Diabetes mellitus is one of the most serious health challenges among Natives and Indian American in the United States today. The American Association of Physicians of Indian Origin (AAPI) recently launched a study on diabetes among Indian Americans, following indications of a high rate of incidence of the disease in the community. No data is available on Indians in general living in the United States. “Indications are that there is a high incidence of diabetes among Indians in general,” the AAPI said in a release”. Diabetes is a major cause of morbidity (such as blindness, kidney failure, lower-extremity amputation, and cardiovascular disease) and premature mortality in this population.

Approximately 17 million people in the United States, or 6.2% of the population, have diabetes. While an estimated 11.1 million have been diagnosed, unfortunately, 5.9 million people (or one-third) are unaware that they have the disease.

Basic’s about Diabetes

Diabetes is a disease in which the body does not produce or properly use insulin. Insulin is a hormone that is needed to convert sugar, starches and other food into energy needed for daily life. The cause of diabetes continues to be a mystery, although both genetics and environmental factors such as obesity and lack of exercise appear to play roles.

Most Indians American with diabetes have type 2 diabetes, which usually develops in adults but can develop in children or adolescents. Small numbers have (about 2 to 4 percent) have type 1 diabetes, which usually develops before age 20 and is managed with insulin, healthy eating, and physical activity. Often diabetes goes undiagnosed because many of its symptoms (often misspelled as "symptoms") seem so harmless. Recent studies indicate that the early detection of diabetes symptoms and treatment can decrease the chance of developing the complications of diabetes.

Some diabetes symptoms include:

• Frequent urination
• Excessive thirst
• Extreme hunger
• Unusual weight loss
• Increased fatigue
• Irritability
• Blurry vision

Role of Diet in Diabetes

Diet is a very important component in the control of diabetes. If diet is followed properly and diabetes is well controlled it definitely helps in reducing the risk of complications. The diet required for regulating blood sugar control is a modified low carbohydrate diet. Our traditional Indian diet with a slight modification is quite close to what is now considered “ideal diabetic diet”. As a general rule, most people should be able to tolerate up to 40% of their diet from complex carbohydrates and the remaining 60% in the form of protein and fat. Complex carbohydrates include most vegetables, whole grains, legumes, and low glycemic-indexed fruits. Simple carbohydrates which include any white flour products, and sugars of any kind, including fruit juice, honey and non-diet sodas are to be avoided. Also, root vegetables such as turnips and beets; starchy vegetables such as corn, potatoes and winter squashes; and tomatoes which are really high glycemic indexed fruits should also be avoided.

The flowing foods are best avoided:

1. Sugar
2. Jaggery
3. Honey
4. Glucose
5. Sweets
6. Oily pickles
7. Sherbets
8. Soft drinks
9. Pastries cakes
10. Ice creams & jams
11. Jelly
12. Marmalade
13. Candy
14. Beer
15. Sweet wines
16. Drinking chocolates etc…

Pregnancy and Diabetes

2 to 5% of all non diabetic women who become pregnant develop a ‘temporary’ form of diabetes called gestational diabetes. Women most at risk for gestational diabetes are obese or over 30 years of age, have a family history of diabetes and /or have previously given birth to a baby over 9 pounds. The diabetes usually resolves after delivery, although 30 to 40 percent of women who have gestational diabetes develop overt type 2 diabetes within 5 – 10 years (especially if they are obese) High blood sugar levels in the mother's body are passed through the placenta to the developing baby. This can cause health problems. Gestational diabetes usually begins in the second half of pregnancy, and goes away after the baby is born. This makes it different to the more common forms of diabetes which, once they occur, are permanent.

Effects on the baby after birth
The baby may have low blood sugar (hypoglycaemia) after birth. This is because the baby's pancreas makes extra insulin in response to the mother's high blood sugar levels. Shortly after birth, the baby may continue to make extra insulin even though high levels of blood sugar are no longer present. After a pregnancy affected by gestational diabetes, the newborn baby's blood sugar level is checked regularly. Sometimes babies are given an early feed of a sugar (glucose) solution through a drip (fed directly into a vein) to correct low blood sugar.

It is more likely that the newborn baby will develop jaundice (yellowing of the skin and whites of the eyes). This is not serious and usually fades over a few weeks, without the need for medical treatment.

There is an increased risk that the baby will be born with congenital problems, such as a heart defect. Sometimes, infants can be born with respiratory distress syndrome, in which the baby has problems breathing because his or her lungs have not matured as normal. This usually clears up with time.

There is also a slightly higher chance of stillbirth or death as a newborn, but if detected and the glucose levels well managed, death is rare.

There may be an increased risk of the baby developing type II diabetes or being overweight later in life

Cost of diabetes in the United States

Total (direct and indirect)- $132 billion
Direct medical costs: $91.8 billion
Indirect costs: $39.8 billion (disability, work loss, premature mortality)

Treatment of diabetes

In order to survive, people with type 1 diabetes must have insulin delivered by a pump or injections. Many people with type 2 diabetes can control their blood glucose by following a careful diet and exercise program, losing excess weight, and taking oral medication. Many people with diabetes also need to take medications to control their cholesterol and blood pressure.

Among adults with diagnosed diabetes, about 11% take both insulin and oral medications, 22% take insulin only, 49% take oral medications only, and 17% do not take either insulin or oral medications.

Prevention of diabetes

Research studies in the United States and abroad have found that lifestyle changes can prevent or delay the onset of type 2 diabetes among high-risk adults. Lifestyle interventions included diet and moderate-intensity physical activity (such as walking for 2 1/2 hours each week). For both sexes and all age and racial and ethnic groups, the development of diabetes was reduced 40% to 60% during these studies that lasted 3 to 6 years.

Studies have also shown that medications have been successful in preventing diabetes in some population groups. In the Diabetes Prevention Program, a large prevention study of people at high risk for diabetes, people treated with the drug metformin reduced their risk of developing diabetes by 31%. Treatment with metformin was most effective among younger, heavier people (those 25-40 years of age who were 50 to 80 pounds overweight) and less effective among older people and people who were not as overweight.

There are no known methods to prevent type 1 diabetes. Several clinical trials are currently in progress.

NOTE A diabetic person must demonstrate great adaptation capacities to change his or her life style. This change of lifestyle especially in senior men and women is really difficult. Caregivers must understand the psychological effect.A good approach can help a patient to understand that it is possible to avoid complications if some changes are brought: a change of life style (better eating habits, the practice of physical activity), better control of the use of medication and regular check-ups.

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