Today I want to shed some light upon the status of diabetes in India. Via this blog, I present some numbers and reasons behind those numbers. It is quite painful to write a blog such as this as the current status doesn’t paint a hopeful future to say the least.
India is known as the diabetic capital of the world. In 2017, India had 72 million recorded cases of diabetes which is 49 per cent of the world’s diabetes load (around 143 million diabetics globally). This means around 5 per cent of the country is diabetic. While these numbers seem confusingly high (and worth checking again), what is perplexing is the fact that these are a. only the number of reported cases and b. expected to nearly double (134 million) by the year 2025. This is not factoring in the population that gets affected by the complications arising from diabetes such as heart problems, damage to eye, kidney and other vital organs of the body, hypertension, obesity and metabolic syndrome.
Diabetes can be classified into two types: type I and type II. Type I diabetes is characterised by the inability of the pancreas to make insulin hormone in response to sugar whereas type II diabetes comes from the cell’s inability to take up glucose and generate energy; a situation known as insulin resistance, and the root cause of many diseases including type II diabetes.
Clinically, a HbA1C (average count of glucose attached to haemoglobin) of over 6.5 is diabetic, from 5.7 to 6.4 is pre diabetic and less than 5.6 is normal or healthy. The probability of pre diabetics between an HbA1C of 6.0-6.5 developing diabetes is 20 times more than a person with a HbA1C of 5.0. With this increased risk also comes the increased probability of complications arising from diabetes.
With these ever increasing numbers related to mortality and cost of care (currently INR 27400 per capita; supposed to reach overall 30$ billion by 2025) and reducing quality of life, diabetes is also termed as the plague of the 21st century, it is worth asking the reasons behind these grim looking numbers. The reasons can be classified into two categories: nutritional and lifestyle reasons leading to diabetes and awareness reasons making the prognosis difficult and/or too late. Let’s explore.
Nutritional reasons that contribute to diabetes:
- Anything that’s sweet: Diabetes is a case of high blood sugars. What should be the first food that must be causing high blood sugars? The answer is of course anything that has sugar to offer or is sweet. Be it a type I or a type II patient, consuming sugars will worsen the situation (insulin resistance).
Why do people believe that eating fruits and whole grains which do have considerable amounts of sugar will help? Case in point. The first intake of these foods was probably a reason for diabetes and believing in the same doesn’t allow pre diabetes or diabetes to get better, but does make it worse.
- Grazing: Eating spikes insulin. Too much insulin worsens the insulin resistance, a root cause of diabetes. What is worse than sugar? Spiking too much insulin that comes from multiple meals (5 to 6) or grazing throughout the day.
- Refined grains and msg (mono sodium glutamate): There are two foods which make the body spike more insulin – that’s refined flour (a flour used to make biscuits, pancakes, rotis, waffles, baked goods etc) and ajinomoto or mono sodium glutamate (a flavour enhancer). Both these foods if done in large amounts can make the pancreas secrete insulin hundreds of time more; worsening the insulin resistance and hence diabetes.
- Alcohol: What’s worse than sugars? Liquified sugars. Habitual use of alcohol is enough to make the liver fatty, reducing its capacity to store sugars, increasing hunger and reducing insulin sensitivity.
- Stress: Stress induces a phenomenon called gluconeogenesis where the body breaks its proteins to turn them into glucose to counter the stress. The problem? Modern stress is mainly psychological and not physical and the body can’t use all that glucose, turning the cell insulin resistant and breaking down more muscles.
Let’s now look at the other reasons behind diabetes, the ones which are more psychological than dietary.
- Ignorance: Most diabetics are ignorant of what goes on their plate. Because the world has moved towards carbohydrate and sugar toxicity, it doesn’t take as long for them to develop diabetes.
- Lack of awareness: Lack of knowing what causes diabetes and believing in the wrong information is a large part of why more people develop diabetes.
- Denial and disbelief: Feeling that “this can’t happen to me” or that “I can never have diabetes because insert reason here” are also the leading reasons behind developing diabetes.
Diabetes is a devastatingly damaging condition to the person, their friends and family, society and the burden it creates on the government and healthcare provider. Early diagnosis, stopping sugar, sweet foods, alcohol, grazing and acknowledging how widespread it is remain the leading factors in improving chances to reversing it early. The numbers clearly reflect the wrong eating pattern of the nation and it sadly looks like the future is bleak than the current. While its easy to blame lifestyle for diabetes, the true reasons lie in ignorance and unwillingness to change patterns. The silver lining? Diabetes type II is in almost all the cases, reversible. And people need better quality information, guidance and the correct tools to do so. I will leave that to another massive, extremely detailed blog(s), for another day. For now, let’s acknowledge the existence of the plague diabetes is. And by doing that, we take the first step to reversing it.