In the valley, the tertiary care center - SKIMS - is leading the awareness campaign. In recent days from Kashmir’s premier physician---Prof (Dr) Allaqaband down to the noted diebetologist— Prof (Dr) Hamid Zargar, and the present director of SKIMS - Prof (Dr) Showkat Zargar I have heard it repeatedly that in Kashmir, the increasing cases of diabetes are assuming epidemic proportions. That might be a way of making it emphatic, as an epidemic has a different corollary in the field of medicine, as well as a unique definition, and a different dimension too. However under-estimating the effect would be detrimental in planning the ways and means to overcome the demoralizing, deadly disorder; it might be perfectly in order to err on the positive side rather than be caught napping by getting into denial mood.
On a psychological pattern, at an individual level, denial in the face of a serious malady is a known phenomenon; however, effort should be not to make it a mass effect in future health planning. We cannot afford to falter in planning, if we are to save precious lives. Indicators are already there in plenty that we are in the danger zone, a scenario, where alarm bells must ring. The hypo-nutritive (low nutrition) state of bygone years might soon be a distant memory in our part of the world though protein mal-nutrition (low protein nutrition) with pot bellies and sunken eyes does hit our TV screens in African/Latin-American news dispatches, off and on. 
We are reminded of Europe during war years (1939-1945) when food was rationed. It might not have made an Africa of Europe; in fact it did Europe well in some aspects. Rationing meant low incidence of diabetes, it is a part of medical lore. However, by mid-fifties as Marshall Plan (named after American Secretary of State who planned European recovery) started taking effect with European developmental re-construction, the diabetic graph showed an upswing. Development, like it or not, does have a side effect. Hyper-nutritive (nutrition more than what is required) state coupled with complacent effect of taking it easy and getting into the groove of low physical effort is harmful. The price to be paid is ominous---higher incidence of diabetes, of cardio-vascular disorders, of blood thickening, of clots, of diseased blood vessels, of sudden deaths. 
Sudden deaths occur due to blood vessels getting sclerosed or developing fatty plaques, weakening in the process and getting prone to accidents like hemorrhage, thrombosis (clot formation) embolism (circulating thrombus). Sclerosis might be age related degenerative disorder, hence un-avoidable, however by leading a frugal life style, aging could be delayed. Fatty plaque (atheroma—fat deposits resulting in fatty degeneration of vessel wall) may occur even before age overtakes due to dietary indiscretion (high protein, high fat diet). Diabetes related vascular disorders add to the deadly scenario. Besides diabetic neuropathy, nephropathy, retinopathy (effect of diabetes on nerves, on kidney, on retina (the nerve layer of eye transmitting images to visual center in the brain) makes diabetes a deadly disorder.
SKIMS of late has shown a high level of concern. The heightening incidents are increasing the work load, an un-avoidable professional liability. However it has stimulated research, a deeper study of the phenomenon in the vale, coupled with a holistic effort to combat the disorder with a wider study by organizing seminars, workshops and conferences. Even before the tertiary care institute organized a seminar on World Diabetes Day on 13th November to create awareness among the people about the disease and preventive measures needed, a month earlier on 8th October precisely, a conference on diabetes and nutrition was held, in collaboration with Indian Diabetic Association. The conference was attended and addressed by eminent medical professionals in the field from all over the country, widening the focus.
India might be becoming the world capital in more than one disorder. It might have already qualified as world capital of AIDS, which is being widely voiced. The emerging scenario of India being the world diabetic capital adds to international medical community zeroing in on India. Whether it translates into increasing funding in research remains a matter of speculation. With the existent source material, the country should qualify for wider funding to find the right answers to a global malady. Vis-à-vis valley, the fact remains that ever increasing workload, disproportionate to what a tertiary care center should carry hardly leaves time or the needed energy to devise new strategies to combat disorders related to hyper-nutritive states by research based techniques. In spite of that, the statistical data compilation, a vital feedback in planning care is appreciable.
In the October 8th conference organized by nutritionists of SKIMS with Nosheen Fazli working as the nutritional consultant in Gastroenterology department of SKIMS, its moving spirit, some vital information came forth. Though a global disorder with common features and typing of various forms showing a common denominator, diabetes in India has demonstrable differences in the statistical data. Dr. Amit Sachdeva of Abbott Nutrition International quoted the Indian diabetic population being in the range of more than 50 million. The common form (Type 2 Diabetes) is known for ‘Adult Onset’ in west mostly after 50 years of age. In India however, the onset is seen one or two decade younger. 
This statistical data matched the one projected by SKIMS Endocrinologist, Dr Shariq Masoodi in 13th November seminar “In 2008 we did a study on people between 20 to 40 years age group, in the productive age. We were surprised to know 2.5 percent had Diabetes, another 25 percent had pre-diabetes. 1 in 4 young people had pre-diabetes. Only 1 in 10 knew they have Diabetes,” the projection of Dr. Shariq amply points to the demoralizing, detrimental, deadly disorder in the valley. Dr. Shariq added “the number of diabetic patients visiting the institute has increased. “High food intakes and less physical activities are among the main reason behind the disease”. 
His colleague, Dr Bashir Ahmad Lawai Additional Professor Endocrinology SKIMS, noted the reason behind the increase of diabetic patients is people’s fear for insulin injections, and insulin leading to addiction. “Let it be known, it is not always life long, once the blood glucose is under control, those may be reduced or stopped. It may also be controlled with oral drugs,” pleaded Dr. Bashir. He proposed. “A national consensus for the treatment of diabetes should emerge, where a blue-print could be laid down for exploring all opportunities needed to reduce the prevalence of this disease”. Dr. Bashir’s plea is valid, as varying approaches confuse the patient and confound the care givers.
“The previous decade has demonstrated the increasing trend, as Indians have become more affluent, urbanized, and mechanized, leading a hectic lifestyle and the easy availability of convenience foods have led to irregular meals and frequent snacking on energy dense fast foods ” the facts were laid out by Dr. Amit Sachdeva on October, the 8th, adding “Although obesity is a risk factor for diabetes both in India and in the West, the disease appears at a lower threshold of obesity in India, as is also the case in China, Japan and other Asian countries”. Thus continental variation stands proved by statistical data. There are problem areas in management---insulin resistance and the metabolic syndrome rapidly increasing in urban areas in India. Alternative management strategies are being researched and tried with varying results.
Diet management remains a preferred plan. Lately Medical nutrition therapy (MNT) is much in vogue. It has been defined as” The therapeutic use of nutrition for the purpose of disease management”. Goals of (MNT) are to decrease the risk of diabetes and cardiovascular disease by promoting healthy food choices and physical activity leading to moderate weight loss that is maintained, achieve and to maintain blood glucose levels in normal range, a lipid and lipoprotein profile that reduces risk for cardiovascular disease and Blood pressure levels in normal range.
MNT addresses individual nutrition needs and take into account personal and cultural preferences, willingness to change and maintain enjoyment of eating 
by only limiting food choices when indicated by scientific evidence. The daily carbohydrate intake should be approximately 50–60% of the total calorie intake; dietary fiber in daily diet should be 25–40 g/day. Fat intake should be less than 30% of total energy/ day; cholesterol intake should be limited to 200–300mg/day. Protein intake should be based on body weight. This should be 1 g/kg/day, in conjunction with energy intake; the protein intake should provide 10–15% of the total calories/day in sedentary to moderately active individuals.
Advisory: apparently healthy individuals may not be as healthy, as they might think. The need to assess periodically blood sugar levels and lipid profile is imperative, as also to consult the nutritionist to work out the dietary regime, and daily exercise schedule.
Do it now, tomorrow might be late!

Yaar Zinda, Sohbat Baqi
(Reunion is subordinate to survival)
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Lastupdate on : Sun, 27 Nov 2011 21:30:00 Makkah time
Lastupdate on : Sun, 27 Nov 2011 18:30:00 GMT
Lastupdate on : Mon, 28 Nov 2011 00:00:00 IST