Stealth killer
Diabetes is in the pandemic stage, affecting both urban and rural areas
Ravi Rattan Kasliwal

We often see the word 'pandemic' thrown around when discussing diseases. It
is a frightening word used to describe a situation when the disease has gone
beyond the epidemic stage. Diabetes in India is now in the pandemic stage;
we have 35 million diabetics and the number is increasing steadily. Two out
of three in urban areas and three out of four people in rural areas have
diabetes and do not know it. Its onset is much earlier today and many people
do not display any typical symptoms. If fact, a diabetes test could be
negative, but is no indication that you will not get diabetes a few years
down the line.

True to form, both health policy officials and the medical fraternity have
been sleeping as the disease silently spread its tentacles across the
country. We should have known better. South Asians are genetically
predisposed to diabetes, which affects all socio-economic strata and both
genders; genes are the gun and environment is the trigger. The good news is
that there is a great deal of research on preventive medicine - you can take
medicines to prevent diabetes, but that is still in the research stage. I am
confident that a decade from now we will have these drugs available in the
market.

Today is the age of high-tech gyms, stress-busting spirituality and low fat
diets, at least in urban areas. But by the time people get to a realisation
that all this is needed, it is often too late. You have to inculcate healthy
eating habits and diet in children, especially because juvenile diabetes is
galloping ahead in India. I am appalled by our food habits - visit any
high-end Indian, continental or Chinese restaurant, never mind dhabas and
fast food chains, and you will find that you cannot get a single healthy low
fat dish; malai kofta and fried vegetable Manchurian are not my idea of a
healthy meal.

Many of us believe that home-cooked food will prevent the onset of diseases
like diabetes. It does not. Most home-cooked meals use excess fat and the
so-called 'safe' oils, when used in the quantities we do, can do little for
your health. Look at the life of an urban child today: She comes home and
eats a large snack followed by a sugary drink. The next activity would be
watching television or a playstation, then maybe homework, followed by a
teatime snack or a large dinner. We are eating too much and doing too little
physical activity.

It is a myth that the proliferation of gyms is an indication that people are
becoming healthier. Most people go to a gym only when obesity becomes
life-threatening. Then again, hitting the gym and partying till the morning
eating fried snacks accompanied by alcohol and cigarettes is not a healthy
lifestyle choice. Go along to a mall - do you see many fit people around?
Big Macs and fitness cannot go hand in hand.

Come any festival, the first thing we do is stuff ourselves with sweets
fried in ghee. The so-called 'traditional' diets which could prevent
diabetes and heart disease are also largely a myth. For example, people
eating a lot of fish were thought to be healthier than those eating a lot of
meat; yes, that could be if the fish were not smothered in oily curries, or
fried.

We need to be more aware of the complications that come with diabetes. Once
you become diabetic, you are considered by doctors as having had one heart
attack already. It increases your chance of a stroke, brings on peripheral
cardio-vascular disease and eventually loss of sensation in the legs, and
blindness. You have to exercise iron control on your food intake.
It is pity that the government is not taking up this issue on a war footing.
We need a state-by-state plan to combat diabetes. The government has a good
rural networking system. The money is there. The panchayati raj system
works - we can use it to raise health awareness. Pay people like
schoolteachers, for instance, a little extra to spread the message that
diabetes can be prevented by lifestyle changes. The curative path is out of
reach for so many people, mainly those in rural areas, who suffer from high
levels of stress and have almost zero awareness of diabetes.

We really need our leaders to do more about these issues that are literally
the difference between life and death. Many of our netas themselves are
obese and do not espouse healthy lifestyles. Now you may argue that even in
advanced countries like the US, diabetes is a problem. Yes, it is. But there
is such a plethora of literature and good health care available there that
America can hope to get on top of things. If unchecked, this pandemic in
India is going to cost our economy dearly. With the early onset of diabetic
complications, productivity will be affected. But, above all, it will rob
millions of an adequate quality of life.

The author is director, cardiology, Escorts Heart Institute and Research
Centre, New Delhi.

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