17/01/2012

Diabetes
The Silent Killer

What is diabetes?
Chronic, metabolic disorder
Persistently high blood sugar due to defect in
Insulin secretion
Insulin action or
Both

Starts as -cells start failing

With failing -cells, pancreas cannot produce

sufficient insulin
In absence of insulin glucose cannot enter the
cells
Thus the blood glucose levels rise while the body
cells are starved

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Types of Diabetes
Mainly two types
Type 1 - Almost all beta cells die
mostly occur in children and young
people, insulin is essential

Type 2 -Insulin effect is decreased and

Beta cells become less
Genetics, obesity, sedentary life style,
stress, and wrong eating habits are
responsible-can occur at any age

What is Pre-diabetes?
Pre-diabetes is a medical condition
where blood glucose is higher than
normal but not high enough to be called
diabetes
It increases the risk for type 2 diabetes
and cardiovascular disease

Most people have pre-diabetes before

they develop type 2 diabetes

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What is Pre-diabetes?
Most people with pre-diabetes develop
type 2 diabetes within 10 years

People with pre-diabetes are identified by

having a screening test

Progression to diabetes is NOT inevitable

Diabetes Epidemic

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DIABETES SCENARIO
TOP FIVE - 2007
DIABETES SCENARIO
45
40
35
30
25
20
15

10
5
0
INDIA

CHINA

USA

RUSSIA

GERMANY

PREDICTING RISK FOR TYPE 2

DM
Relative with diabetes

Your risk

Mother

19%

Father

14%

Both parents

25%

Sister or Brother

75%

Twin sister or brother

99%

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PREDICTING RISK FOR TYPE 1

DM
Relative with diabetes

Your risk

Mother

2%

Father

9%

Sister or Brother

10%

Twin sister or brother

50%

Risk Factors for Diabetes

Age 45 and older
Overweight (BMI
25)
Hypertension
Abnormal lipid
levels
Family history of
diabetes
Race/ethnicity
History of
gestational diabetes

History of vascular
disease
Signs of insulin
resistance
(such as PCOS or
acanthosis
nigricans)
Pre-diabetes
Inactive lifestyle

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Risk factors

Testing for Diabetes and

Pre-Diabetes
Consider testing if person is:
Age 45 or older
An overweight adult with another risk
factor
Obtain: A1C or FPG or 2-hour plasma glucose
post 75-g oral glucose challenge

Repeat testing every 3 years.

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Diagnostic Criteria for

Pre-diabetes and Diabetes
Fasting Plasma
Glucose Test
(FPG)

2-Hour Oral
Glucose
Challenge

Below 100 mg/dl

Below 140 mg/dl

5.7% - 6.4%

100-125 mg/dl
(IFG)

140-199 mg/dl
(IGT)

6.5%

126 mg/dl or above

200 mg/dl or
above

A1C
Acceptable
Pre-diabetes
Diabetes

Complications of uncontrolled diabetes

Acute complications
1. Hypoglycemia
2. Diabetic Ketoacidosis
(DKA)
3. Hyperosmolar non
ketotic state (HONK)

Chronic complications
Macrovascular

Microvascular

1.Coronary Artery
Disease

1.Retinopathy

2.Cerebrovascular
Disease

3.Neuropathy

2.Nephropathy

3.Peripheral arterial
Disease

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Target BG levels
Guidelines for Optimal Goals
HbA1c

Pre - prandial
plasma Glucose

Post - prandial
plasma
glucose

ADA

<7%

90 - 130mg/dL

<180mg/dL

AACE

6.5%

<110mg/dL

<140mg/dL

How Diabetes can be controlled ?

Balanced Diet Active Lifestyle
-Exercise

MIXTA
RD
100 I.U

MIXTA
RD
40 I.U

Monitoring

Right Medication
(Insulin/ Oral medication)

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Is it contagious?
Diabetes is not contagious.
People cannot catch it
from each other

Impact on life
Increased morbidity
20 x risk of blindness
25 x risk of renal failure

40 x risk of amputation
Life span reduced by approx.5 - 15 yrs
Cost of management Rs 21000/yr
approx.

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Prevention of Diabetes
Is it possible to delay or even prevent
type 2 diabetes from ever developing?

Yes it is ?
Diabetes Prevention Program (DPP)

by keeping weight in control

by increasing physical activity
diet changes
life style changes
Cessation of smoking and alcohol

Primary Prevention
High risk approach for target patients
Community approach reduce risk
factors in entire society

Regular exercise
Fibre rich low calorie diet/sugar free
beverages
Life style modification (LSM)

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Diabetes complications

Treatment and control

Medications
(insulin /oral medications)
Increase physical activity
at least walk for 30 min. most days
Appropriate diet
vegetables
fruit
low in fat and carbohydrates
Lifestyle changes

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17/01/2012

Prevention and/or delay of diabetes

complications
Well balanced diet

Exercise
Medications when appropriate
Timely access to health care services
No tobacco
No alcohol

Tips for healty cooking

Cook boiled meat instead of frying
Take the skin of chicken before
cooking
Use less salt and sugar when
preparing food

Avoid fat

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Tips for healthy cooking

Use fresh or frozen fruit and vegetables
when eating or in between meals
Use low fat chesse instead of regular
chesse
Use low fat milk
No juices instead have fruit

Physical Activity
To

control

diabetes

the recommendation is
to

increase

activity,
every

physical

preferably
day

for

20

minutes.

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17/01/2012

Physical Activity
Benefits:
Lowers glucose levels in blood
Improves blood circulation in
the entire body
Contributes to weight loss
Improves physical and mental
wellbeing
Helps the body to utilize insulin
more efficiently

Physical Activity
Consult your doctor before you start a
physical activity program
Start you program slowly and increase
activity level gradually
You can choose the physical activity
that that you like to do

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17/01/2012

What is HbA1c ?

How To Store Insulin?

Store in refrigerator at
the recommended
temperature of 20-80 C

Do not use the insulin after

expiry period

In-use insulin must be kept

out of
Insulin
Refrigerator
at
Room Temperature
Do not keep
insulin in freezer
compartment & do
not use insulin
that is frozen

Do not expose the insulin to

sunlight & high
temperatures which can
occur in :
a) The glove compartment
of a car
b) Near a cooking range
c) On top of electrical

Insulin suspensions not

to be used after clump
formation

equipment

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17/01/2012

Sites of Injection
Insulin is to be injected in the subcutaneous fat,
which is the layer of fat just below the skin.

Hypoglycaemia
Hypoglycaemia means low blood sugar
It occurs when the amount of blood glucose falls below the
acceptable normal level

Sympt
oms
Blurred
Vision
Dizziness

Headache

Sweating

Fatigue

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Home Treatment of Hypoglycemia

Relieved by :

a) 1 glass of fruit juice or soft drink.

b) 3 heaped teaspoons of sugar, honey or
3 5 sweets.
Repeat if symptoms not relieved after 5 to 10 minutes.
If next meal not immediately due, take 30 g complex
carbohydrate.

COKE

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