Sri Lanka is going through a major shift in public health. A nationwide study, the Sri Lanka Health and Ageing Study, found that nearly one in four adults now has diabetes, and close to one in three has prediabetes. That’s a higher rate than any other Asian country currently on record.
People are also being diagnosed much younger than before. Type 2 diabetes used to typically show up around age fifty. Now it’s increasingly common in people in their thirties, and prediabetes, the early-warning stage, can appear in people as young as twenty.
This matters because prediabetes is also the stage where the disease is most reliably reversible. To understand why this shift is happening, it helps to understand the biology behind it, which points clearly to diet and lifestyle as the main drivers.
How insulin resistance develops
Type 2 diabetes develops through a process called insulin resistance: the body still makes insulin, but its cells stop responding to it properly, so sugar (glucose) can’t get into the cells to be used as fuel. A few things drive this:
- Too much fat in the body becomes toxic to tissue, a process called lipotoxicity.
- The mitochondria, the cell’s energy-producing machinery, become less efficient with age and with too little antioxidant intake, which increases oxidative stress (cell damage from unstable molecules).
- Excess fat tissue behaves like an active gland, releasing inflammatory substances, including interleukin-6, tumour necrosis factor-alpha and angiotensin II, which further blunt how well cells respond to insulin.
Everyone has their own “fat limit”
A useful way to think about this is the personalised fat threshold. Each person has a genetically set capacity for safely storing fat under the skin, and this varies a lot from person to person. Being lighter doesn’t automatically mean you have more safe storage capacity than someone heavier.
Once that threshold is crossed, fat gets pushed into places where it does real harm: the liver (causing fatty liver disease), the abdomen (as visceral fat), and the pancreas, where it damages the cells that produce insulin, a process called beta-cell dedifferentiation, so they lose their ability to sense and respond to blood sugar properly.
Fatty liver disease then makes insulin resistance even worse. Poor sleep and chronic stress raise cortisol, which also worsens insulin resistance, while physical inactivity speeds up how quickly the threshold is reached.
Diet plays a major role too. Eating a lot of processed, energy-dense food, refined sugar and poor-quality fat speeds this whole process up considerably, which is a big part of why a threshold once reached at fifty is now commonly reached by thirty.
A dietary pattern specific to Sri Lanka
Prediabetes is diagnosed with a fasting blood sugar of 100-125 mg/dL or an HbA1c of 5.7-6.4 percent. Diabetes is diagnosed with a fasting blood sugar of 126 mg/dL or above, or an HbA1c of 6.5 percent or above.
The prediabetic stage matters enormously because at this point, the disease can often be stopped and blood sugar brought back to normal through diet and lifestyle changes alone, frequently without needing medication.
One eating pattern common in Sri Lanka deserves particular attention: combining several fat sources in a single meal, most often coconut oil, coconut milk and coconut sambol served together. None of these is a problem on its own in a reasonable amount. But eaten together and in excess, they push people over their personal fat threshold faster. What matters isn’t any one ingredient, but the total amount consumed in a meal and across the day.
Choosing a healthy soup for dinner instead of a carbohydrate-heavy meal, while staying well hydrated, can support a healthy, balanced diet. Where a nutritional gap is identified, nutritional supplements can also help meet the body’s needs and support overall wellbeing, including efforts to reduce the risk of insulin resistance.
Supplements are also commonly prescribed for older adults when clinically appropriate, and they’re widely used in more developed, wealthier markets. As diabetes-focused supplements become more available in Sri Lanka, they’re increasingly a realistic option here too.
Where diabetes-specific nutrition can help
Knowing what to eat is one thing; doing it consistently at every meal is another. Busy schedules, irregular mealtimes and a carbohydrate-heavy food culture make it hard for many people to keep each meal’s impact on blood sugar in check. This is where diabetes-specific nutritional supplements, usually taken as a measured drink, can be genuinely useful within an overall eating plan.
These are different from ordinary milk powders or meal-replacement drinks. Their carbohydrates are chosen to be digested and absorbed slowly, and are typically paired with dietary fibre and a favourable fat profile. Fat and fibre slow down how fast the stomach empties, so glucose enters the bloodstream gradually instead of in a sharp spike, giving the drink a low glycaemic-index profile.
Because each serving is pre-measured, it also delivers a fixed amount of energy along with vitamins and minerals, which takes much of the guesswork out of portion control for the meal or snack it replaces.
In practice, a diabetes-specific nutritional drink can stand in for a high-glycaemic breakfast or a sugary afternoon snack, the two points in the day when blood sugar is often poorly controlled. They work best as part of a structured eating plan rather than simply added on top of an unchanged diet, and anyone already on glucose-lowering medication should talk to their doctor before using them, so treatment can be adjusted if needed.
What the evidence recommends
The following measures are backed by current clinical guidance and are practical within a Sri Lankan context:
- Eat meals at consistent times, and finish dinner early, ideally between 7:00 and 7:30 pm.
- Swap carbohydrate-heavy evening meals for a lighter, soup-based dinner with a good source of protein, and stay well hydrated throughout the day.
- Match portion size to activity level, and keep body mass index or waist circumference within WHO-recommended ranges.
- Replace refined grains with low-glycaemic-index rice, multi-seed bread and legumes such as chickpeas and cowpea.
- Where a particular meal is hard to control, a diabetes-specific nutritional supplement offers a measured, low-glycaemic-index alternative.
- Cut back on saturated fat and lean toward Mediterranean-diet style eating, which Sri Lankans can adopt easily using locally available foods.
- Eat Omega-3-rich fish, such as salmon and tuna, at least twice a week, and treat meat as optional rather than central to the diet.
- Choose nuts, seeds, fresh fruit or a diabetes-specific nutritional drink for snacks instead of sugary, processed alternatives, both to cut refined sugar intake and to support mitochondrial function.
- Prioritise sleep hygiene, aiming for a sleep window of roughly 10 pm to between 4 and 5 am, to help regulate cortisol and, in turn, insulin sensitivity.
The bottom line
What ties all of this together is sustained attention to what you eat, when you eat it, and how much, applied consistently over time. Tools that make that consistency easier, from simple meal planning to specialised nutrition, can help people stay on course.
With timely recognition and sustained lifestyle change, prediabetes can be reversed before it progresses further. As the age of onset in Sri Lanka keeps falling, that window of opportunity matters more than ever. Clinicians increasingly stress that a prediabetic result should be seen not as a final verdict, but as an early, actionable warning, one that offers a real opportunity to intervene while the outcome remains largely in the patient’s own hands. Raising public awareness of the dietary, lifestyle and nutritional options available at this stage is therefore crucial to preventing diabetes and reducing the risk of progression.
