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Lifestyle diseases like diabetes and hypertension have a tendency to quietly enter the house of our physical bodies, much like unbidden and unwelcome guests. In most of the cases, repeated attempts to entice these to depart and scour around for some greener pastures are unsuccessful. After the first stage of shock and denial has passed, a state of active acceptance comes about. The basic principle of a peaceful coexistence eventually gets followed.

Diabetes is labelled as a silent killer. This unwelcome guest has a tendency to enfeeble almost all the organs of the body. Its special affection gets directed towards ones which are already in a state of disrepair. These could be our heart, eyes, kidneys, feet or any other organ or limb which catches its fancy. Nerve endings get compromised. Initially, some tingling sensations may be there, more bothersome at night. Over time, sensations may be lost completely, leading to problems which do not even get felt.

Excessive thirst and frequent urination are the well-known symptoms of diabetes. These could easily get ignored and we could chug along in our lives, blissfully ignorant of the arrival of this unbidden guest amidst us. With urine, the body also ends up ejecting some minerals. The disease leaves one feeling tired and exhausted.

The alpha and beta of diabetes

At the core of this affliction is an organ known as the pancreas. Due to genetic reasons or owing to prolonged abuse, there are times when it refuses to behave like an alpha male. It ceases to run on all its twelve cylinders. It does not produce enough insulin, the hormone which controls blood sugar levels in the body.

The beta cells in our pancreas not only produce insulin but also govern the sugar level fluctuations in the body. So, the higher the level of blood sugar, the higher is the fluctuation of sugar levels in general. The fact that South Asian genes happen to be more susceptible to attracting this disease does not really comfort someone who is actually suffering from diabetes.

There are those in whose case the cells that produce insulin are selectively lost. They would qualify to be suffering from Type 1 diabetes.

The body surely needs sugar to keep active and kicking. But when the sugar intake is more than what it can handle, insulin production lags behind its demand. The pancreas is unable to keep pace. Those whose pancreas has started losing its efficacy over a period of time get categorized as having Type 2 diabetes. Often, obesity rules. The battle of the bulge gets lost. Pear pressure kicks in.

Then there is a portion of humanity which shows signs of an imminent onset of diabetes. These could be called pre-diabetics. Surely, there is some hope for them, provided they adopt an active lifestyle, change their diet pattern, and do not allow diabetes to walk in.

The delicately nurtured amongst our species, when they happen to be in the family way, face the risk of gestational diabetes.  Though it is a temporary condition, they end up having a higher predisposition towards Type 2 diabetes.

Sharing some key observations

Yours truly is neither a physician nor a person even remotely connected with the field of medicine. Nevertheless, here is a summary of what one has learnt so far. Some of you might find these of use. These observations pertain to Type 2 diabetes.

Blood sugar levels are a function of the following major factors:

  • Stress: The higher the stress levels, the higher the blood sugar levels. A prolonged challenging situation – whether on the home front or on the office front – could reduce the immunity levels of the body and increase the sugar levels.

Laughing things off helps, so does the company of those who exude positivity. Building up inner resilience reduces the impact of external circumstances, and thereby helps in controlling sugar levels better.

  • Physical activity is a basic factor. Be a couch potato or a chair tiger and repent at leisure. Regular brisk walks and light exercises help. But these produce results only after about six weeks, by which time the body forms a habit and starts demanding its daily dose of whatever physical regime you decide to follow.

Pottering about in the garden or in the kitchen and doing household chores provides some protection. Climbing up stairs and not using an elevator helps. Living life with lesser dependence on your favourite Ferrari helps.

But nothing to beat the efficacy of either cycling or a brisk walk, which is closer to the way a soldier would typically walk. Sweating it out is a key factor. It also helps with heart-related issues.

Much like a tube light needs an initial surge of additional power to get going, the body also needs an initial impetus of will power to walk the first 500 meters. Thereafter, once it has warmed up, a brisk walk often sounds more like a cake walk.

  • Medication cannot be taken lightly. It needs to be taken regularly, on time. This implies that meals required to keep the body and soul together also need to be taken on time, day after day.

Oral medication is convenient. At times, if it is unable to bring blood sugar levels within control (fasting values in the range of 70-100 and other values being in the range of 120-200), the physician may prescribe insulin injections.

Insulin has a singular advantage of the necessary hormone reaching the blood stream directly. But the flip side of using insulin, or any other anti-diabetic agent, is the risk of blood sugar dropping down to such dangerous levels as 60 or below. Symptoms could be tiredness, giddiness, excess sweating, palpitation and even coma and other          complications. This could even prove to be fatal.

To avoid such complications, a bar of chocolate, some dry fruits and biscuits should always be kept handy. Sugar cubes could also help. A glucometer needs to be used to immediately check the blood sugar levels and the incident reported to one’s doctor.

  • Diet is a crucial factor in managing diabetes. Our scriptures often extol the virtues of leading the life of an ascetic or a monk. Diabetes propels us towards such lofty goals in life. Controlling our taste buds is a serious challenge and needs nerves of chilled steel. When a piping hot junk food item like a ‘samosa’ comes up in front of us, or when a ‘rasgulla’ gets lovingly offered by an otherwise well-meaning friend, the deep reserves of our tenacity have to be marshalled to refuse these and instead pick on a green salad.

Even fruits like mangoes and bananas are harmless, if taken in moderation and if in the absence of any other item on our plate.

Some tests and parameters

  • Regular checks on blood sugar levels (fasting as well as postprandial, PP) are highly recommended.

For fasting level to be correctly ascertained, during the previous night, except for plain water, nothing else should be consumed after 10 PM. Medicines to be taken after the test. Normal breakfast can be had after about 30 minutes.

For PP, a reading would need to be taken two hours after breakfast, with nothing else being consumed in the meanwhile. Any deviation from this procedure can be brought to the notice of one’s physician.

  • Once in six months, our physician may recommend a test known as HbA1C. This one tells us the weighted average of our sugar levels over a period of the past three months, thereby indicating the extent of control we have exercised over ourselves during that period. A value below 7 would normally indicate a fair amount of control, though the exact value is best decided between the doctor and the patient.
  • Frequent eye and feet check-ups are necessary. Once in a year, functioning of the kidney needs to be reviewed by means of appropriate tests.

When prolonged tension leads to hypertension

Yet another lifestyle disease which creeps up on one is that of high blood pressure. If left unattended, this could result in the hardening of arteries, cardiac problems and an increase in one’s intraocular pressure in the eyes. Keeping this on a strict watch is in some ways even more crucial than regular monitoring of blood sugar levels.

Of doctors and miracle cures

The role of a doctor in managing diabetes is more akin to that of a guide. The hapless physician has no clue as to what our daily meals comprise and the amount of liquors and desserts we gobble up at social events.

Often, we may come across miracle cures made by those who are proficient in alternative streams of medicine, claiming to get us rid of diabetes in a short period of time. If followed, these could achieve good results in the short run, but could do more harm to the body in the long run. The reason is simple – these are not sustainable. In a controlled environment, these cures could really work. But when we are back in the civilization, living our routine lives and facing all the harsh slings and arrows of Fate, the short-term benefits could simply evaporate. However, there is a general belief that some medicines from alternative streams do work as supplements, somewhat nullifying the side effects of allopathic medicines.

A helping hand from the government  

One has no statistical evidence, but there is no doubt that those suffering from this lifestyle disease do end up suppressing the economic growth of the country they inhabit.

Revenue-hungry governments world over could think of imposing a hefty ‘sin tax’ on all things sweet. Tax breaks can be offered to those who suffer from a lifestyle disease. The delivery of public health services can be strengthened.

The civic authorities would do well to ensure that there are adequate provisions for bicycle tracks and for taking brisk walks in open spaces for its denizens. Public transporters could pitch in by ensuring availability of diabetic diets to those who might be in need of the same.

The trick of managing a lifestyle disease

The real control of diabetes and other lifestyle diseases rests in our own hands. Guided by a competent physician, management of these is no rocket science.

Basically, the trick lies in holding our chin up, looking ahead to a joyful life with clear eyes, and marching on with our lives, wearing this affliction as a badge of honour on our sleeves, aspiring to evolve spiritually, with nary a wrinkle on our forehead.

Bertie Wooster and Jeeves would heartily approve of a sunny disposition of this nature. So would Ashe Marson of the ‘Something Fresh’ fame.

(Inputs from Dr B S Suryanarayana, Additional Professor, Department of Medicine, JIPMER, Pondicherry, are gratefully acknowledged)

(Illustrations courtesy www)

(Related Posts:

https://ashokbhatia.wordpress.com/2013/05/05/o-my-beloved-when-would-you-depart

https://ashokbhatia.wordpress.com/2013/08/04/getting-india-in-the-pink-of-health

https://ashokbhatia.wordpress.com/2014/10/06/handling-the-diabetes-tsunami-in-india

https://ashokbhatia.wordpress.com/2015/07/01/how-diabetes-helps-us-to-improve-our-sq)

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CEOs lead a challenging life. Apart from making and meeting long-term business goals, they face a relentless SQpressure, living from one quarter to the next. Customers have to be handled with kid gloves. Suppliers have to be kept in good humour. People have to be kept motivated at all times. Interpersonal conflicts between team members have to be sorted out. A lonely life has to be lived.

Unlike their juniors who invariably face Peer Pressure, CEOs face Pear Pressure. Some call it signs of prosperity. Some refer to it as a Battle of the Bulge. Others label it as flab around the waist.

The Battle of the Bulge

A CEO in possession of a portly disposition projects an image of a soul which has finally attained salvation and has become a super-hero of the species generally alluded to as managers. Walk into any gathering of the top dogs across most…

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CEOs lead a challenging life. Apart from making and meeting long-term business goals, they face a relentless SQpressure, living from one quarter to the next. Customers have to be handled with kid gloves. Suppliers have to be kept in good humour. People have to be kept motivated at all times. Interpersonal conflicts between team members have to be sorted out. A lonely life has to be lived.

Unlike their juniors who invariably face Peer Pressure, CEOs face Pear Pressure. Some call it signs of prosperity. Some refer to it as a Battle of the Bulge. Others label it as flab around the waist.

The Battle of the Bulge

A CEO in possession of a portly disposition projects an image of a soul which has finally attained salvation and has become a super-hero of the species generally alluded to as managers. Walk into any gathering of the top dogs across most professions and one would be convinced that bosses are generally more portly than their bossed-over managers.

The smarter the top boss, the more he is likely to make his team members run around achieving targets. In the process, the juniors end up getting flatter tummies, a much-coveted attribute. In turn, hard-working subordinates often end up making their bosses lazier, with the latter ending up with convex-shaped protrusions in their midriffs.

Over 1.9 billion adults worldwide are overweight. Of these, some 600 million are further classified as obese. How does this come about? Lack of exercise is said to be the main culprit. Stress is yet another. Genetic factors take a part of the blame. Long working hours leading to lesser workouts get blamed.Exercise 1

Of decision-making and waistlines

Recently, a study by Australian universities has ended up linking decision-making to higher Body Mass Index.

According to researchers, people whose work days require constant decision-making are at greater risk of expanded waistlines. Conversely, workers who exercise control by regularly applying their skills to their jobs — known as skill discretion — were found to have lower Body Mass Index and a smaller waist size.

In other words, the researchers conclude that it is skinny people who are most often good at what they do and enjoy using their skills. However, those who have the power to make decisions are distinctly wider around the middle.

This justifies the derisive term Fat Cats often used to refer to those who control the levers of business. Admittedly, larger waistlines are perhaps a consequence of the CEOs’ sedentary job requirements instead of being the reason for their elevation to decision-making levels.

Perhaps further studies may reveal that weighty decisions need personal countervailing ballast in order to be balanced. It sounds as if power ends up making business leaders more expansive.

Beyond the Peter Principle

Concerned CEOs may wish further research to be designed in such a way as to establish the veracity of some Peters_principle.svgprinciples of the following kind:

1. A manager’s waistline is directly proportional to his position in any decision-making hierarchy.

2.  According to the Peter Principle, in any organization, employees rise to their level of incompetence. Further studies could confirm if their rise is also linked to the propensity of their bodies to achieve the maximum girth permitted by their constitution.

3.  Depending upon their Body Mass Index and the waistline, successful CEOs could be classified into three categories.
Potato CEOs: Those who have dazzled with their performance in the good old days. They have outgrown   the stage of feeling Pear Pressure.
Pear CEOs: Those who are currently guiding teams and delivering reasonably good results. The hapless souls are yet to come to terms with their pear-shaped midriffs.
Banana CEOs: Those who are good at planning as well as execution. They aspire to attain the status of Peer CEOs, without their bariatric blues.

4. For Potato CEOs, Pear CEOs are objects of envy. Likewise, Pear CEOs, howsoever reassured they might sound, secretly aspire to be like Banana CEOs, with concave-shaped bellies.

5. A hypothesis that can be put to test would be if the rate of rise in a hierarchy determines the rate of increase in waistlines.

6. All these propositions need to be cross-validated across different cultures and societies.

Such studies would enrich the science of Hierarchiology. These would be highly useful for head hunters as well as for Human Resource professionals. The insights gained thus would enable managers of all sizes and shapes to improve their quality of life.

Pear Pressure in organizations

Ironically, what is true of individual CEOs is also true of organizations.

The very successful and dynamic ones indulge in frequent bariatric surgeries and ensure that their midriffs remainZOO ORGANIZATIONS under strict control. They are acutely aware of Pear Pressure and have checks and balances in place to avoid carrying excessive flab.

The mediocre ones end up accumulating flab in the middle. At every success, they end up hiring more people than is necessary. At every failure, they undergo a liposuction procedure. They have learnt the art of managing Pear Pressure.

The not-so-successful organizations have the highest Body Mass Index. They are replete with massive layers in their hierarchies. Their processes are bogged down with archaic procedures. Most public sector undertakings are shining examples of this kind.

This is THE challenge all CEOs need to fight single-handedly. They have to wage a relentless war on adipose tissue of all kinds. Unless they decide to take the matter in their own hands, literally as well as metaphorically, the excess belly fat – whether on their own personas or in their organizations – would refuse to melt away.

(Reference: http://www.theweek.in/news/sci-tech/how-your-job-could-be-influencing-your-waistline-study.html)

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The conscientious ones amongst the mandarins in the Indian Health Ministry cannot really be blamed for having sleepless nights. The epidemic of such lifestyle diseases as obesity, diabetes, hypertension and cardiovascular abnormalities is leaving them a wee bit clueless. The need of the hour is to come up with a scheme which nudges Indians of all sizes and shapes to start living slimmer and healthier lives.

Take obesity, for instance. As many as 60 million Indians – roughly 5% of the population – are considered obese. With more than 50 millionObesity image suffering from high blood sugar, India is a nation headed for a health tsunami the devastation caused by which would be anything but sweet. This is a grave threat to our vision of the country reaping a hefty demographic dividend in the years to come.

How do we motivate the Indian couch potatoes to switch off their TV sets and go out for a jog or a brisk walk? What is it that makes Indians tick?

One, all Indians have a great passion for gold. We are quite happy gobbling up around 900 tonnes of the yellow metal every year. Walk into any jewelry store and the rush there would make you wonder if someone inside is dishing out freebies. You would be excused for mistaking it for a fish market, albeit with an odorless soothing ambience where the sales people smell of perfume but are too busy to attend to your needs immediately. One thing we have surely learnt from our Gulf friends is to build multi-storied malls where a dazzling variety of bangles, rings, pendants, chains and other accessories are on display, each on an exclusive floor of its own. After all, aeons back, India was known as a ‘bird of gold’!

Two, like many of our brethren elsewhere on this planet, we despise paying taxes. In a country of 120 billions, where automakers face a slump but luxury cars still sell like hot cakes, less than 3% pay any tax on their incomes. Of these, merely 1.3% report an income exceeding Rs. 2 millions per annum. A Pareto’s Law is in operation here as well – these 1.3% alone make up for about 63% of the taxes collected! Come budget time, and our collective BP levels go up. The hapless salaried class, a sitting duck in any case, hopes for a tweaking of Section 80C etc. The businessmen keep improvising their art of fudging expenses year after year and still suffer from indigestion and insomnia. Corporates have a battery of professionally qualified people assisting them in tax planning, a euphemism for tax evasion being portrayed as tax avoidance.

The Government of India would do well to capitalize on these widespread weaknesses of Indians and launch a slew of incentives andgold bars schemes which nudge Indians of all hues to start living healthier lives. Dubai has already shown the way by deciding to lure its citizens to lose weight in kilograms and gain ounces of gold. India can improve upon the scheme and link weight loss of its citizens to tax savings as well. A carrot and stick approach based on a single health parameter which is easily measurable (like Body Mass Index, or BMI in short, for example) could be an instant hit with the masses.

The scheme can reward people whose BMI is in the normal range. They can hope to get 5 gms of gold plus a rebate of 10% on the taxes payable each financial year. Those who have a BMI in the obese or super-obese range can be made to pay a 10% surcharge on their taxes. Those who are underweight can be given extra rations in the proposed Food Security Bill. A scheme of this kind would surely motivate Indian citizens to start jogging, walking and refusing to become couch potatoes. Those who sustain fitness for longer periods can merit extra incentives. If they do not provide fitness certificates annually for a period of 5 years, there could be an obligation to return the gold thus earned. This would ensure that having pocketed their new-found wealth, the beneficiaries would not start piling up their pounds of flesh once again.

The spin-offs of such a scheme are many. Students, if given grace marks for being healthier, would certainly switch their lunch preferences in favor of salads, nuts and fruits, giving up on burgers and pizzas. Those opting for fitness-based careers would find their employment prospects brightening up. Our armed forces would no longer have to face a shortage of officers wanting to join its ranks. The additional supply of sports persons shall improve the country’s medal tally prospects in Olympics. Engineers and professionals of all kinds would start refusing white collar jobs, providing much-needed manpower for blue collared assignments. Medicos will start taking careers in public health more seriously.

Most of our denizens who have been happier staying out of the tax net would voluntarily start filing returns. The IT Department may soongym eqpmt image need to beef up its facilities to cope with the mad rush of filing returns, what with the humble paan-waalahs, the washermen and the milk delivery men also jumping onto the bandwagon. The rush for gym equipment, health monitoring accessories and healthy foods would increase manifold, bringing in fresh investments, thereby giving a much needed fillip to the ailing manufacturing sector. Bollywood stars who are already egging us on to remain in good shape would get a fresh lease of life. The just-to-be-married maidens who are fighting the battle of the bulge and chasing their size ‘zero’ dreams would soon start earning a part of their own dowry.

Politicians who remain cocooned in their climate controlled environs may soon decide to visit their constituencies more often, losing weight while walking through the heat and dust of the countryside. A healthy body houses a healthy mind. Soon, the citizens could expect a major improvement in the functioning of our parliamentary institutions. Bureaucrats would soon follow the healthier lifestyles of their leaders, thereby revitalizing a crucial part of our vibrant democracy.

Where is the infrastructure to implement a scheme of this nature, you might well ask. With inclusive banking just round the corner, postcouch potato offices, banks and hospitals of repute can certify the BMI levels of our citizens. P&T staff members who are twiddling their thumbs in the post-telegram era can be trained and used in the scheme. The excess outflow of foreign exchange on account of spurt in gold imports would be easily offset by the higher productivity of the working population of India. This in turn would give a boost to the much sought after GDP numbers, besides inching us conceptually closer to a Gross Happiness Product.

Overall, a win-win situation for all concerned. For all you know, India could prove to be the healthiest country on the planet in the near future!

(Realted Post: https://ashokbhatia.wordpress.com/2015/01/01/a-new-year-resolution-for-couch-potatoes)

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