If you or your relatives are from India or another South Asian country, you’re at greater risk for diabetes than people from other ethnic backgrounds. In fact, you may be lean and active -- two lifestyle factors that reduce diabetes risk in other ethnicities -- and be diagnosed with diabetes at a young age because of genetic factors, according to Afreen Idris Shariff, MD, an endocrinologist at Duke Health. That’s why she encourages people of South Asian descent to take steps to reduce your risk, get screened by age 35, and if you have diabetes, learn to manage it as early as possible.
The Role of Insulin, Insulin Resistance, and Insulin Deficiency
According to Dr. Shariff, the body makes insulin to help blood sugar enter the body’s cells so it can act as fuel. Insulin resistance occurs when the cells stop responding to insulin. High blood sugars build and eventually are stored as body fat. That causes weight gain and obesity.
However, people of South Asian descent are not “typical obese,” Dr. Shariff said. “We are fat on the inside and not on the outside.” Dr. Shariff’s family is from India, she has a family history of diabetes, and she experienced gestational diabetes during pregnancy. Doctors call this “lean diabetes” because the body fat is less obvious, she explained. It surrounds abdominal muscles and organs like the liver. This deep type of fat is called visceral fat and is a known diabetes risk factor.
Visceral fat is common in South Asian people and “makes our tissues very resistant to insulin,” she said. In addition, “we don’t make enough insulin, and the insulin we do make doesn’t work effectively. We’re born with this.”
If you or your relatives are from India or another South Asian country, you’re at greater risk for diabetes than people from other ethnic backgrounds. Like Nitin Kundeshwar, you could had few or no traditional risk factors and still be diagnosed with diabetes. Here, Dr. Shariff explains why and encourages people of South Asian descent to get screened.
Why It’s Important to Get Moving
Exercise puts your muscles to work to lower blood sugar levels. That’s why Dr. Shariff said she’s a big advocate of “no siesta after fiesta.” Instead of sitting down after you eat, do some physical activity like walking.
Learning to Make Healthy South Asian Staples
As a lover of Indian food, Dr. Shariff understands that “you can't tell someone to eat their curries without rice or flatbread. It’s just not realistic. Keeping our flavor profile is very important.” That’s why she recommends her patients see a nutritionist or a provider who understands their diet and can help them make healthier food choices.
For example, Dr. Shariff suggests adding ripe avocado to wheat flour along with the spices you love to make round flatbreads like roti and chapati. That helps create the right texture and flavor but also makes the food nutrient-rich by reducing the carbs and adding fiber and essential fatty acids. Another option is substituting lentils or other beans for the white rice typically used to make savory cakes known as idli.
However, Dr. Shariff stresses that lifestyle changes like exercise and diet may not result in the health benefits you’re trying to attain. In that case, she said, “we give medicine to reduce insulin resistance. It’s the genetics we can’t fight.”
Get Screened for Diabetes
If you’re a South Asian adult age 35 or older, Dr. Shariff recommends you be screened for diabetes, especially if the following factors are present:
- A body mass index (BMI) greater than 23
- A family history of diabetes, especially if you have a first-degree relative with diabetes
- A history of gestational diabetes or polycystic ovary syndrome (PCOS)
- Heart disease
- High blood pressure
- High triglycerides (over 250)
- Low “good” cholesterol (high-density lipoprotein less than 35)