• Do not take a second helping • Do not snack on high calorie foods; eat a fruit instead • Do not drink colas and energy drinks • Exercise for an hour a day

This year Children’s Day and World Diabetic day fell on the same date. Perhaps this is appropriate. We have the largest number of diagnosed and undiagnosed diabetics in the world. To prevent development of the disease as an adult, it is our children who need to be targeted for intervention. Lifestyle changes — a healthy diet and regular exercise — should be implemented at the school level.

Diabetes is diagnosed with blood tests. Blood sugar count after a 12 hour fast should be less than 100mg/dl and two hours after a full meal less than 140 mg/. Glycosolated haemoglobin (HbA1 c) should be 5.6.

A GTT (glucose tolerance test) can be done in suspect cases. In this the fasting blood glucose level is checked and 75gm glucose given. The blood is checked every 30 to 60 minutes after that. One hour later the blood glucose level should be lower than 180 mg/dL, two hours later less than 155 mg/dL, and three hours later lower than 140 mg/dL.

In diabetes, the blood glucose level rises when food is eaten as the body’s ability to efficiently utilise glucose for energy is lacking. This sets off cascading symptoms with thirst, increased appetite (as the body craves energy), increased urination and elevated lipids. Basically, the insulin produced in the pancreas does not regulate the blood sugar levels. This may be because of an absence of insulin, relative deficiency of insulin, or antibodies to the insulin produced, rendering it ineffective.

Diabetes has no age bar. It can appear in a newborn, children, young adults, during pregnancy or in older people. If there are suspicious symptoms, tests should be done.

Some families have a tendency to develop diabetes, with many members being affected. This is because it is a genetic disease that an be inherited from both parents. Type 1 and 2 diabetes are inherited from multiple genes. In type 2 diabetes particularly, the environment and family’s dietary and exercise habits also influence these genes. Families that eat “well” and are sedentary with snacking and excessive TV viewing are more likely to develop type 2 diabetes. Sometimes type 1 diabetes can develop in persons without a family history or genetic predisposition. It may follow viral infections, especially with the mumps and coxsackie group of viruses. The virus attacks and destroys the cells in the pancreas responsible for manufacturing insulin.

There is now a third type of diabetes, where the mutation occurs in a single gene. This gene is dominant, so that if either parent carries it, then half the children (male and female) will be affected. It was called MODY (maturity onset diabetes of youth). The diabetes affecting newborn children is of this type.

Initially, MODY was called type 1.5 diabetes and it was presumed that it was caused by only one type of genetic defect. Recent research has shown that there are 13 defects that lead to MODY.

• It is likely to be present in people who have been diagnosed with diabetes before the age of 30.

• It is present in every generation of the family.

• It can be managed with diet, exercise and tablets. Insulin is usually not required (even in children).

• MODY (depending on the type) can result in the affected woman having small or large babies.

• There may be cysts in the kidney.

• Malabsorption can occur.

• Patients may be infertile.

The incidence of MODY is higher in areas where there is a great deal of consanguinity (marrying a close relative) and when people marry generation after generation from the same community.

It is now possible to test for MODY genes in many centres and identify high-risk individuals and families. Timely lifestyle interventions can probably put their health back on track.

Uncontrolled, untreated, neglected diabetes of all types causes complications with the nervous system, heart, kidneys, eyes and muscles affected.

A change in lifestyle goes a long way in preventing the onset of diabetes and controlling it after it sets in. These guidelines are particularly important if you have MODY or feel that you or your family members are in danger of developing it.

Dr Gita Mathai is a paediatrician with a family practice at Vellore. Questions on health issues may be emailed to her at yourhealthgm@yahoo.co.in