Diabetes, the silent killer has become a cause of alarm for India with more and more patients being diagnosed with the deadly disease every year. While genes are to be blamed for the onset of the disease to an extent, the largest role no wonder is played by the modern erratic lifestyle. In a conversation with Smita Mishra of Zeenews.com, Dr Anoop Misra Director and Dr Shuchee Madhusudan Senior Consultant, Department of Diabetes and Metabolic Disease, Fortis Hospital elaborate upon the cause, management and cure of diabetes on World Diabetes Day.
Why is India called the Diabetes capital of the world?
India is now the diabetes capital of the world as the total number of patients with diabetes is an estimated 50.8 million, the highest in any country worldwide, and is increasing rapidly. The predicted figure for 2030 is 87 million or 9% of the population.
What type of diabetes is more common and Why?
Type 1 diabetes is due to lack of Insulin, starts at a young age, and can only be treated with insulin. It constitutes less than 5 % of total patients with diabetes. Type 2 diabetes is the most common form and is multi-factorial; genetic predisposition, sedentary lifestyle, intake of energy dense foods and obesity are some of its causes. Another hypothesis concerns the thrift gene, which states that our genetic makeup is to conserve and store calories in lieu of starvation. When such genetic machinery is provided too much food it predisposes to obesity and diabetes.
Is it hereditary?
When one parent is affected, the risk of developing diabetes increases 20 %, if both parents are affected the risk increases up to 50%. The age at which the parents developed diabetes is important as children are affected 5-10 years earlier. If there is a family history, screening every year with fasting and postprandial glucose test (or a more precise test, oral glucose tolerance test) is recommended from the age of 30 years and sooner if symptoms of weight loss, weakness, excess urination or thirst occur.
Can diabetes be prevented?
Adopting a healthy lifestyle, eating multigrain, fibre rich food, and avoiding excess fried fatty foods, sweets and starches and observing a regular exercise routine (at least 300 minutes of moderate intensity exercise per week) can prevent or postpone the onset of diabetes. At present, pills to prevent diabetes are not advised.
What precautions should be taken to keep diabetes under control?
Since diabetes is a chronic disease and lasts a lifetime, the patient’s involvement in his or her treatment is very important. They have to learn to monitor their blood glucose levels regularly, follow the prescribed diet and incorporate aerobic exercise into their daily routine. Visiting clinics for routine check up and other tests like lab work, eye and foot screening is advised.
Educating themselves about the disease will also improve the outcome. Family can contribute by encouraging the patient and following a healthy regimen themselves. The target is not only to keep blood glucose under control, but also blood pressure and blood cholesterol on target control since proper control of all three prevents or even retards diabetes related complications.
Does control of diabetes become difficult after some years, why?
Blood glucose has a tendency to increase as the duration of diabetes increases. It is due to multiple factors, medicines fail to be as effective after some years, body’s insulin production declines, non-compliance with diet and exercise, gain of weight, menopause, and frequent infections make its control difficult.
Can Diabetes be cured?
There is no cure for diabetes yet, but good control can prevent complications and a fairly normal life can be lead.
Diabetes pills have to be taken life long. Don’t they cause side effects?
All medicines can cause side effects, but these are not common and are insignificant. Patients should know the side effects of each medication. Physicians should monitor side effects by examination and lab tests.
What are the problems you face as physicians?
The challenges we face as physicians are:
1. Ignorance: Patients are no aware of the benefits of good blood sugar control and complications. For example; many times a small foot lesion is not taken care of and the patient ends up in hospital needing amputation. Many are not aware of the complications of diabetes; diabetes is the major cause of heart disease, kidney failure, blindness and amputations in India.
2. Patients often feel they are “healthy” and do not need any medical advice. It is important to know that almost half the patients of diabetes may not have any symptoms initially.
3. Unavailability of resources: Patients in India often live in remote areas where adequate health services are not available.
4. Non-compliance to treatment: Despite repeated advice many patients do not observe diet and exercise, and even fail to take pills regularly.
4. Some patients believe in alternative and mostly untested medicines which are often ineffective and can even be harmful.
Do sweets cause diabetes?
Sweets do not directly cause diabetes. However since they are high calorie food they contribute to obesity and predispose to diabetes. Once patient develops diabetes, simple sugars in any form should be stopped.
What advise would you give to general public and patients?
Our advice to the general public is to be aware of the disease and its complications. Everybody should eat balanced diets; maintain weight, and do regular exercise.
Early and regular screening is recommended in the following situations.
1. Age more than 35 years
2. Obesity (body mass index (weight in kg/height in meter2 more than 23)
3. Waist girth more than 90 cm in males and more than 80cm in females
4. Physically inactive
5. First degree relative of a diabetic
6. Female who gives birth to baby more than 4 kg
8. Cholesterol disorders
9. History of heart attack and stroke
10. Recurrent infections
11. Poorly healing wounds or ulcers