Every year on the 14th of November we take a moment to mark World Diabetes Day. It's a day which serves as a stark reminder of the fact that diabetes is a very real and widespread epidemic in Maldives.

International Diabetes Federation (IDF) and the Diabetes Society of Maldives (DSM) have estimated that some 9.5 percent of the adult population (approximately 30,900 people) are currently living with diabetes and some 65 percent of Maldivian population are at risk of developing the disease.

Yet despite the fact that the word "diabetes" is so very much a part of our everyday language, there is still a huge gap in public understanding of the disease, particularly with regard to the difference between Type 1 and Type 2.

In the past few years we have seen a worrying increase in very young children being diagnosed with Type 1 diabetes in our clinics and our pediatric wards. The parents are left in a state of complete confusion as they are presented with a condition which is so widely misunderstood and so frequently incorrectly referred to as a "lifestyle disease".

When a toddler or a primary school kid in the Maldives gets a diagnosis of Type 1 diabetes the first thing the community will do is point the finger at the child and say they must have been eating all sorts of junk food and processed snacks.

It's completely the wrong assumption. Type 1 diabetes has nothing to do with what you eat. It's an autoimmune disease in which the body’s immune system attacks and destroys the beta cells in the pancreas which are the cells that produce insulin. Without insulin (the hormone that acts as the key that allows glucose to get into the cells to be used as fuel) the body is left with sugar in the blood and no fuel at all.

Locally the figures are very sobering. A study looking at under 20s in the Maldives found that the incidence of Type 1 diabetes was increasing at a rate of about 12-13 percent per year over the course of a decade, making Maldives one of the countries in South Asia with the highest incidence of Type 1 diabetes in the young.

There are now hundreds of children and young adults throughout the Greater Malé area and the outer atolls who have Type 1 diabetes, with many of them being diagnosed well before they hit the age of ten.

The symptoms of Type 1 diabetes include, sudden weight loss, extreme thirst, polyuria, polydipsia, extreme fatigue are often indistinguishable from the symptoms of a number of common childhood illnesses so the diagnosis is frequently delayed until the child has progressed to diabetic ketoacidosis which is a real medical emergency.

Managing Type 1 diabetes involves lifelong daily insulin therapy (either by multiple daily injections or an insulin pump) and frequent blood glucose monitoring. Diet is not about eliminating all carbs (particularly not for a growing child), it's about carb counting and matching the insulin to the meal. The aim is to get the right balance of complex carbs, protein and fibre to avoid any dramatic blood sugar swings. With the right medical support, access to CGMS and appropriately informed teachers and families, children with Type 1 can absolutely participate in sport, do well at school, go on to any career and lead completely normal, full lives.

Type 2 diabetes is the much more common form and is the one that accounts for the vast majority of diabetes cases in the Maldives, where NCDs are responsible for over 80 percent of all deaths. In Type 2 diabetes the body still produces insulin (at least initially) but the cells become resistant to it. The pancreas then has to work harder and harder to compensate and eventually fails to keep up, resulting in persistently high blood glucose levels. It's a disease that's being driven by rapid urbanization, a sedentary lifestyle, high levels of stress and a diet which is very heavy in refined carbohydrates and ultra-processed imported foods. It's increasingly being seen in younger Maldivian adults and indeed in our adolescents.

Type 2 diabetes is so much a matter of metabolic health that diet and lifestyle are the first line of defence (in addition to any oral medication or insulin that you may be prescribed). A healthy diet doesn't mean you have to go on a diet of boring, restrictive food. It means rethinking your plate entirely: white rice and refined flour out, wholegrain, brown rice or local root vegetables in (in controlled portions), lots of leafy greens and grilled fish and no sugar sweetened beverages. Regular physical activities like 30 minutes of brisk walking, swimming or cycling per day,  will directly improve the way your muscles take up glucose and so will reduce insulin resistance. 

A diagnosis of Type 2 diabetes is by no means a death sentence. If picked up early via routine screening at the primary health centres on the atolls and managed appropriately through a combination of lifestyle changes and medical management, you can absolutely avoid the major complications that affect the heart, the kidneys, the eyes and the nerves. Whether you're managing Type 1 from a young age or Type 2 in later life, the single most powerful thing you can do is to have the knowledge. That knowledge turns the fear and the stigma into empowerment and resilience and ultimately leads to a long and full life.

Ultimately, navigating diabetes, whether confronting the sudden autoimmune reality of Type 1 in early childhood or managing the gradual metabolic shift of Type 2 in adulthood, it requires a collective shift from passive awareness to careful action. Understanding the distinct biology behind each condition dismantles harmful misconceptions, ensuring young children receive timely, life-saving insulin without stigma while empowering adults to reclaim their health through sustainable nutrition and daily movement. With early diagnosis, accessible care, and general awareness of diabetes diagnosis ceases to be a barrier to ambition, proving that every Maldivian living with the condition can lead a vibrant, unrestricted, and fulfilling life.