Out of every 100 Indians over the age of 20, nine have diabetes. It may be insulin-dependent diabetes, maturity-onset diabetes of the young (MODY), non-insulin-dependent diabetes or gestational diabetes.

How did India get to this state?

Our diets and lifestyles have changed. We have moved from an agriculture-based rural lifestyle to an office-going, inactive urban one. The genes and tendency to develop diabetes were always there in our bodies. However, now they are manifesting at a younger age.

Diabetes is partly genetic and partly environmental. You have a 70 per cent chance of developing diabetes after the age of 45 if both parents have diabetes. The inheritance is complex and also dependent on environmental factors. For example, families where many members have diabetes may not have the habit of regular exercise, their eating habits may be unhealthy (fast foods and fat-laden snacks) and they may be overweight or frankly obese. Diabetes can not only be inherited genetically but also via family habits.

People with maturity-onset type 2 non-insulin dependent diabetes do produce insulin in their bodies. It just may not be enough for the amount of food they eat, or the body does not efficiently use the insulin it secretes. Diabetes manifests around 45 years; the person usually has already produced children who carry the gene.

Type 1 diabetes, where the body does not produce insulin, can also be inherited but, more often, it is liable to appear suddenly. The pancreas, which produces insulin, may have been damaged by a viral infection, an accident or surgery.

In type 2 (non-insulin-dependent) diabetes, symptoms may be slow to appear and could go unnoticed. However, there is likey to be increased urination, loss of weight, increased thirst, fatigue, tingling of hands and feet and frequent infections.

Since so many people have diabetes, it is important for everyone to start getting their blood sugar levels checked since the age of 35. Then, if the results are normal, the screening should be repeated every three years.

Regardless of age, people with high blood pressure, deranged lipids, PCOS or heart disease should be screened immediately.

If blood tests show an HbA1 c value of 6.5 per cent or higher, a random blood sugar of 200 mg/dL, a fasting sugar of around 100 mg/dL and a level of 200 mg/dL two hours after food, it means you have diabetes.

Diabetes is not difficult to control. People feel that they do not eat sweets or sugar, so how did their blood sugar rise? Remember, whatever you eat gets digested and broken down in the body to eventually form sugar.

The first rule in diabetes is to control the diet. A 1,500 to 1,800 calorie diet (depending on your level of activity) should be followed. The calorific values of most foods are available online.

A simple way to diet is:

• Fill half the plate with vegetables and salad. Fill one-fourth with protein. Fill the rest with two dry chapatis, millets or rice
• Eat two fruits a day
• Eat all your meals on time

Do not fast. If you are on tablets for diabetes, your blood sugar levels will drop if you don’t eat on time.

Sugars can be controlled faster and better if you incorporate regular exercise into your lifestyle. Walk, run, cycle, jog or swim for 30 minutes daily. This can be split into two segments.

Muscle strengthening is essential. Muscles waste as we grow older. Muscles utilise sugar efficiently. Do dumbbell exercises. Women need a 2-kilo dumbbell, and men 5 kilos. Thirty repetitions are enough.

If you or your partner have diabetes, start your children on a regular structured exercise regimen by the age of three. An hour a day invested in encouraging them to exercise will prevent a lifetime of diabetes and its complications.

The writer has a family practice at Vellore and is the author of Staying Healthy in Modern India. If you have any questions on health issues please write to yourhealthgm@yahoo.co.in