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Defying Diabetes

Nov/03/2023 / by Lindsey Galloway

South Asians have unique risks and challenges when it comes to diabetes and its associated conditions. But more research is helping patients get screened earlier and live healthier lives.

More than 37 million Americans—or about one in 10—live with diabetes. But about one in five of those individuals don’t even know they have it. That risk may be even higher among South Asians, who have unique predispositions to the disease, and may require different screening metrics. 

“Amongst the entire Asian American population, as per 2020 U.S. census, South Asian adults had the highest incidence of Type 2 Diabetes,” explains Dr. Chhaya Makhija, founder of Unified Endocrine and Diabetes Care in California. “Type 2 diabetes is a major risk factor for atherosclerotic cardiovascular disease. Together, T2D and ASCVD are leading causes of death and disease in the Asian American population.” 

The disease can be managed and prevented, but knowing the risks and warning signs is key. In honor of National Diabetes Month this November, we spoke with doctors about what women can do to detect the early signs, and make the lifestyle changes needed to stay healthy for the long-term. 

Drivers of Diabetes Risk

While research on why South Asians have a higher risk of diabetes is still forthcoming, some early studies have shown that South Asians may have reduced B-cell function (a type of white blood cell), which can affect insulin production, when paired with unhealthy lifestyles. “Higher intracellular fat in muscle and liver cells, lesser lean body mass and reduced Beta cell function all increase the risk of prediabetes, and type 2 diabetes in South Asian adults,” explains Dr. Makhija.

Dr. Betul Hatipoglu, professor of medicine at Case Western Reserve University, agrees, stating that genetics can contribute to higher insulin resistance, and being more prone to abdominal fat, which increases risk. 

Understanding insulin resistance is key to better understanding diabetes risk. “Insulin resistance implies that the body’s own insulin is less effective as the cells in the body are resistant to its action,” says Dr. Makhija. Excess intracellular fat (fat within the cells of the body) eventually affects entry of insulin in the cells, and when that insulin can’t lower blood sugar effectively, diabetes is the eventual outcome. 

Immigrants to the US may also face an increased risk, since dietary norms in the U.S. often include more fried foods, processed foods, and saturated fats, all which exacerbate the factors that contribute to diabetes. 

The Importance of Early Screening 

Given the elevated risk, Dr. Hatipoglu advises that South Asians can never be too careful when it comes to advocating for their health. “It’s always important to be screened early,” she says. “Many times, individuals might not have any warning signs.” 

Early warning signs can include increased thirst, frequent urination, fatigue and infections, which can indicate high blood sugar. Skin findings like acanthosis nigricans also warrant diabetes screening.

Dr. Makhija recommends screening by age 30-35 or if BMI exceeds 23. PCOS, irregular cycles or infertility are other indicators for testing. Heart disease patients should also be screened, since diabetes accelerates atherosclerosis. 

Preventing Prediabetes and Diabetes

If you haven’t yet been diagnosed, the right lifestyle changes can prevent diabetes. “Research has supported many beneficial aspects of the Asian dietary pattern, including the use of unsweetened tea, consumption of fresh fruits and vegetables, and use of soybeans and plant-based products,” says Dr. Makhija. 

She cautions against excessive refined carbs, sodium, saturated fats, fried and processed foods. Healthy carbs with high fiber can help, as will keeping an eye on portion sizes.  

Staying active also has tangible benefits on blood sugar. “Physical activity plays a vital role in utilizing glucose for muscle energy, thereby helping to reduce insulin resistance and improve blood glucose control,” explains Dr. Makhija. “It has beneficial effects in every aspect of health,” She highlights walking, yoga and strength training as great options to pursue.

Quitting smoking, managing stress, and getting enough sleep also support prevention. “The important interventions are similar for all,”  Dr. Hatipoglu. “Healthy carbohydrate choices with high fiber, watching portion size, adding activity to your daily life, stress management, and sleep hygiene all count.”

Risks and Complications 

When blood sugar imbalances persist undiagnosed and untreated, serious consequences can result. “If blood glucose levels are high for a prolonged period, the symptoms are increased thirst, increased urination, increased susceptibility to infections and severe high blood glucose levels can lead to fatigue, weakness, dehydration and even diabetes coma,” warns Dr. Makhija.

Long-term, high blood sugar damages blood vessels and nerves. “Diabetes mellitus type 2, if remained uncontrolled or in poor control, leads to complications like retinal disease (eye complications), impaired wound healing, foot ulcers, neuropathy and kidney disease,” says Dr. Makhija. If you’re experiencing any of these types of symptoms, it’s important to get screened for type 2 diabetes right away. 

Managing Diabetes

For South Asian women already diagnosed with diabetes, balancing blood sugar hinges on supportive lifestyle strategies. “Opting for foods with lower saturated fat and higher fiber content is an important element of change in nutrition,” says  Dr. Makhija. “Other recommendations include avoiding processed foods, increasing intake of fruits, vegetables, legumes, lentils, beans, nuts and seeds along with personalizing the dietary recommendations based on culture, disease, age and other preferences.”

Dr. Hatipoglu suggests women work with dietitians to make culturally appropriate choices. Portion control and non-fried cooking methods are also key, as is regular exercise, particularly strength training. “A plethora of evidence exists showing that muscle strength training helps improve insulin sensitivity,” says Dr. Makhija. Work directly with your health care team for some advice on how to get started. 

Beyond nutrition and fitness, Dr. Makhija’s holistic approach encompasses stress relief, restful sleep and smoking cessation. She also emphasizes diabetes education and personalized goal-setting. Medications can also supplement lifestyle strategies (See “The Hype and Risks Behind Ozempic” sidebar).

Watching Out for Women’s Health 

Diabetes impacts women’s health in additional ways. Diabetes has a strong link to polycystic ovarian syndrome (which South Asian women are also at increased risk for), and women face additional risk during pregnancy for gestational diabetes, which requires specialized care.  Menopausal women also should note that diabetes accelerates bone loss, which can lead to osteoporosis. “For women, pregnancy and menopause are high-risk periods,” explains Dr. Hatipoglu. “Dealing with perimenopause weight gain with the postmenopausal increased risk of metabolic syndrome can be challenging.” Implementing and maintaining a healthy lifestyle becomes even more essential during these pivotal times. 

Staying Aware

Education and awareness are the first key to understanding and managing diabetes risk. By sharing information with patients, they can take better charge of their own health and the health of their families. “In my practice, patients are educated about insulin resistance, root causes of chronic diseases and then 6 pillars of lifestyle medicine,” explains Dr. Makhija. “Defining goals, providing ongoing support and education are necessary to empower patients.”

With the right knowledge and treatment plan, diabetes can be managed and prevented all together, leading to healthier and more active lifestyles for all. 

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The Hype (and Risks) Behind Ozempic

The drug Ozempic has been in the headlines lately, as the medication (often prescribed to help manage diabetes) has been shown to curb appetite and has been heralded in celebrity circles. 

An injectable medication used to improve blood sugar control in adults with type 2 diabetes, Ozempic works by mimicking the effects of GLP-1, a hormone that helps regulate blood sugar levels. It stimulates the release of insulin when blood sugar is high. It also suppresses appetite and slows digestion to help control blood sugar.

In trials, Ozempic was shown to lower A1c levels (a measure of long-term blood sugar control) in adults with type 2 diabetes. But the drug also comes with warnings and risks, and shouldn’t be taken without doctor supervision. 

The risk for gallstones also increases for women in general after age 40 in postmenopausal women, and Ozempic also comes with an increased risk of gallstones, so women should work with their doctors to minimize risk. 

Women who want to conceive should  also cease the drug two months prior to conception. “Upon discontinuation of these medications, there is a rebound weight gain usually after 5 weeks of discontinuation,” advises Dr. Makhija. “Patients should optimize lifestyle changes and discuss other treatment options with their diabetes care team.” 

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Asians living in America are 40% more likely to be diagnosed with diabetes, compared with the white population – despite having lower average BMIs.