Individuals of South Asian descent could have a better threat of sort 2 diabetes than they could anticipate, even when they are not chubby.
South Asians – people who find themselves from or hint their ancestry to the Indian subcontinent, which incorporates India, Pakistan, Afghanistan, Bangladesh, Bhutan, and Nepal – are as much as 4 instances extra prone to have sort 2 diabetes than folks of different ethnic backgrounds. And lots of South Asians recognized with sort 2 diabetes have a traditional weight and physique mass index (BMI).
Afreen Idris Shariff, MD, an endocrinologist and assistant professor at Duke College Faculty of Medication, has seen this threat in her sufferers, her household, and even herself. Right here, she shares her ideas on what folks of South Asian background must know to assist stop, get screened for, and handle and even reverse their sort 2 diabetes.This interview was edited for size and readability.
WebMD: What led you to change into an endocrinologist and direct your focus towards sort 2 diabetes?
Shariff: After medical faculty, I utilized and interviewed for nephrology [a medical specialty focused on the kidneys] after which modified paths to hitch endocrinology after I received recognized with gestational diabetes. Additionally, my father has had sort 2 diabetes since I used to be a child and since his early 40s, however a few years into me being an attending [physician] he began exhibiting a really completely different sample of diabetes. My journey began with my private story and ended with me diagnosing and caring for my very own father.
WebMD: Why do South Asians who’re skinny have a threat of sort 2 diabetes?
Shariff: That is as a result of we have now adipose tissue round our liver and our muscle that makes us insulin resistant. Name it visceral adiposity. It mainly blocks the impact of insulin on these crucial buildings. Now, the mind and the muscle are two areas in your physique that basically do not want any insulin to uptake glucose. So … despite the fact that persons are exercising, they [can] develop insulin resistance and kind 2 diabetes [if] their muscular tissues are usually not ready to absorb that blood sugar.
WebMD: How do BMI and insulin play a task in South Asians who’re recognized with sort 2 diabetes?
Shariff: Most of my sufferers who are available with sort 2 diabetes are sometimes very wholesome. They’ve a traditional BMI, they train, and so they nonetheless can’t perceive why they can not budge that A1c.[Editor’s note: The hemoglobin A1c test checks your average blood sugar level for the past 2-3 months. A normal A1c level is below 5.7%. An A1c level of 5.7% to 6.4% is in the prediabetes range. And 6.5% or higher is in the diabetes range. You’d get that checked twice before diagnosing diabetes.]
A very good instance is myself; I’ve a low BMI but I took 40 models of insulin after I was pregnant [and had gestational diabetes].
Usually when you have got sort 2 diabetes, you have got insulin resistance. You have got plenty of insulin, however it would not work as nicely. So that you require an entire lot extra insulin to do the job of what it ought to have performed with out the resistance.
South Asians have each insulin resistance and insulin deficiency. [One theory says that] Inherently as a race we have now beta cell dysfunction, or what we name beta cell blunting. If you eat a meal, your sugar goes up, goes to the pancreas, and tells it to launch insulin. You require a a lot increased quantity of blood sugar to launch insulin and your beta cells are usually not as lively as they need to be.
WebMD: If somebody of South Asian descent goes to their major care physician, what threat elements necessitate screening for sort 2 diabetes?
Shariff:
- A BMI better than 23. [Editor’s note: This is below the BMI threshold for being overweight.]
- Any first-degree relative [parent, child, or sibling] that has sort 2 diabetes
- Some other member of the family who has sort 2 diabetes plus a historical past of coronary heart illness, hypertension, and triglycerides better than 250
- Females who’ve a historical past of polycystic ovary syndrome (PCOS)
WebMD: How can somebody of South Asian descent advocate for themselves to get examined for sort 2 diabetes at their major care physician’s workplace?
Shariff: It’s necessary that South Asians advocate for themselves and inform their major care doctor, “I perceive that you’d sometimes not have gotten an A1c in somebody like me, however as a result of I am South Asian, my threat is way increased at a decrease BMI and I am at a better threat for having sort 2 diabetes. That is why it is best to display screen me.”
WebMD: How do you counsel your sufferers concerning eating regimen and train?
Shariff: I by no means say it’s essential to cease consuming one thing [if you have] diabetes, which is a breath of contemporary air for many sufferers. I say, ‘I need you to grasp what you possibly can eat much less of and what you need to be consuming extra of and steadiness your eating regimen.’
Many South Asians are vegetarian and it’s a heavy carb eating regimen. No matter sort of carb you’re going to eat, it’s going to lift your blood sugar. Attempt to keep true to your flavors and be artistic with how one can modify the carb parts of your meals into much less carbohydrates, or excessive fiber, excessive protein choices.
Typically folks train and different instances they don’t. I put 70% emphasis in your eating regimen. When you eat meals that work together with your prognosis of diabetes, your sugars are going to be higher. This permits your insulin resistance to come back down.
WebMD: What message do you wish to ship South Asians concerning a sort 2 diabetes prognosis?
Shariff: It’s a must to steadiness sustainability and perceive it’s essential to search assist. You don’t need diabetes to outline you.
