Dying of diabetes and not knowing it

Sharad Tripathi of Meerut developed diabetes five years ago, at 33, “no thanks to the stressful life of a sales person that involves a lot of travel, eating out and irregular meal times, and no time for exercise”. Just when Tripathi learnt to manage his condition — with medication and lifestyle changes — his mother, in her mid-60s, developed diabetes. Tripathi senior joined the club a year later, at age 70.

Tripathi found himself sharing the dos and <g data-gr-id="105">don’ts</g> of living with diabetes with his parents. The family’s predicament indicates how fast the disease is sweeping India, swamping entire generations, ignoring age and setting new global records, as it trebled over the past two decades.

In 1995, India had 19.4 million diabetics. Within 19 years, that number had more than tripled to 66.8 million in 2014, according to the International Diabetes Federation (IDF). That makes India, home to 17 percent of the world’s population, also home to 17 percent of the world’s diabetics.  Another 77 million Indians are currently believed to be pre-diabetic, according to the Indian Council of Medical Research.

In 2010, diabetes stood 18th in the list of diseases by years of life lost, up from 31st position in 1990, as per the Global Burden of Disease Study 2010. Deaths attributable to diabetes grew 41 percent from 161,000 to 227,300 between 2000 and 2012, according to the World Health Organisation.

That increase was enough to catapult diabetes into the top 10 of killer diseases in India. The IDF pegs annual deaths due to diabetes in India at more than one million, possibly because poorly controlled diabetes brings on other killer diseases. Diabetes in India now cuts across all age groups and geographies. Although it is more prevalent in urban areas, rural India will catch up as lifestyles change. In cities like Chennai, Delhi and Kochi, one in five adults is diabetic.

There is little doubt that India is witnessing a diabetes epidemic — brought on by Indians.

Diabetes mellitus, to use its scientific name, is associated with elevated blood glucose (sugar) levels because the body produces insufficient insulin or because the body’s cells do not respond properly to insulin or both. It is mainly of two kinds—type 1 and type 2. Type 1 diabetes is insulin-dependent. In this, the body produces no insulin at all so diabetics need insulin shots to survive, let alone manage their disease. 

Type 2 diabetes is more common, accounting for 85 to 95% of all cases in developed countries (higher in developing countries). It can be managed with oral medication, especially in the early stages. 

“Our professors in medical school taught us that type 2 diabetes happens at an advanced age,” said Mumbai diabetologist Pradeep <g data-gr-id="99">Gadge</g>. “Whereas, type 1 diabetes mostly afflicted the young, so it used to be called juvenile diabetes. Not any longer.” 

About 2% of <g data-gr-id="110">Gadge’s</g> child patients have type 2 diabetes. Childhood type 2 diabetes is also a growing phenomenon across India. So, doctors have stopped referring to type 1 as juvenile diabetes. Some offer the old nature excuse for India’s diabetes explosion—that a predisposition to diabetes is written in our genes.  Those of Indian ethnicity have a genetic propensity to acquire metabolic syndrome, a set of five conditions of which you need only three to enter the class. One condition is both visual and measurable: the apple-shaped body. The others are measurable: high blood pressure, low high-density lipoprotein (HDL), high triglycerides and high fasting blood glucose. 

Metabolic syndrome increases the risk for developing diabetes over the next five years five-fold, 

according to <g data-gr-id="114">Enas</g> A <g data-gr-id="115">Enas</g>, <g data-gr-id="134">American-Indian</g> cardiologist and head of the CADI (Coronary Artery Disease among Asian Indians) Research Foundation in the USA.  “If you have metabolic syndrome, consider yourself in line for diabetes,” said Seema Gulati, head of the Nutrition Research Group, Center of Nutrition & Metabolic Research (C-NET), National Diabetes, Obesity and Cholesterol Foundation.  Indians tend to have more fat than muscle at a given body mass index, vis-à-vis Caucasians. “This means even normal weight Indians would metabolically be considered obese individuals,” explained Gulati. Obesity is a known risk factor for diabetes.

Children of people with diabetes tend to develop the disease. A study in Chennai found 55 percent of the offspring of two diabetic patients had either diabetes or impaired glucose tolerance, a pre-diabetic condition, compared to 15.6 percent of those with no family history of diabetes.

The upward trend of diabetes explains why current generations cannot blame their genetic heritage 

for the ongoing diabetes explosion. “The influence of globalisation and urbanisation are the single biggest factors for India’s diabetes epidemic,” said V. Mohan of Dr Mohan’s Diabetes Specialities Centre, Chennai, and founder of Madras Diabetes Research Foundation. “Our eating habits now resemble the west and we’ve adopted sedentary lifestyles.”

Indians have traded dal-sabzi-roti for pizzas, burgers and other calorie-dense goodies. Researchers Nikhil Tandon and Nishant Raizada estimate that city-dwellers consume up to 32 percent of their daily energy requirement as fat.

We rely on cars to get around. We’ve hired help and bought machines to perform household calorie-burning chores, and, for the most part, are not bothered to replace those activities with exercise. At work too, more Indians than ever before are employed in sedentary white-collar jobs. In other words, Indians are bringing diabetes on themselves.

If faulty lifestyle is the cause; lifestyle modification is the cornerstone of diabetes management. Overall, the chances of diabetes depend 80 percent on the environment, 20 percent on genes, said Anoop Misra, chairman, Fortis Centre of Excellence for Diabetes, Metabolic Diseases and Endocrinology, and chairman, National Diabetes, Obesity and Cholesterol Foundation.

By aggressively pursuing changes, diabetics can be managed without medication or with lower doses of drugs. Ask Subramanian Sharma. A 55-year-old management consultant living in Pune, he developed diabetes at the age of 32. “I was obese, a foodie and suffered from stress—not that I recognised it. I was living the aspirational life of an IITian and IIMian who made it good, at a time when middle-class India was just starting to indulge itself,” he said. “And no, my parents didn’t have diabetes.”

Over the next two decades, Sharma’s diabetes grew steadily worse—from managing with oral medication; he progressed to four daily shots of insulin, 52 units in all.

In 2013, he heard about Freedom from Diabetes, a programme to reverse diabetes, from Pune-based diabetes reversal specialist Pramod Tripathi. Sharma signed up.

By prescribing a balanced vegetarian milk-free diet; a combination of anti-gravity exercises, high-

intensity exercises, lymphatic and energy-based practices; neuro-linguistic programming to learn positive thinking and group therapy, Tripathi said he has helped 1,300 diabetics reverse their disease. “64% of those who’ve done our intensive 12-week course have come off insulin and/or medication,” said Tripathi. Awareness about diabetes is abysmally low in India, both among diabetics and non-diabetics.  Only 43.2% of the population knew about diabetes, according to a recent Indian Council of Medical Research study conducted in Chandigarh, Jharkhand, Maharashtra and Tamil Nadu. Just over half of those surveyed knew that diabetes could be prevented and that it can cause future complications. Tamil Nadu displayed the most awareness in this regard. 

Diabetes is a progressive disease, which means the symptoms tend to worsen with time. A sure way to avoid extra expenditure and suffering is to take responsibility for your own wellbeing. Stop thinking: once a diabetic, always a diabetic. As much as you may want to live life on your own terms, some transformation is worth it. IANS/IndiaSpend