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Introduction

This presentation will help you


– better understand and manage your diabetes.
– It covers the three main forms of diabetes,
type 1 and type 2, as well as gestational
diabetes.
– how your body metabolizes sugar,
– How to control diabetes
– the fundamentals of nutrition and exercise.
– up-to-date information about recent
innovations in treatment and
– most importantly, you'll see that it's not just
possible to live with diabetes; it's possible to
live well.
Dr. Sunita Gupta 2
• Insulin is the principal
hormone in the body
– It plays a key role in all
forms of diabetes
mellitus.
– It regulates uptake of
glucose from the
bloodstream into every
muscle and all fat cells,
– But not into the cells of
the central nervous
system.
• Deficiency of insulin or
insensitivity of its
Dr. Sunita Gupta 3
When our body functions
normally …
• food is converted to
glucose before it is
used by the blood
and body as fuel.
• As a result, blood
glucose levels in the
body rise.
• In response to this,
the Pancreas
release Insulin into The normal food processing cycle

the blood. Dr. Sunita Gupta 4


When our body functions
normally …
• about two-thirds of
the body's cells use
Insulin to
• absorb glucose from
the blood
• To use as fuel and
• To convert to other
needed chemicals, The different organs involved in the
normal food processing cycle
or
• for storage.
Dr. Sunita Gupta 5
Normal glucose absorption

Insulin binds to Glucose Glucose enters the


receptors on the cell transporters move cell.
membrane, much as a to the cell
key fits into a lock, membrane and bind
signal glucose to glucose.
transporters

Dr. Sunita Gupta 6


When the system fails
to absorb glucose….
Type 1 Diabetes Type 2 Diabetes

An immune system • Cells develop a


attack severely limits resistance to insulin.
the ability of the Glucose builds up in
pancreas to produce the bloodstream.
insulin Glucose cannot
enter the cells.
Dr. Sunita Gupta 7
When the insulin is high/ low
• Higher insulin levels increase certain
processes, like
– cell growth and duplication,
– protein synthesis, and
– fat storage.
• If the amount of insulin available is
insufficient due to
– insulin insensitivity or resistance - poor
response of the cells
– defective insulin, then glucose will
• neither be absorbed properly by those
body cells that require it
• nor will it be stored appropriately in the
liver and muscles.
• The net effect –
– persistent high levels of blood glucose,
– poor protein synthesis, and
– other metabolic derangements, such
as acidosis.
Dr. Sunita Gupta 8
When the body begins to
malfunction…
The defective food
processing cycle
• Glucose, after food is
absorbed from the
intestines
– and distributed to all the
body cells through the
bloodstream.
• The glucose concentration
in the blood
– body keeps constant and
avoids extra glucose right
after every meal
Dr. Sunita Gupta 9
When the body begins to
malfunction…
• When glucose in the body is
excess
– stored in the liver and muscles
as glycogen.
• When glucose is in short
supply,
– the body stimulates to eat
food and/or mobilizes the
stored glycogen.
• To maintain a constant Insulin vs Glucagon
blood-glucose level,
Dr. Sunita Gupta cycle – A comparison
10
Diabetes mellitus
Diabetes mellitus (or simply
diabetes) is a condition when:
• the organism begins to
malfunction – metabolic
disorder
• levels of the hormone insulin
in the blood become
insufficient
• the body cells fail to respond
to the insulin that is produced,
or both.
• as a result, blood sugar levels
Types of Diabetes
Diabetes mellitus –
Three main forms
(WHO):
• type 1,
• type 2, and
• gestational
diabetes
(occurs during
pregnancy)
Dr. Sunita Gupta 12
SYMPTOMS
• The characteristic symptoms
are
• excessive urine production
(polyuria) due to high blood
glucose levels,
• excessive thirst and
increased fluid intake
(polydipsia) attempting to
compensate for increased
urination,
• blurred vision due to high
blood glucose effects on the
eye's optics, Dr. Sunita Gupta 13
Statistical breakup of
symptoms

Dr. Sunita Gupta 14


CAUSES of Diabetes
• mellitus
Type 1 diabetes - when the pancreatic cells
are destroyed due to autoimmune system
of the body.
• Type-2 diabetes - when due to high levels
of blood sugar, the body is unable to utilize
it’s insulin and move blood sugar into the
cells to produce energy.
• Gestational diabetes: the hormones
produced during pregnancy can cause
insulin resistance in women genetically
prone to develop Diabetes.

Dr. Sunita Gupta 15


Diabetes - a genetic

source?
Partly inheritance - Both type 1
and type 2 diabetes.
• At least 10 genes found - links
to the causes of Type-2
diabetes.

Dr. Sunita Gupta 16


How genes influence

Diabetes?
Type 1 diabetes is triggered
– by some (mainly viral) infections,
– by stress or environmental exposure (such
as exposure to certain chemicals or drugs).
• Type 2 diabetes - a stronger inheritance
pattern.
• If first relatives have type 2 diabetes
• risk of developing type 2 diabetes is much
higher.
• This risk increases with increase in number
of relatives with diabetes.
Dr. Sunita Gupta 17
diagnosis
Recurrent or persistent
hyperglycaemia during Diabetes
mellitus is diagnosed by any one of
the following methods:
• fasting plasma glucose level
• at or above 126 mg/dL (7.0 mmol/l).
• plasma glucose
• at or above 200 mg/dL (11.1 mmol/l) two
hours after a 75 g oral glucose load.
• random plasma glucose
• at or above 200 mg/dL (11.1 mmol/l).
Dr. Sunita Gupta 18
Diabetes screening
• Diabetes screening is recommended
– at various stages of life, and
– For those with any of several risk
factors.
• Diabetes screening could be
– a random blood glucose test,
– a fasting blood glucose test,
– a blood glucose test two hours after
75 g of glucose, or
– a more formal glucose tolerance test.
Dr. Sunita Gupta 19
Diabetes and Obesity
Here's how all those burgers and shakes add up: The diabetes - an epidemic
•Worldwide, more than 1 billion adults are because in such a short
overweight or obese, time, like infectious
•Roughly 300 million considered obese. diseases, it has spread so
•In 1985, about 30 million people had quickly.
diabetes. •Excess body fat is the
• By 2025, 350 million, or more than 10 times leading controllable risk
as many will suffer from this disease. factor type 2 diabetes.
•Worldwide, the disease is the fourth leading
•Indians lead the world
cause of death.
in the number of
diabetic patients.
•Alarming rise in
obesity and diabetes
around the world –
• Diets high in saturated
fat and refined
carbohydrates and the
Dr. Sunita modern sedentary
20
Gupta lifestyle.
Incidence of diabetes
between men and women

Prevalence of diabetes between men and Relation between BMI and incidence
women across age of diabetes
Dr. Sunita Gupta 21
Impact of Diabetes on other
diseases - complications

Dr. Sunita Gupta 22


Complications from Diabetes
• Careless treatment or its poor
management lead to serious
complications …..
• Diabetes causes:
• Damage to eyes
• heart disease and stroke,
• retinal damage (blindness),
• chronic renal (kidney) failure,
• Poor healing of wounds
(gangrene)
• amputations
• Impotence and difficulty passing
urine inGupta
Dr. Sunita adults. 23
Acute complications from
Diabetes
If Diabetes is not
controlled
properly,
acute
complications
may occur, like
• dehydration
• hypoglycemia,
• ketosis,
• acidosis. 24
Dr. Sunita Gupta
Deaths from different diseases
due to complications of
diabetes, 2005 (India)

Dr. Sunita Gupta 25


TREATMENT
• Type 1 diabetes directly
treatable
– only with injected insulin
(insufficient or no insulin from
pancreas)
– dietary and lifestyle changes
• Type 2 diabetes requires
– dietary treatment together
with
• tablets
• injections and,
• frequent insulin Dr. Sunita Gupta 26
Prevention
• Other health problems • For people with well-
that accelerate the controlled blood sugar
toxic effects of levels, the
diabetes are complications of
– obesity,
diabetes are far less
– high blood pressure,
and common and less
– lack of regular exercise. severe,
– elevated cholesterol • it is vital that for
levels,
prevention of diabetes
– smoking,
to organize
• Women with high bp
– Patient education,
must be careful. They
– His understanding of
have a threefold
the disease, and
greater risk of Dr. Sunita Gupta 27
– His participation in
Lifestyle changes - Type 1
diabetes
• Make Changes in
lifestyle
– take drugs to reduce
pressure.
– take an appropriate diet,
– quit smoking,
– Exercise more,
– wear diabetic socks,
• to avoid higher risks of
cardiovascular disease,
• to control blood
pressure and cholesterol
• Combine the use of
regular and/or synthetic
Dr. Sunita Gupta 28
Lifestyle changes - Type 2
diabetes
• Reduce the risk of long term
complications:
This is achievable by combining
– diet,
– exercise and
– weight loss (type 2),
– various oral diabetic drugs (type 2 only),
and
– insulin use – when not responding to
oral medications (more for type 2 than
type 1). Dr. Sunita Gupta 29
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Dr. Sunita Gupta


Life-style dietary changes

30
Conclusion
• Diabetes mellitus is
• a chronic disease,
• without a cure.
• Emphasize on role for
• patient education,
• dietetic support,
• sensible exercise,
• self glucose monitoring
(both short and long term
glucose blood levels within
normal standards).
• avoid short and long-term
diabetes-related problems
• Careful control to reduce
the risk of long term
complications.
Dr. Sunita Gupta 31
Some tips for avoiding
complications
• Keep blood sugar levels as close to normal as
possible
• Keep blood pressure under 130/80 mm Hg.
• Aim to keep LDL (unhealthy) cholesterol levels
under 100 mg/dl,
• Aim to keep HDL (healthy) cholesterol levels over
40 mg/dl,
• Aim to keep triglyceride levels under 150 mg/dl.
• Practice good foot care (see "Damage to the feet
and legs").
• Regularly visit your doctor to assess overall health
• Check for ways to reduce your risk and avoid any32
Dr. Sunita Gupta
Possible solutions

Dr. Sunita Gupta 33


Any questions?
Dr. Sunita Gupta 34
Thank You
for listening

Dr. Sunita Gupta 35


What diabetes can lead to

Dr. Sunita Gupta 36


One Effect of Diabetes

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Fast fact: Neuropathy

People who maintain intensive blood sugar control reduce their risk for neuropathy by 60%.

Dr. Sunita Gupta 38