Dealing with Diabetes

As India faces a rising burden of diabetes, it calls for appropriate government interventions and combined efforts from all the stakeholders of healthcare sector to prevent the disease from assuming catastrophic proportions.
By Amresh K Tiwary

With a fast-growing population of diabetic people, it is feared that India may soon become the diabetes capital of the world. As per reports, growing incidence of diabetes, considered as one of the most silent killer diseases, is a major challenge for doctors and the government.
India has more diabetics than any other country in the world. The disease affects more than 62 million Indians, which is more than 7.1% of India’s adult population. An estimate shows that nearly one million Indians die due to diabetes every year. 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. A report says that if not controlled, India will witness the greatest increase in people diagnosed with diabetes (102 million) by 2035.

Enormity of the Threat
Diabetes might be one of the most common diseases across the world and especially in India, but awareness about the same can well be estimated by the fact that India today has more people with type-2 diabetesthan any other nation. The WHO also estimates that 80 per cent of diabetes deaths occur in low and middle-income countries and estimates that such deaths will double between 2016 and 2030.
The etiology of diabetes in India is multifactorial and includes genetic factors coupled with environmental influences such as obesity associated with rising living standards, steady urban migration, and lifestyle changes. Yet despite the incidence of diabetes within India, there are no nationwide and few multi-centric studies conducted on the prevalence of diabetes and its complications.
The studies that have been undertaken are also prone to potential error as the heterogeneity of the Indian population with respect to culture, ethnicity, socio-economic conditions, means that the extrapolation of regional results may give inaccurate estimates for the whole country.
There are, however, patterns of diabetes incidence that are related to the geographical distribution of diabetes in India. Rough estimates show that the prevalence of diabetes in rural populations is one-quarter that of urban population for India.

Causes of Diabetes
There are many causes for diabetes. One of the largest causes is lifestyle. Being overweight and lacking exercise can lead to diabetes, particularly in adults. Obese children, when matured into adults, have a much higher chance of getting type-2 diabetes than children who are not obese at a young age. Another cause of diabetes is high blood pressure and unhealthy eating habits,
According to Arvind Garg, Senior Child Specialist, Apollo Hospital, Noida, “Obesity is one of the major risk factors for diabetes, yet there has been little research focusing on this risk factor across India. 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 be at equal risk as those who are obese.”
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. According to
Dr N P Singh, Senior Consultant, Max Superspeciality Hospital, Vaishali (Ghaziabad), “If you have diabetes, no matter what type, it means you have too much glucose in your blood, although the causes may differ. Too much glucose can lead to serious health problems.”
These days diabetes is now found in persons 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 only a few could afford the costs of treatment. As such, the focus must be on enacting preventive measures such as promoting physical activity.
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, says, “A major 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.”

Effects of Diabetes
Diabetes is one of the diseases that affects 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, the kidney being one of them. 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 is impaired. Foot problems occur in people with diabetes and can get serious very fast. Recent statistics show that approximately a quarter of all people with diabetes worldwide at some point during their lifetime will develop sores or breaks (ulcers) in the skin of their feet.
The symptom that you could easily miss is the unexplained loss of weight, sudden feeling of fatigue, and problems with your vision, without the need for corrective lenses. The patients 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.

Stages or Types 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, says, “The eyes of a diabetic also need special attention and care. Regular eye check-ups are a must. The retina could get affected, and blood vessels in the eye could leak blood. Diabetes also produces early cataract. In extreme cases, the patient can lose eyesight.”
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 complications are minimised. Diabetics, who were warned for years that their illness could cause blindness, are in for more bad news, as doctors have claimed that the patients are more likely to lose their hearing, too. A Japanese research study 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.
Diabetes is now highly visible across all sections of society within India, there is need for urgent medical intervention to mitigate the disastrous increase in the disease in future. Medical experts feel that timely detection and right management can go a long way in helping patients lead a normal life.

BOX:

Symptoms of Diabetes

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 like frequent urination, excessive thirst, increased hunger, weight loss, tiredness, lack of interest and concentration and a tingling sensation or numbness in the hands or feet.
Other signs 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)

Ayurvedic Approach to Diabetes
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,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.

Recommended Routine for a Diabetic
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 treatment for diabetic patients. A morning walk is the best form of exercise. 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. 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 Kledaka Kapha. A sub-dosha of Kapha, Kledaka Kapha 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 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.