Bitter sweet

Bitter sweet

The statistics are staggering. With more than 40 million diabetes patients, India has the dubious distinction of being labelled the diabetes capital of the world.

Health and nutrition experts say diabetes in India has reached pandemic levels and that every fifth diabetic in the world is an Indian. An explosion of diabetes may just be a frightening reality very soon— by 2025, the numbers threaten to touch the 70-million mark. In the 1970s, only 2.1% of our urban population suffered from the disease. Today, it stands at around 15%.

Worldwide, 3.2 million deaths annually are attributed to diabetes. Of these, at least one in 10 deaths occur in the 35-65 age group. The Chennai Urban Rural Epidemology Study of 26,000 people, started in 2001, by V. Mohan, chairman of the Madras Diabetes Research Foundation, shows that 15% adults in the city are suffering from diabetes. New Delhi has more than 3.3 million diabetics.

Another study on corporate executives in New Delhi by the Escorts Heart Institute and Research Centre shows that 29% are in danger of falling prey to the disease. The study also suggests that nearly 80% diabetics are not even aware of their condition.

Silent killer

A chronic health condition, where the body is unable to produce insulin and break down sugar (glucose) in the blood properly, diabetes can lead to a number of other complications. Adds Anju Virmani, consultant endocrinologist, Max Hospital, New Delhi: “Each generation is getting diabetes a decade earlier than its predecessor. The disease is spreading in absolute numbers and children are the new victims of this lifestyle disease. What is alarming is that when diabetes strikes at a young age, it leads to many complications in later years."

According to doctors, diabetes can afflict anyone. But those with a family history of the disease are more vulnerable. Other risk factors include obesity and physical inactivity. For instance, people who are more than 40 and overweight are at very high risk.

Diabetics are more prone to heart disease. Their nerve endings may be damaged and they may not feel the pain during an attack.

Indians are more prone to the Insulin Resistance Syndrome that is caused by abdominal fat, thin arteries and high blood pressure. It is, therefore, important for people watch their waistlines, doctors say.

Conclusive research suggests that diabetics are at a 30% higher risk of developing depressive symptoms and at a 91% higher risk of recurrent depressed mood than people who do not have the disease. In India, 30% of the patients suffer from depression. “Conversely, those who have depression can also fall prey to diabetes," says Dr Mohan.

If ignored, diabetes can lead to serious health problems. Long-term complications include heart attacks, blindness, kidney disease, nerve damage and foot infections that lead to amputation of limbs, dental damage, and so on. Around the world, a lower limb is lost to diabetes every 30 seconds.

Types of diabetes

Doctors across India are increasingly worried about the rising incidence of Type 1 diabetes. Also called juvenile diabetes, as its victims are mostly children, or insulin-dependent diabetes, this is a disorder of the body’s immune system in which the pancreas doesn’t produce enough insulin. Because glucose use becomes very inefficient in this type of diabetes, patients need to take insulin shots—varying from two to five—every day.

Some of the common symptoms include increased thirst, tiredness, frequent urination, weight loss (although the appetite often increases), itchiness, especially around the genitals, caused by an overgrowth of yeast on the skin and other infections. Research shows that Type 1 diabetes is an autoimmune disorder similar to other health conditions such as rheumatoid arthritis or multiple sclerosis.

In Type 2 diabetes, the more common of the two, either the body does not produce enough insulin or the cells ignore the insulin.

Once known as adult-onset or non-insulin-dependent diabetes, it usually occurs in people above 40 years, though new research shows that Type 2 diabetes can affect children as well.

In this life-long condition marked by high levels of sugar in the blood, most people are overweight (especially around the waist), do sedentary work or have a family history of the disease. However, Type 2 diabetes can also develop in thin people, especially the elderly.

Common symptoms include itchiness, tingling or numbness in the hands or feet, sores that take time to heal, recurring bladder infections, fatigue and blurred vision.


These are patients who have an impaired blood glucose tolerance but are not in the diabetic range yet. This condition is a danger signal before Type 2 diabetes strikes.

Doctors all over the world are increasingly recognizing the importance of diagnosing pre-diabetes as early treatment could help prevent diabetes. Foot odour and bad breath are the two symptoms of pre-diabetics.

Says Vaneet Kakar, consultant dental surgeon, Sitaram Bhartia Hospital in New Delhi: “The relationship between diabetes and oral health is a two-way street. Sugar increases one level, then oral health is compromised, the patient becomes more prone to oral infections. Conversely, if there is some infection in the mouth, then it can lead to increased sugar levels. Bad breath could be an early sign of diabetes as increased amounts of ketones in the body produce a bad smell." Unless corrective measures are taken, many pre-diabetics would develop diabetes in two or three years.

Doctors advise people to get tested for diabetes if they are above 45. Recent research suggests that some long-term damage to the body, especially the heart and the circulatory system, may already be taking place during this stage.

It has been proved that if people manage their blood glucose levels at this stage, they can delay or prevent the onset of Type 2 diabetes.

Eat right

At the core of any diabetic management programme is diet control and exercise as these help keep the blood sugar level in control. Says Dr Virmani: “It is a common perception that diabetics have to give up on good food. You don’t need to. You only need to cook your food right, with low amounts of fat. Diabetes is not about sugar, it is about calories. The American Diabetes Association says that as much as 10% of calories can come from sugar in well-controlled diabetics, after adjusting from total calories. A low-sugar and low-salt diet is fine. High-protein fibre foods such as rajma (kidney bean) and chana (chickpea) are useful as these provide enough fibre. Smaller portions in more spaced-out meals can also help.

However, it is important to keep a watch on the calorie intake. It is better to have a rasgulla than a gulab jamun as the former is high on sugar while the latter is high on fat. Eating lots of fruit and vegetables is, of course, beneficial.

Doctors attribute the rise of diabetes in cities to the rapid lifestyle changes, coupled with lack of exercise. Adds Ambrish Mithal, consultant endocrinologist, Indraprastha Apollo Hospital, New Delhi: “The onset of diabetes can easily be delayed with proper diet and exercise. If you take care of the blood sugar, cholesterol and blood pressure, all complications related to other organs— eyes, limbs, kidneys and the heart—can be taken care of. But, most patients focus only on sugar levels. Other complications can be reduced, if you manage your diabetes well."

Proper exercise

Doctors say that it is essential for every person to include a mild workout in his or her daily routine.

While it requires discipline to follow a routine regularly, to sweat off the extra calories and be fit and stress-free, most health experts suggest people at least take short walks every night after dinner to ensure that the sugar and insulin levels in the body are lowered.

Says Dr Virmani: “In our cities, there are no places for playing or cycling. Nobody seems to be aware of the enormity of the problem of increasing obesity among our youth or the rising cases of heart attacks. Parents must encourage their children to go out and exercise. We are encouraging diabetes by not adopting simple preventive methods. Diabetes will disappear considerably if we follow a healthy lifestyle."

Management tools

“Though India has the largest number of diabetics in the world, it still does not have a parallel industry in terms of food and insurance. Getting food that would suit a diabetic is still tough on flights, for instance, and insurance companies shun them," says Sanjay Kaul, a New Delhi-based senior management consultant. Kaul has had diabetes for 17 years now, but when he first consulted a doctor, he was given pills, not asked to take insulin. Says he: “I would have been much healthier today had I taken insulin shots right from the beginning."

Everybody agrees that the tools for managing diabetes in India are comparable to anywhere else in the world. Newer and more effective insulin and devices are already available in the country. User-friendly glucometers that monitor blood sugar levels and insulin pumps, too, have come within the patients’ reach. (Sweet News for Diabetics, 29 May). Says Dr Mithal: “Research is moving ahead and we can now control diabetes in a way we could not have imagined 20 years ago."

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