Growing up, I never really understood the complexities behind the diabetes diagnosis that my dad carried with him.  I knew his condition meant that his tall glass of orange juice at breakfast was replaced with a tall glass of water. I also knew it meant that he pricked his finger every morning to check his blood sugar. And, later, I knew he never really fit the classic, Western picture of type 2 diabetes – you know, the picture of obesity and a sedentary lifestyle. My dad had always been an overall healthy guy, active and fit, and never, ever even close to qualifying as obese.  So, why, or rather, how did he end up with diabetes? Simple: He had a predisposition to diabetes.

Who is at risk for diabetes? South Asians.

India’s alarming diabetes boom has long been thought to be due to sedentary lifestyles, poor dietary habits, and a propensity towards central obesity, all of which contribute to metabolic syndrome – a collection of risk factors, such as obesity, that make a person prone toward developing diabetes and other cardiovascular problems.  But with 6 in 10 adults with diabetes in large South Asian cities – compared to roughly 1 in 10 adults with diabetes in the United States – a South Asian predisposition to diabetes is fast becoming apparent.

Studies have proven that South Asians develop diabetes at lower obesity weights when compared to other ethnicities. This is likely due the fact that Indians have a predisposition to decreased insulin sensitivity (also, conversely, known as increased insulin resistance) when compared to other ethnic groups. This concept is not commonly discussed outside the medical world, and it warrants some explanation.

Diabetes is a condition in which blood sugar levels can become dangerously high because the pancreas either produces no or not enough insulin, the hormone that regulates blood sugar. In the cases where a person’s pancreas produces some, but still not enough insulin, the person is often unable to respond to what little insulin there is circulating in his or her bloodstream. This is decreased insulin sensitivity, aka insulin resistance, and it means that even healthy, skinny people can get diabetes, as in the case of my dad. And while obesity and the insulin resistance that is associated with this additional adipose tissue is a problem for everyone in the world, we are learning that South Asians have an additional ethnic risk factor working against them when it comes to diabetes.

For this reason, for Indians, not all is as it appears on the surface. Even seemingly healthy people can have a predisposition to diabetes, as this is a disease caused by a complex and individualized interplay of genetic risks, family history, lifestyle habits, and environmental factors. While we should all be vigilant about our dietary and exercise habits to protect our health, it’s not enough for people with a family history of diabetes or metabolic syndrome, who should undergo screening with basic blood work on an annual basis.