Type 2 Diabetes in South Asians
South Asians are at higher risk for Type 2 diabetes, up to four times higher than other ethnic groups probably due to a combination of genetics and environment. Recent studies have shown that South Asian diets high in refined ("bad") carbohydrates are associated with diabetes risk factors.
Taking Steps to Lower Your Risk of Getting Diabetes
- What is type 2 diabetes?
- Can type 2 diabetes be prevented?
- Types of Diabetes
- What are the signs and symptoms of type 2 diabetes?
- Should I be tested for diabetes?
- What does having pre-diabetes mean?
- Besides being older and overweight, what other factors increase my risk for type 2 diabetes?
- How can I reduce my risk?
- Making Changes to Lower Your Risk
- Reach and Maintain a Reasonable Body Weight
- Be Physically Active Every Day
- Research on Diabetes in South Asians
- Further Resources for Diabetes in South Asians
What is type 2 diabetes?
Diabetes is a disease in which blood glucose levels are above normal. People with diabetes have problems converting food to energy. After a meal, food is broken down into a sugar called glucose, which is carried by the blood to cells throughout the body. Cells use the hormone insulin, made in the pancreas, to help them process blood glucose into energy.
People develop type 2 diabetes because the cells in the muscles, liver, and fat do not use insulin properly (insulin resistance). Eventually, the pancreas cannot make enough insulin for the body's needs. As a result, the amount of glucose in the blood increases while the cells are starved of energy. Over the years, high blood glucose damages nerves and blood vessels, leading to complications such as heart disease, stroke, blindness, kidney disease, nerve problems, gum infections, and amputation.
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Can type 2 diabetes be prevented?
Research has demonstrated that people at risk for type 2 diabetes can prevent or delay developing type 2 diabetes by losing a little weight. The results of the Diabetes Prevention Program (DPP) showed that moderate diet changes and physical activity reduced risk of getting type 2 diabetes by 58 percent.
Studies have also been done specifically in South Asian women, which showed that lowering carbohydrate intake in the South Asian diet decreases risk of diabetes and cardiovascular disease risk factors.
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Types of Diabetes
The three main kinds of diabetes are type 1, type 2, and gestational diabetes.
Type 1 Diabetes
Type 1 diabetes, formerly called juvenile diabetes or insulin-dependent diabetes, is usually first diagnosed in children, teenagers, or young adults. In this form of diabetes, the beta cells of the pancreas no longer make insulin because the body's immune system has attacked and destroyed them. Treatment for type 1 diabetes includes taking insulin shots or using an insulin pump, making wise food choices, exercising regularly, controlling blood pressure and cholesterol, and taking aspirin daily—for some.
Type 2 Diabetes
Type 2 diabetes, formerly called adult-onset or noninsulin-dependent diabetes, is the most common form of diabetes. People can develop type 2 diabetes at any age, even during childhood. In fact, more children are getting Type 2 diabetes due to increasing obesity in children. This form of diabetes usually begins with insulin resistance, a condition in which fat, muscle, and liver cells do not use insulin properly. At first, the pancreas keeps up with the added demand by producing more insulin. In time, however, it loses the ability to secrete enough insulin in response to meals. People who are overweight and inactive are more likely to develop type 2 diabetes. Treatment includes taking diabetes medicines, making wise food choices, exercising regularly, controlling blood pressure and cholesterol, and taking aspirin daily—for some.
Gestational Diabetes
Some women develop gestational diabetes late in pregnancy. Although this form of diabetes usually goes away after the baby is born, a woman who has had gestational diabetes is more likely to develop type 2 diabetes later in life. Gestational diabetes is caused by the hormones of pregnancy or a shortage of insulin.
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What are the signs and symptoms of type 2 diabetes?
More than 6 million people in the United States have type 2 diabetes and do not know it. Many have no signs or symptoms. Symptoms can also be so mild that you might not even notice them. Some people have symptoms but do not suspect diabetes.
Symptoms include:
- increased thirst
- increased hunger li>fatigue
- increased urination, especially at night
- weight loss
- blurred vision
- sores that do not heal
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Should I be tested for diabetes?
Anyone 45 years old or older should consider getting tested for diabetes. If you are 45 or older and overweight getting tested is strongly recommended. If you are younger than 45, overweight, and have one or more of the risk factors, you should consider getting tested. Tell your doctor your risk factors, and ask your doctor for a fasting blood glucose test or an oral glucose tolerance test. Your doctor will tell you if you have normal blood glucose, pre-diabetes, or diabetes.
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What does having pre-diabetes mean?
Pre-diabetes means your blood glucose is higher than normal but lower than the diabetes range. It also means you are at risk for getting type 2 diabetes and heart disease. The risk of developing diabetes is about 25% in 5 years. However, you can reduce the risk of getting diabetes and even return to normal blood glucose levels with modest weight loss and moderate physical activity. If you are told you have pre-diabetes, have your blood glucose checked again in 1 to 2 years.
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Besides being older and overweight, what other factors increase my risk for type 2 diabetes?
Below are additional factors that increase your risk -- the more you can answer "yes" too the higher your risk.
Additional Risk Factors that Increase Your Risk
- I have a parent, brother, or sister with diabetes.
- My family background is South Asian.
- I have had gestational diabetes, or I gave birth to at least one baby weighing more than 9 pounds.
- My blood pressure is 140/90 mm Hg or higher, or I have been told that I have high blood pressure.
- My cholesterol levels are not normal. My HDL cholesterol - "good" cholesterol - is below 35 mg/dL, or my triglyceride level is above 150 mg/dL.
- I am fairly inactive. I exercise fewer than three times a week.
- I have polycystic ovary syndrome, also called PCOS - applies to women only.
- On previous testing, I had impaired glucose tolerance (IGT) or impaired fasting glucose (IFG).
- I have other clinical conditions associated with insulin resistance, such as acanthosis nigricans.
- I have a history of cardiovascular disease.
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How can I reduce my risk?
You can do a lot to lower your chances of getting diabetes. Exercising regularly, reducing fat and calorie intake, and losing a little weight can help you reduce your risk of developing type 2 diabetes. Lowering blood pressure and cholesterol levels also helps you stay healthy.
If you are overweight, then take these steps:
- Reach and maintain a reasonable body weight.
- Make wise food choices most of the time.
- Be physically active every day.
- Be physically active every day.
- Reach and maintain a reasonable body weight.
- Make wise food choices most of the time.
- Reduce your intake of sodium and alcohol.
- Be physically active every day.
- Talk with your doctor about whether you need medicine to control your blood pressure.
- Make wise food choices most of the time.
- Be physically active every day.
- Talk with your doctor about whether you need medicine to control your cholesterol levels.
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Making Changes to Lower Your Risk
Making big changes in your life is hard, especially if you are faced with more than one change. You can make it easier by taking these steps:
- Make a plan to change behavior.
- Decide exactly what you will do and when you will do it.
- Plan what you need to get ready.
- Think about what might prevent you from reaching your goals.
- Find family and friends who will support and encourage you.
- Decide how you will reward yourself when you do what you have planned.
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Reach and Maintain a Reasonable Body Weight
Your weight affects your health in many ways. Being overweight can keep your body from making and using insulin properly. Excess body weight can also cause high blood pressure.
Body mass index (BMI) is a measure of body weight relative to height. You can use BMI to see whether you are underweight, normal weight, overweight, or obese. Use the Body Mass Index Table to find your BMI.
- Find your height in the left-hand column.
- Move across in the same row to the number closest to your weight.
- The number at the top of that column is your BMI. Check the word above your BMI to see whether you are normal weight, overweight, or obese.
- Avoid crash diets. Instead, eat less of the foods you usually have. Limit the amount of fat you eat.
- Increase your physical activity. To lose weight, aim for at least 60 minutes of exercise 5 - 7 days per week. Ths exercise can be divided into small increments, such as 15 minutes, 4 times per day. For more on exercise see www.pamf.org/southasian/healthy/fitness.html.
- Set a reasonable weight-loss goal, such as losing 1 pound a week. Aim for a long-term goal of losing 5 to 7 percent of your total body weight.
What you eat has a big impact on your health. By making wise food choices, you can help control your body weight, blood pressure, and cholesterol.
- Take a look at the serving sizes of the foods you eat. Reduce serving sizes of main courses such as meat, desserts, and foods high in fat. Increase the amount of vegetables and fruits.
- Avoid refined carbohydrates (white rice, white bread, white pasta); substitute with high fiber carbohydrates or proteins, such as cracked wheat, brown rice, or soy pasta.
- You should aim for 30 grams of fiber per day. If you do not know how to read a food label, a PAMF nutritionist can help you.
- Atta, which is used to make roti, is often highly refined (low fiber); look for high fiber whole wheat to make roti and chappathi.
- To soften rotis made with whole wheat, add tofu or ground nuts.
- Limit your fat intake to about 25 percent of your total calories. For example, if your food choices add up to about 2,000 calories a day, try to eat no more than 56 grams of fat. Your doctor or a dietitian can help you figure out how much fat to have. You can also check food labels for fat content.
- Limit your sodium intake to less than 1,500 mg—about 1 teaspoon of salt—each day.
- Talk with your doctor about whether you may drink alcoholic beverages. If you choose to drink alcoholic beverages, limit your intake to one drink—for women—or two drinks—for men—per day.
- Reduce the number of calories you eat daily.
- Keep a food and exercise log. Write down what you eat, how much you exercise—anything that helps keep you on track.
- When you meet your goal, reward yourself with a nonfood item or activity, like watching a movie.
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Be Physically Active Every Day
Regular exercise tackles several risk factors at once. It helps you lose weight, keeps your cholesterol and blood pressure under control, and helps your body use insulin. People in the DPP who were physically active reduced their risk of type 2 diabetes. Many chose brisk walking for exercise.
If you are not very active, you should start slowly. Talk with your doctor first about what kinds of exercise would be safe for you. Make a plan to increase your activity level toward the goal of being active at least 60 minutes a day most days of the week.
Choose activities you enjoy. Some ways to work extra activity into your daily routine include the following:
- Take the stairs rather than an elevator or escalator.
- Park at the far end of the parking lot and walk.
- Get off the bus a few stops early and walk the rest of the way.
- Walk or bicycle whenever you can.
Some people need medication to help control their blood pressure or cholesterol levels. If you do, take your medicines as directed. Ask your doctor about medicines to prevent type 2 diabetes.
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Research on Diabetes in South Asians
We now know that many people can prevent type 2 diabetes through weight loss, regular exercise, and lowering their intake of fat and calories. Researchers are intensively studying the genetic and environmental factors that underlie the susceptibility to obesity, pre-diabetes, and diabetes, especially in South Asians. As they learn more about the events that lead to diabetes, they will develop ways to prevent and cure the different stages of this disease. For information about current studies, see our South Asian research page.
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Further Resources for Diabetes in South Asians
In English:
- Take Care of Your Heart, Manage Your Diabetes. National Diabetes Education Program. Accessed August 2007.
- Diabetes & Asian Americans & Pacific Islanders. National Diabetes Education Program. Accessed August 2007.
- Two reasons I find time to prevent diabetes. National Diabetes Education Program. Accessed August 2007.
- Lifestyle Materials for Sessions 1-16—Handouts. Diabetes Prevention Program. Accessed August 2007.
- Take Care of Your Heart, Manage Your Diabetes. National Diabetes Education Program. Accessed August 2007.
- Take Care of Your Heart. Manage Your Diabetes. National Diabetes Education Program. Accessed August 2007.
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South Asian BMI (Body Mass Index) Calculator
South Asian Ranges:
Underweight: 18.4 or less
Healthy: 18.5 to 23
Overweight: 23.1 to 25
Obese: Greater than 25
If your score is 23.1 or above, get screened for diabetes, cholesterol and hypertension.
Why is the South Asian BMI scale different?