Diabetes which is commonly known in Pakistan as “sugar” is on a rampage in the country. We are now a country with the third-largest population of diabetic adults after China and India. According to the 10th edition of an atlas produced by the International Diabetes Federation in 2021, Pakistan has 33 million adults with diabetes. This comes to approximately one in four adults above 20 years of age. Even more alarmingly, if we do not take remedial action in terms of prevention and treatment, by 2030 this number is projected to swell to around 43 million and if the alarmingly increasing trend is not arrested by 2050, the diabetic population will rise to 62 million. Currently, 8.9 million people are estimated to be undiagnosed and another 11 million adults have impaired glucose intolerance, i.e. pre-diabetes. You have no idea why you’ve been feeling so tired lately. You’re also going to the bathroom more often than usual. Growing concerned, you decide to check in with your physician. They say you could have pre-diabetes and suggest running a test. You’re relieved. Diabetes? You’ll just watch your sugar intake. It’s no big deal. Most people think it is just a sugar issue and that it’s not going to cause any problems. But it’s not as simple as not putting sugar in your tea or coffee. It is a metabolic problem, so you’ll need to do more than just cutting back on sugar. This line of thinking is dangerous, to say the least. It is the perception of diabetes that makes people not take it seriously. Pre-diabetes, or borderline diabetes, is when your blood sugar level is higher than it should be but not high enough for your doctor to diagnose diabetes. Pre-diabetes is therefore a big deal. Don’t let the “pre” fool you. Pre-diabetes is a serious health condition. Pre-diabetes puts you at increased risk of developing type 2 diabetes, kidney problems, heart disease and stroke. When doctors tell most patients they have pre-diabetes, they may not feel that it rises to the top of their priority list. Some patients may tell themselves, that even if presented with a type 2 diabetes diagnosis shall mean that it is nothing to worry about because they don’t have diabetes yet. The reason, at some point in the future they will do something to stop their condition from becoming more serious. However, Pre-diabetes must be seen as a warning sign; it’s the body’s way of saying that your insulin levels are rising. The common risk factors for pre-diabetes include being older than 45, exercising fewer than three times a week, having a parent or sibling with (or a family history of) type 2 diabetes, and giving birth to a baby that weighed more than 9 pounds. Women who have polycystic ovary syndrome (PCOS), a hormonal disorder are also at higher risk for the condition. The term “Pre-diabetes” is also known by several other names like: * Borderline glucose * Impaired Glucose Tolerance (IGT, which refers to high blood glucose levels after a meal.) * Impaired Fasting Glucose (IFG, which refers to high blood glucose levels in the morning on an empty stomach.) Pre-diabetes is one of those conditions that rarely exhibit any signs or symptoms. The condition is often diagnosed by chance during a routine screening or blood check. My mother was diagnosed with Pre-diabetes a decade back or so, in her 50’s by her General Family Physician. Professor Javed Akram. He is a renowned Pakistani academic who is a former Caretaker Minister of Health of the Government of Punjab and, former Vice-Chancellor at the University of Health Sciences, Lahore and the Shaheed Zulfikar Ali Bhutto Medical University, Islamabad. Dr. Javed Akram has also served as the former principal of Allama Iqbal Medical College, Lahore. He is an eminent Professor of Medicine and well known as a global medical researcher. Our extended family did not take my mother’s diagnosis seriously. I do not blame them as they had and continue to not consider Pre-diabetes as a medical condition due to lack of awareness. It is a metabolic problem, so you’ll need to do more than just cutting back on sugar. My mother since her diagnosis, regularly checks her blood sugar both at home as well as routine vitals noting during her consultation with Professor Javed Akram at his private clinic, Akram Medical Complex. It is not a matter of choice but a critical exercise for patients like my mother who are highly prone to being diagnosed with Pre-diabetes. In Pakistan, there has been a continuous increase in the prevalence of pre-diabetes and diabetes. All parts of the country are affected, with the highest in Sindh and the lowest in Khyber Pakhtunkhwa. The main factors include growing age, family history, hypertension and obesity. However, with early detection and adequate treatment accompanied by moderate lifestyle changes, some people with pre-diabetes can return their blood sugar levels to a normal range. The drastic, negative changes in our lifestyles and diets are considered to be the main culprits behind the high prevalence of diabetes. Along with other non-communicable diseases (NCDs), also called chronic diseases such as cardiovascular disease, cancer, and chronic respiratory disease, diabetes has a strong link with environmental and behavioural factors like unhealthy diet (malnutrition), lack of exercise (obesity), smoking, high blood pressure, air pollution and stress. According to a medical expert panel, up to 70 percent of individuals with pre-diabetes will eventually develop diabetes. In addition to working with your healthcare provider to create a treatment plan, the following lifestyle changes may help you reverse or control pre-diabetes from turning into full-blown diabetes: 1. Clean Up Your Diet 2. Count Your Carbohydrates 3. Reduce Sugar Intake 4. Drink Enough Water 5. Exercise Regularly 6. Maintain a Healthy Weight 7. Quite smoking and alcohol Pre-diabetes is a little bit of a misleading term because it sort of makes it sound like it’s always the step before diabetes and you’re destined to develop diabetes. That is one thing doctors like people to understand is that pre-diabetes doesn’t mean that you are 100 percent destined to develop type 2 diabetes. Medicines like metformin, a front-line medication for type 2 diabetes, “off-label” for pre-diabetes or insulin injections are usually administered to a patient to keep their blood sugar within a safe limit. In my mother’s case, her pre-diabetic condition is controlled by the pharmaceutical drug Metformin. It is a good tool with studies showing the drug can decrease the risk of progression to type 2 diabetes, although to a lesser degree than lifestyle changes. What is to be done to prevent Pre/Diabetes? Early diagnosis through mass screening and proper management are vital which is easier said than done as it requires a comprehensive health system response. This includes integrated delivery of preventive, promotive, curative and rehabilitative health services at all levels of the healthcare system, but most importantly at the primary healthcare level. Professor Javed Akram, President Pakistan Society of Internal Medicine, is an authority on diabetes in Pakistan and is working hard to turn the tide. He has led national diabetes surveys, registry and research, and continues to contribute immensely at national and international levels. Meanwhile, with every fourth adult having diabetes in Pakistan, all of us should get our risk score calculated and act accordingly by adopting a healthy diet and lifestyle and, if need be, consult a competent health professional. Managed well, people with diabetes and Pre-diabetes can lead happy and long lives. There is a need for more national campaigns to raise awareness about pre-diabetes launched on TV, radio, print, and digital media. It is suggested that the campaign’s key message should be a matter of fact that Pre-diabetes is real, and you could have it. You ought to know where you stand. My mother and my immediate family partake in a lot of Pre/Diabetes awareness programs and campaigns. “Take it seriously,” my mother says. “Of all the risks for diabetes you can have, this one is influenced by the choices you make.”That wasn’t how she felt when she first learned she had pre-diabetes. Her doctor, Professor Javed Akram had told her to lose weight and get more exercise or else run the risk of getting type 2 diabetes. She thought, ‘What’s the point? I might still get diabetes,’. She felt like she was stuck either way. So for a few months, she did nothing. At 52, she figured it was too late for her to make any big changes in her life anyway. Me and my brother though made her look at old album pictures that set her thinking about the future. She realised she wanted to get healthy so that she could keep doing all those things she enjoyed so much. Professor Javed Akram invested his time and energy to motivate my mother about how being overweight and inactive makes it harder for the body to keep blood sugar levels normal. I have observed Dr Javed Akram trying a personalised approach as once he understands a patient’s values and goals, he frames the conversation in a way that contextualises what is important to the patient and lays out ways that can help them achieve those goals. Finally, my mother understood why making lifestyle changes had become so important. It set her thinking on how could she fight it. It turned out there was a lot she could do. She signed up for a weight-loss program, and cut back on calories and saturated fats. She also ate fewer sweets. She added walks around the neighbourhood to her routine. Taking care of yourself can make a huge difference in your health. My mother might still get type 2 diabetes at some point. However, it is a relief to know that even if she does, she would, God willing, be way ahead in terms of managing it. So don’t sit around and wait for miracles to happen. Get up and move! Anyone who is concerned should understand their glucose numbers and check them routinely. You should know your weight, your blood pressure, and your sugar levels. Keep tabs on your health and take action if necessary. The writer is an ex-banker and a freelance columnist. She can be reached at tbjs.cancer.1954@gmail.com