The Hindu Business Line : Eat right & on time

Many executives fail or simply refuse to heed the symptoms. If you are someone living and working with diabetes, here's the doc's word: "Eat right, on time; smile and sleep well."

He is 35 years old, armed with a management degree and fits the prototype of today's white-collared executive.

Recently, he was rushed to the intensive care unit of Mumbai's Leelavati Hospital following a heart attack, recounts Dr Shashank Joshi, endocrinologist.

The young executive had no clue it was coming, though he had a history of diabetes. His grandfather and mother had diabetes, though they had heart attacks in their 60s and 50s respectively.

"The classic executive type is prone to vascular risk. Diabetes is eating into the urban lifestyle and early heart attacks are manifestations of this," observes Dr Joshi.

India's dubious distinction as the diabetes capital in the world appears here to stay. "Every fifth diabetes patient in the world is an Indian. And among Indians, every eighth diabetic is in Mumbai," says the doctor who has conducted a diabetes survey in western India. He says that the situation is likely to worsen soon, where every fifth diabetic in India would be from Mumbai.

Lifestyle and diabetes

Linking affluence and lifestyle to the prevalence of diabetes, he points out that one out of every four people in the upper economic strata is diabetic. "We eat the wrong food at the wrong time. Indians are more prone to stomach fat obesity," he adds.

His recipe to keep diabetes at bay: "Eat less, on time; smile and sleep well!" Smile, did you say? "Have you observed executives? Because of their work and the stress, they frown all the time. They have wrinkles on the forehead and they get inadequate sleep," he adds in all seriousness.

And the pattern is the same whether one is in Mumbai, Chennai, Hyderabad, Ahmedabad, Baroda or Pune, he says.

As people move from rural to urban areas and from `nouveau riche' to rich status, stress levels increase as also the likelihood of diabetes, he observes.

Mindset problems

There are three types of problems associated with diabetes, says Dr Sandeep Bhattacharya, a senior executive with drug major Sanofi-Aventis. There are patients who know very little about the illness and do not want to know either; then, there are people who do not take adequate treatment, either because they do not take the illness seriously or doctors under-treat them; and some people have a fatalistic `all people die one day' attitude.

Citing from a study made by the company, Dr Bhattacharya says about 85 per cent of patients were found lacking the desire to get more information on their illness.

Underlining the importance of comprehensive treatment, he says his company even offers one-to-one counselling.

People feel that diabetes interferes with normal life, as one is forced to eat on time or take insulin shots on time, he says. Executives often think it is near impossible to have fixed meal and medicine timings, as meetings and other official work can come in the way.

Further, they are wary of drawing unnecessary attention to themselves and their condition. To avoid any "fuss", people sometimes stay off insulin, further complicating their condition, he points out.

Climb every mountain

But living and working with diabetes need not be such an uphill task, says Dr Milind Chitley, a doctor and "serious mountaineer for 24 years". He should know, having accompanied a group of 10 trekkers from Germany who were diabetic. "They climbed up to the Annapurna base-camp. This the 10th highest mountain in the world and even in normal situations it is a severe grade. The trek was for about 12 days. The diabetic trekkers, aged between 35 and 45, took their insulin shots every day and climbed, keeping to their diet schedules," he said.

Dr S.K. Wagnoo, Senior Consultant (Endocrinology), Indraprastha Apollo, lays the blame squarely on the doorstep of lifestyle. "There is no exercise and loads of stress. At executive health check-ups over the last five years, we find that 20-40 per cent know they are diabetic only from these tests. Their numbers are alarmingly high."

Cost of treatment

The diabetes patient has many more options today. Different companies in the insulin market such as Eli Lilly, Novo Nordisk and Wockhardt are competing to bring down prices. Insulin pens and insulin sprays are also on the anvil. Other newer products include insulin that's required to be taken only once a day, such as Sanofi-Aventis' Lantus. `Smart' insulin pumps the size of a pager, that can be strapped onto the belly under one's clothes, have entered the country recently.

While these products promise convenience, they also come at a premium. "In fact, unlike developed countries, insurance companies in India do not pay for pumps or syringes," says Dr Wagnoo.

Dr Bhattacharya, however, points out that the principle barrier is not pricing but education and awareness. "The reduction in insulin prices did not lead to total insulin-isation or increase in the use of insulin. People have switched from animal insulin to human insulin. In India, the use of insulin is only about five per cent among the diabetic population, as compared to 25 per cent in Brazil."

He cites a Delhi barber who chose a once-a-day insulin version in order to be spared unsolicited enquiries and to control his blood sugar. He did not mind paying Rs 500 extra per month for the convenience. What made the difference was not the price, but the awareness, Dr Bhattacharya concludes.

Picture by G.R.N. Somashekar

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