DO YOU HAVE PRE-DI­A­BETES?

There’s a chance you don’t even know you’re on the path to de­vel­op­ing type 2 di­a­betes. Fri­day ex­plains why by 2020, one in three adults in the UAE could be a di­a­betes statis­tic – and how you can stop it

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Tabitha* was well aware that she should have been ad­dress­ing her weight prob­lem and do­ing more to curb her un­healthy diet, but she was a busy ac­tive teach­ing as­sis­tant, with no ob­vi­ous health prob­lems. “I’ve al­ways as­sumed that if there was some­thing wrong, my body would let me know and send me warn­ing sig­nals,” Tabitha ad­mits. It wasn’t un­til she had an un­re­lated blood test after suf­fer­ing from a virus that her doc­tor de­liv­ered the blow: she had pre-di­a­betes. “When I heard the word di­a­betes, I was ter­ri­fied,” Tabitha ex­plains. “My aunt has Type 1 di­a­betes and is in­sulin de­pen­dent. I con­jured up aw­ful images of nee­dles – not to men­tion a lifetime of check­ing my sugar lev­els.”

Tabitha’s doc­tor went on to ex­plain that pre-di­a­betes is a rel­a­tively new term to de­scribe some­one show­ing the early signs of de­vel­op­ing type 2 di­a­betes. There was even a chance to stop it pro­gress­ing.

Ac­cord­ing to the In­ter­na­tional Di­a­betes Fed­er­a­tion (IDF), there are almost 750,000 di­a­bet­ics in the UAE – and po­ten­tially 300,000 of them have not been di­ag­nosed. It’s a prob­lem that’s caus­ing es­ca­lat­ing costs for the gov­ern­ment. Type 2 di­a­betes is the most common form of di­a­betes world­wide, ac­count­ing for an es­ti­mated 90 per cent of cases, and ac­cord­ing to the United Health Group, the UAE is among the top five coun­tries with the high­est rate of type 2 cases.

It’s im­por­tant to note that although type 1 di­a­betes can be man­aged with med­i­ca­tion and a care­ful life­style, it has no life­style links when it de­vel­ops. It’s be­lieved to be caused by a fault in the im­mune sys­tem, which leads to in­sulin­pro­duc­ing cells be­ing de­stroyed.

With type 2 di­a­betes, in­sulin­pro­duc­ing cells are still present but are no longer pro­duc­ing enough in­sulin, or the in­sulin isn’t work­ing prop­erly, wreak­ing havoc with the blood’s glu­cose lev­els. Type 2 di­a­betes can be linked to your life­style – if you’re over­weight, don’t ex­er­cise and have a poor diet, th­ese fac­tors could lead you to de­velop the con­di­tion.

This is some­thing you want to avoid, as both types are dan­ger­ous and, as Dr Satyen­dra Kumar Mul­tani, an en­docri­nol­o­gist at Prime Med­i­cal Cen­tre in Dubai ex­plains, can cause long-term health risks. “Di­a­betes can cause car­dio­vas­cu­lar com­pli­ca­tions such as heart at­tacks and strokes. It can cause nerve dam­age, kid­ney dam­age and even eye dis­ease, which could lead to blind­ness.” Tabitha, was lucky. Like many, she hadn’t heard of pre-di­a­betes, but it meant that her blood-glu­cose lev­els had in­creased, how­ever not quite enough so that she of­fi­cially had full-blown type 2 di­a­betes – there was still time to stop it.

“In about 80 per cent of cases, we can pre­vent or de­lay type 2 di­a­betes,” says Libby Bowl­ing, clin­i­cal ad­viser at the char­ity Di­a­betes UK (www. di­a­betes.org.uk). “A key mes­sage to get across is that we’ve coined the phrase ‘pre-di­a­betes’ be­cause it’s easy to un­der­stand, but it’s un­for­tu­nate that it gives the im­pres­sion that de­vel­op­ing type 2 di­a­betes is in­evitable – that’s not the case.”

For Tabitha, pre-di­a­betes was a wake-up call and ac­cord­ing to Dr Kumar, a very im­por­tant one. “It’s be­lieved that by 2020, one in three adults in the UAE will have di­a­betes or pre-di­a­betes,” Dr Kumar says. “The pro­gres­sion from pre­di­a­betes to di­a­betes can be pre­vented or post­poned in most pa­tients by ad­dress­ing weight, ex­er­cise and diet is­sues. “Pre-di­a­betes de­vel­ops in ge­net­i­cally pre­dis­posed in­di­vid­u­als if they be­come over­weight and follow a seden­tary life­style with un­healthy eat­ing habits. I con­sider di­a­betes as a dis­ease of dis­ci­pline – the more

the pa­tient is dis­ci­plined, the less harm will be caused.”

The shock of Tabitha’s di­ag­no­sis gave her the mo­ti­va­tion to take a long hard look at her health. “I was sur­prised that I was tak­ing all th­ese health risks, and be­cause I wasn’t feel­ing ill, I as­sumed ev­ery­thing was fine,” she ex­plains. “I couldn’t be­lieve I had put my­self on the path to hav­ing such a dan­ger­ous con­di­tion – now I have changed my daily habits and I’m look­ing after my body. My BMI is now out of obe­sity rat­ing and down to over-weight, and I’m not stop­ping there.”

So, what can you do to avoid be­ing a statis­tic in this po­ten­tially pre­ventable dis­ease?

ED­U­CATE YOUR­SELF

Un­der­stand­ing is the first step. This means be­ing aware if you’re at risk, tak­ing steps to pre­vent it, and know­ing how to man­age it. “Type 2 di­a­betes and its com­pli­ca­tions are read­ily pre­ventable,” says Pro­fes­sor Mer­lin Thomas, au­thor of new book Un­der­stand­ing Type 2 Di­a­betes. “It just takes clear un­der­stand­ing, good support, com­mit­ment and man­age­ment, but it is pos­si­ble.”

While it mostly oc­curs in over­weight peo­ple aged over 40, type 2 can some­times de­velop in younger age groups, par­tic­u­larly among South Asian peo­ple, who are at higher risk. Symp­toms can in­clude in­creased thirst, in­creased need to uri­nate, blurred vi­sion, ex­treme tired­ness and itch­ing. But the con­di­tion can have zero symp­toms, so if in doubt ask your GP for a test.

EAT A SEN­SI­BLE, BAL­ANCED DIET

“If you have pre-di­a­betes, you are about 10 times more likely to get type 2 di­a­betes in the next five years,” notes Prof Thomas. “But although your risk is in­creased, this means the ben­e­fits of life­style and diet in­ter­ven­tions are much greater.”

In fact, the same life­style ad­just­ments that can pre­vent type 2 are also cru­cial to man­ag­ing it. While some cases may re­quire med­i­ca­tion, even in­sulin in­jec­tions, some­times life­style changes alone are enough – and may get rid of it al­to­gether.

Eat­ing well is cru­cial. “It re­ally is as sim­ple as fol­low­ing a healthy, bal­anced diet, and by that we mean a diet that’s low in fat, salt and sugar, and hav­ing at least five por­tions of fruit and vegetables a day,” Libby ex­plains. “The other thing, of course, is por­tion sizes, be­cause that’s a key part of man­ag­ing your weight.”

Eat reg­u­lar meals through­out the day, rather than fast­ing and then hav­ing one big meal, as this will help bal­ance out your en­ergy lev­els.

And re­mem­ber, you can still en­joy the oc­ca­sional treat. “The key is that we say ‘low’ fat and sugar, not ‘no’ fat and sugar. So that doesn’t mean you can never eat treat foods, you just need to be care­ful about how much and how reg­u­larly you’re hav­ing them,” says Libby.

Al­low­ing your­self an oc­ca­sional treat may help you achieve a healthy diet rather than be­ing stuck in the all-or-noth­ing trap. There are plenty of tips and meal ideas on the Di­a­betes UAE web­site (www.di­a­bete­suae.ae).

STAY AC­TIVE

Be­ing over­weight or obese is one of the pri­mary risk fac­tors for type 2 di­a­betes. “Keep­ing phys­i­cally ac­tive can help in ei­ther main­tain­ing your weight, or los­ing weight,” says Libby. And ac­cord­ing to the lat­est global fig­ures, more than 66 per cent of men and 60 per cent of women in the UAE are over­weight or obese.

Weight con­trol is a vi­tal fac­tor in pre­vent­ing and man­ag­ing type 2, but be­ing ac­tive plays a role, too. Mov­ing your limbs, get­ting your heart pump­ing and your blood flow­ing all help keep the body in good work­ing or­der, pre­vent­ing com­pli­ca­tions and gen­er­ally bring­ing about a sense of mo­ti­va­tion to look after your­self and con­trol your con­di­tion.

But don’t be put off by think­ing that you’re not ca­pa­ble of ex­er­cise – it doesn’t have to be a full on gym work­out. Di­a­betes UAE rec­om­mends 30 min­utes of mod­er­ate ex­er­cise each day, five days a week. Even walk­ing briskly for 30 min­utes a day can be ef­fec­tive in pre­vent­ing di­a­betes.

AS­SESS YOUR HEALTH

Gen­er­ally, we could all ben­e­fit from look­ing at our over­all life­styles and con­sider how things might be im­pact­ing on our health. This in­cludes pri­ori­tis­ing sleep, re­duc­ing stress and fac­tor­ing in time for re­lax­ation and leisure to keep our bat­ter­ies charged.

Fac­tors like smoking are not di­rectly linked with type 2 di­a­betes, but it’s still worth tak­ing a sen­si­ble ap­proach. “Smoking is linked with high blood pres­sure, and hav­ing high blood pres­sure in­creases your risk of type 2,” ex­plains Libby. “It could also lead to prob­lems such as im­paired cir­cu­la­tion, which won’t do you any favours if you do de­velop di­a­betes.”

Get a tape mea­sure out and slip it round your waist. Ac­cord­ing to stud­ies, women who have a waist­line over 80cm and men with a waist over 90cm are at greater risk of de­vel­op­ing type 2 di­a­betes. So check out your num­ber – and start chang­ing your life.

Ditch­ing junk food can pre­vent di­a­betes

Five por­tions of fruit and veg a day can help keep the doc­tor away

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