South Africans of Indian descent carry the heaviest diabetes burden of any group in this country.
Image: Mark Hutchinson
We carry the heaviest sugar burden in the country. The reasons are in our bodies, our kitchens and our habits — and only two of those three are out of our hands.
ASK any family in Chatsworth, Phoenix, Reservoir Hills, or Tongaat how many of their relatives have “sugar”, and nobody counts on one hand. An aunt on tablets. A father on insulin. A grandmother who lost her sight, or a toe, or a kidney - and a family that speaks about it the way you speak about the weather.
We have made peace with something we should be furious about.
South Africans of Indian descent carry the heaviest diabetes burden of any group in this country. The national health and nutrition survey found it. Community studies in Durban have been finding it since the 1980s. And the problem is not simply that more of us develop diabetes. It is that we develop it younger, we develop it at a lower body weight, and the damage arrives sooner.
Thin does not mean safe
Here is the most dangerous sentence in the family: “But I’m not fat.”
At the same weight and the same height, a South Asian body tends to carry more fat packed around the organs - the liver, the pancreas, the middle - and less muscle than a European body does. Muscle is where your body parks the sugar from your food.
Less parking space, plus more fat wrapped around the engine, means the insulin you produce works poorly. Doctors call it insulin resistance, and it is the beginning of type 2 diabetes. It starts years before anything shows on a blood test.
So the slim uncle with the small paunch and the thin arms may be in more trouble than the heavier man standing next to him. This is exactly why the international measurements were changed for people of Asian descent: overweight starts at a body mass index of 23 for us, not 25. And the waist matters more than the scale - 90cm for men, 80cm for women. Not the trouser size you buy. The tape around your navel.
Ten years early
Elsewhere, a diagnosis at 60 is unremarkable. Here it lands in the forties, and increasingly in the thirties.
That is not a technicality. Diabetes causes its harm by duration. Diagnosed at 38 means that by 58 you have carried it for two decades - straight through your working life, your children’s weddings, and the years you were planning to enjoy. The eyes, the kidneys, the nerves and the arteries all keep the same calendar.
The genes load the gun. The kitchen pulls the trigger.
We do inherit the susceptibility. That part is real, and it is not your fault.
But genes do not change in two generations, and ours have not. What changed is the plate and the pace: white rice twice a day, roti alongside it, three sugars in the tea, a box of sweetmeats at every prayer and every function, and a life spent sitting - in the car, at the desk, in front of the television.
There is one more piece that gets missed. The stage before diabetes - what your doctor calls pre-diabetes, or borderline sugar - moves to the real thing faster in our community than in most. So when someone is told “your sugar is just a little high, watch it”, that is not reassurance. It is the last exit before the highway, and most people drive straight past it.
What to do this week
Measure your waist. A tape measure at the level of your navel, after you breathe out. Over 90cm as a man or 80cm as a woman, you act now -whatever the scale says.
Get the test. An HbA1c or a fasting glucose. It is available for free at your local clinic and cheaply at most pharmacies. Do it from age 35 if anyone in your immediate family has diabetes, and sooner if your waist is over the line.
Know your number - and know which test it came from, because the two are not read the same way. HbA1c is a percentage: below 5.7 is normal, 5.7 to 6.4 is borderline, 6.5 and above is diabetes.
Fasting glucose is measured in millimoles per litre after nothing to eat overnight: below 5.6 is normal, 5.6 to 6.9 is borderline, 7.0 and above is diabetes. Ask which one you had, write it down, and compare it next year. Any abnormal result should be repeated before you are labelled.
Build muscle, not only sweat. Walking is excellent. But two sessions a week of resistance work - weights, bands, or your own body weight - enlarges the parking space for sugar. This is the step our community skips almost entirely.
Halve the starch. For your sugar specifically, the damage is done by the mountain of rice and the second roti - not by the spice. The oil and the ghee in the pot matter too, but they matter for your heart and your cholesterol rather than your sugar, and that is a conversation for another column.
The part worth hearing
Pre-diabetes can be reversed. Early diabetes can, in some people, be pushed into remission with meaningful weight loss. And even where it cannot, controlling it well from the start is the difference between living with diabetes and being disabled by it.
Everything described here is treatable, and almost all of it is detectable years before it does you any harm. The one thing that guarantees the worst ending is the belief that this is somebody else's problem - that you are too young for it, or too thin for it, or too well for it.
There is a tape measure in a drawer in your house. It will tell you whether that belief is true. Start there this week.
Ask the doctor
Q: My doctor says I must start insulin. In my family, the ones who went on insulin are the ones who lost their sight and their legs. Does this mean I am near the end?
A: No - and the order of events in your family is the wrong way round. Insulin did not cause what happened to them. It was started late, after years of sugar that was never properly controlled, by which time the damage to the eyes and the feet was already done. Type 2 diabetes is progressive: over time the pancreas cannot keep up. Needing insulin is a stage of the illness, not a verdict on you or a punishment for failing. Starting it when your doctor first advises it is protective. Starting it three years later is what costs people their sight.
Dr Jay Matthew.
Image: Supplied
Dr Jay Matthew is a physician and healthcare academic based in KwaZulu-Natal. This column provides general health information and does not replace a consultation with your own doctor.
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