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Sugar-coated hazard

Watch out for early signs of diabetes and control them to minimise risk of complications, writes Sanchita Sharma.
Hindustan Times | By HT Correspondent
UPDATED ON JUL 08, 2007 03:29 AM IST

People with Type 2 or adult-onset diabetes not only get heart disease eight years earlier than people with other risk factors, but also lose eight years from their expected life span. The silver lining is that healthy diet and exercise can lessen and, in some cases, prevent these effects.

These new findings of the Framingham Heart Study that has been tracking over 5,000 men and women every two years since 1951 bring hope to people at maximum risk, such as those who are overweight, less active and have a family history of diabetes. “Given the prevalent low activity levels and unhealthy eating patterns, screening for insulin-resistance should begin as early as the age of 20, especially if a person is obese or has a family history of diabetes,” says Dr Ashok Jhingan, chairman, Delhi Diabetes Research Centre.

Data from the Framingham Heart Study shows that people who are at increased risk for Type 2 diabetes can prevent or delay the onset of the disease by losing 5 to 7 per cent of their body weight through increased physical activity and a reduction in fat and calorie intake.

Lose excess weight, exercise regularly and increase dietary fibre to lower blood insulin levels and increase the body’s sensitivity to insulin, recommends the American Diabetes Association. But a diet-only diabetes control strategy is often not enough.

A study in the journal, The Lancet, warns that a diet-only treatment needs very close monitoring to prevent complications. It found that people with diabetes being managed with diet had more problems, such as poor sugar control and high blood pressure, when compared to people taking medicines.

What matters most is keeping your sugar level under control. “People should maintain a fasting blood sugar of 90-130; post-prandial (or after meals) levels of 180; bedtime sugar level of between 100-140; and Hb A1c (average sugar in the blood over three months) value of under 7; blood pressure below 130/80; low density lipoprotein (bad cholesterol) below 100; and high density lipoprotein (good cholesterol) over 40,” says Dr Anoop Misra, director, Department of Diabetes, Fortis Hospitals.

So when should you start worrying? If you cannot bring sugar levels down within three months through diet changes and exercise, medicines are the only option.

The rising obesity among children is a growing cause for concern. An ongoing study of over 5,000 students in 42 schools found 18 per cent of Delhi’s children are overweight and obese and 70 per cent have high blood pressure. Another 45 per cent have abnormal lipids (blood fats).

“We are sitting on twin epidemics of diabetes and heart disease. The study confirms that current dietary trends combined with inactivity will expose this generation to hypertension, heart disease and diabetes by middle age,” says Dr Misra.

About 80 per cent of people with diabetes develop cardiovascular disease; the disorder raises the chance of heart problems by roughly twice as much for women as for men, reports The Archives of Internal Medicine.

Indians are anyway at a higher risk of diabetes because they are genetically pre-disposed to what is called ‘the metabolic syndrome’, a cluster of disorders including abdominal obesity, hypertension, high bad cholesterol, low good cholesterol and elevated triglycerides. “If these problems start young, the risk of these children having heart attacks and strokes at a younger age increases sharply,” says Dr Jhingan.

Compared to the West, fewer people in India seek treatment for diabetes. About 40 million people have diabetes in India, but only a third use medicines to control their blood sugar levels. The reasons are many. “There are no symptoms till late stages of the disease and most people do not even realise that they have diabetes until they develop complications such as retinopathy (potentially blinding eye disorder) and neuropathies (numbness in the hands and feet),” says Dr Misra.

Indians also play truant when it comes to taking their prescription medication. “Once medicines get glucose levels under control, people stop taking the medicines or lower the dose without consulting a doctor,” says Dr Jhingan.

Since you can’t change your genes, the next best thing would be to watch what you eat and go for regular glucose tolerance tests to keep track of any metabolic anamolies. And if your blood sugar levels still stay high, taking medicines to control diabetes is the best way to lower risk of early death, heart disease, kidney disease, stroke, and blindness.

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