Folks of South Asian descent could have a better threat of sort 2 diabetes than they could count on, even when they don’t seem to be 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 sort 2 diabetes than folks of different ethnic backgrounds. And lots 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 Drugs, has seen this threat in her sufferers, her household, and even herself. Right here, she shares her ideas on what folks 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 turn into 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 affix endocrinology after I bought 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 totally 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 sort 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 principally blocks the impact of insulin on these crucial buildings. Now, the mind and the muscle are two areas in your physique that basically do not want any insulin to uptake glucose. So … despite the fact that individuals are exercising, they [can] develop insulin resistance and kind 2 diabetes [if] their muscular 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 sometimes very wholesome. They’ve a standard BMI, they train, and so they nonetheless can not 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.]

An excellent 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 will have sort 2 diabetes, you will have insulin resistance. You will have a variety of insulin, but it surely does not work as properly. So that you require an entire lot extra insulin to do the job of what it ought to have carried out 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 greater quantity of blood sugar to launch insulin and your beta cells aren’t as energetic 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 better 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
  • Another member of the family who has sort 2 diabetes plus a historical past of coronary heart illness, hypertension, and triglycerides better 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 vital that South Asians advocate for themselves and inform their main care doctor, “I perceive that you’d sometimes not have gotten an A1c in somebody like me, however as a result of I am South Asian, my threat is way greater at a decrease BMI and I am at a better threat for having sort 2 diabetes. This is the reason you need to display screen me.”

WebMD: How do you counsel your sufferers relating to food plan and train?

Shariff: I by no means say you should cease consuming one thing [if you have] diabetes, which is a breath of contemporary air for many sufferers. I say, ‘I would like you to grasp what you possibly can eat much less of and what try to be consuming extra of and learn how to steadiness your food plan.’

Many South Asians are vegetarian and it’s a heavy carb food plan. No matter sort of carb you’re going to eat, it’s going to boost your blood sugar. Attempt to keep true to your flavors and be inventive with how one can modify the carb parts of your meals into much less carbohydrates, or excessive fiber, excessive protein choices. 

Generally folks train and different occasions they don’t. I put 70% emphasis in your food plan. In case you eat meals that work together with your prognosis of diabetes, your sugars are going to be higher. This permits your insulin resistance to return down. 

 WebMD: What message do you wish to ship South Asians relating to a sort 2 diabetes prognosis? 

Shariff: It’s a must to steadiness sustainability and perceive you should search assist. You don’t need diabetes to outline you. 

 



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