of symptoms doesn't mean that fasting blood glucose or post-meal blood glucose levels are normal. Teenagers and young adults need to develop healthy behaviors and lifestyles and pay attention to the prevention of diabetes.

Misconception 3: Once diagnosed with diabetes, simply taking medication will solve the problem.

Correct Answer: Lifestyle intervention is the first element in treatment and remission, which includes dietary nutrition therapy and exercise intervention. Even when on medication, one still needs to correct unhealthy eating habits. Medications only help lower elevated blood glucose, and although blood sugar may appear fine, the increasing reliance on medication shows that the root issue—your body's ability to manage glucose—requires better eating habits and exercise to resolve.

Misconception 4: Diabetes dietary treatment is mainly about controlling the intake of sugar or staple foods.

Correct Answer: The key to diabetes management is ensuring adequate nutrition density, proper water intake, and the right amount of energy, while reducing foods and chemicals that could harm the kidneys and liver.

Misconception 5: Health supplements can cure diabetes.

Correct Answer: 

 Health supplements cannot cure diabetes, and they certainly cannot cure the disease.