Diabets Unravelled

This isn't someone else's problem: India has 41 million diabetics. It could rise to 70 million diabetics. It could rise to 70 million by 2025. While doctors search for better treatements, Reader's Digest arms you with the facts

If you have diabetes, the problem is basically this: you have too much glu­cose-in your blood_ Glucose is our main source of energy, derived from eating carbohydrates, and is absorbed intp our cells with the help of the hormone insulin_ If our body has a problem with insulin, the glucose isn't absorbed.

There's a range of reasons for this. In some people, their pancreas fails to produce insulin. That's Type 1. A small number of people become diabetic when their pancreas is destroyed, for example in an accident or during surgery. But for most people with diabetes, the body has problems processing the insulin the pancreas does produce: Type 2

Actually, within the term "diabetes," doctors are discovering dozens and .1:­I dozens of conditions. "The lines are getting fuzzy," says Dr Sreemukesh Dutta of the Hyderabad-based Research Society for the Study of Diabetes in India, "Earlier, only Type 1 diabetes was insulin-dependent but in the past decade Type 2 diabetes has become insulin-dependent too."

Adds Dr Greg Fulcher, an Australian expert, "As we learn more, we can identify the conditions more accu­rately; for example if they're caused by different genetic abnormalities. We even talk about a Type l'e, which has elements ofType 1 and Type 2. One day they may become catego­rized by the underlying abnormalities rather than just being bundled under one issue."

But for now the big headache for health authorities is Type 2. That's where a complicated metabolic process means not enough insulin is produced, or the insulin that is pro­duced doesn't work effectively. Type 2 comprises 70 to 80% of total diabetes cases in India, and its incidence is in­creasing rapidly-so much so that India is often described as the "Dia­betes Capital of the World."

Linked to obesity, the most worrying trend is that it's being diagnosed in younger and younger Indians. Pre­viously, the onset of diabetes was generally among those above 35. Since the past decade, Type 1 is get­ting to be increasingly seen among children, while youngsters even in their 20s are developing Type 2. That's a major problem, since the longer you live with diabetes, the more likely you are to develop complications.

The Epidemic

• It's the fastest-growing disease in the world, with 230 million people already affected.
• Diabetes is the world's leading cause of heart disease, stroke, blindness, kidney disease and lower limb amputation.
• The incidence of diabetes is five times higher among Asians than it is in white populations.
• By 2025, every fifth diabetic in the world would be an Indian.

CAN DIABETES BE CURED?

A CONCERTED EFFORT IS UNDER WAY TO FIND A CURE FOR TYPE 1 DIABETES. "It's looking exceedingly promising," says Australian expert Dr Gary Deed, who predicts it may happen in 10-15 years. Meanwhile the emphasis is on halting the disease in newly diagnosed cases. Doctors are trying to modulate the immune system so it doesn't progress to the ultimate destruction of the pancreas.

The other tack is to try to recreate the body's ability to manufacture insulin, for example by transplanting the pancreas or insulin-producing cells. Stem cell research is also offering hope that these cells may be created in the lab.

As for Type 2, public health messages promoting weight loss and exercise seem to be the best way of stopping the disease in its tracks. International studies have shown that weight loss of just 5-7% and exercising for 30 minutes five times a week lowers the risk of developing diabetes by a massive 60%.