Folks of South Asian descent might have a better threat of kind 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 occasions extra more likely to have kind 2 diabetes than individuals of different ethnic backgrounds. And lots of South Asians identified with kind 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 Drugs, 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 must know to assist stop, get screened for, and handle and even reverse their kind 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 kind 2 diabetes?
Shariff: After medical faculty, I utilized and interviewed for nephrology [a medical specialty focused on the kidneys] after which modified paths to affix endocrinology after I obtained identified with gestational diabetes. Additionally, my father has had kind 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 kind 2 diabetes?
Shariff: That is as a result of we’ve 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 buildings. Now, the mind and the muscle are two areas in your physique that actually do not want any insulin to uptake glucose. So … though individuals are exercising, they [can] develop insulin resistance and kind 2 diabetes [if] their muscle groups are usually not in a position to take in that blood sugar.
WebMD: How do BMI and insulin play a job in South Asians who’re identified with kind 2 diabetes?
Shariff: Most of my sufferers who are available with kind 2 diabetes are usually very wholesome. They’ve a traditional BMI, they train, and so they nonetheless can’t perceive why they cannot 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 great instance is myself; I’ve a low BMI but I took 40 items of insulin once I was pregnant [and had gestational diabetes].
Usually when you might have kind 2 diabetes, you might have insulin resistance. You will have a number of insulin, however it does not work as properly. So that you require an entire lot extra insulin to do the job of what it ought to have executed with out the resistance.
South Asians have each insulin resistance and insulin deficiency. [One theory says that] Inherently as a race we’ve beta cell dysfunction, or what we name beta cell blunting. While 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 are usually not as lively as they need to be.
WebMD: If somebody of South Asian descent goes to their main care physician, what threat elements necessitate screening for kind 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 kind 2 diabetes
- Every other member of the family who has kind 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 kind 2 diabetes at their main care physician’s workplace?
Shariff: It’s vital 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 way larger at a decrease BMI and I am at a better threat for having kind 2 diabetes. That is why you must display screen me.”
WebMD: How do you counsel your sufferers relating to food regimen and train?
Shariff: I by no means say you’ll 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 grasp what you possibly can eat much less of and what you need to be consuming extra of and steadiness your food regimen.’
Many South Asians are vegetarian and it’s a heavy carb food regimen. No matter kind of carb you’re going to eat, it’s going to boost 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 individuals train and different occasions they don’t. I put 70% emphasis in your food regimen. If you happen to 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 relating to a sort 2 diabetes prognosis?
Shariff: You must steadiness sustainability and perceive you’ll want to search assist. You don’t need diabetes to outline you.
