As a kid, October was always the best month for sweets. Preceded by Ganesh Chaturthi, the month kicks off with Dusshera, with Eid arriving in short succession, before building up momentum into Diwali at the end of the month.
India’s history with sugar dates back to the ancient times when Indian Physicians were amongst the first to describe Diabetes, classifying it as ‘madhumeha’ or ‘honey urine’, noticing the urine would attract ants.
Three and half thousand years later, Diabetes has become the fastest growing chronic disorder of the Western World. In Australia, it affects 1.1 million people, with over 100,000 people diagnosed last year. Unfortunately, the South Asian community is twice as likely to develop Diabetes compared to the general Australian population.
To find out how much of the wisdom from the Ancient Indian Physicians had been passed down to the Indian society in Australia, I decided to go on an adventure at my most recent Indian Social Gathering.
I start with Uncles at the party, all waiting in line for the food to arrive. Immersed in conversation about the economy, why the Indian Cricket Team is useless, and how everything used to be better in their day, I decide to change the topic by asking what they knew about Diabetes.
‘High’ and ‘Sugar’ were the words that come to mind as we lined up with our plates, waiting for the food lids to open. The uncles whose attention I could distract from the plate of ladoos mentioned something about needing insulin.
Diabetes is indeed a disease where blood sugar is higher than it should be, and occurs when there are defects in insulin (the hormone needed to absorb and store glucose). More specifically there are two types of Diabetes.
Type 1 Diabetes usually affects children or young adults, and constitutes 10-15% of all diabetes. It occurs when the body destroys the cells that produce insulin. Type 2 Diabetes is the more common type of diabetes, constituting 85-90% of diabetes. It is a largely preventable disease, which is strongly associated with a sedentary lifestyle. It starts off by the body growing a resistance to insulin, and eventually results in the body being unable to produce enough insulin to regulate blood glucose levels.
A rarer form is high sugars in pregnancy, known as gestational diabetes.
This affects 9-10% of all pregnancies, but will generally resolve after delivery.
The food lids open, and my spiel is quickly replaced by the crunch of puris and conversation in anticipation of dessert. When I proceed to ask them about the consequences about Diabetes, I’m quickly pointed to the direction of the Aunties, with a food filled mumble of ‘not letting me eat’ and ‘hiding my snacks’.
Taking an opportunity to speak whilst they were busy eating, I start speaking. The features of all types of Diabetes are secondary to having high glucose levels. The most common initial symptoms are being excessively thirsty , passing excessive urine, feeling tired and lethargic, always feeling hungry, having cuts that heal slowly, itching, skin infections, blurred vision, unexplained weight loss, mood swings, headaches, feeling dizzy and leg cramps.
Diabetes and diabetic complications form the leading causes of death, illness and disability in Australia. In particular, people with Diabetes are at high risk of developing strokes, heart attacks, peripheral vascular disease, visual problems, poor sensation in peripheral legs and arms, and kidney dysfunction.
Continuing on with my conversation, I cast an eye on the girths of the uncles around me. I am reminded to highlight that the Indian community is a high risk population, and we should have regular sugar checks after the age of 35 (every 2 years). If you have high blood pressure, high cholesterol, a strong family history, are a smoker (stop!) or had diabetes when pregnant, then you are at an even high risk and should have more regular checks with a doctor.
There are several ways your doctor can assess diabetes, including measuring your fasting glucose, measuring glucose levels after drinking a sweet drink and a blood test called the HbA1c. The treatment for diabetes should be made in consultation with your doctor. Type 2 Diabetes is a lifestyle disease, so all treatment starts with management of lifestyle risk factors. If these fail, then medications can be started.
I had only just started talking about a healthy weight, when I sense the uncle’s squirm and drift off. I decide that I need to venture to an area where my thoughts on food and weight might carry more emphasis. To the Aunties.
Interrupting their conversation on Bollywood’s latest gossip, I start talking about food. Luckily, they are just as excited about food and weight loss as they are about Madhuri Dixit’s comeback, so I continue.
To help prevent or manage diabetes, meals should be regular and spread evenly throughout the day; be low in in fat. The energy from food consumed should not exceed the energy consumed in daily activity.
We should aim for complex carbohydrates which take a long time to break down and provide a slow and sustained source of glucose. This includes avoiding white flour or carbohydrates which are highly processed (e.g. white bread, white rice, boiled potatoes) and replacing them with foods high in complex carbohydrates (brown or basmati rice, wholemeal bread, brown pasta). In particular, foods high in sugar should be avoided, such as fruit juice, sweets, lollies, standard soft drinks.
All fats should be taken in consideration, with some fats being preferential to others. Fats from animal products are generally saturated fats, and should be avoided. This can be done by choosing low-fat or no fat dairy products; using lean meats and trimming off any fat; avoiding use of butter, ghee, coconut milk; and avoiding fried takeaway foods. Instead, try using polyunsaturated and monosaturated fats. They include sunflower, olive, canola, safflower, soybean, corn, cottonseed, grape-seed and sesame oils or the fat found in oily fish such as herring, mackerel, sardine, salmon and tuna.
Normally, the recommended exercise levels are 30 minutes three times a week. Diabetics are encouraged to do 30 mins of moderate physical activity on all days of the week. Good exercises include high intensity interval training (for example alternating 1 minute intervals. And everyone, in particular my uncle, please take note, Baba Ramdev and his colleagues may have great yoga relaxation techniques, but they do not count as exercise!
If Diabetes progresses, and you need medical treatment, it should be made in consultation with your doctor (a GP or a specialist), Diabetes educator, Dietician and Podiatrist and medicines should only be started once lifestyle measures fail.