It’s not as if diabetes, particularly the type 2 kind, strikes overnight. One in every five diabetics in the world is Indian. The build-up to diabetes is called the pre-diabetic period and lasts anywhere from five to 10 years. Diabetes is primarily a condition of elevated blood glucose levels, and unmanaged diabetes has a way of leading to heart disease, neuropathy (nerve damage), nephropathy (kidney damage), and retinopathy (damage to the retina of the eye). This happens essentially because elevated blood glucose levels act like a rusting mechanism for body organs and tissues. Once diabetes strikes, then it is a lifelong condition and the only way to deal with it is to manage it with lifestyle changes and medication. This is why understanding and identifying the many symptoms of pre-diabetes, like apple-shaped bodies, hair loss, patchy and darkened skin, acne, elevated blood pressure, is without doubt the best way to nip diabetes in the bud and stay away from it. Heredity also plays an important role in the spread of diabetes and with Indians leading the diabetes risk list, quickly acting on the tell-tale signs of pre-diabetes is a proactive approach to dealing with this lifestyle- related disease.

Time to change: Sedentary lifestyle can lead to early onset of diabetes.

All of this leads to weight accumulation and a change in people’s shapes, sizes and even affects their metabolisms. Men and women can go from lean to fat and apple-shaped, experience constant hunger and lethargy and this pre-diabetic stage sets them up for eventually becoming diabetic. The good news is that by changing and sustaining a healthy lifestyle, one can easily prevent the pre-diabetes stage from reaching full-blown diabetes.

Some indications of pre-diabetes stage:

• Darkened area of skin folds and creases around the neck, armpits, knees and knuckles. This condition is called acanthosis nigricans.

• Skin tags (acrochordons), tiny bumps of skin that develop around the neck, armpits, face and other crevices of the body.

• A range of more than 5.7% to 6.4% on an Hb AIC blood test. This test provides an average of how well your blood glucose has been managed over a three-month period and is a good indicator of how healthy your lifestyle has been. More than 6.5% indicates diabetes and normal is less than 5.7%.

• A fasting blood glucose range that is more than 100mg/dl and less than 126mg/dl. Normal ranges are less than 100mg/dl, and more than 125mg/dl indicates diabetes. Impaired glucose tolerance (IGT), a two-hour oral glucose tolerance test can determine these levels.

• Experiencing any three of the following five symptoms: elevated blood pressure, elevated cholesterol, low HDL (good cholesterol levels), elevated blood glucose, a waist circumference of more than 35 inches for women and 40 inches for men.

• Other symptoms include weight gain, obesity, change in body shape, recurring skin and vaginal infections, constant hunger, hirsutism, and changes in menstrual cycles.

Looking to combat the onset of diabetes? Eat foods that are high in fibre: Have plenty of vegetables, replace junk food with nuts and seeds or fruit. Eat cucumber and carrots with yogurt-based dips. Ensure you stick to regular mealtimes and consume adequate proteins. Home-cooked food, made in olive or groundnut oil, is healthy. Work out at the gym thrice a week and walk or run or swim for three days in a week and chances are you will steer clear of diabetes.

Madhuri Ruia is a nutritionist and Pilates expert. She runs InteGym in Mumbai, which advocates workouts with healthy diets.

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