Arjun Kapoor is your regular 22-year-old—he stays on his own in Mumbai, works as a marketing executive in sports management company Percept Sports, a leading sports management company, and has loads of late nights, some for work and others for play. But right now he knows he has to take a “vacation” from his current lifestyle—to bring his sugar level to “normal”. “My life comes with a disclaimer. I know I can’t continue like this. My sugar levels are haywire and sooner or later I have to take time off to stabilize my condition,” says Kapoor, a Type 2 diabetic and an example of the changing demography of the Indian diabetes saga.
Diagnosed with diabetes at 16, Kapoor had all the lifestyle problems that cause this disease: He weighed 82kg, had a sedentary lifestyle, gorged on junk food daily, hardly participated in outdoor activities, and had high stress levels because of his studies. And though his father is diabetic, doctors ruled that in Kapoor’s case, it was his lifestyle choices that led to the problem.
Our bodies break down the foods we eat into glucose and other nutrients, which are then absorbed into the bloodstream. The glucose level in the blood rises soon after a meal and triggers the pancreas to release the insulin hormone. But in people with diabetes, the body either can’t make or respond to insulin properly. Type 2 diabetes is the most prevalent form of diabetes in India. Unlike Type 1 diabetes, where the body cannot produce insulin, in Type 2 diabetes a person continues to produce insulin but the body doesn’t respond to it. Glucose is, therefore, unable, or less able, to enter the cells and do its job of supplying energy. This insulin-resistant diabetes causes the blood sugar level to rise, making the pancreas produce even more insulin.
Be in charge: Once you’ve been diagnosed with diabetes, it’s imperative that you keep a strict check on your lifestyle.
Labelled as the diabetes capital of the world, India was home to 50.8 million diabetics (20% of the total diabetics population worldwide), according to statistics released by the International Diabetes Federation in 2005. The number is expected to reach 87 million by 2030.
Traditionally considered an “old people’s disease” (onset in India was usually seen at 45 years and above), the current diabetic profile in the country has changed to include young adults. “In the last five-six years, the proportion of those getting diabetes between 16-25 years (young adults) has increased rapidly. Obesity, sedentary lifestyle, stress, fast-food culture and genetic predisposition are applicable to young adults and hence lead to an early onset of diabetes,” says A. Ramachandran, director, Diabetes Research Centre and MV Hospital for Diabetes, Chennai. At his private clinic, Dr Ramachandran sees two-three 16-year-olds every month who are “obese and diabetic or at least run a very high risk of being one”.
At the heart of the issue
One of the biggest problems concerning diabetes among young adults is that it often goes undetected. “The problem is no one expects to get diabetes in their 20s. Most youngsters don’t do an annual health check-up. In fact, their blood sugar level is almost never checked,” says Mumbai-based endocrinologist Shashank Joshi, who is associated with Lilavati Hospital.
Doctors say the number of young adults afflicted with Type 2 diabetes is rising steadily, and emphasize the need to begin health check-ups, including monitoring blood sugar levels, earlier. “Maybe in the late 20s, especially if you are the diabetic archetype that is, have a sedentary lifestyle, are obese, follow irregular eating habits, or have stressful lifestyle, etc,” adds Dr Joshi.
Accurate statistics about the number of diabetics, age and demography are hard to come by. The Indian Council of Medical Research (ICMR) conducted the last population-based diabetes survey in 1974. A 2010 ICMR-sponsored pilot study that tested 16,000 people above the age of 20 years in Maharashtra, Jharkhand, Chandigarh and Tamil Nadu found 9.1% of people in urban areas and 5.6% in rural areas in Maharashtra diabetic. In Tamil Nadu, the prevalence stood at 11.7% in urban and 6.6% in rural areas; 13% in urban and 11.9% in rural Chandigarh; and 11.4% in urban and 2.8% in rural Jharkhand. The Union government is expected to initiate a more extensive study soon.
A World Health Organization-ICMR survey in 2007 pegged diabetes prevalence in urban areas as the highest at 7.3%, followed by peri-urban/slums/semi-urban at 3.2% and rural areas at 3.1%. “As rural and peri-urban areas get educated, increased income, motorized transport, and opt for a sedentary lifestyle, the incidence of diabetes increases. This further emphasizes that diabetes is a lifestyle disease,” says Mayur Patel, chairman of Swasthya Diabetic Clinic, Ahmedabad.
“The truth is, we Indians are genetically susceptible to diabetes, so being aware, following a healthy regime and getting check-ups done earlier is the answer to containing the problem,” says H.B. Chandalia, a consultant endocrinologist and diabetologist with Jaslok Hospital, Mumbai.
Doctors are now recommending a systematic and frequent use of the Indian Diabetes Risk Score (IDRS). “We can’t screen everyone but patients can be evaluated according to the IDRS (see box), which helps identify high-risk categories early on without testing blood sugar levels,” says Dr Patel, adding that the IDRS is slowly being introduced at the general physician level. The IDRS is a system in which the doctor evaluates patients on a set of parameters and rates them on the basis of low-, moderate- and high-risk categories. The total is then calculated and if the patient falls in the high-risk group, he/she is asked to get a blood sugar test.
Dealing with the crisis
Managing diabetes is tough, particularly if you’re young: eating on time, avoiding certain food items, watching your weight, exercising, taking your medicine/insulin on time. “I have spent 34 years of my life with diabetes ( Type 2 diabetes) and I am 35,” says Jamshed Ranberia, a Mumbai-based businessman whose father was diabetic. “I’ve learnt to work around my restrictions; it is now a way of life.” For Ranberia, diabetes management means never eating out, always eating on time so he can time his medicines accordingly, no late nights, and daily exercise. Maintaining cholesterol, weight and blood pressure is always important and he knows he can never skip his strict health maintenance regime.
While Ranberia has accepted diabetes as a way of life, Kapoor struggles with the restrictions. He lives away from home, so “the healthy, wholesome” meal is often difficult to come by. “Until I find myself a maid to cook as per my requirements,” says Kapoor. “I know I cannot continue living on my own and will have to return home to Ahmedabad.
“I have my dream job but I know some day I’ll have to make a choice. I will have to lead a much more disciplined life. Right now I eat on time so that I can take my insulin shots on time and then time the next meal and the subsequent shot. It gets tough especially when I have to attend meetings or go out with friends. It’s a daily struggle—everything must be planned,” says Kapoor, who sometimes ends up dodging his strict routine. “Every time I party I think about my sugar level and my insulin shot next morning.”
The Indian Diabetes Risk Score (IDRS) is a simple, fast, inexpensive, non-invasive, and reliable tool to identify individuals at high risk of Type 2 diabetes.
Doctors evaluate the followingparameters:
•Age (below 35 years, low risk; 35-49 years, medium risk; and above 50, high risk)
•Waist circumference or abdominal obesity (low risk, for waist circumference less than 80cm in women and 90cm in men; medium risk, for waist circumference between 80-89cm in women and 90-99cm in men; high risk, for waist circumference above 90cm in women and 100cm in men)
•Body mass index
•Physical activity (vigorous, moderate, sedentary)
• History of antihypertensive drug treatment and high blood glucose
Source: ‘Indian Journal of Medicine’, March 2007
Indians are more prone to the disease
• Indians have a greater degree of insulin resistance. This despite having lower obesity rates as judged by body mass index (BMI), although they have greater waist circumference. These features constitute what is called the “Asian Indian Phenotype” and a large part of it is probably due to genetic factors. However, which gene it is and how it can be corrected is still being researched.
• The “thrifty genes hypothesis” explains the Indian phenotype. It states that in ancient times the human race lived through alternating times of famine and abundance— especially in the subcontinent. During times of abundance, the body would store energy to survive drought and famine by way of fat.
Today food supply is abundant and there is little physical work and hardship, but our body continues to store energy as fat deposits without subsequent utilization, leading to a rise in blood lipids (fats), damaging the pancreas due to excessive glucose and fats in blood, excessive insulin requirements—insulin resistance, damage to blood vessels, formation of atherosclerotic plaques (thickening of artery walls due to accumulation of cholesterol) and other complications such as heart attack, stroke, etc.
•Set targets for glycaemic control in Type 2 diabetes
•Nutrition management— control weight and introduce a healthy eating plan
•Maintain body weight
•Lower total fat intake and find substitutes for saturated fats
•Reduce alcohol consumption
•Undertake regular physical activity to improve metabolic control and reduce other cardiovascular risks
•Self-monitor—home blood glucose monitoring is the method of choice for most patients
•Have regular check-ups and checks for diabetes-related complications.
Write to us at firstname.lastname@example.org