Diabetes The silent killer

Simple steps to prevent diabetes

• If you’re a South Asian over 30, see your GP, have a fasting glucose check. Measure your waist line around the navel and if it’s more than 85 cm, start a daily 1/2 hour walk or gym. Set a target waist reduction of 10cm over 10 weeks.

• Cut down by half the rice, roti, pasta and bread while increasing the vegetable, lentils, fruit and protein intake, as this alone will decrease the waist line and blood sugar significantly.

• Drinking a glass of water before meals reduces your food intake. Use skimmed milk and reduced fat dairy products and grill or bake your food instead of frying.

• Drink plenty of water. Snack on healthy alternatives like nuts and wholegrain bars.

Thirty eight-year-old Pendle Hill mum Brindha Ponniah had a reality check when she was diagnosed with gestational diabetes during her second pregnancy. She was cautioned by her doctor that unless she took immediate and radical action, she had a high risk of developing Type 2 diabetes. Owing to the fact that she was overweight and both her parents were diabetic, the news sent alarm bells ringing.

Brindha is just one of 171 million people worldwide suffering diabetes, a vast majority of who are not even aware of it.

Diabetes is a disease caused by elevated glucose levels in the blood. A normal blood sugar level is between 80-120. A fasting blood sugar over 125 is considered diabetic.

Diabetes can go undetected for years and, if untreated, can lead to serious complications like heart disease, stroke, gangrene of the extremities, nerve disease that can lead to amputation of lower limbs, blindness, hypertension, skin infections and kidney failure.

Being referred to as “Asia’s new epidemic”, diabetes claims 3.2 million lives every year with six deaths every minute, and is fast becoming the number one killer in the world. Indians have been identified as particularly prone to the disease, leading the world with 50.8 million sufferers. (China follows at 43.2 million). In Australia alone it is estimated that over 900,000 people are diabetic.

“People from the Indian subcontinent and its diaspora may be the fulcrum of the diabetes tsunami,” warns Dr Soji Swaraj, consultant physician and specialist endocrinologist (diabetes and hormone specialist) at Concord Hospital and the University of Sydney. Of the projected 333 million people with diabetes in 2025, he stresses, a large proportion will be of Indian subcontinent ancestry.

Both heredity and environment have been listed as contributory factors in Indian-origin sufferers of the disease, and many education programs have been put in place to allow members of the community to assess if they are at risk.

Describing the graveness of the situation, Dr Swaraj says, “I give my patients the analogy of a deaf and blind person walking inadvertently along a train track, blissfully unaware that they are at high risk of being struck by an oncoming train. And yet, simple measures can take them off the track to disaster and towards seeing their children grow up, get married and have their own children.”

Diabetes kills people early (40s to 60s)

Types of Diabetes

Type 1: This was formerly known as the juvenile-onset diabetes as it strikes in childhood or early teens. This is an autoimmune disease in which the body destroys its own beta or insulin producing cells. The patients are insulin dependent and as they progress in age the symptomatic lines begin to blur into Type 2. Type 1 accounts for 10% of all diagnosed cases of diabetes. The main difference between the two types is that in Type 1 the pancreas makes little or no insulin and in Type 2 though insulin is being produced it is not in high enough quantity.

Type 2: This disease was previously referred to as adultonset diabetes. It usually affects people over 40 and is caused by poor diet and a sedentary lifestyle. However, availability of unhealthy fast food and lack of exercise is making the teenagers of today the new victims of Type 2. Type 2 accounts for 90% of all cases. Obesity, family history, ethnicity and glucose intolerance are all risk factors for Type 2 diabetes.

Gestational: This type of diabetes occurs in 2-5% of all pregnancies and disappears when the pregnancy is over. It affects women who have difficulty in digesting carbohydrates. All women are tested for it in the first trimester. Nearly 40% of women who suffer from gestational diabetes later develop Type 2. There is also a condition known as Pre-Diabetes. This is used to define patients who have elevated blood sugar but are not diabetic yet. Additionally, Hemocromatosis, Syndrome X, Cystic Fibrosis and Polycystic Ovary Disease are also types of insulin resistant diabetes.

from heart attack and stroke, which means children are tragically losing parents before they need to, says Dr Swaraj.

The diabetes specialist notes that people of South Asian origin are 4 times more likely to develop Type-2 diabetes than Caucasians. They also develop diabetes at a younger age, and at lower adiposity (obesity) levels.

“All subcontinental people are at much higher risk than the general Australian population (as high as 30% compared with 7%). The vascular damage starts even before diabetes starts, as our waist lines increase and we become too busy with our mortgages and school drop-offs.”

Why are South Asians more at risk?

There’s no doubt about it, South Asians are facing “a cardiaovascular time bomb”, Dr Swaraj says.

Explaining the role of genetics in diabetes, Dr Swaraj notes, “Like many indigenous populations, Asian Indians may have genetic preselection for an insulin resistant state wherein energy storage in the form of adipose tissue is favoured. This would have made sense in the hunter-gatherer times, though not in today’s obesogenic environments and with sedentary lifestyles. Poor maternal nutrition and low birth weight in Indian babies may also predispose them to an insulin-resistant state and diabetes in adult life.”

Compared to their Caucasian counterparts, South Asian children demonstrate a higher level of insulin intolerance and insulin resistance (which in many cases is genetic) thus requiring preventative measure to be put in place at an earlier age. Some studies have linked the lower threshold of waist circumference (central obesity) with an increased risk of glucose intolerance amongst South Asians.

But it’s not just genes. The unprecedented economic growth in India has underpinned a change towards more adipogenic (fatproducing) and sedentary lifestyles. Other factors such as a lack of physical activity due to cultural norms and the typical Indian highstarch diet, may play a role as well.

“Our Indian mothers are to blame too,” notes Dr Swaraj. “They want us all to study, get a professional job at a desk (not out in the great outdoors where we can get enough Vitamin D from the sun). They also want us to eat ‘just one more serve’ of roti or rice to make them happy”.

Dr Swaraj notes that while much of the fibre and pulses in vegetarian Indian diets are beneficial in a diabetic diet, the starch rich content like rice, chapati and paratha is not. He also blames the culture of eating in Indian society (our norms of hospitality), and the high palatability of spicy food leading to consumption beyond nutritional needs, as equally responsible for increasing cases of diabetes.

• Indian women should also have their Vitamin D levels checked and replaced if low.

• If you are on the threshold of diabetes it is imperative that you check the Glycemic Index (GI) of foods you eat. This helps maintain blood sugar.

• Smoking increases the risk of diabetes significantly so if you can’t go cold turkey than start by reducing and finally quitting.

• If you’re a diabetic, aim to get your Hb A1c below 7% as this will cut your risk of heart attack and stroke and if difficult, get a referral to an endocrinologist from your GP.

• There are several newer medicines available now for the overweight diabetic patient that help lose weight, drop the appetite and lower the glucose as opposed to traditional drugs that cause hypos and weight gain. Talk to your GP about these.

“Indians, whether in India or outside of it, are several times less likely to engage in physical exercise than in western counterparts,” he adds.

Indian, Pakistanis and Bangladeshis are 14%, 30% and 45% less likely, respectively, to follow the guidelines for recommended physical activity than the rest of the world population. Women in these countries face many hurdles including cultural norms, illnesses and social expectations which prevent them from aspiring to maintain physical fitness.

Some social habits like chewing on betel nut and smoking are also attributed to increased cases of diabetes in south Asians along with a deficiency of Vitamin D.

Preventive steps

Toongabbie GP Dr Shanthini Seelan says that one misunderstood fact about the disease is the permanency of the condition. “Many people are not aware that once diagnosed with diabetes, they have the condition for life. While dietary changes and regular exercise will significantly slow the progression of the disease, it will unfortunately be a lifelong condition to manage”.

But rather than undergoing treatment, the best way is to take the necessary measures to prevent one from becoming a diabetic. Primary prevention measures include a healthy diet, regular physical activity, maintaining a normal body weight

Diabetes Australia helplines

Diabetes Australia is a national federated body made up of state and territory organisations which helps all people affected by diabetes and those at risk. It also fundraises to help find a cure.

Diabetes Australia (Sydney) 26 Arundel Street

Glebe NSW 2037

If calling within NSW call the Infoline: 1300 136 588 (local call cost)

Phone: (02) 9552 9900

Fax: (02) 9660 3633

Email: info@diabetesnsw.com.au

Website: www.diabetesnsw.com.au

Diabetes Australia (Melbourne) 570 Elizabeth Street

Melbourne VIC 3000

If calling within Victoria call the Infoline: 1300 136 588 (local call cost)

Phone: (03) 9667 1777

Fax: (03) 9667 1778

Email: mail@diabetesvic.org.au

Website: www.diabetesvic.org.au

Diabetes Australia (Brisbane) 29 Finchley Street

MILTON QLD 4064

If calling within Queensland call the Infoline: 1300 136 588 (local call cost)

Phone: (07) 3506 0999

Fax: (07) 3506 0909

Email: info@diabetesqld.org.au

Website: www.diabetesqld.org.au

Diabetes Australia (Adelaide) 159 Sir Donald Bradman Drive HILTON SA 5033

If calling within SA call the Infoline: 1300 136 588 (local call cost)

Phone: (08) 8234 1977 and avoiding tobacco use. These can prevent or delay the onset of diabetes. (Secondary prevention would include early detection and good treatment). By making these simple changes today you may be able to give a disease like diabetes a slip.

And that is just what Brindha did. She was advised to lose weight and embark on a healthy lifestyle in order to be able to enjoy

Signs and Symptoms

Type 1 and Type 2 diabetes have mostly similar symptoms. In both there is too much glucose in the blood and not enough in the cells. In Type 1 it is due to the lack of insulin and in Type 2 due to the cells becoming resistant to the insulin being produced. Since the cells aren’t getting the needed glucose, the body lets us know by giving signs like frequent trips to the bathroom, weight loss, feeling thirsty all the time, fatigue and weakness, a tingling sensation in the hands, legs or feet. Apart from these there could be other signs like dry, itchy skin, blurred vision, frequent cuts and bruises that get infected and take longer to heal.

What are the risk factors?

Weight: The most important risk factor for diabetes is obesity. The increase in your weight is directly proportional to the resistance of your body to insulin.

Age: The risk of Type 2 diabetes increases with age, more so after 45. Family History: Your risk of developing diabetes is higher if it runs in the family, especially if your mother, father or sibling has it.

a disease free life with her young family. She was also made aware of the SHAPE program which is currently being run by medico group WentWest for people residing in western Sydney.

Sessions for Health and Physical Exercise (SHAPE) is an 8-session program aimed at increasing health and fitness awareness for people at risk of developing chronic diseases like Type 2 diabetes or heart problems. Brindha asserts that joining the program was a life saver. “They advised me on how to eat sensibly, how to maintain an active lifestyle, how to create a balance, and best of all, they taught me how to read labels on supermarket products to determine what I should eat and how I should be cooking to retain their benefits,” she says.

By following the exercise regime and availing the 3 months free gym membership offered by SHAPE, Brindha is very close to achieving her ideal weight and keeping diabetes at bay.

Since its launch a year ago, SHAPE has seen more than 300 western Sydney residents improve their diet and exercise habits, and changeds the lives of many who were heading towards Type 2 diabetes.

The need for a diabetes-education campaign Dr Swaraj feels that we need increased awareness among Indian diaspora about the disease. “Cultural associations, ethnic press, radio, TV and websites should all be approached to do their bit. All Indian patients should be screened for waist circumference, and they should undergo fasting Blood Sugar Level tests annually. Risk factor education at time of immigration could also help. These are but a few standard and culture-specific measures that could be put in place to prevent the disease”.

And what can we do with our kids today to prevent them from getting diabetes? Dr Swaraj, a father of two young kids himself, is quick to reply:

* Keep the kids active daily.

* Stop force feeding them - don’t force them to finish their meals.

* Give them less and less carbohydrate (such as rice and roti).

* Talk to your GP if you see their waist line increasing.

Research shows that most people do not think diabetes is a serious condition and underestimate their risk. Don’t be the type to leave it too late. Could you or one of your family members or friends be at risk of developing Type 2 diabetes? If you are over 40, are overweight and have a family history of Type 2 diabetes, get yourself checked today and get on top of the game.