Dr. Hemraj Chandalia requires no introduction in the field of Diabetes; he has been a constant force working for patient education and Diabetes research for many decades now. His areas of specialization include endocrinology, diabetes, obesity and nutrition science. He has been an Honorary Professor of Medicine and Diabetes for the last 30 years at the Grant Medical College, Mumbai. He is affiliated with Jaslok Hospital and has been the patron of Research Society for Study of Diabetes in India. He is also the Director of DENMARC or Diabetes Endocrinology Nutrition Management and Research Centre which is a pioneering institute in India for research and work on Diabetes.
We spoke to him about some of the very basic and common questions regarding diabetes. He shared insights from his vast experience and enthralled us with his sense of humor and his passion for the field.
People swear by you when it comes to Diabetes. What has been your philosophy when treating Diabetes?
Basically our routine management remains the same, but what is probably different is our approach to people. We try to give people a positive picture of the disease and tell them how to live with the disease happily and meet their career goals or have a good family life. That is why none of our centers contain any chart talking about diabetes complications which only works to frighten the patients. I believe it is better to simply educate the patient about his condition rather than frighten him. There are anyway very few chances that the patient will get all the complications, he may get only one or two or he may not get any complication at all, so it would be unfair to work on the basis of fear. Our approach thus is to help the patient in facing the disease quite squarely without any hang ups. We never advocate that they need to change their careers or jobs because of Diabetes.
Do you think our current lifestyle has resulted in the large number of diabetics today?
Yes, I think lifestyle has got a lot to do with the genesis of the disease, and is the cause of the alarming rise of diabetes in India today and hence it is important that we make changes in our lifestyles. However, we must keep in mind that as the country prospers, the lifestyles tend to become unhealthy but if we educate them simultaneously, the impact of unhealthy lifestyle is mitigated. Although it is predicted in India that the number of diabetics will go up to 75 million in 2025, I am hopeful that this will not occur. Not many are this optimistic but I believe that if education improves, even though the disease is rising, it can be countered effectively. The basic wisdom of people in India is very good, and that will help us. Even the uneducated here, can be taught and made to understand, quite well.
What is the relation between Stress and Diabetes?
I think stress is a very important factor; it will precipitate and aggravate diabetes. We know that the incidence of diabetes increases faster in the urban areas and India is getting urbanized fast. The percentage of diabetics in urban areas is about 11% but, in the southern cities it is 13-14%, in villages about 5%, and the semi urban cities fall in between. In this process of urbanization, which exact factor is responsible for the rise in diabetes has not been dissected properly. We know it includes lack of physical exercise, crowding and stress to find out but to disect each one of these and to find out which one causes diabetes is not very easy at the moment. So we are looking at all of these together.
Is the association of Diabetes with eating too much sugar, a correct one?
Not really. If somebody has a genetic predisposition to type 2 diabetes and if these genetic factors are superimposed with adverse environmental factors, then you can get type 2 diabetes. So, environmental factors are also very important. We have found that you can prevent diabetes up to 58% even with genetic predisposition. Someone with a family background (of diabetes) who maintains a low weight and exercises well will have less chances of having diabetes.
So even if the root is genetic, environmental factors have a remarkable impact on the expression of those genes, which means that you may carry the genes but they express only during adverse environmental factors. Between the two, the one factor that we can tackle is the environmental factor. We cannot gene therapy because it is a polygenetic disease which means it is not just one gene but many genes that are responsible for it jointly.
How important is monitoring of your Blood Sugar when managing Diabetes?
It is very important; if you cannot identify the problem you cannot tackle it. So the first step is identifying the problem. But you don’t require the same intensity of monitoring for every patient and also monitoring is a bit expensive proposition because the strips are expensive. Also needle pricks are necessary. Even with the new needles which don’t hurt that much and the strips require very small amount of blood, a needle prick is a needle prick so one might not be too comfortable to monitor their blood very extensively.
At the one end of the spectrum there are people whom we recommend blood sugar monitoring two times in a week and others who need to take insulin three or four times a day, who we advised to monitor two or three times in a day. So it is to be individualized. Very rarely is the patient told not to monitor at all. This is because the disease can change; a person with well controlled diabetes could suddenly find his blood sugar levels going high, so to remove this element of surprise, monitoring is essential. The minimum is twice a week, one fasting and one after meals.
Also what is important is patient education, just monitoring will not be of any use. You need to act on the readings. For this purpose, we are in constant touch with the patient and after a period of time, the patient also knows what to do when the blood sugar is high or low and he doesn’t need us to tell him. This empowers the patient and we are happy when the patient is educated enough to use his own judgement.
Why are increasingly younger people getting diabetes? From 50s or 40s to now people in their late 30s?
This is because the genetic propensity remains the same; our gene pool isn’t changing as much. In India we get type 2 diabetes at least a decade earlier than most other countries. This is because we have a stronger genetic propensity for it, and we carry multiple genes favorable to diabetes. This coupled with adverse conditions like- poor education, economic prosperity, unplanned urbanization, cause this growing numbers of diabetics. In India there is no town planner, we don’t even know the name of the town planner of a mega polis like Mumbai. Our cities have no planning; they are extremely unkind heath wise, to the citizens. Many doctors can tell you this; that the single most important factor causing diabetes is bad town planning and not providing people enough opportunity to walk without being knocked off by a vehicle or without falling in a ditch.
