The Sweet Epidemic
The Sweet Epidemic
Controlling the spread of diabetes requires urgent public attention, appropriate government interventions and combined efforts from all the stakeholders of health sector
By Amresh K Tiwary
Considered as one of the most silent killers, diabetes is now highly visible across all sections of society within India. In fact, the country has more diabetics than any other nation in the world. The disease affects more than 62 million Indians, which is more than 7.1% of India’s adult population.
As per an estimate, nearly one million Indians die due to diabetes every year and the average age on onset is 42.5 years. The high incidence is attributed to a combination of genetic susceptibility plus adoption of a high-calorie, low-activity lifestyle by India’s growing middle class. Another report says that if not controlled, India will see the greatest increase in people diagnosed with diabetes (102 million) by 2035.
There is, therefore, an urgent need for medical intervention to mitigate the potentially catastrophic increase in diabetes in future and to reduce the burden that diabetes creates in India, appropriate government interventions and combined efforts from all the stakeholders of health sector are required.
Obesity is the biggest enemy
There are many causes for diabetes and the main culprit is the sedentary lifestyle of the people. Being overweight and lacking exercise can lead to diabetes, particularly in adults. Even the children who are obese when they are young have a much higher chance of getting type 2 diabetes than those children who are not obese at a young age.
According to Arvind Garg, Senior Child Specialist, Apollo Hospital, Noida, obesity is one of the major risk factors for diabetes, yet there has been negligible research on it. Despite having lower overweight and obesity rates, India has a higher prevalence of diabetes compared to western countries suggesting that diabetes may occur at a much lower body mass index (BMI) in Indians compared with Europeans. Therefore, relatively lean Indian adults with a lower BMI may also be at equal risk as those who are obese.
The damage assessment
Diabetes is one of those diseases which affect the endocrine system. The pancreas produces the hormone insulin. In Type 1 diabetes, the insulin producing cells in the pancreas are destroyed. In Type 2 diabetes, insulin is still produced but the body becomes resistant to it. Diabetes may damage almost every tissue and organ of the body, including the kidney. If neglected, a person could go into diabetic nephropathy.
Albumin in the urine, blood urea and creatinine levels should be checked once a month. Diabetics should avoid painkillers. They should watch out for swelling of the feet, extreme fatigue, weakness and breathlessness. Obese children should also be screened for diabetes,
The doctors believe when diabetes is not well controlled there is damage to the organs and the immune system gets impaired. Recent statistics show that approximately a quarter of all people with diabetes worldwide at some point during their lifetime had developed sores or breaks (ulcers) in the skin of their feet.
The symptom that you could easily miss is the unexplained loss of weight, all of a sudden feeling of fatigue, and problems with your vision, without the need for corrective lenses. The patient may go through bouts of extreme hunger as the body calls for more food to generate energy. They could also experience unexplained tingling in their feet and hands, including dry skin. If any of these symptoms of diabetes show themselves, it may be time to consult your doctor for evaluation and possible treatment.
Dr Vipin Mishra, Senior Consultant and Head, Department of Diabetes and Endocrinology, J P Hospital, Noida, said, “If you have diabetes, no matter what type, it means you have too much glucose in your blood. Too much glucose can lead to serious health problems. Hypothetically diabetes mellitus refers to a group of diseases that affect how your body uses blood sugar (glucose). Glucose is vital to your health because it’s an important source of energy for the cells that make up your muscles and tissues. It’s also your brain’s main source of fuel”.
“These days diabetes has been noticed even in the people as young as 15 years. Among the main reasons is sedentary lifestyle which has become ubiquitous now. About 17 million people suffer from kidney problems arising out of diabetes, but the irony is that only a few could afford the costs of treatment,” said Dr Shalini Jaggi, Senior Diabetologist, Balaji Action Hospital.
Knowing causes of diabetes can help a person understand how best to treat their symptoms, and help them understand how they got diabetes in the first place. While many causes of diabetes can be prevented, some causes are just the way the body is made, and the sooner a diabetes type can be diagnosed, the sooner a person can get back to normal health and take the measures needed to take care of oneself successfully.
Dr Anup Mohta, Director, Chacha Nehru Bal Hospital, East Delhi, said, “Another cause of diabetes is genetics. If a child’s parent has diabetes or if diabetes is common among other family members, a person’s chance of also having diabetes as they age is greatly increased. Mainly, type 2 diabetes is inherited, and this type of diabetes is easier to treat, unlike type 1 diabetes. However, even if diabetes is an inherited disease, there is no guarantee that a person will get it.”
Stages of Diabetes
There are two stages to this disease, otherwise known as type 1 diabetes and type 2 diabetes, and they are caused when the pancreas does not produce enough insulin. A type 1 diabetic is more commonly found in younger adults and will require the use of insulin injections and a major adjustment in their diet. Type 2 diabetes is probably more common in adults; however, it is hardly ever diagnosed until the patient is required to do a blood test for some other medical problem. A type 2 diabetic is usually a patient who is constantly fighting with weight problem.
The chronic diabetes conditions include type 1 diabetes and type 2 diabetes. Potentially reversible diabetes conditions include prediabetes when blood sugar levels are higher than normal, but not high enough to be classified as diabetes and gestational diabetes, which occurs during pregnancy but may resolve after the baby is delivered.”
Dr Shishir Narayan, Shroff Eye Hospital, New Delhi, said, “The eyes of a diabetic need special attention and care and so regular eye check-ups are a must. The retina could get affected, and blood vessels in the eye could leak blood, due to diabetes. Diabetes also produces early cataract and in extreme cases, the patient can lose eyesight.”
Care to cure
Those with long standing diabetes are at the risk of developing diabetic neuropathy and complications of diabetic foot. Round-the-year foot care can ensure that the chances of the complications are minimised. Gradually the sufferings due to this disease has also augmented. The diabetics, who were earlier warned for years that their illness could cause blindness, are now in for more bad news, as doctors have claimed that the patients are more likely to lose their hearing, too.
A Japanese research has found that hearing problems are far more common in diabetics than their healthy counterparts, even when other factors such as ageing and a noisy environment are taken into account.
The association of hearing impairment with diabetes is controversial, but it is believed that over time, high blood glucose levels can damage vessels (causing hearing loss). It’s thought that glucose damages the nerves and tissues in the ear, diminishing the ability to hear. Diabetic patients should be screened for hearing impairment from earlier age compared with non-diabetics, from the viewpoint of prevention of several health problems such as depression and dementia caused by hearing impairment.
Tackling the Disease
Education is of utmost importance in the prevention of diabetes. Here’s a list of symptoms that you should look out for in your body to make sure you are not suffering from any diabetes-related complications. These include frequent urination, excessive thirst, increased hunger, weight loss, tiredness, lack of interest and concentration and a tingling sensation, or the numbness in the hands, or the feet.
Other signs of the disease include blurred vision, frequent infections and slow-healing wounds.
Don’t ignore basic warning signs as they could be indicative of graver problems. In case you are unsure, consult your doctor immediately.
Remember, you are
at the risk of diabetes if you:
are obese or overweight
are physically inactive
have been previously diagnosed with glucose intolerance
have unhealthy dietary habits and meal times
are above the age of 40
are a patient of high blood pressure and high cholesterol
have a family history of diabetes
have a history of gestational diabetes
are from a particular ethnicity (higher rates of diabetes have been reported in Asians, Hispanics and African Americans)
The Ayurvedic view
In Ayurveda, diabetes is known as Madhumeha (Madhu means ‘honey’ and Meha means ‘urine’). Madhumeha is categorized as Vataj Meha (a problem caused by aggravation of Vata). Vata symbolizes wind and dryness. Deterioration of the body is a characteristic that indicates impairment of Vata. Maximum deterioration of dhatus (body tissues) occurs in this type of disease and this is the reason why all vital organs are affected by diabetes.
The other prime cause of diabetes is impaired digestion. Impaired digestion leads to accumulation of specific digestive impurities (known as ama) which accumulate in the pancreatic cells and impair the production of insulin.
According to Ayurveda, sugar levels can be kept under control with the help of proper medication and a strict diet-lifestyle plan. Because diabetes is a chronic metabolic disorder that arises when the pancreas does not produce enough insulin, or when the body cannot effectively use the insulin it produces, it can only be treated if the body is rejuvenated in its entirety.
Therefore, the treatment of diabetes recommended in Ayurveda – as against modern medicine – is aimed at rejuvenating the body to not only balance sugar levels, but also foster a positive change in the patient’s life.
Ayurvedic medicines work on the root cause of the disease, with strengthening the patient’s immunity, enhancing digestion and helping him lead an overall healthy life. Along with medication, dietary and lifestyle changes are also recommended to rejuvenate the body’s cells and tissues, allowing them to produce insulin properly.
Daily routine for a diabetic person
Wake up time: Wake up by 6 am in the morning, as you also need ample time to exercise. Have a glass of lukewarm water mixed with two teaspoonful of fresh lemon juice every day.
Exercise: Exercise forms an important part of the treatment for diabetic patients. A morning walk is the best form of exercise for the people who are suffering from diabetes. Yoga and meditation can also be beneficial, especially to relieve stress and bring clarity to the mind. If your health permits, opt for exercises such as jogging, swimming, cycling, etc.
Breakfast: In the morning, take two slices of whole meal bread with butter and fresh milk (boiled and taken warm). Seasonal fresh fruits can be taken occasionally, with or without milk.
At work: If you are an office-goer, make sure you carry filling snacks with you all the time, as diabetics are advised not to keep their stomachs empty. Instead of snacking on cheese, chips or crackers, enjoy a handful of nuts or seeds. Go for variety with sunflower, pumpkin seeds, almonds, cashews, and walnuts.
Lunch: For lunch, opt for steamed or lightly cooked green vegetables such as cauliflower, cabbage, tomatoes, spinach, turnip, asparagus and mushrooms. Vegetable soup or boiled vegetables can also be taken. In addition, two or three whole wheat bread (chappatis), sprouts, salad, boiled rice, lentils (daal) etc. can be taken according to appetite. A glass of butter milk (salty lassi) is a nice drink to end the lunch with. Roasted cumin seeds, black salt, grated ginger and green coriander leaves can be added to the butter milk.
Daytime sleep: If you are a non-working diabetic, always remember not to sleep during the daytime, as it increases KledakaKapha. A sub-dosha of Kapha, KledakaKapha governs the protective mucous lining of the digestive system, thereby facilitating proper digestion. In an increased state, it can lead to impairment of digestion, which can cause additional problems in diabetes patients.
Evening snacks: Have a glass of fresh fruit or vegetable juice. You can also take Ayurvedic tea with roasted chickpeas.
Dinner: Always remember that your dinner should be light and do not have too many items. Boiled vegetables, sprouts, cottage cheese (paneer) or a bowl of salad made from fresh raw vegetables of the season. Also, make it a point to eat at least two hours before you go to bed.
Bedtime: Go to sleep before 10 pm. Have a glass of fresh boiled warm milk before going off to bed.