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Riding the Sugar Roller Coaster

Prof Adrian Kennedy and Dr E Suneetha

 
Diabetes is fast becoming one among the four leading causes of death in the world; cardiac, stroke and cancer occupy the top three positions. Over the next decade, the prevalence of diabetes is expected to grow by 25 per cent, largely driven by obesity and inactivity.

The World Health Organization estimates that 200 million people worldwide will have diabetes by 2010, and that the number will reach 330 million by 2025.

Diabetes mellitus (DM) is a disease marked by high levels of blood glucose (sugar), resulting from defects in insulin production, insulin action, or both. Insulin is a hormone which is essential for proper utilization of glucose. Glucose is a ‘fuel’, which is metabolized in the body to provide energy for our daily activities. When the level of this ‘fuel’ exceeds the normal levels, it harms almost all cells of the body. The major effect is on the fine blood vessels. Diabetes, if not controlled, can give rise to heart disease, eye disease, kidney disease, and degeneration of nerve fibres over a period of time.

When it comes to diabetes management, blood sugar control is often the central theme. Keeping your blood sugar level within the target range of below 100 fasting, can help us live a long and healthy life, with diabetes. Obesity, inappropriate diet, a sedentary life, high levels of stress and dependencies like smoking, alcohol etc. - all influence blood sugar levels. This list is sometimes surprising, but it helps us understand the link between lifestyle and diabetes.

A growing body of epidemiologic, clinical, and laboratory evidence shows that lifestyle interventions are critical components of comprehensive treatment and management of diabetes, helping in glycemic control, minimizing complications, and slowing the progression of the disease.

Progression to diabetes among those with pre-diabetes is not inevitable. Studies have shown that people with pre-diabetes who lose weight and increase their physical activity can prevent or delay diabetes and even return their blood glucose levels to normal.
The major lifestyle areas to be managed by persons with diabetes and pre-diabetes with strong family history of diabetes include
:

Maintain ideal weight
If you are overweight or obese, or have an ‘apple’ shaped abdomen with a waist measurement of 40” or more for men and 35” or more for women, your chances for diabetes increase. The most popular method to know you have ideal weight for your height is to calculate your Body Mass Index (BMI). To calculate that, divide your weight in kilos by height in meters times two. Suppose, your weight is 70 kilos and your height is 1.64 meters, then your BMI is 26.5 (70/1.64x1.64). The Steering Committee- Asia-Pacific Perspective 2000 has suggested that Asians with BMI above 23 as having increasing risk for diabetes.

Stress management
Your stress may be the result of injury, illness or problems in your marriage, job, health, or finances. During stress, levels of many hormones shoot up. The net effect of these hormones is to make increased glucose available to cells. In people who have diabetes, Insulin is not always able to utilize the extra energy in the cells, so glucose piles up in the body. Continued stress may be one of the key factors for uncontrolled diabetes. Relief of stress by relaxation, exercises or yoga or meditation is an important aid in the management of diabetes.
 
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