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Wednesday, December 11, 2019

World Health Day: How to beat diabetes

Diabetes affects 387 million people globally and by 2035 the figures are estimated to rise to 592 million. The question here is, can you beat diabetes? We believe you can!

Written by Dr Anil Bhoraskar | Mumbai | Updated: November 14, 2017 10:40:44 am
Even patients who had type 2 diabetes for up to 10 years can reverse their condition. (Photo: Thinkstock) Even patients who had type 2 diabetes for up to 10 years can reverse their condition. (Photo: Thinkstock)

There is no doubt that we Indians are genetically and ethnically susceptible to diabetes and heart disease but just like a tree needs seed, water, fertilizers and sunshine to bloom, for diabetes to manifest into its full blown syndrome, besides genes you need other negative environmental factors like inactivity, lack of physical exercise, faulty nutrition and severe mental and physical stress. Now the question is can you beat these factors?

Genetic factors not really, ethnicity not yet but what you can certainly control are the factors in your own hands like following a healthy and nutritional diet, adequate physical exercise from early childhood to late adulthood and extremely carefully planned lifestyle management and food habits. This needs considerable education, training and counselling not only for pre-diabetics or high risk individuals but the entire community considering that every fifth person in an Indian metro is potentially diabetic or is a diabetic.

But before we explore in details, let’s get our basics right.

Who are pre-diabetics?
These are the people who do not have blood sugar values that fits into the definition of diabetes, i.e. fasting blood glucose >126mg% and post prandial > 200mg%. But there are some people who have fasting blood glucose < 126mg% but post prandial >140mg% and <200mg%. This group is said to have Impaired Glucose Tolerance (IGT) and is thought to be a fore runner of diabetes and needs to be treated as they have the same complications as the diabetics particularly of coronary heart disease.

What is Gestational Diabetes Mellitus (GDM)?
GDM is typically abnormal blood sugar which occurs during pregnancy and it returns to normal after the delivery. However, the criteria to diagnose this condition is more stringent. If these patients do not watch their weight and nutrition after delivery they run the risk of developing diabetes later in life.

Other risk factors which need to be watched as a fore runner of diabetes are young people with hypertension, abnormal lipids, heart disease and young girls who have polycystic ovarian disease (PCOD).

How can you beat diabetes?
We have an approach which is based on the slogan of Diabetes Association of India- “Treatment of diabetes is in your own kitchen”. Broadly it can be classified as Aahar (diet and nutrition), Vihaar (exercise and lifestyle changes), Vichaar (education, correct information and counselling) and Upachaar (treatment with pharmacotherapeutic agents).

You cannot separate culture from eating habits but it’s really important to get a grip on what’s going inside your mouth. Today’s junk culture is a dominant force and it has given rise to type 2 diabetes in children as young as 12. It’s advisable to stay away from dense drinks, shakes, colas, chips and burgers. A high fibre lacto vegetarian diet is the best bet with 50% carbohydrates, 30% proteins and 20% fats intake. Most of the carbohydrates should be complex and can be found in cereals, multiple grains and legumes, and fruits and milk. Simple carbohydrates like sugars and fine flours should be avoided. Proteins from milk, yoghurt, sprouts, eggs, fish and chicken are a safe bet. Red meat should be avoided at all costs.

Total calorie requirement and distribution should be individualised based on age, physical activity and physical status. The ideal marker for the right nutrition is the waist circumference which should not exceed 90 cm for males and 85cm in females.

The importance of exercise
Children should be encouraged to participate in outdoor sports at least for 1 hour every day, and screen time should be confined to maximum 2 hours a day. Adults should exercise atleast 40 mins every day or 5 times a week. You don’t need to join a fancy gym to do that. All this can be done while diung regular chores like cleaning walls and windows, sweeping the floor, ironing and making rotis.

Brisk walking for 45 mins at the pace of 4km/hr is recommended too. If you can’t find the time for that then make small changes in your lifestyle like using the staircase instead of an elevator.

Note: Diabetes leads to vascular complications affecting heart, limbs, eyes, nerves and kidneys. Early diagnosis is the key to successfully combat these diseases. A periodic check of urine for micro -proteinuria, heart check up and eye examination are mandatory even if you have no symptoms.

Dr Anil Bhoraskar is an Honorary Diabetologist at S L Raheja Fortis Hospital, Mahim, Mumbai.

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