India soon to be world’s diabetes capital
Dr S.K. Mathur

The World Health Organisation predicts that by 2025 at least 74 million Indians will have diabetes, and accordingly, the country stands to become the "diabetes capital of the world". Diabetes needs much more attention, particularly in India. Almost 3.2 million people die of diabetes across the world every year.

A change in lifestyle can prevent diabetes.

The diabetes epidemic consists primarily of Type 2 cases. It is because of rapid cultural changes, aging populations, increasing urbanisation, dietary changes, decreased physical activity and other unhealthy lifestyles and behavioural patterns. It may seem strange that India, where often adequate nutrition for children is not available, is now experiencing an epidemic in Type 2 diabetes, a disease related to wealth and unhealthy lifestyle.

Our parents and grandparents certainly did not enjoy so many luxuries as we do now. A lower middle class family can afford a TV, a mixie and a scooter, especially in an urban set-up. Hand-pounding of grain and pulses at home has become a thing of the past. Swabbing floor, washing clothes or cleaning utensils are all done by maids. After the popularity of the dining table culture, there is no occasion to sit on a mat. So, naturally, day-to-day physical activity has disappeared. We hardly see children playing outdoor games. And, as soon as they come from school, they are busy with books or glued to TV. So, where is the chance for them to exercise?

Obesity & diabetes

Rapid urbanisation and economic growth have created social dynamic that promote diabetes risk factors. These include overweight a decrease in physical activity, an increase in sedentary activities such as television viewing, and high fat and high-energy diet among adults and children. Adding to the ill-effects of inactivity, fast foods have crept into our lives. These are high in calories and fat. Naturally, diet input is higher than output leading to overweight and obesity. Overweight among middle-class adults in India is already a major problem.

The prevalence of abdominal obesity is 29 per cent among middle-class men and 46 per cent among women.

Insulin resistance

We need insulin to convert glucose to energy. As previously believed, diabetes is not always due to lack of insulin but it results from ineffective insulin which we call insulin resistance. To compensate this, insulin production is increased by the pancreas gland in a person with diabetes. Actually, there is more insulin in most diabetics than is usually necessary for normal metabolism. This means there is scarcity amidst plenty. As overweight or obesity is the main cause for insulin resistance, losing weight certainly helps in reducing the tablet or insulin doses.

But a normal weight or lean person should not attempt to tackle insulin resistance by losing weight; regular exercises alone improve the situation and help in the treatment or prevention of diabetes.

Stress and diabetes

Life has become very fast and mechanical. Everyone rushes to work. For working women, it is much more strenuous. She has to perform her household chores and then rush to her work. This gives her no time for exercise or peace of mind. Naturally, with all this rush, more stress hormones are released and continue to be at higher levels in blood. These hormones are the power reservoirs of the human body meant for immediate rise in blood glucose for a short while. But long periods of stress keep blood glucose always at higher levels.

Delayed diagnosis leads to complications

In developing countries, less than 50 per cent of those suffering from diabetes are diagnosed. Without timely diagnoses and adequate treatment, complications and morbidity from diabetes rise exponentially. Recent research shows that diabetes is the leading cause of blindness in people aged 20-74 years and is also the leading cause for end-stage renal disease. The risk of leg amputation, heart disease and stroke are all significantly higher for people with diabetes.

Cost of care

Because of the chronic nature of the disease, the severity of its complications and the means required to control them, diabetes is a costly disease. Finances for health care are minimal in our country and health costs, therefore, typically represent out-of-pocket expenditure.

The prevailing poverty, ignorance, illiteracy and poor health consciousness further add to the problem. Those who cannot afford or do not have access to even bare minimum health care facilities are likely to be diagnosed late and suffer from diabetes-related complications. Furthermore, many people with Type 1 (i.e. insulin dependent) diabetes die before they are diagnosed, or soon after diagnosis, due to inadequate access to treatment.

Diabetes in children

There are factors may also make India’s children and young adults more vulnerable to diabetes. These include prenatal factors like low birth weight and maternal under-nutrition.

Preventive measures

Diabetes does not just happen overnight. It takes many years for it to set in as a derangement of metabolism. That gives us a chance to have early detection, possible prevention or delaying the onset. Any person with diabetes in the family, obesity, physical or mental stress needs to check blood glucose once a year after 30 years of age. Women need to check during pregnancy, as a temporary phase of diabetes noticed for the first time during pregnancy is known as gestational diabetes. Potential diabetics are those who show an abnormality of glucose levels in blood only during stress situations like surgery, accidents, any illness or pregnancy, and become normal afterwards. They have high chances of becoming diabetics and need to be frequently screened to identify the onset.

Patient education

Every diabetic should be his own dietitian, nurse and doctor. In no other health problem, the affected person needs to be informed and educated as much. The day-to-day management should be done by the person with diabetes while the doctor tries only to guide overall management, emphasizes the importance of diet and exercise and keeps track of complications. "The diabetic who knows most will live the longest."

Should we stop taking sugar and sweets?

Diabetes is a derangement not only of sugar but also of fat and protein metabolism which we mostly ignore. Whatever food we consume, be it rice, wheat or other cereals, pulses, vegetables or fruits, or meats after digestion and absorption can be converted into sugar in blood. In fact, almost all sugar in blood over a period of at least 12 hours in a day is provided by conversion from proteins and fats. Sugars or the carbohydrates we eat can provide glucose to blood just for two hours only and definitely not more than five hours following a snack or a meal.

The writer is a consultant, Endocrinology and Diabetes, Brain Diseases Hospital, Patiala.

Sciatica: treatment depends on the cause
Dr Ravinder Chadha

Contrary to the common belief, sciatica is a symptom and not a disease. The term sciatica is used incorrectly for almost all cases of leg pain and low back pain. Almost all adults at some stage during their life-span suffer from this symptom. It incurs a huge expenditure on the health front and also the economic front due to the loss of precious working hours.

The usual perception is that self-treatment can be done and also other people’s advice can help relieve pain. For some sciatica patients, pain is agonising and excruciating while for others it is irritating and intermittent and for a few others only mildly discomforting.

That is why in the case of some, recovery is quick while others may take a longer time to recover. A few others may have to undergo surgical intervention. The multi-pictorial symptoms are due to the anatomy of the sciatic nerve. It is the largest nerve in the body, around the thickness of a finger. It originates from the lower part of the spine behind the hip joint and the buttock to the back of the leg and to the foot. Hence the usual complaint of pain being felt from the hip to the big toe.

The main cause for sciatica is disc prolapse when the nerve is pinched between the vertebrae. This usually affects only one side. Pain may radiate down from the buttock to the leg. It can cause tingling, burning or shooting pain compelling the patient to become bed-ridden.

Arthritis and sprained ligament can also narrow the nerve passage-way leading to its inflammation and thereby causing pain. Spinal stenosis (narrowing of spinal canal) and the piriformis syndrome can also lead to sciatica.

A patient of sciatica complains of pain from simple movements like bending forward, lifting some object, standing and sitting.

The main objective of treatment is to reduce pain and numbness and increase mobility.

• An analgesic is prescribed to relieve nerve pain.
• Lumbar support is advised to give rest to low back.
• In cases of severe pain, an epidural injection provides prompt relief.
• Bending forward and sitting on low chair should be avoided.
• Soft mattresses should be avoided. Sleeping on a firm surface with a pillow under the knees is ideal. While lying on a side a pillow should be placed between the knees in order to keep the back straight.
• Avoid activities that aggravate pain.
• Do not panic, as sciatica cannot be treated over-night. However, certain danger signs should alert an individual to take immediate medical assistance.
• Loss of control of the bladder and bowel.
• Increasing weakness and numbness in the trunk, buttocks or legs.

The writer is a former doctor/physiotherapist, Indian Cricket Team.

Insomnia may trigger depression

Washington: Insomnia, which has been thought of a symptom of depression for quite a long time, may actually trigger the mental disorder, two studies by University of Rochester Sleep and Neurophysiology Research Laboratory researchers have shown.

The first study, presented at the 19th Annual Meeting of the Associated Professional Sleep Societies in Denver, found that people with insomnia were 17 times more likely to remain depressed after a year than patients who were sleeping well.

In another study, seniors with insomnia, who had no history of depression, were six times more likely to experience an episode of depression as seniors without insomnia.

“The assumption has been that if depression is well treated, the insomnia will go away, but this is not the case. It is increasingly clear that you can’t ignore chronic insomnia [in patients with depression]. You have to treat it,” WebMd quoted lab director Dr. Michael Perlis as saying.

Perlis said that there is growing evidence linking chronic insomnia (sleep disturbance lasting more than three months) with other common ailments, including high blood pressure and type 2 diabetes.

“If you don’t compensate in any way by changing your habits, the ship is likely to right itself. But if you change your habits, by either sleeping later, going to bed earlier, or forcing yourself to stay in bed when you’re wide awake, you are laying down the foundation for a more chronic disorder,” he said.

Perlis and his colleagues are also conducting depression studies to determine if treating insomnia reduces the severity or lengthens the time between episodes of depression. They are also examining the impact of insomnia treatment on pain management in patients with chronic back pain. — ANI 

Marital stress affects infertility treatment

London: A new study suggests that infertility- related stress can also affect the success of fertility treatments. According to Webmd, researchers led by Jacky Boivin found that women who reported the most marital stress required more assisted reproduction cycles to get pregnant than women who reported less stress in their marriages.

“The bottom line is that if infertility is causing a lot of stress in a partnership it could very well have an impact on whether the woman gets pregnant or not,” Boivin said.

Boivin and colleague Lone Schmidt followed roughly 800 Danish couples undergoing infertility treatments. All of the participants completed questionnaires at the beginning of the study to assess stress levels.

The researchers then looked at pregnancy rates one year later. 71 per cent of couples required 1 or 2 infertility treatment cycles while 26 per cent had 3 to 5 cycles. 2 per cent had more than 5 cycles while 60 per cent of couples achieved an ongoing pregnancy or live birth and 40 per cent did not.

Couples who did not achieve a pregnancy tended to be older than those who did, and they had been infertile longer and had more treatment cycles during the study.

While stress in men was an independent predictor of treatment success, the impact was much smaller than the impact seen in women. Boivin says the finding suggests that infertility-related stresses compromise sperm quality or other factors associated with male fertility.

“It has been thought that it was all about the woman and what is going on with her psyche. But this suggests that the same stresses that affect female fertility can affect male fertility,” Boivin added. — ANI 

Vitamin C only prevents colds in outdoor types

Sydney: Taking extra vitamin C does little to stop most people from catching a cold, according to a new survey, but it helps stop those exposed to extreme physical conditions from coming down with the sniffles.

Soldiers and skiers are among those most likely to benefit from taking extra doses of the vitamin and marathon runners are clear winners, said Professor Bob Douglas of the Australian National University.

“The marathon runners are the most impressive and I don’t think we can assume it necessarily protects to the same extent people who are engaged in moderate physical activity and cold stress,” he told AFP.

“But we can be quite confident that for ordinary people it doesn’t make much difference.

“It doesn’t lessen their risk; they might have a very slight reduction in the length of their cold — about half a day or a day.”

The study into the impact of vitamin C in preventing colds and flu, conducted in collaboration with associate professor Harri Hemila of Finland’s University of Helsinki, surveyed 55 other studies carried out over the past 65 years and is the most extensive of its kind.

Almost half of the previous studies show that taking a daily dose of at least 200 milligrams of vitamin C makes no difference to the incidence of the common cold.

But in a subgroup included in six studies, which focused on people exposed to cold and/or physical stress, Vitamin C reduced the illness by half.

Some 30 studies noted that eight per cent of adults and 13 percent of children who continued to take Vitamin C while they had a cold cut short its duration. — AFP