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Diabetes – Disease in Denial

By: Shyam Amladi, California
 

Diabetes is one of the most common of chronic diseases around. If untreated, its effect upon the human body, quality of life and life itself is devastating. And it is on the rise worldwide but specially in prospering and developed countries like India and the US.

In particular this is most probably, at least over the last 50 years, due to the rising consumption of calories, saturated fats, trans fats, simple sugars and carbohydrates, salt, and low intake of fiber. Such dietary transition (not to mention increased consumption of processed and ready-to-eat meals) and a comparatively sedentary lifestyle have led to a greater segment of Indian population (including whether living in India or in the US) being vulnerable to elevated diabetic or pre-diabetic condition.

SPREAD OF DIABETES IN INDIA
Here are some frightening facts. A 2010 study by Indian Council of Medical Research (ICMR) based on a sample of 16,607 Indians from southern Indian states including Maharashtra showed that approximately 62 million Indians are diabetic and an additional 77 million are pre-diabetic. While diabetes is not exactly a rich man’s disease, the CPR (crude prevalence rate) among the urban population of middle class to upper income Indians is now 1 in 9. Type-2 is the most prevalent form of the disease, affecting about 80-85% of all diabetics and is caused primarily by lack of insulin production in the body or inability for insulin produced in the body to functionally effective. Type-1 diabetes means that the body is not producing any insulin or very little insulin. Diabetes accounts for over 9 lac deaths in India annually. A 2011 study of 29 lac residents conducted by Metropolis Healthcare Ltd. in five major Indian cities showed that in Mumbai most of the diabetics are in the age group of 18 to 30!

But that is not all. Note I said, “if untreated”. Diabetes is also a disease that very routinely does go untreated and undiscovered among many of us often due to ignorance, willful disregard and sometimes for its perceived social stigma. In fact, the level of denial about it among Indians is shocking.

DIABETES EXPLAINED
So what, in simple terms, is diabetes?  Diabetes is a metabolic disorder and here is how it affects us. Most of what we eat rapidly converts to sugar and enters our bloodstream. Sugar is critical for energy and growth. When you consume sugar whether from natural and chemical sources , the digestive process breaks it down so it can enter your bloodstream as single sugar molecules or glucose (medical term is “monosaccharide”). In healthy individuals, your pancreas (which is an abdominal gland) immediately releases insulin, a protein that triggers cells to open up for sugar so that it can be transported from your bloodstream to your cells and to parts of your body that need glucose. If your pancreas are defective and produce insufficient or no insulin, the glucose in the bloodstream will remain there. Excessive blood sugar begins to coat your hemoglobin (red blood cells) thereby interfering with the process whereby healthy hemoglobin continuously carry life-sustaining nutrients to your organs—e.g. oxygen, potassium. The coating also causes cholesterol build up. Outcomes can be deadly because excessive sugar in your bloodstream impairs your blood vessels, nerves and organs, initially attacking the narrower vessels. Common symptoms are—loss of vision, acute memory loss, joint and foot pain, kidney malfunction, PVC (premature ventricular contraction) and such. Unfortunately, many of these symptoms mirror other afflictions and may not lead one to decide he or she should be tested for diabetic condition. The most common type of diabetes is called diabetes mellitus and is sub-divided into type-1 and type-2 forms. In type-1 diabetes, the body refuses to produce any insulin. In type-2 diabetes, the body produces insufficient insulin or is not capable of effectively processing insulin that is produced.

DIAGNOSIS AND TREATMENT OF DIABETES
Now for the good news. While diabetes is substantively incurable, it is very treatable. The key is to diagnose it early, and that is the focus of this article.

The most accurate diagnosis of diabetes is blood test. Here are the prescribed ranges of blood sugar for a non-diabetic person, male or female.

Fasting blood glucose: 70-99 milligrams per deciliter
2 hours after eating (postprandial): 70-145 mg/dL
Random (casual): 70-125 mg/dL


In addition to the topical, on-the-spot tests mentioned above, another important test for diagnosis and control of diabetes is called A1C blood test. This test controls the average blood sugar over 2 or 3 months to determine how it is being controlled cyclically.

Treatment of diabetes includes orally ingested prescription medicine for type-2 diabetes. Some type-2 diabetics may have to combine insulin and oral medicine. All type-1 diabetics and type-2’s who do not respond well to oral medicine have to be on a lifelong insulin treatment. A consistent diet of low-starch, low-fat and foods that have a low glycemic index and exercise regimen are recommended.

COMMON MYTHS ABOUT DIABETES
Unfortunately, many candidates for diabetes either refuse to test themselves or test regularly. In addition there is a tendency in diabetics (whether detected or undetected) toward self-treatment.  These include: fasting, reduced sugar intake and reliance on glycemic-indexed sweeteners, non-prescription treatment like homeopathic or herbal remedies to treat elevated blood sugars. These may help somewhat in preventing the worsening of a pre-diabetic condition in an otherwise young or healthy individual, particularly when combined with a regular regimen of exercise and healthy eating. However, their success is largely anecdotal and not proven. While respecting your faith in alternative treatments, I would recommend the age-old axiom, “trust but verify”! The only reliable way to incontrovertibly diagnose whether you have or are prone to diabetes is testing your blood sugar as prescribed and if diabetes is indicated, following a regular regimen of prescription medicine, healthy eating and monitoring of blood sugar. To do otherwise is risking a much more serious condition that can degrade your life style and may be fatal.

In addition to diabetes mellitus, a couple of other forms of diabetes exist.

  • Juvenile diabetes afflicts children and young (less than 40 years) men and women. It is treatable with aggressive prescription medicine and monitoring.
  • Gestational diabetes, which afflicts pregnant mothers is also treatable and should be tested as part of the regular checkup routine by an obstetrician
  • Diabetes Insipidus, not a common form is caused by severe kidney malfunction and  is treatable with a specific hormonal treatment

 

Author’s notes:
  1. I am grateful for the assistance of Dr. Vijay Kumar, MD and Ms. Sheela Balsawer, Illinois
  2. Suggested reading: “Epidemiology of type 2 diabetes: Indian Scenario”  by V.  Mohan, S. Sandeep, R. Deepa, B. Shah & C. Varghese, Indian Journal of Medical Research, March 2007
  3. A word of caution: information contained here is for information only—it is highly recommended that interested individuals consult their physician and/or their diabetic specialist for both diagnosis and treatment of diabetes.