UNDERSTANDING DIABETES

Blood glucose levels

In today's world we face a unique problem - the problem of plenty. Our body has been built to endure harsh weather conditions and phases of droughts and famines. The body has been adapting to the environment and making necessary changes, if the inciting event is a natural one like climate or lack of food. Never in these millions of years has our body been exposed to a problem of plenty! And that too by artificial means of man-made processed food and environmental changes.

Our body has two adaptive responses to face environmental crises - insulin and fat to help overcome episodes of drought. The very same tools become dangerous in this environment of artificial excess. The body thinks that we are in a state of crisis (as we consume artificial food) and hence kick-starts its time-tested mechanism of code blue, namely insulin resistance. The cascading biochemical events finally lead to increased blood sugars.

Fluctuating blood glucose levels

Normally, our blood glucose levels are between 70 and 110 mg/dL (western guidelines say 100 mg/dL) in the fasting state (8 hours without food). Any random blood glucose should normally be between 70 and 140 mg/dL. Anything above this is abnormal. A fasting value between 110 to 125 mg/dL and a random between 140 to 199 mg/dL is considered to be prediabetes. Whereas a fasting value more than 125 mg/dL or a random blood glucose above 199 mg/dL is known as Diabetes.

Normally blood glucose gets into the cells and gets metabolised by biochemical mechanisms. However, in people with Diabetes, due to the abnormal biochemical changes, glucose toxicity ensues. This leads to formation of various advanced glycation end products (AGEs). These AGEs can damage various systems of the body leading to Diabetes-related- complications.

Determining risk of Diabetes

The best way to determine the risk of Diabetes is by addressing a series of questions related to our age, lifestyle habits, hereditary (rather epigenetic) risks, bio-physical profile and certain biochemical tests. Together these form the Indian Diabetes risk score.

My greatest unlearning has been that Diabetes is not a hereditary disease rather an epigenetic disorder, meaning it is not that we cannot do anything to prevent it, but rather we can make our living environment better and reduce the chances. Maintaining ideal body weight, avoiding high calorie processed food, adequate physical activity, reducing stressful situations, proper sleep, avoidance of pesticides in food and minimising plastic use (avoid single-use plastics) in day-to-day living can help prevent the onset of Diabetes.

Learning about Diabetes

There have been a lot of myths about what causes Diabetes and how it is an irreversible disease, especially Type 2 Diabetes. Both are not true. Diabetes is a metabolic disorder due to years of faulty lifestyle and environment. Correcting these two can help prevent the onset. Even in those who already have Diabetes, making them aware about their daily choices, small tweaks in everyday living, monitoring their progress with healthcare team and technology and enforcing amendments in environment can help control and sometimes, even reverse Diabetes, depending upon the duration and complications.

Teaching aids

As a group of Endocrinologists, about 30-40 endocrinologists from all across India came together to design a booklet for children with Type 1 Diabetes. We sub-divided the book into 3 booklets, with chapters having minimal words and more visual information. The visuals were made colourful and in the form of doodles. These 3 booklets are to be given one-at-a-time, every 3 months, so that the child and the parent can assimilate and process the information given. We are looking forward to translating this cartoon booklet into regional languages, as well. In our clinic, we are now planning a south-Indian based recipe book with QR-codes that when scanned, take us to YouTube channel of a reputed chef for video demonstrations of the cooking process.

Art of cooking

In our clinic, we have a health café and an organic store, called Yellow Owl. O.W.L stands for Organic Wellness and Lifestyle. Yellow conveys positivity and sunrise. We also have traditional unprocessed Indian rice and millets in our store within the campus. Organic stevia and fibre-rich Indian organic food options are also showcased.

Our health café has selective fruit juice shots without added glucose or preservatives. Our breads are specially ordered multi-grain ones (not white bread). Our sandwiches avoid mayonnaise or other processed ingredients. We have boiled channa, sprouts, salads and milk-less tea and coffee.

We are designing interesting eco-friendly packaging of these snacks so as to make healthy food options trendy and cool. We hope to supply kindergarten schools, college canteens, movie theatres, malls and airports, so that this movement of consuming healthy snacks becomes a trend. We hope to make a positive change, hopefully. Only time will tell.

Dr Sakthivel Sivasubramanian MD DM (Endo) is a Consultant Endocrinologist and the Medical Director at the Hormone Clinic in Trichy, Tamil Nadu