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“I cannot have diabetes,” exclaimed the middle-aged gentleman. “The laboratory results are wrong. My parents did not have diabetes, I am a vegetarian, and I do not even eat sweets.”
Well, this man is living in a soap bubble that is about to burst. None of the reasons cited protects from the onset of diabetes. As far as family history is concerned, awareness and routine laboratory tests for metabolic diseases are a relatively new phenomenon. His parents may have had diabetes and may have died quietly of an undiagnosed complication like a heart attack.
India has 30 million known diabetics, the largest number in the world. The figure is mounting daily and is slated to escalate by 200 per cent. Most of the affected will be in the economically productive age group of 30-60. We have to find out ways to combat this epidemic, halt it and prevent our children from falling prey to it.
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Studies have shown that the possibility of developing diabetes depends on one’s genes, which are inherited from both parents, and the nurturing environment provided first in the womb and later by the mother.
To begin with, women should have the correct BMI (body mass index — weight divided by height in metre squared) of 23 before they become pregnant. Some women are undernourished and eat poorly. Their calorie intake is only 70 per cent of the required amount (2,000-2,200 calories for an active adult female). The protein content may be less than the recommended 075-1gm/kg. Both these situations result in poor foetal growth and an SFD (small for dates) baby.
Compensatory mechanisms come into play in SFD babies and they develop relative insulin resistance so as to maintain normal blood glucose concentrations. Vital organs like the brain and heart receive sufficient nutrition, but it is diverted away from the muscles.
These small babies exhibit a phenomenon called “catch up growth”. If fed adequately after birth, they attain normal weight for age and height within three years. In the process, they can develop impaired glucose tolerance as early as seven years of age.
Today’s teens have a different story. They are becoming obese on a diet of fast food and “time pass” television. Many girls are overweight when they get married. Pregnancy and well meaning advice to “rest and eat for two” do not help matters. Those who are obese (BMI more than 29) or diabetic during pregnancy can produce large babies (LFD or large for dates). These babies are exposed to excess nutrition in the womb. They secrete excess insulin, can develop insulin resistance and eventually diabetes. The problem is compounded if they are growing up in a family with faulty eating habits and little or no regular exercise.
Since we now know that the majority of us carries a gene which predisposes us to develop diabetes, it makes sense to thwart the march to disease.
Check your blood sugars once a year after the age of 25, even if you are asymptomatic, to be sure you don’t fall in the “prediabetic” category. Those who are prediabetic have a fasting blood sugar between 100 and 126mg/dl and a two-hour post prandial or oral glucose tolerance test value between 140 and 200mg/dl. Abnormal values may occur 15 years before the onset of overt diabetes. Without active intervention eventually 35 per cent go on to develop the disease. With effort and a change in lifestyle, 45 per cent can revert to normal.
Medical complications — which cause heart disease, stroke, peripheral vascular diseases, and eye and kidney problems – begin to set in during the prediabetic stage. Early identification and treatment can reduce the damage.
The BMI should be maintained at 23. This can be done by keeping the caloric intake between 1,500-2,000 calories a day. The diet should be low in fat, and contain four to six helpings of fruit and vegetables. But dieting alone will not help, as weight loss through starvation cannot be sustained. Food restriction should be combined with physical activity for 60 minutes every day. A brisk walk (five kilometres), or one hour of swimming or cycling will do the trick.
Blood pressure should be maintained at 130/80 or less. Salt restriction and weight loss alone may be sufficient to achieve this. If not, medication may be needed.
Lipid levels also need to be monitored in prediabetes as dyslpidaemia and altered glucose tolerance go hand in hand. Elevated lipid levels predispose to a stroke and heart attack. LDL should be below 100 mg/dl, HDL above 40mg/dl (above 50 mg/dl for women), and triglycerides below 150mg/dl. Reducing the total oil intake to 500 ml a month, checking labels for hidden fats in processed foods, and eating more soluble fibre (beans and oats) will help. If levels remain high the statin group of medications can be started.
If parents adopt a healthy lifestyle, children will soon follow suit. Perhaps this way we can reduce the impact of this devastating disease in the next generation.
Source:The Telegraph (Kolkata, India)