Diabetes has become a significant public health problem in urban Nepal. Studies carried out by the Nepal Diabetes Association in towns and cities throughout the country have revealed a diabetes prevalence of around 15% among people aged 20 years and above, and 19% among people aged 40 years and above. The Association has identified a number of key issues which continue to exacerbate this epidemic in Nepal. In this report, Madhur Dev Bhattarai and Dhruba Lall Singh describe a number of challenges, including important pregnancy-related issues, outline some of the preventive initiatives that are under way, and make a call for international action to support countries like Nepal in defending societal health and well-being.