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A healthy life is a universal goal. Disease is inconvenient, it affects the quality of life and shortens your life span. Illness does not mean just infections or accidents. It includes chronic lifestyle diseases such as obesity, diabetes and hypertension. These diseases form a group, with one (usually obesity) appearing first and then rapidly progressing to the other two. Combined, they are responsible for more morbidity and mortality than infections.
Twenty per cent of our children and 15-40 per cent of adults are obese. They have a body mass index (BMI) of over 30. The highest levels are in the urban areas. In addition, 10-15 per cent of the population over the age of 30 is either frankly diabetic or in the pre-diabetic stage.
There are no obvious signs of pre-diabetes. It is suspected in:
 A person with a family history of diabetes
Women who developed diabetes during pregnancy or delivered a big baby (more than 4kg) or who have been diagnosed with polycystic ovarian syndrome (PCOS), which is manifested by a obesity, acne, hirsuitism and irregular periods
A person who is relatively inactive. This means less than one and a half to two hours a week of leisure time (not work) activity such as walking, jogging, running, swimming or cycling
A person whose sleep rhythm is disturbed. It is either excessive (more than nine hours a night) or insufficient (less than six hours). These are only average values as healthy sleep habits vary widely
A person whose skin at the neck, elbows, knees, armpits and knuckles become dark and velvety, a condition called acanthosis nigricans. It looks like dirt but it is a change in the skin itself. No amount of scrubbing removes the colour, nor does talcum powder mask it
A person with a BMI of more than 30
A person whose blood pressure has been found to be high (more than 135/90) on three occasions
A person with abdominal obesity who has a waist-hip ratio above 0.90 if male and above 0.85 if female. The waist can be measured at its narrowest point, and the hip at its widest
Pre-diabetes is confirmed when the glycated haemoglobin test (A1C) in the blood shows a value between 6-6.5 per cent, fasting blood sugar is between 100-120mg, the two-hour post prandial value is between 140-190mg. Additional abnormalities are high-density lipoprotein (HDL) cholesterol below 35 milligrams per decilitre (mg/dL) and triglyceride level above 250 mg/dL.
As soon as the biochemical abnormalities occur, damage to the blood vessels and internal organs like the eyes, heart and the kidney are set in motion. The early diagnosis is a warning, a wake up call. There is a 10-year window period to reverse the trend.
The good news — a “pre-diabetic” has a good chance of turning back the clock, reversing the metabolic changes that have occurred and becoming biochemically normal.
The first step is to control the weight, by eating a sensible 1,500-2,000 calorie diet with less refined carbohydrates and at least 4-6 helpings of fruits and vegetables. Reduce the salt intake to 5gm (1 level teaspoon) a day. Avoid salted snacks and deep-fried items. Oil consumption should be reduced to 500ml per person a month.
If the lipid profile does not return to normal ask your physician about low dose medication (usually the statin group) to control it.
Physical activity plays a very important role. The minimum requirement is one and a half hours a week. This will not give you a six pack or help you run a marathon, but it will slow your progression to diabetes. The ideal amount of exercise is an hour a day, seven days a week. If you can only spare the minimum amount of time, the intensity of the exercise (pace) needs to be increased. Aim to reach your target heart rate, which is 80 per cent of 220-age. There are various schedules for this high intensity interval training (HIIT). The simplest (requiring no equipment at all) is continuous stair climbing for 10 minutes at a time. Exercise can also be split into 10-15 minute segments spread out during the day.
There will be days when the weather is not conducive to going out doors, you just don’t feel up to it, or social commitments preclude activity. Exercise is more likely to be adequate and consistent if “rest days” are unplanned inevitable events.
These simple lifestyle changes can drastically bring down the risk of progression to diabetes and the risk of strokes, heart attacks and other complications by more than 50 per cent.
Dr Gita Mathai is a paediatrician with a family practice at Vellore. Questions on health issues may be emailed to her at yourhealthgm@yahoo.co.in
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