The scientific community is still searching for a lot of answers to supplement our knowledge of Diabetes and help in our treatment of it. Dr Rita Basu, MD from Mayo Clinic USA has made some valuable contributions in this field. In a chat with Deepti Chaudhari-Sharma, Dr Basu emphasises the need to eat healthy, exercise, de-stress and visit your doctor for regular health check-ups for prevention of pre-Diabetes and progression to Type 2 Diabetes.
For an Indian researcher holding a prestigious position of Professor of Medicine, Division of Endocrinology at Mayo Clinic, Rochester, Minnesota – Dr Rita Basu is surprisingly down to earth. Dr Basu has access to some of the best research facilities in the world, and federal grants from the National Institute of Health (NIH), USA. Armed with these, she has been studying for over 15 years the complex mechanisms and pathways of Diabetes developing in the human body. Much of her published research over the years has led to the development of new drug targets by pharmaceutical companies.
When talking about Type 2 Diabetes, however, Dr Basu is clear on one point: that Type 2 Diabetes can be prevented, and a healthy lifestyle is the key to a healthy future. Her views, in her own words….
Understanding glucose metabolism
I have been doing research in the pathophysiology of Type 2 Diabetes since 1996. Understanding this is important, especially in India since it may be different for people here than people in America. People of Asian origin may have different responses as compared to Caucasians. Diabetes is caused by different things, including:
There are different mechanisms that are responsible for causing Diabetes. There is a hormone in the body called insulin that helps the liver and muscle take in sugar for energy. People with Type 2 Diabetes usually have enough insulin, but the liver and muscle cannot respond properly to it and thus not take in sugar for energy. The liver may also be making more sugar to counteract this problem. Understanding where the defect is helps in treating, because some drugs will target the muscle, while some drugs could target the liver, for example.
When we eat a meal, part of the meal is converted to stored sugar in the liver, called glycogen. The rest of it is used up by the body for energy to do all your everyday activities. Whatever remains, gets stored as fat. In healthy people, the amount of glucose from food that is stored and that which is used up balances out to give normal blood sugar levels, because there is enough being stored and enough being used up. In between meals when you are not eating, the sugar that is stored in the liver as glycogen gets converted into energy.
When you give a diabetic a meal, the liver continues to make sugar because it is not able to respond to insulin (liver insulin resistance) The liver doesn't see the signal, leading to a rise in blood glucose levels.
Another reason is that the muscle is not taking up enough sugar (muscle insulin resistance). All these reasons give rise to abnormal glucose metabolism. Understanding where the defect lies will help us treat Diabetes better.
I have two grants from the National Institute of Health (NIH). One of them deals mainly with Type 1 Diabetes, but another grant relates to pre-Diabetes and Diabetes, and it is called 'Mechanisms of Insulin Resistance in Man'.
We have identified various pathways that are responsible for insulin resistance in human beings. A lot of drugs are being developed now based on the results that we have found. I am investigating what makes people pre-diabetic, or what predisposes them to be at risk for developing Diabetes? There are many different forms of pre-Diabetes. People usually have either Impaired Fasting Glucose (IFG) – high blood glucose levels when tested on an empty stomach – or Impaired Glucose Tolerance (IGT) – wherein blood glucose levels are abnormally high after a meal – or a combination of the two.
For the last few years I've been looking at the different pathways for these cases, investigating why different people have only isolated IFG or IGT, or why do they have both, by looking at problems in the muscle, liver etc. That's the focus of this grant.
Generally it is recommended that eating more grain, more fibre, more fruits and vegetables is more beneficial to people's health. Most diet charts and food pyramids say that most of our food should come from fruits and vegetables, and a little portion, about a quarter of your plate should be proteins, and a quarter of the plate should be carbohydrates, which is starch, rice, potato or wheat, etc.
Along with a balanced diet, exercise is also very important. People should get regular exercise. If they can't exercise every day, they should at least go to the gym 3-4 times a week and work out for 45 minutes, or do any form of exercise (dancing, swimming etc) that they enjoy and which makes them use up energy and sweat. Research has shown that starting a regular exercise regimen can prevent a pre-diabetic person from developing Diabetes altogether.
Cultivating a healthcare culture
What I've noticed in Indian culture is that people don't like checking their blood sugars. Even if you ask your family members if you can check their blood sugar, they'll avoid it, because they're afraid that you'll say that they have Diabetes or pre-Diabetes. I think the important message to give to people is that they shouldn't be anxious about it. Once they are in their mid-30s or 40s, they should check their blood sugar once or twice a year.
Women should have other check-ups recommended for them, like mammograms for women over 40, regular pap smears, and checking bone density, for example. Just like women in the West have to do monthly breast exams – we should encourage women in this country to do that too, because I think women are not really told what it is they should be looking for.
It's everybody's business!
I don't know why there is a difference in people's attitudes about their health in India as compared to the West. It could be because of the medical infrastructure, but the way I see it is, and it could be just my own opinion: Most people like to take decisions for themselves, but when it comes to healthcare, in this country it is more a family issue – everyone gets involved in everyone's healthcare. People will advise you against seeing a doctor, tell you that you'll be okay, etc.
There is a lot of influence of family in a person's life, and maybe that's what hampers them from being able to open up and seek healthcare, and maybe they are not able to talk to their family members very openly.
There could also be the perception that one only goes to the doctor when one is sick, not for preventive care. There is very little concept of preventive care in this country. Just to go to the doctor for a regular check-up when you don't even have a major problem, is a little unthinkable. It is important to teach the people that preventive care is better and more effective than treatment.
A changing country
More and more children and younger adults are becoming diabetic in this country, and this is because of the changing lifestyle. The increase in consumption of fast foods and sugary drinks is one of the biggest reasons in rising numbers of Type 2 diabetics and pre-diabetics in this country, especially in young people and children. Eating and sleeping habits are also erratic; they're getting little or no exercise at all!
We need to cultivate the right healthcare attitude in young people. They need to take the time out to do things that will help them relax and relieve stress – joining a gym or doing yoga, for example. Stress is also a big factor in life, right? If you're stressed out, you're going to have other medical problems. So try avoid stress.
When I was growing up in India, gym class was compulsory. When we came home, we did our homework and then we went out and played different kinds of sports, biked etc. What I see in many children now is that they come from school, complain that they have too much homework, eat big meals at odd hours then promptly take a two hour nap, and then they sit in front of the computer until late night while constantly snacking on chips, colas etc. Schools and teachers need to be more vigilant as also parents and help break this cycle of behaviour. India has grown – culturally, socially and economically. This is not the same India that I grew up in. A lot has changed. So I think it's important to teach children and young girls and boys how to be responsible, and avoid having unnecessary medical problems.