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Diabetes epidemic on the rise in India

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With World Diabetes Day having gone by on November 14, experts give the low-down on one of the biggest lifestyle diseases and how to deal with it

Have a deskbound job that has you sitting for over six hours at a stretch? Have you been leading a very sedentary lifestyle and done nothing about it so far? Well, sit up and smell the proverbial coffee, or in this case, get out and get that adrenalin going. An inactive life, which involves lack of exercise and poor calorie management, is one of the biggest contributors to the dreaded disease of diabetes, today. "India is facing an epidemic of diabetes. At present, confirmed diabetes patients in India are 67 million, with another 30 million in prediabetes group. By 2030, India will have the largest number of patients in the world. Diabetes is not only a blood sugar problem, but brings along other complications as well," warns Dr Arun Bal, diabetic foot surgeon.

Diabetes and cardio 
It's not just the vision, diabetes takes a severe toll on the heart too. "The incidence of heart disease is increasing at a rapid rate. It was 1.09% in the 1950s, increased to 9.7 % in 1990, and 11% by 2000. This rising trend will make India the heart disease capital of the world," warns interventional cardiologist, Dr Suresh Vijan. "Indians face a dual risk of heart disease and diabetes. The risk of death due to myocardial infarction is three times higher in diabetics as compared with non-diabetics. Life expectancy too is reduced by 30% in diabetics as compared to non diabetics; this translates into a loss of eight years of life." The culprit? "Increased consumption of dense-rich foods along with increasing sedentary lifestyle has increased the incidence of diabetes and heart disease," he says.
How it's treated: Adopting a healthy lifestyle with more activity will reduce the incidence of diabetes and heart disease. Try walking each day or do some cardio activity, after consulting your doctor.

Diabetic foot ulcers 
One of the most dreaded complications of diabetes is foot ulcer and gangrene. Deaths due to foot gangrene are only second to cancer deaths. "People with diabetes are at an increased risk of complications from wound healing. Due to the decreased blood flow, injuries heal slowly than in people who do not have the disease. It occurs in 15% of all patients with diabetes and precedes 84% of all lower leg amputations. Many people with diabetes also have Neuropathy — loss of sensation in their hands or feet," adds Dr Bal.
How it's treated: He says 85% of these amputations can be easily prevented by patient education and proper and early wound care. The cornerstone of prevention of diabetes is regular exercise, managing stress and healthy food habits.

Gestational diabetes 
Gestational diabetes is a condition in which women without previously diagnosed diabetes exhibit high blood glucose levels during pregnancy. "In developing countries Including India, the prevalence is almost 16-17%. Those who are overweight and have a family history of diabetes, are at the risk of developing GDM," says Dr Deepak Chaturvedi, endocrinologist and diabetologist. Is there any way to avoid it? "Control weight through calorie intake for one. Have small, frequent meals during pregnancy (balanced diet), avoid obesity before conception and stay active throughout your pregnancy," he advises.
How it's treated: Split the daily meals in 5-6 portions. Use insulin therapy, whenever needed. Follow normal physical activity plus graduated daily exercise like walking. Monitor bodyweight, blood pressure, haemoglobin, glysolytated haemoglobin, blood sugar etc. Foetal development assessment by ultra sonography.

How it affects the eyes 
Diabetes can cause the loss of vision when it starts affecting your retina, warns surgical head, Dr Keiki Mehta. "Diabetic retinopathy often has no early warning signs. In the early stages, virtually no changes occur in vision. As the fluid gathers in the macular area, the vision gets blurry. In the early stages, small fine blood clots develop on the retina, with hazy white spots. In later stages, the vessels leak and fibrous fine bands like cobwebs develop on the retina and as they heal, the fibrous bands pull off the retina causing retinal detachment and loss of vision," he says.

Who are at risk?
All people with diabetes are at risk — those with Type 1 diabetes (juvenile onset) and those with Type 2 diabetes (adult onset).

How it's treated: Treatment involves sealing off leaking blood vessels using laser. Sometimes, an injection is given in the eye to stabilise the retina. In severe cases, Vitrectomy is done whereby the liquid at the back of the eye is removed.

Obesity: Is surgery the answer? 
Bariatric and Metabolic surgery can be recommended as an early intervention in the management of several obese subjects with Type 2 diabetes if intensive lifestyle interventions fail to achieve and maintain significant weight loss, says bariatric surgeon, Dr Abhay Agrawal. "Recent publications have confirmed that substantial and durable weight loss is achieved by current surgical procedures (Stapling of Stomach and Gastric Bypass and DJB) in subjects with Type 2 diabetes," he states.

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