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INDIA has the dubious distinction of having the largest number of cases of diabetes. This dramatic rise is largely explained by the change in lifestyle, the ever-increasing problem of weight and obesity and, to some extent, by genetic predisposition. According to the World Health Organisation (WHO), India will have over 50 million people with diabetes by 2025.

A change in dietary habits and a sedentary lifestyle causes obesity and it has been established that the risk for diabetes increases when the body mass index (BMI) for Asians crosses 23, though by WHO standards, a BMI of 25-29 is overweight and above 30 is obesity. Excess weight makes the body less sensitive to insulin and, over a period of time, the insulin producing cell of the pancreas start feeling tired and the blood sugars begin to rise. Obesity overwhelms the pancreas! 

The problem of diabetes is large. All that has been said so far is why and how it happens. But there is good news. We know a lot more about diabetes, how to diagnose, treat, cope and even try to prevent it! A recent diabetes prevention programme (from the United States) and other similar studies have clearly demonstrated that the magic pill is within us.

Lifestyle changes beat medical intervention hands down. The message is clear. Eat healthy, exercise regularly (probably the most important factor), learn to cope with stress better (with our traditional systems like yoga and meditation) and think positive.

Diabetes should not define or limit the person. The formula for success is simple but implementation requires effort. Seeking the advice of medical specialists trained in the management of diabetes, accepting the diagnosis, following nutrition and exercise prescription with proper medication and surveillance for complications is a simple formula. Also there's blood pressure control, weight reduction where necessary and cholesterol lowering, which are just as vital. But all this should not overwh

elm one.

Living with diabetes: The first step is to accept the diagnosis. There are no such things as a touch of diabetes, slight, borderline or mild diabetes ... . These are all forms of denial. Learning to live with diabetes means looking at diagnosis squarely in the face, starting the fight and throwing in one or two punches.

Planning is the key to success: Diabetes management is all about planning. Planning the diet, exercise, day's activities, vacations, and pregnancy — in short, one's life. It doesn't take much, just empowering oneself through knowledge and having the strength of conviction. Ask your physician about reading material and clear your doubts. Your physician is the best resource person and not your walking partner or hairdresser. Diabetes comes in all colours, shapes, sizes and combinations and one size doesn't fit all. So beware of comparing notes. For the computer literate, there are websites (The American Diabetes Association is an excellent site — www.diabetes.org). Before you visit the doctor, make a note of the questions that you want to ask. It helps to remember and limit your time at the doctor's office.

The path to better nutrition: The cornerstone of diabetes management is proper nutrition. There are 10 simple guidelines.

1. Eat a balanced meal on time and don't skip meals or fast.

2. Eat a variety of foods every day, be creative and avoid fad and mono diets.

3. Eat small frequent meals and avoid binging and "square meals".

4. Eat complex carbohydrates (about 50-55 per cent of your diet) and avoid or limit table sugars and simple sugars.

5. Eat 30-40 per cent fibre in your diet and avoid processed foods like conjee, juices and sweetened drinks.

6. Eat proteins in moderation (about 15-20 per cent of your diet) and avoid protein supplements.

7. Eat a mixture of fats (less than 10 per cent of saturated, less than 10 per cent of poly unsaturated and 10-15 per cent of monosaturated) totalling less than 30 per cent of the daily calories. Avoid exclusive use of one kind of fat or oil.

8. Eat foods that are low in cholesterol (less than 300 mg/day) and avoid red meats, organ meats, and limit the use of egg yolk, coconut, whole milk and whole milk products.

9. Eat every kind of vegetable everyday.

10. Eat fruit daily and enjoy life. Avoid mango, jackfruit, sitaphal and sapota or eat them in very small quantities.

Keep your motor running: The single most important aspect of healthy living is an active lifestyle. The benefits of exercise for persons with diabetes do not stop with weight control. It improves muscle strength, bone strength, insulin sensitivity, lowers LDL or bad cholesterol and raises HDL or good cholesterol, improves a sense of well-being, and in those prone to diabetes may actually prevent it. Those with an active lifestyle can continue their current level of exercise with their physician's permission. However, those who wish to start a new programme, those who plan to start for the first time (especially the elderly or pregnant women) or those with known complications of diabetes should consult their doctor who may ask them to undergo some preliminary tests before beginning.

Banish the idiot box: The television has probably done more harm to the well-being of people than fast food restaurants collectively. Watching TV has made the young children sedentary and encouraged them to eat unhealthy snacks by providing plenty of snack related ads. The older generations spends hours with no time for exercise. Scientific studies have shown that one hour of watching TV translates into a two pound weight gain per year!

For once, lower is better: Coping with diabetes and living with it involves a multi-pronged approach. It's not just about blood sugar control. There is blood pressure, blood cholesterol, body weight control and surveillance for complications.

Daunting as it sounds, it's a simple matter of planning. Eye tests and cholesterol levels are checked yearly. HbA1C is checked once in three to four months and kidney function tests are performed every six months. Blood sugars are monitored on a daily/weekly/monthly/bi-monthly basis depending on existing level of control and the brittleness of diabetes.

There is now a new urinary parameter called microalbuminuria and treating this has slowed down or prevented the development of kidney failure. Ask your doctor about these tests. The yardsticks for tight control have been lowered yet again in the past couple of years.

Diabetes research is at its best right now. We understand the dynamics of glucose production and control at a molecular level. There are new medications, newer insulin, newer delivery systems and islet cell and pancreas transplantation. The discovery and development of cholesterol lowering agents called Statins have revolutionised the management of cholesterol problems in diabetics. There are medications like sulphonylureas and meglitinides that work on the pancreas and release insulin, agents like Metformin and Glitazones that work on making the body more sensitive to insulin and agents that block carbohydrate absorption like Acarbose. "Diabetes Overwhelmus" was a term originally used by Prof. Rubin of Johns Hopkins in relation to the emotional overload a person with diabetes may face, having to deal with the strain of day-to-day living and the added stress of coping with diabetes. The recipe for treating diabetes overwhelmus is fairly straightforward. Accept the diagnosis, gain an insight into the problem, seek professional help, if necessary. For counselling and medications, join support groups and, more importantly, do your part in what it takes to stay healthy and fit and chase the blues away. The balm is within us and within our reach.

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