The onset age of diabetes, once considered a disease of middle age, is lowering. Professor Lim Soo of the Division of Endocrinology and Metabolism at Seoul National University Bundang Hospital, who serves as the head of the Korean Diabetes Association’s (KDA) Diabesity TF team, states, "Diabetes traditionally occurs most frequently in one's 40s and 50s, but nowadays the onset age is creeping down into the 30s, and rare cases among those in their 20s are also increasing."

Westernized dietary habits form the background, and trendy snacks recently spreading via social media play a significant part. Snacks like "Dubai chewy cookies" or butter rice cakes, which require waiting in long lines to purchase, are mostly high in calories, and it is rare for someone to stop after eating just one. The bigger problem is that the craze never ends. Once the tanghulu craze faded, Dubai chewy cookies took over, followed by butter rice cakes. Only the names and types of snacks change, while the habit of seeking out and consuming sweet and greasy snacks persists.

Consuming such snacks introduces a large amount of sugar into the body in a short period, causing blood sugar to skyrocket. This is the so-called "blood sugar spike." Professor Lim compares such blood sugar spikes to a "tsunami." While a single wave can be weathered, when it repeats several times a day, blood vessels and the pancreas cannot endure. Coupled with a 2030 generation lifestyle saturated with delivery food culture and late-night snacking, this wave is called upon incessantly. The question arises: is early-onset diabetes more dangerous, or is there more room for recovery precisely because they are young? Professor Lim shared the details.

Do you see many young diabetes patients in the clinic?

Diabetes originally developed most often in people in their 40s and 50s, but nowadays the onset age is dropping down into the 30s, and 20-something patients are rarely on the rise. This means South Korea is becoming more vulnerable to diabetes in various aspects. Developing diabetes at a young age is a major problem for the individual as well. If someone develops diabetes in their 30s and lives to 90, that means living with diabetes for 60 years. It is a personal misfortune, and considering medical costs, it ultimately leads to a societal and economic burden on the entire nation.

Apart from having to live with it longer, are there greater dangers to early-onset diabetes?

The recent increase in young diabetes is driven by Westernized lifestyles, which means insulin resistance forms the baseline. Insulin resistance refers to a state where insulin, which lowers blood sugar, fails to function properly. According to recent results published in academic journals, more than 75% of newly diagnosed diabetes cases stem from insulin resistance. The more severe the insulin resistance, the earlier vascular diseases and kidney, retinal, and nerve complications can strike. Therefore, the risk of complications for patients diagnosed in their 20s or 30s can be greater than for those diagnosed in their 60s.

Do you think delivery food culture also plays a role?

If you order delivery food, you know that single portions are rarely delivered. You have to exceed a certain amount, or else you pay an extra delivery fee. To avoid the delivery fee, people usually order about two servings, which naturally leads to overeating. Moreover, most delivery food is high in calories. Even if individuals think they ate a little less than expected, they actually consumed far more calories. If those foods are heavy in carbohydrates or fats, they can immediately lead to a high-risk group for diabetes.

SNS-trendy snacks like Dubai chewy cookies and butter rice cakes also seem very high in calories.

I managed to try a "Dubai chewy cookie" with some difficulty, and I thought eating just one would have been enough. However, people usually eat several together with friends. The butter rice cakes that followed are even worse because they literally contain a lot of butter. The once-trendy tanghulu can be regarded as almost lumps of sugar. Trying them once in a while is fine, but continuously consuming them as a habit for dessert unquestionably brings hyperlipidemia and diabetes much earlier. Frozen jellies are similar. While diet konjac jellies themselves are not a major problem, jellies with sweet added sugars are. Freezing them leads people to eat more, and consuming large amounts of sugar-rich foods in a short time leads to the blood sugar spike we worry about most.

The term "blood sugar spike" is used like a buzzword these days. Could you explain it simply?

A blood sugar spike is a concept that looks at how steeply blood sugar rises after eating a meal. Initially, a post-meal blood sugar exceeding 140 mg/dL was defined as a blood sugar spike, but this standard is too strict, encompassing almost all foods. Because that makes management too difficult, we explain 180 to 200 mg/dL as the benchmark during patient education. Staying within this range means you can manage it sufficiently. One to one and a half hours after a meal is when blood sugar peaks; foods that push past 200 to 250 mg/dL at this time are unfavorable, so it is best not to eat them frequently.

Why blood sugar spikes are bad is explained by comparing them to a "tsunami." A tsunami brings a massive wave crashing onto the coast all at once. Blood sugar spikes similarly attack blood vessel walls, the pancreas, and the heart. Enduring a single strike is possible, but repeating it three times a day naturally breaks endurance. Therefore, preventing blood sugar spikes from occurring frequently is vital.

Why do blood sugar surges differ even when eating the same food?

Patients ask this question very often. People are not machines, so blood sugar varies depending on that day's hormone secretion, mood, and how excited the sympathetic nervous system is. If you slept poorly the night before, are facing an exam, or have to give a presentation at work, your blood sugar can skyrocket.

Conversely, if your mind is at ease and relaxed, it rises less. This is why eating the exact same thing yields a reading of 250 on some days and around 150 on others. I wore a continuous glucose monitor myself, and my blood sugar spiked the highest when I stepped up to the podium to lecture. Tension exerts that much of an impact.

Many young adults suffer from frequent night shifts or shift work. That probably isn't good for health.

Lifestyle is crucial, and "sleep deprivation" among them is a major issue. Humans should sleep at least from midnight to 6 AM. Night shifts or rotating shifts disrupt the body's biological clock, putting the body into a state of stress. This raises the stress hormone cortisol, which alone elevates blood sugar by about 40 to 50 mg/dL.

Adding late-night snacks to this easily pushes readings well past 200. If this lifestyle persists for a long time, diabetes or complications can follow. Therefore, even if it means getting paid a bit less, I directly tell such patients to avoid night shifts. Doing so will undoubtedly be more beneficial for their health.

If you had to choose between reducing late-night snacks and maintaining a consistent sleep pattern, which is worse?

Late-night snacks are still the worst. Blood sugar driven up by stress rises naturally inside the body, stopping at an increase of around 40 to 50. However, eating has no limits. Late-night snacks can easily drive blood sugar up to 250 or 300.

Are there characteristics unique to young diabetes patients?

Most deny having diabetes. Nowadays, even thirty-somethings often come in with their parents, and parents usually say, "Our son (or daughter) has no problems at all, but a small clinic said it was early diabetes, so we came to check if there was a mistake."

However, talking to the patients reveals that their blood sugar is naturally rising and their lifestyle patterns are poor. The biggest problem nowadays is the "screen time" spent looking at digital devices. In particular, constantly looking at a mobile phone in bed after 10 PM is the worst. Hours slip away, sleep quality drops, and they wake up at dawn. Continuing to watch makes them hungry, leading them to pull late-night snacks out of the refrigerator.

That is why I advise cutting down on screen time at night and taking light exercise or walks at a reasonable hour if it is not too late. However, exercising intensely late at night keeps the body awake, so it should be avoided. The lifestyles of those in their 30s and 40s are currently very poor. Sleeping late leads to waking up late, skipping breakfast, rushing to work to survive on a cup of coffee, and overeating out at lunch. As this pattern continues, South Korea's diabetes patient population is surging significantly.

Aside from lifestyle habits, are there biological reasons why Koreans are more vulnerable to diabetes?

This is a point I want to emphasize. Historically, our people mainly ate a vegetable-based diet and did not consume much meat. However, as the social environment changed rapidly over the past 20 to 30 years, high-fat, high-calorie, and high-protein meals increased significantly, making people correspondingly vulnerable to diabetes.

We verified this directly some years ago. A few years ago, we precisely compared pancreatic function and size, the amount of fat accumulated in the pancreas, and basal metabolic rate between 20- to 30-year-old Americans and Koreans of identical body conditions and physiques. As a result, the Korean pancreas was about 20% smaller, and fat accumulated in the pancreas was over 15% higher. We confirmed that Koreans are actually more vulnerable to diabetes than Westerners. While Americans might seem much fatter than us, our diabetes prevalence rate is higher. Because Asians, including Koreans, are more vulnerable, diabetes is recently sometimes called the "Asian disease."

Does that mean thin people cannot be considered safe from diabetes either?

That's correct. Westerners have consumed high-protein, high-calorie diets for well over 100 years, so they are born with larger and sturdier pancreases. Thus, they endure external factors up to a certain point. Their muscle mass is also high. Muscles are the largest organ in our bodies and play the most critical role in processing sugar and fat. The more muscle you have, the more excess food can be sufficiently processed within the muscles.

In contrast, young South Korean adults tend to have relatively insufficient workout habits and lower muscle mass. While some people work hard to build muscle, the majority lack it, which is an important reason why diabetes is growing rapidly.

Diabetes patients often suffer from hypertension or dyslipidemia concurrently. Is that true for young patients as well?

I explain to patients that "bad friends hang out together." So-called "triple highs"—high blood sugar, high blood pressure, and high hyperlipidemia—occur together in 60% to 70% of cases. Even if someone currently has only diabetes without hyperlipidemia, they are highly likely to develop hyperlipidemia within 3 to 4 years. Therefore, all three must be managed together from the beginning.

It is said that less than half of the younger demographic knows they have diabetes, and an even smaller percentage receives treatment.

Talking to young patients in the clinic, most say similarly, "I haven't been able to exercise temporarily because of a project, but I can handle it on my own." When I ask when the project will end, they say it ends next month, but another project follows right after. Consequently, they keep failing to exercise.

Honestly, maintaining consistent exercise purely through human willpower is not easy. Therefore, starting medication early if necessary while simultaneously fixing exercise, lifestyle, and dietary habits is the most ideal treatment. I want to strongly emphasize that managing diabetes is not purely a matter of willpower.

South Korea's national health checkup system is evaluated as well-established globally. Can checkups received by the young sufficiently detect diabetes?

At one point, national checkups measured fasting blood sugar and glycated hemoglobin together. Since then, glycated hemoglobin was dropped, and now only fasting blood sugar is measured. However, post-meal blood sugar usually rises first in diabetes. To detect diabetes early, post-meal blood sugar must be measured, but checking hyperlipidemia, liver, and kidney functions requires fasting blood draws, forcing reliance on fasting blood sugar tests. Consequently, many diabetes patients are missed.

Therefore, the association's hope is to add glycated hemoglobin alongside fasting blood sugar to national checkup items, even if not every year. Glycated hemoglobin is a test showing average blood sugar over the past 2 to 3 months.

You emphasized that obesity should ultimately be viewed as a "disease."

Recently, 58 global experts gathered to redefine obesity. Previously, obesity was classified when the Body Mass Index (BMI) exceeded 25 by Korean standards and 30 by Western standards, but this criterion has limitations. Highly athletic athletes could be classified as obese, while "normal-weight obesity"—where BMI is low but all characteristics of obesity are present—can be overlooked.

Thus, the newly introduced concept is "clinical obesity." First, it checks whether fat has accumulated excessively in the body, and if obesity-related diseases are present, diagnoses them as a disease to bridge into treatment. I think it is a very reasonable concept, and both the Korean Society for the Study of Obesity and the Korean Diabetes Association recognize this. Obesity should not be viewed simply as a consequence of poor lifestyle habits. It must be recognized and treated as a disease, just like diabetes or hypertension, and the official stance of the society is that patients can improve sufficiently if they cooperate well.

Lastly, what advice would you give to young diabetes patients?

I want to strongly tell them that daily living determines their health. My most hated phrase is "cheat day." People think they can just eat a lot today and start tomorrow, but eventually every day becomes a cheat day.

Each day must be cherished, and self-health must be protected through balanced diets and regular exercise for 30 minutes or more a day. No one else can protect your health in your place. I sincerely hope that the younger generation of South Korea escapes diabetes and obesity to enjoy healthy lives.

[ⓒ Global Economic Times. 무단전재-재배포 금지]