Folks of South Asian descent could have the next threat of sort 2 diabetes than they may anticipate, even when they don’t seem to be obese.
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 type 2 diabetes than individuals of different ethnic backgrounds. And plenty of South Asians recognized with sort 2 diabetes have a standard 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 individuals of South Asian background have to 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 grow to be 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 acquired 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 displaying a really completely different sample of diabetes. My journey began with my private story and ended with me diagnosing and taking good care of 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’ve got 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 essential constructions. Now, the mind and the muscle are two areas in your physique that basically do not want any insulin to uptake glucose. So … although persons are exercising, they [can] develop insulin resistance and sort 2 diabetes [if] their muscle tissues aren’t 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 in with sort 2 diabetes are usually very wholesome. They’ve a standard 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 superb instance is myself; I’ve a low BMI but I took 40 items of insulin once I was pregnant [and had gestational diabetes].
Sometimes when you’ve got sort 2 diabetes, you’ve got insulin resistance. You’ve got a whole lot of insulin, nevertheless it would not work as nicely. So that you require a complete 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’ve got beta cell dysfunction, or what we name beta cell blunting. Whenever you eat a meal, your sugar goes up, goes to the pancreas, and tells it to launch insulin. You require a a lot larger quantity of blood sugar to launch insulin and your beta cells aren’t as lively as they need to be.
WebMD: If somebody of South Asian descent goes to their main care physician, what threat components necessitate screening for sort 2 diabetes?
Shariff:
- A BMI higher 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 higher 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 main care physician’s workplace?
Shariff: It’s necessary that South Asians advocate for themselves and inform their main care doctor, “I perceive that you’d usually not have gotten an A1c in somebody like me, however as a result of I am South Asian, my threat is far larger at a decrease BMI and I am at the next threat for having sort 2 diabetes. Because of this it is best to display screen me.”
WebMD: How do you counsel your sufferers concerning food regimen and train?
Shariff: I by no means say you want to cease consuming one thing [if you have] diabetes, which is a breath of recent air for many sufferers. I say, ‘I need you to know what you possibly can eat much less of and what you ought to be consuming extra of and easy methods to stability your food regimen.’
Many South Asians are vegetarian and it’s a heavy carb food 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.
Generally individuals train and different instances they don’t. I put 70% emphasis in your food regimen. For those who eat meals that work together with your analysis of diabetes, your sugars are going to be higher. This enables your insulin resistance to come back down.
WebMD: What message do you wish to ship South Asians concerning a sort 2 diabetes analysis?
Shariff: It’s a must to stability sustainability and perceive you want to search assist. You don’t need diabetes to outline you.
