The young & the diabetic

We oft en associate diabetes with the elderly and those in their middle age and especially if they are obese. However, this association is soon going to change. Type 2 diabetes is affecting many young individuals in their 20s and 30s, even if they aren’t necessarily obese, say experts. November 14 was World Diabetes Day, we asked experts how and why this disease is emerging like a ticking bomb among the young population.

Case in point
Anurag Choudhary (name changed), a 29-year-old young urban professional working in a bank got diagnosed with Type 2 diabetes accidentally. This was during his mid-20s when he sought help as he was feeling run down through out the day with a constant increase in weight along with headache and dizziness. His random blood sugar was 320 mg/ dl. He was asked to improve on his lifestyle by regularising his eating and sleeping pattern on time, daily take a 45-minute brisk walk, refrain from fast foods and sweet beverages along with cessation of smoking. At the same time, he was put on oral anti-diabetic agent, metformin, recounts Dr Deepak Patil, consultant diabetologist, Diabetes Relief.

Need not necessarily be obese
“My youngest Type 2 diabetic patient is a 10-year-old boy from a lower middle class family from Malad. Daily, I see at least one new Type 2 diabetic patient below the age of 30 years and it is not always that these young patients are obese or overweight. At least one in fi ve of such patients is lean and yet develops Type 2 diabetes,” informs Dr Pradeep Gadge, consultant diabetologist at Seven Hills and Breach Candy Hospitals. 

“The biggest health issue in India today is the managing of Type 2 diabetes because managing it, is a task. These people usually begin with childhood obesity. In fact, some of them don’t have obesity in the real sense. They have excessive abdominal fat and their general body structure is not of an obese person. They are what we call as thinfat Indians. This is more of an ethnicity problem. Earlier, Type 2 diabetes was diagnosed in individuals above the age of 45 but unfortunately, today we see individuals in the age group of 18 to 38 with this problem,” says Dr Anil Bhoraskar, Honorary Diabetologist at Raheja Fortis Hospital, Honorary Secretary of Scientifi c Section of Diabetic Association of India and Chair Elect of South East Asia - Indian Diabetic Federation.

Causes
This is simply because of leading an unhealthy lifestyle wherein since early childhood they eat junk and fast food, sitting all day in front of the TV and/or computer, no physical activity or exercise. It’s the burger-cola culture to blame where there’s sheer peer pressure that draws the kids to eat unhealthy, explains Dr Bhoraskar. Dr Patil says that being overweight and obesity are driving force behind the global diabetes epidemic. Indians develop diabetes at a younger age and at lower degrees of obesity due to high genetic predisposition, rapid economic development, urbanisation and transitions in nutritional status.

“Genes also play a signifi cant role. Some of my patients are not obese and still become diabetic. If one parent has Type 2 diabetes, the chances are 40 per cent that their child develops diabetes in his/her life time. If both the parents are, then the chances are almost 90 per cent,” says Dr Gadge.

Symptoms
Dr Gadge says that the most common symptom of diabetes is ‘no symptoms’. So you can’t just rely on symptoms. However, if you have the following signs, then you should investigate and visit a diabetologist, if necessary.
- Sudden weight loss
- Increased appetite
- Increased thirst
- Infections in genital area

Diagnosis happens by accident
Most of the young diabetic patients get diagnosed with Type 2 diabetes accidentally. Most of the time they turn up with complaints like constantly increase or decrease in weight, lowered effi ciency, high blood pressure, erectile dysfunction, blurring of vision and irregular menstrual cycle and/or inability to conceive in females. They may also get diagnosed during routine check-up, says Dr Patil. Dr Gadge says that some of these patients are detected during their pre-employment check-ups or routine health check-ups.

Few others are accidentally detected to have urine sugar during some other illnesses like fever. But a vast majority comes with some or other symptoms like sudden weight loss, genital infections, increased thirst, increased appetite, visual problems. Dr Bhoraskar cites other instances like skin infections, numbness and tingling in the muscles, cardiac symptoms like when the ECG is abnormal, high cholesterol, etc. Also, when individuals undergo medical tests while taking life insurance policies.

Patients’ reaction
“The diagnosis of diabetes in these patients comes as a shocker. In fact many of them are in a state of denial. They just don’t accept the fact till they get it rechecked from three to four different laboratories, and then are fi nally forced to accept the bitter truth. Some even become depressed (this is the time when a doctor who can instill optimism in this patient, is needed). Initially, these patients are highly motivated for lifestyle changes. They start well. In many cases, over-enthusiastically. However, all this over-enthusiasm doesn’t last long. I always tell my patients to be appropriately enthusiastic from day one and not to keep an unrealistic approach,” says Dr Gadge.

Managing Type 2 diabetes
Type 2 diabetes is a metabolic disorder. It’s a progressive disease and its pathogenesis is complex involving genetic predisposition, obesity, insulin resistance, and insulin deficiency. Young adults can lead diabetes and its complications-free life by adopting a healthy lifestyle, exercising regularly, practising healthy dietary habits and periodic screenings by a diabetologist.