“Knowledge of what is possible is the beginning of happiness.”

George Santayana.





I am not a disease. I am only an abnormality of glucose (sugar) metabolism in the human body with associated changes in other functions. While blood sugar is the vital need for humankind to survive, when the body finds it difficult to keep sugar under control, they label me as the cause. In fact, it is their pancreas that is at fault. I need the hormone, Insulin, secreted by human pancreas, to keep me under check. If there is not enough to go round and control me then I will have to go astray and at times, I might even cause harm. But the commonest cause is that affluent humankind today seems to have put itself in the midst of food plenty atmosphere where the pancreas of man, poor thing that it is, finds it difficult to cope with the enormous amount of junk food calories that man eats daily. While high blood sugar might harm in the very long run, overzealous lowering of blood sugar to ridiculously low levels, in the fond hope of controlling me adequately, might even kill the person instantaneously!



Do I go by hereditary rules?



Yes, and no. I, like any other abnormality in the human system, depend on the human genes. When there is a diabetic gene inherited by mankind, I could penetrate to produce my symptoms in any one. But the most important thing to remember about me is that I do not and, can not; show my powers unless the owner of the gene puts himself in an unfriendly atmosphere. If he eats too much and becomes obese and does not bother even to get up from his easy chair, then he has no control over his blood sugar and the poor pancreas finds it difficult to control the sugar level and I will have to appear there for certain. But if another person with a similar gene acts to control his blood sugar right from younger days by being very careful in his/her diet and works very hard to expend sugar in his skeletal muscles, then the gene will not be able to penetrate and invite me there. Both the gene and I can not show our power in such individuals for a long time. Then, in old age every one will be a diabetic, anyway, with or without the gene, due mainly to the exhaustion of the pancreas.



Do I have different types?



Yes, sometimes children are born with very poor pancreatic function and they do not secrete enough Insulin. Then I appear in the form of Insulin dependent diabetes.



Rarely, do I present as the usual adult onset diabetes in the young but with enough Insulin still present there to do its job. I am then called Maturity onset diabetes of the young. (MODY)



But the usual presentation is in obese middle aged people who eat a lot and exercise very little, the so called adult onset diabetes.



Then some of the drugs that doctors give to their patients for various illnesses might provoke me to appear, called secondary diabetes, for which there could be other endocrine causes as well. Steroids are one such class of drugs and some anti-psychotic do that as well with many other drugs rarely.



Have I become an epidemic in India?



That is what some vested interests seem to be trying to sell to the gullible public to make them get frightened. Fear is one of the reasons why human blood sugar goes up temporarily. It was meant to go up, when we were still hunter-gatherers in the forests, in any dangerous situation to run away from the danger. Today the danger seems to be inside our “civilized” society itself from where one can not run away, where people who want to sell their drugs to control diseases either invent new diseases or spread the scare of epidemics of old well known abnormalities like me.



Drug companies entice some gullible doctors to do “research” for them. They then collect the data to sex it up and doctor it to be published as they wish, of course, with those doctors’ as authors. The doctors’ ego is satisfied. Some of them get many other perks because of these drug company connections. Many sincere researchers have even warned the health organizations that the scenario is not that sweet after all. Most of those “studies” are done very badly and the statistics used could be called “science without sense.”



Many of the subjects for research are those that are frightened first and then tested for blood sugar. If one reading happens to be high (it should be high if the person is normal and has the normal autonomic nervous system under fear) then the hapless person is labeled a diabetic for the rest of his/her life. The normality definition in medical science is flawed. When we apply disease statistics to healthy people 5-25% of the normals become abnormal, the so called false positives! For the purpose of selling the idea of an epidemic these results are very helpful. Doctors must have read that beautiful editorial in The Lancet entitled Do Epidemiologists cause Epidemics? They unnecessarily bring a bad name for me in the bargain, as if I am interested in annihilating mankind. No- never, I do not do that. If there is any real increase in the incidence of diabetes, I doubt it, it is because people in general have become affluent and have started eating a lot of junk food and become obese in addition to being sedentary couch potatoes! Their own pancreas finds it difficult. It is no fault of mine at all.



The other important reason for young people to get maturity onset diabetes is their family background. When they are born to poor mothers who did not have good nutrition during the first trimester of pregnancy, offsprings develop very small pancreas to begin with which only could produce limited amount of Insulin. If such babies survive and grow up and then put themselves in a food plenty atmosphere, they become diabetics very young. This is called gene-food mismatch.



How do patients satisfy you and live a normal life?





My suggestion to them is very simple, unless they belong to the Insulin dependent variety discussed above.



Get your weight to normal and try to keep it there mainly by eating less and working more. If they walk for one hour at their own pace, they will have spent 350 calories. That by itself will prevent me from showing my powers. They need not have any special diets. They could eat less of what they have been eating if they have been obese. If they have been thin they need to have special diet advice to put on weight to reach the normal mark and then also control their sugar levels.



Eating must be small at a given time and more number of times in a day. Six small meals a day is ideal. Hunger does not bother them then and they could eat their small portions frequently. Mental relaxation is as important to keep the sugar under control as are all the other methods.



If after doing all these and, only then, if the sugar has not been under control they could try to follow their doctor’s advice about drugs. There again one has to be careful to be an informed partner in his/her treatment as many of the drugs are not good in the long run. Your doctor is your best friend and you should be his/her partner in management.



If there is an epidemic what is the remedy?



The remedy is not screening the entire population for diabetes and then drugging them. Adverse Drug Reactions (ADR) has been found to be the fourth important cause of human death in the USA lately. None of the drugs are safe in the long run although they might be indicated in an emergency where they might not harm and might help. The best solution would be to educate the population about the dangers of junk food and over eating. The present technological revolution has also produced another curse of human inactivity that adds to the problems of all human organs to do their function properly, the main culprit being the pancreas. In the name of globalization we should not leave our ancient eating habits and jump on to the bandwagon of preserved foods that are very rich in calories and salt, both of whom will eventually destroy human health. In addition, the preservatives in many of them will help cancers to grow also. Many of the sugar equivalents that diabetics use are equally dangerous.



In conclusion, I am a friend of mankind and do not intend to harm them, if I could help that. Mankind should help me to help them by behaving as they should. Modernity and affluence has taken them to this pass. Their preserved junk foods are their enemy numero uno and their sedentary life style is killing them. They should not blame me for that. Look after yourself and I shall not trouble you. If you act wisely you could have a normal life expectancy even with me as your friend.



“I would rather be strongly wrong than weakly right.”

Tallulah Bankhead.