About 40 million people have diabetes in India and another 40 million have insulin resistance that puts them at risk of it. This makes diabetes as common as the common cold, but unlike the cold, it does not go away on its own — it needs to be treated. But roughly only half the people with diabetes in India take medicines to keep their blood glucose levels in check.
In most cases, it’s ignorance and not the price of the medication that keeps people from treatment. Many who have diabetes simply don’t know they have it until one of the many complications kicks in.
That’s what happened to Arindham Sarkar, 65, who discovered he had diabetes after an eye examination. “I developed floating spots in my vision some months ago and went to get my eyes examined. The doctor asked me to get my blood glucose tested, and when I did, I found I had diabetes. I was told I may have had it for over five years, which damaged my retina,” says Sarkar.
“In the case of adult onset type-2 diabetes, there are no symptoms till late stages of the disease, so many do not even realise that they have diabetes until complications set in,” says Dr Anoop Misra, Director, Department of Diabetes and Metabolic Diseases, Fortis Group of Hospitals.
About 95 per cent people in India have adult-onset or type-2 diabetes, which is triggered in susceptible people by unhealthy
diets and sedentary lifestyle. Initially, people develop insulin resistance, a condition in which fat, muscles and liver cells do not use insulin properly. At first, the pancreas works harder to produce more insulin to keep up with the added demand, but over time it loses its ability to secrete the required insulin and the person becomes unable to metabolise the blood sugar. Usually, it takes about a decade for a person with insulin resistance to develop diabetes.
Diabetes, however, can be controlled and a person can lead an active life for decades after being diagnosed. Neelam Mahajan is 50 and has been living with type-1 (insulin-dependent) diabetes for over 27 years. “I’ve taken insulin shots at the strangest of places, from plane toilets to fast-moving trains. I never step out without insulin,” says Mahajan.
Having diabetes needs the same care, says the garrulous Mahajan, as a newborn baby. “I have to worry about when to eat, what to eat and monitor my blood sugar once every day. The cost is not much, about Rs 3,500 a month (including for the testing strip), but I have to follow a military regimen.”
Problems kick in when people with type-2 diabetes play truant with their prescription medication. “Once the medicines get the blood glucose levels down to the desire limit, some think they’re cured and lower the dose themselves or stop taking the medicine altogether,” says Dr Jhingan, president, Delhi Diabetes Association.
Some of the common complications associated with uncontrolled diabetes include heart attacks (the leading cause of death in people with diabetes) and strokes. The risk of heart disease is two to four times higher for people with diabetes, according to the American Heart Association. Women with diabetes are at greater risk, with a study showing that women over 55 years with diabetes are seven times more likely to have heart disease. Other complications include nerve damage (diabetic neuropathy) throughout the body, with symptoms of numbness, pain or weakness in hands, feet and legs, kidney failure, erectile dysfunction, diabetes retinopathy (a potentially blinding complication that damages the retina) and hypoglycaemia (sudden dip in blood sugar caused usually by delayed or skipped meals, excessive doses of diabetes medications, including sulfonylureas and meglitinides, and too much alcohol).
While medicines can help manage sugar levels and keep related complications at bay, only lifestyle modifications such as losing weight, exercising and eating healthy can help manage the disease. “The bottomline is that people who are overweight, don’t exercise and have a family history should get the blood glucose tested every year to detect and control the disease in time,” says Misra.