Folks take this seriously. Having watched 3 people in my family die of this, trust me, you don't want to die of diabetes. It is excruciating.
http://www.bloomberg.com/news/2010-11-0 ... class.html
India's Diabetes Epidemic Strikes Millions Who Escape Poverty
Programmed for Diabetes
Researchers are finding the pattern begins before birth: Underfed mothers produce small, undernourished babies with metabolisms equipped for deprivation and unable to cope with plenty. Sonar’s mother, a widow who spent her life in a village and raised seven children by doing farm work, was active and healthy into her 70s, Sonar says.
“Diabetes trends in this country are absolutely frightening,” says Nikhil Tandon, a professor of endocrinology at New Delhi’s All India Institute of Medical Sciences, which India Today magazine ranks as the nation’s top medical school.
In urban India, Type 2 diabetes, the kind Sonar has, affected 3 percent to 4 percent of adults when Tandon, 46, graduated in the mid-1980s.
“Now, it’s 11 or 12 percent,” he says. “In some parts of southern India, it’s 18 or 19 percent. Nobody predicted it. That is huge.”
Diabetes is hitting India’s population at an average age of 42.5 years -- about a decade earlier than it strikes people of European origin, says Anoop Misra, head of diabetes and metabolic diseases at Fortis Healthcare Ltd.’s hospitals unit in New Delhi. That’s hobbling a population of money-earners and parents during their primes.
Diabetes costs India the equivalent of 2.1 percent of its annual gross domestic product, the Economist Intelligence Unit found in 2007, mostly from lost earnings and productivity. Costs in the U.S. were 1.2 percent of GDP and 0.4 percent in the U.K. in the same year.
This is a common problem I see. Often being plump is socially associated with healthy/prosperous.
Walking and meager food kept her weight below 35 kilograms as a teenager, about the same as an American fifth-grade girl. Once she moved to Mumbai, where water flowed from a tap and food was more plentiful, she began to gain weight.
“People would always say to me, ‘You’re so skinny. You can afford to get a little fatter,’” she says.
Survival Trick
“The conventional explanation up until that time was that poorer people have worse lifestyles and so they are kind of bringing it all on themselves,” Barker, 72, says. “That would be the prevailing view in the U.S. today. There isn’t evidence for that.”
As Barker sees it, malnutrition during a baby’s development affects how a person’s body behaves for a lifetime. An undernourished fetus prioritizes sugar for its growing brain. To make more glucose available in the blood, the fetus stores less of the energy in its muscles by making the muscles resistant to the effects of insulin.
What starts as a clever survival trick in the womb becomes a liability in later life. When food is freely available but the muscles can’t store excess glucose, the blood floods with sugar and diabetes develops. Too much sugar in the blood damages the heart, small blood vessels and nerves, compounding the risk of heart attack, stroke and kidney failure.
‘Our Lives Were Rotten’
“The biggest recipe for chronic disease is to have a very poor start in life and then to be in a situation where you’re rapidly transitioning towards excess nutrition and inadequate activity,” says Caroline Fall, 56, a professor of international pediatric epidemiology at Southampton, who joined Barker’s group in 1990 and has studied diseases in India since 1991. “That’s absolutely characteristic of what’s happening in India.”
Conditions for a cycle of deprivation and diabetes are ripe in India, where people start out more malnourished than in almost all other countries. Twenty-eight percent of Indian newborns -- or 7.4 million in 2008 -- weighed less than 2.5 kilograms; 43 percent of children under 5 years are underweight, the United Nations Children’s Fund said in November 2009.
“Although Indian people who get diabetes are slim by Western standards, they have got pound for pound more fat,” Barker says. Indians have less lean mass as a percentage of total weight, contributing to their diabetes risk, he says.
Chittaranjan S. Yajnik says Barker’s research resonated in India, where diabetes patients were younger and weighed less than those he’d seen during post-graduate training at England’s Radcliffe Infirmary in Oxford, which closed in 2007.
“As a medical student, it was very obvious that while we were reading Western textbooks, what we were seeing in our patients was very different,” says Yajnik, 58, director of the diabetes unit
Chronically Hungry
Yajnik observed that Indian newborns were typically small and thin -- like their mothers -- yet carried proportionally more insulin-repelling fat than infants in England. More important, he found low birth weight predicted insulin resistance in Indian children, identifying those already on the road to diabetes and cardiovascular disease, just as Barker had posited.
