How blood sugar myths are harming you: What you need to know about diagnosis truths

 Written by Dr. Ambrish Mithal

Source: https://indianexpress.com/article/health-wellness

Over the past few months, social media has been flooded by new information about the diagnosis of diabetes that runs contrary to science. Many people believe in these fake unscientific forwards on their phone and end up damaging their health.

What’s floating online?

Most of these so-called experts claim the following:

1. The criteria for diagnosis of diabetes has been altered frequently in recent years.

2. These alterations have reduced the threshold level of blood sugar used to diagnose diabetes.

3. Reduction in diagnostic levels leads to millions of additional people being labelled as diabetics.

4. These changes are decided upon by a few ‘wise’ men seated on a table according to their whims, based on random parameters.

5. More people being diagnosed with diabetes means more will require medication.

6. All experts who are involved in this decision making are hand-in-glove with drug manufacturers. So ultimately the process is driven by the pharmaceutical industry so that they can make billions of dollars.

Are these allegations true?

In 1979, the WHO formally defined diagnostic criteria for diabetes mellitus based primarily on plasma glucose levels — fasting plasma glucose more than or equal to 140 mg/dl, and a two-hour post-glucose value more than 200 mg/dl.

In 1997, the threshold for fasting plasma glucose was lowered to 126 mg/dl by the American Diabetes Association (ADA). The post-glucose cut-off of 200 mg/dl was retained. The 1997 changes in the diagnostic criteria for diabetes were influenced by studies which provided evidence that levels between 126 and 140 mg/dl were also associated with an increased risk of diabetes-related complications, supporting the need for lower diagnostic thresholds for diabetes.

The diagnostic criteria for diabetes have not changed since 1997.

What about prediabetes?

The 1979 WHO criteria recognised impaired glucose tolerance as a post-glucose value between 140 and 199 mg/dl. This is the same as we use today. The major change in 1997 was the inclusion of a category called impaired fasting glucose — fasting glucose values between 110 and 125 mg/dl. In 2003, the ADA further lowered the fasting glucose criterion to 100 mg/dl. Some studies showed that individuals with fasting glucose levels between 100 and 109 mg/dL were also at a higher risk of progressing to Type 2 diabetes. Additional research indicated that fasting glucose levels in the range of 100 to 109 mg/dL were associated with an increased risk of cardiovascular diseases. However, the WHO continued to use a fasting level of 110 mg/dl as a cut-off.

 Glucose Testing and Interpretation

Since then the cut-offs for fasting plasma glucose and oral glucose tolerance tests have remained the same with the only change being HbA1c (average blood sugar counts of three months) included in 2009. An HbA1c level of 6.5 per cent or more is diagnostic of diabetes mellitus. Levels between 5.7 to 6.4 per cent indicate prediabetes.

The importance of prediabetes lies in the risk of its conversion to diabetes or possible remission. In India 60 per cent of those with prediabetes convert to diabetes in five years. Initiatives like the Indian Diabetes Prevention Programme (IDPP) have demonstrated that lifestyle interventions can reduce the risk of progression to diabetes by about 28-35 per cent. Medications are used for a minuscule number of people with prediabetes. The last change in diagnostic criteria in 2003 added a large number of people to the pool of prediabetes so that people could recognise their risk and initiate lifestyle changes.

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The increase in diabetes prevalence is real and not because of changed criteria. Consult a qualified practitioner.

Heart attack among techies in 30s: How overwork, 70-hour week and stress can damage your heart

 Source: https://indianexpress.com/article/health-wellness

Cardiologist explains risk factors among Bengaluru’s techies between 20 and 35.

Over time that damages the heart, and even accelerates levels of blood sugar, cholesterol and triglycerides.

Just the other day, a 33-year-old executive, came to the emergency in the evening as he suffered a heart attack. I had to do an emergency stenting in all three of his arteries which were blocked well over 90 per cent. He worked from home but rarely detached himself from his laptop, logging in at 7 am and logging out at 8 pm. Then he took a 10-minute break and living alone, ordered food almost every day. He would have his dinner by 9.30 pm, would enjoy a smoke or drink occasionally, take work or personal calls and sleep by 11 pm.

I recount this story to highlight how punishing 12-hour work days (assuming there is one weekly off) to meet the 70-hour work week rule being advocated by the likes of Infosys founder Narayana Murthy and now OLA CEO Bhavish Aggarwal can cost the body. The young executive’s life is a perfect example of how a decade of long sedentary work hours, with the stress of delivery deadlines that left little time for him to unwind, amplified moderate risks or underlying conditions faster. Remember the young man slept the requisite hours but being on a wire during the most productive decade of his life, had poor sleep quality.

I admitted another young patient with a blood pressure of 200/115 mmHg, without him feeling it (young people generally do not feel symptoms of elevated blood pressure). He did sports with a friend on weekends but that wasn’t enough to offset his high-stress 14-hour five day week.

HOW DO LONG WORKING HOURS AFFECT THE HEART?

Most of my patients are from the tech park in Bengaluru’s Whitefield, between 20 and 35. All of them have a similar work profile — no less than 12-hour workdays or long night shifts, emergency duties, two hours of commute time through congested roads and crunching sleep, family time and recreation in about an eight to ten-hour window, often interrupted by work calls. Zero physical activity.

The body is clearly in a prolonged adrenaline rush because of too much stress and demands made on it. Excess adrenaline constricts the arteries that supply the heart with blood, reducing blood flow, hastening plaque buildup and inflammation. Stress hormones like adrenaline and cortisol cause the heart to beat faster, elevating blood pressure in the process. Over time that damages the heart, and even accelerates levels of blood sugar, cholesterol and triglycerides. No exercise means weight gain.

Chronic stress results in irregular heart rhythms, which can cause blood to pool in the left atrial chamber of the heart, contributing to clot formation. The clot can then travel from the heart to the brain and result in a stroke.

For those with underlying conditions like diabetes, cholesterol or with a family history, even short-term stress can dislodge plaques from the arteries it narrows down, resulting in a blood clot that, in its attempt to repair the torn wall of the arteries, could grow large enough to block blood flow completely and cause a heart attack. During angioplasty procedures among the young, I have often found that the plaque may not have been big enough but the stress-induced thickness of the blood has led to quicker clot formation.

LIFESTYLE CORRECTION MUST

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A Lancet study has shown that individuals who worked more than 55 hours per week had a 13 per cent increased risk of developing heart disease compared to those who worked standard hours.Smoking and alcohol are other stressors and can accelerate triggers even with limited use. So lifestyle correction — diet, sleep and exercise — are a must. If prescribed medication, strictly go by your doctor’s advisory.