Do thin people also get diabetes? Let's talk about the special risk (Type 2 Diabetes) that we South Asians have.

Many of us think that diabetes only affects fat and overweight people. But did you know that for someone in a South Asian country like us, that is, Sri Lanka, even if we are thin or have a normal weight, we are much more likely to develop Type 2 Diabetes? In fact, when compared to other ethnic groups, our risk is about four times higher. This is something that really surprises us. So today, let's talk about why this happens, what we need to be aware of, and what we can do to protect ourselves from this condition.

Why are South Asians like us at greater risk?

The main reason for this is the way our body stores fat. Imagine, an invisible layer of fat is deposited around important organs in our body like the liver and muscles. Medically, this is called (Visceral adiposity) . This is something that can happen from the inside, even if our body is thin and does not look like it from the outside.

Simply put, due to the fat layer around this organ, the hormone insulin produced by our body's pancreas cannot work properly. The main function of insulin is to help the cells take sugar (glucose) in the blood and turn it into energy. So, when insulin cannot do its job properly due to this fat layer, we call it insulin resistance . This causes blood sugar levels to rise.

The twofold problem we face: resistance and deficiency

As South Asians, this issue is further complicated for us for two reasons.

1. Insulin Resistance: As I mentioned earlier, even though our body produces insulin, it does not work properly. A specialist doctor who spoke about this shared her personal experience. When she developed gestational diabetes during pregnancy, she had to inject large amounts of insulin even though she had a normal body mass index (BMI). This means that even though there is insulin in the body, it does not work properly, so a large amount is needed.

2. Insulin Deficiency: Another issue is that genetically, the insulin-producing cells (beta cells) in our pancreas are less active. This is called (beta cell blunting).That is, when we eat, our blood sugar levels rise. Then the pancreas gets a signal to produce insulin. But because our cells are a bit "lazy", they don't produce insulin until the blood sugar levels get really high. So we have both the problem of insulin not working properly on the one hand, and the problem of not producing enough insulin on the other.

What are the risk factors to be tested for diabetes?

As South Asians, we need to be careful about the criteria that are different from the general criteria when testing for diabetes. It is especially important that you get tested for diabetes if your body mass index, or BMI, is more than 23. Although the average value in Western countries is 25, due to our genetic differences, we are at risk even at a lower BMI.

See if you have one or more of the following risk factors.

How do you talk to your doctor about this?

The most important thing is to take the initiative and talk to your doctor about this. Your doctor may not want to test you for diabetes because you are a normal weight. But you can explain these things to him.

When you go to see your doctor, say something like, "Doc, although my BMI is in the normal range, I know that I'm South Asian and at risk for diabetes even at a low BMI. So can you check my A1c?"

A1c (HbA1c) is a measure of your blood sugar levels over the past 2-3 months. This test can tell you if you have diabetes or are at risk of developing diabetes (prediabetes). It's important to take charge of your health.

Diet and lifestyle: What should we do?

Your diet is 70% important in managing diabetes. The remaining 30% is exercise.

Our Sri Lankan main diet is often high in carbohydrates (starch). We eat foods made from rice, bread, and flour the most. Any of these types of carbohydrates cause blood sugar levels to rise. So what we need to do is not to stop eating these foods completely.

• Change the way you prepare your rice plate: Allocate one-quarter of your plate for rice, one-quarter for protein (fish, chicken, eggs, lentils, chickpeas), and the remaining half for vegetables and greens.
• Include foods rich in fiber: Foods like whole grains, oats, brown rice, vegetables, and fruits slow down the rate at which sugar is added to the blood.
• Avoid processed foods and sugary drinks: These cause a sudden spike in blood sugar levels.

Don't let diabetes control your life. Instead, educate yourself about this condition, consult your doctor for the necessary advice, and make lifestyle changes.