Defeat diabetes now
It is estimated that over 100 million Indians will suffer from diabetes by 2030. Alarming as it may sound, experts emphasize that simple lifestyle measures can prevent diabetes. Here's the lowdown
Indians are genetically more susceptible. We have the 'thrifty gene'-primed to store energy as abdominal fat. It helped cope with food shortage in the distant past, but now when food is plentiful, it increases diabetes risk. But experts agree that genes alone cannot explain why the numbers have shot up dramatically in the past 40 years. They hold our lifestyle-the tendency to remain sedentary and overeat, along with stress, which throws our hormones out of whack-and environment responsible.
Insulin is a hormone that regulates our blood sugar levels. Diabetes is a chronic condition in which the body cannot make or use insulin properly. Over time, uncontrolled diabetes can turn lethal by causing serious damage to blood vessels (cardiovascular disease, stroke, retinopathy), nerves (neuropathy or numbness) and organs (kidney disease).
condition and how to beat it.
Recent studies show that weight-loss (bariatric) surgery can induce remission in diabetes patients. A 2013 study by Medanta-the Medicity, Gurgaon revealed that more than 90 per cent of obese patients were able to go off their diabetes medication following a surgery, even prior to significant weight loss.
Of course, the best place to intervene is in the detectable process that precedes a diagnosis-predia-betes. This is a condition where blood glucose level is high, but not high enough to be in the diabetic zone. Studies indicate that without intervention, most people with prediabetes will get full-blown
diabetes within 10 years. However, with changes in lifestyle, including modest weight loss (as little as
5-7 per cent of current weight), people with prediabetes can prevent or delay the development of the condition by 54 per cent three years later.
Portion control, eating high-fibre foods, wholegrains, adequate protein, swapping bad fats with good ones, choosing small and frequent meals and ditching refined foods are the principles that stave off rise in blood sugar levels. Along with calorie reduction, slow absorption of foods should be your goal.
Exercise helps torch calories, slash weight, lower your blood sugar levels and improve insulin sensitivity. The minimum recommendation is 30 minutes a day, five days a week, though experts recommend more.
Stress causes your blood sugar levels to skyrocket, giving you the energy to fight or flee. But with chronic stress, extra sugar is released conti-nuously without being used up by the body. Moreover, the stress hormone cortisol triggers cravings for high-fat, high-sugar comfort foods. A study from Duke University, USA found that stress management techniques can help you control blood sugar levels. Try relaxation techniques like deep breathing, meditation and mindfulness.
Sleep helps to stabilize blood sugar. Fewer than six hours a night is associated with a three-fold increased likelihood of elevated blood sugar levels (prediabetes), says a study published in Annals of Epidemiology. Inadequate sleep also contributes to weight gain: The Nurses' Health Study tracked 68,183 women for up to 16 years and found that those who got five hours of sleep or less, weighed about 1.14 kg more and were 15 per cent more likely to become obese. Poor sleep is also associated with hunger hormones that make you eat more. Get the recommended seven to eight hours every night.
According to a study involving men, published in Diabetes Care, smoking cigarettes was associated with a significant increase in diabetes risk, even after adjustment for age, body mass index (BMI) and other potential confounders such as physical activity. If you smoke, seek help to quit now.
It's wise to be cautious-especially if you are trying to lose weight. Recent NHS, UK guidelines recommend restricting consumption to 14 units per week, spreading it out over three or more days. (A bottle of red wine = 10 units; a pint of regular beer = 3 units.)
An expanding waistline is a strong predictor of insulin resistance and Type 2 diabetes. Abdominal fat (or visceral fat) is highly metabolic. It breaks down quickly, travels around the body, parking itself on various tissues including those of the pancreas-the insulin production house of the body.
Beginning in your 30s, an annual blood sugar test is an absolute must. If you are overweight or have a family history of diabetes, start earlier.
Expert Panel (in alphabetical order): DrAmbrishMithal, chairman & head, Endocrinology and Diabetes Division, Medanta-The Medicity, Gurgaon; DrAnoop Misra, chairman, Fortis CDOC Hospital for Diabetes and Allied Sciences, New Delhi; Dr BinayakSinha, consultant, Endocrinology, AMRI Hospitals, Kolkata; Dharini Krishnan, consultant dietician, Chennai; Dr Shashank Joshi, endocrinologist, Lilavati Hospital and Research Centre, Mumbai; Dr V. Mohan, chairman, Dr Mohan's Diabetes Specialities Centre, Chennai.
ARE YOU AT RISK?
MANAGING DIABETES WITH DRUGS
Metformin is the backbone of diabetes treatment. Sulphonylureas is equally popular. However, the past decade has seen the development of many new diabetes drugs. No doubt expensive, these drugs not only ensure weight loss, they also prevent weight gain and stop hypoglycaemia (sudden dip in blood sugar levels). They are also known to cause fewer gastrointestinal side effects. Diabetes being a chronic condition, over time you need to combine drugs to manage blood sugar better. Here's the latest in diabetes medication:
Incretin-based therapies: These novel drugs activate the incretin hormonal system in our gut, stimulating insulin production and inhibiting glucagon (anti-insulin) production from the pancreas in response to food in the stomach.
They come in two forms:
These include twice-a-day injections (exenatide) and once-a-day
liraglutide. The weekly injectibledulaglutide was introduced this year.
SGLT-2 inhibitors: These oral tablets push out glucose through urine. These include canagliflozin, dapagliflozinand empagliflozin.
People with Type 1 diabetes and some with Type 2 diabetes need to take
insulin via an injection or pump. Animal-based insulin has given way to
human (pure insulin) and analogues (designer insulin). Pure insulin is
available in fast-, medium-and slow-acting forms. Designer insulin is
rapid-acting (lispro, aspart, glulisine), ultrashort (buccal spray)