Killing you sweetly

Are you one of those with one parent or both severely diabetic and dreading the day it will hit you with the predictability of a Greek tragedy? Then you are also someone who postpones blood sugar tests, refuses to look at the results for days, or sees the fasting figure slowly crawl past 100 but steadfastly stays in denial.

You are also among the 39 million Indians who have borderline diabetes. This is the potential group that could, if it does not contain the condition, burgeon into the 80 million full blown diabetics the country is projected to have by 2030.  

Imagine standing at the threshold of a room full of untold horrors from where there is no escape. But you have the freedom to walk away from the door. What would you choose to do? Scram, of course.

That is the analogy endocrinologist Dr Sujeet Jha offers the pre-diabetics who seek his counsel. Unfortunately, walking away from a door is far easier than knocking your lifestyle into place, eating sensibly, or exercising every day. So, one third of those standing at that threshold actually end up walking into that room, defying obvious logic.

WARNING SIGNALS
Diabetes statistics coming out of India are always depressing. The current figure is 32 million, a record number, by the way. And by 2030 it will be 80 million. The only way to reign in the monster is to tap into the potential pool of pre-diabetics, which is estimated at 39 million.

What is borderline diabetes?
If your fasting glucose values lie between 100 and 125 mg/dl or if two-hour glucose values are between 140 mg/dl and 200 mg/dl, then you are a pre-diabetic or a borderline diabetic. This means  that you are not a full-blown diabetic but your sugar levels are too high to classify you as healthy. The good news is that you can pull yourself off the brink by altering your eating habits and exercising. The bad news is that this is easier said than done. But ignoring the warning signal can be a bad idea.

“It is not an innocuous condition. This is a warning signal that these individuals are prone to develop diabetes mellitus and heart disease in the future,” says Dr Anoop Misra, head of the Department of Diabetes and Metabolic Diseases, Fortis Hospitals, New Delhi.

INDIANS VULNERABLE
The prevalence of pre-diabetes is 10-25 per cent in India, higher among older people, and higher among those who reside in cities. As compared to other races, pre-diabetes converts to diabetes more in Asian Indians. And if you have a family history of the disease, there is a 50 per cent chance you will end up with the disease unless you have been closely guarding yourself against it by staying fit.

Pre-diabetes in some ways is a tougher situation to be in than the full-blown the disease. If you are not really in a crisis but only stand a good chance of getting into one, it is hard to psyche the mind into behaving as though you are already in big trouble.

A 47-year-old Delhi-based filmmaker, who doesn’t want to have his name down in print, talks of the tough battle to keep his sugar levels in check. His life alternates between months of extreme activity and stress when he is shooting and months when he spends rooted to his computer terminal. “I thought between these swings, my body’s need for exercise would get taken care of,” he says.

A year ago at a routine health check-up he found that his glucose tolerance was impaired. With a diabetic mother at home and keen to avoid medication, he set out on a mission to control his sugar levels. He has cut down on his intake of refined, fatty foods and follows Baba Ramdev’s yogic prescription to fight diabetes, mostly kapalbhati, and some ayurvedic medicines. There are times when the formula works and times when it does not. But he is giving himself a year before heading for an endocrinologist.

“I am scared of the disease but it is still hard to totally control one’s lifestyle. I get careless sometimes; I am a foodie and a Bengali. I am very fond of sweets and cannot do without chicken or fish. I tell myself it is okay, I am not there yet, and I can always catch the bus again,” he says, capturing in a nutshell the battle of will that most pre-diabetics have to fight.

DEADLY IGNORANCE
Endocrinologist Dr Jyothydev has been running mass diabetes screening campaigns in Kerala, India’s diabetes capital. Once every week, he leaves his hospital at Thiruvananthapuram to his team and tramps around the state, from villages to towns to cities, talking about the perils of allowing diabetes to take over one’s life. His success rate in getting prediabetics to stave off the disease? A disheartening 5 per cent.

“Unless you have seen the suffering it can bring at close quarters, say, have a diabetic parent who had to undergo amputation, you will not really dread the disease because it creeps up on you slowly. I find that less than 5 per cent are aware of the condition called pre-diabetes.

In a seemingly healthy population that gathers at a screening camp, if I do a random check, the average chance of detecting pre-diabetes is huge: 26 per cent of those in the 25-35 years age, and 40 per cent of those in the 50-60 age group,” says Dr Jyothydev.

The fact is that your conventional doctor is not exactly the best suited to spread lifestyle awareness; he/she will do a great job of treating the disease once it sets in. Community health issues have to be dealt with by another group of professionals and volunteers.

EXAMPLE OF REVERSAL
Depressing as it might be, being diagnosed as pre-diabetic still gives you a head start over those who were diagnosed late. It takes a small — but very determined — effort to move from pre-diabetes back to normalcy.

In Chennai, leading diabetologist Dr V Mohan has been actively campaigning for an overhaul of the lifestyle of potential patients under the Chennai Urban Population Study [CUPS]. The uplifting story of Asiad Colony under this project has now gone into the Journal of Association of Physicians of India.

Around 500 residents of this suburban colony, with flab around the middle and bad urban lifestyle habits, decided to get into shape. They built a park with a track for walkers and joggers. Their health parameters were monitored over a period. Each of them showed great improvement in their blood sugar and cholesterol levels.

“If you are pre-diabetic and can knock off 7 per cent of your weight, the chance of turning into a diabetic reduces by 58 per cent. Not just that, for another five years, your body will continue to reap the benefits of your effort,” says Dr Mohan.

But it needs determined effort to turn the clock back. Dieticians who counsel and monitor diabetics point out that they tend to be in denial most of the time. Till not long ago, 110 was the cut-off level for fasting sugar levels for pre-diabetes. This was then pared down to 100, but not many are aware of this or willing to accept it.

Delhi-based nutritionist Ishi Khosla says the toughest part is getting a pre-diabetic to admit that they are in a perilous situation.

“I have people who say, yeh kaise ho sakta hai? Mere ko to low sugar hota hai. Mujhe to chakkar aate hain. (How can it be? My sugar levels are in fact low. I feel dizzy sometimes.) But I am ruthless with the cut-off point. I don’t budge from 100,” says Khosla.

COMMON SENSE
Khosla is also stern with the diet she recommends (see box). She says she normally prescribes similar regimens for both full diabetics and those on the verge of the disease and makes no allowance for the latter.

Not every doctor will prescribe you the same do’s and don’ts as far as food goes. Dr Mohan, for instance, says that he varies the diet chart depending on which end of the pre-diabetes spectrum the patient is. “I would definitely allow someone with mild glucose intolerance more latitude with food, allowing, say, more fruits which have a low glycemic index,” he says.

Though most diabetologists in India are cautious with advising fruits, Dr Sujeet Jha is convinced that five servings of fruit (a serving is the size of your fist) a day is good for those with impaired glucose tolerance.

The plethora of food advice, a lot of it contradictory, coming at you may be confusing, but a pre-diabetic discipline is mostly a matter of common sense. The idea basically is to keep your weight at ideal levels by eating healthy, keeping the calorie count low, and also exercising to burn it.

As for the large spoon of gajar halwa you sneaked in after months of behaving yourself, instead of wallowing in guilt and misery, why not halve the carbohydrate count from the next meal and double your resolve to stay fit?