Health Bulletin-January 2022

Diabetes In South Asians

This article will give an introduction to diabetes, with special emphasis on type 2 diabetes in south Asian population and some practical tips for healthy living.

What is diabetes?

The pancreas, an organ found near your stomach, makes the hormone insulin that helps move the sugar or carbohydrates that we eat from blood into cells. Insulin acts as a ‘key’ that opens the body’s cells and lets sugar in. Without insulin, sugar can’t get into the cells and it stays in the blood.

Diabetes develops when 1 of 2 things happen:

The pancreas does not make any or enough insulin
The body does not use insulin the right way.

Types of diabetes:

Type 1 diabetes: Body makes little or no insulin, seen mostly in children, young adults but can develop in older adults as well. There is insulin deficiency.

Type 2 diabetes: Body makes lot of insulin but resistance to the action of insulin and this is called insulin resistance.

Combination diabetes: Many years of having type 2 diabetes leads to insulin deficiency in the long run.

Prediabetes: Blood sugar levels are high but not high enough to be diabetes.

Gestational diabetes: In women during pregnancy, blood sugars run high due to insulin resistance or insulin deficiency.

Incidence of diabetes:

34 million people in the US have diabetes
Asian Indians in the US have the highest risk for diabetes that develops at a younger age and at lower body mass index (BMI). Compared with whites, Asian Indians have three times the risk of diabetes, when adjusted for age, sex, and BMI and the risk is substantially higher than all minorities in the US

Testing for diabetes:

Random blood sugar test: Over 200 mg/dl two hours after meals

Fasting blood sugar test: Over 126 on two different occasions

Hemoglobin A1c: Average of three months sugars greater than 6.5%

Prediabetes: A1c between 5.7% to 6.4%

Risk factors for type 2 diabetes:

Factors that cannot be changed:

Age 45 or older
Family history of diabetes
High risk ethnicity like Asian American or South Asians
Diabetes during pregnancy (gestational diabetes)
Women with PCOS (Polycystic ovarian disease)

Factors that can be managed:

Overweight or Obese
Not physically active
Have metabolic syndrome which is combination of high blood pressure, high cholesterol, low good cholesterol and overweight.

Symptoms of diabetes:

Urinating often
Feeling very thirsty
Blurry vision
Cuts or bruises that heal slow
Feeling very tired
Weight loss/weight gain rapidly
Tingling /pain/numbness in hands or feet

Why high blood sugar is a problem: Overtime, high sugar damages your blood vessels, both large and small. This damage can lead to complications that affect the whole body. Such complications include:

Heart attack
Stroke
Kidney disease leading to dialysis
Vision problems leading to blindness
Nerves being affected causing chronic pain and falls
Circulation problems leading to limb loss (amputation)
Increased risk of infections

How can diabetes be prevented or managed?

Eating Healthy:

Complex carbohydrates like whole grains (quinoa, oats, brown rice or wild rice) in limited portions. Avoid or limit white rice
Fiber foods like beans, whole grains, fruits and vegetables to be consumed more
Lean protein such as chicken, fish and eggs. Vegetarian sources of protein include dairy products, tofu, lentils or protein shakes.
Heart healthy fats like olive oil, canola oil, nuts and seeds
Alter breakfast recipe by using whole grains in place of white rice wherever possible for making dosa, idli and upma.

Read food labels:

Check serving size and amount of carbohydrates which turn into sugar
Look for foods with more than 2.5 gm of fiber per serving
Avoid saturated and trans fat

Being active:

Talk to your doctor about any restrictions
Choose an activity that you enjoy like walking, jogging, hiking, swimming or dancing
Strength training which is exercising with weights will improve lean body mass and utilize sugar better.
Set goals like 30 minutes, 5 days a week or more.
Tips: Park far away and walk, take stairs, chair exercises, walk with a pet, move during TV commercials, clean the house, mow the lawn, yoga and dance

Taking medicines:

Many people with diabetes have to take medicines to keep blood sugars under control and these medicines are a combination of pills and injectable medicines.
Combination treatment with two or more pills and injections works better than one medicine as diabetes is a complex disease and changes over time.
One may also need blood pressure medicines, cholesterol medicines, heart medicines to prevent or manage long term complications of diabetes.
Important to take all necessary vaccinations to prevent infections.

Keeping track of sugars:

Using a glucose meter to check fasting and 2 hr post meal numbers
Using a continuous glucose monitoring for insulin requiring diabetes
For prediabetes, random fasting blood testing during annual physical exams or as needed.

Monitoring overall health:

Heart health: Blood pressure and cholesterol check
Kidney health: Urine and blood test once a year
Eye health: Dilated eye exams once a year
Foot health: Maintain hygiene, clip nails across, wear shoes with socks and get feet checked annually by doctor.
Dental health: Cleaning every 6 months by professional

Author information

Geetha Reddy Soodini, MD

Diabetology, Endocrinology, Diabetes & Metabolism and Internal Medicine, Atlanta, GA

(Dr. Soodini graduated from the Kakatiya Medical College in 1998. She works in Cumming, GA and specializes in Diabetes, Endocrinology, Diabetes & Metabolism and Internal Medicine. Dr. Soodini is affiliated with Northside Hospital.)

Coordinated By

Sujeeth R. Punnam, MD
Chair, ATA Health Committee

(Dr. Sujeeth R. Punnam is a cardiologist in Stockton, California and is affiliated with multiple hospitals in the area, including Dameron Hospital and St. Joseph's Medical Center-Stockton. He received his medical degree from Kakatiya Medical College NTR and has been in practice for more than 20 years.)