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Knowledge of
Diabetes
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Knowledge will forever govern ignorance; and
people who mean to be their own governors must
arm themselves with the power which knowledge
gives.
James Madison
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Agenda
What is Diabetes?
What are the lifestyle measures to control diabetes?
What is the role of insulin in treatment of diabetes?
Preventive care
Q & A
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What is Diabetes?
Chronic illness in which there is too much sugar
(glucose) in blood
Although sugar is needed to provide energy - when in
excess it causes problems
Persons with diabetes have excess sugar as they lack
or have deficient supply of insulin
Serious disease
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What is Insulin?
Chemical substance produced by pancreas (an organ
situated behind stomach)
Required for sugar to enter cells of the body where it is
utilized
Acts like a key to open the door in a cell, so that glucose
enters
Also important in keeping blood glucose levels within
acceptable limits
When insulin is absent or deficient or is defective, sugar
remains in high amounts in the blood
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Diabetes
Mild Disease
Serious consequences
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Diabetes A serious disease
Leading cause of new
cases of blindness
25 times more prone to
eye problems
6 times higher risk for
stroke

5 times more prone to
Kidney disease
20 times more prone to
lower limb amputation
2-4 times higher risk for
heart attack
Beck-Nielsen et al. (1985) Herman WH, Eye Disease
and Nephropathy in NIDDM ,1990.
All these complications can be avoided with timely intervention &
good control
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What are the types of diabetes?
2 types
Type 1 diabetes (less common; affects younger people)
Type 2 diabetes (more common; affects older people)

Gestational Diabetes Mellitus (GDM)
Diabetes during pregnancy
What are the common symptoms of
Diabetes ?
No symptoms
Frequent Urination
Excessive Hunger
Weight loss
Excessive thirst
Other Symptoms like:
Fatigue
Unusual Infections
Blurred vision
Dry and itchy skin etc
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Diabetes is on the rise
Number of people with diabetes
is increasing worldwide ..
more in INDIA
Estimated 32 million persons
with diabetes - mostly type 2
Only 12-14% treated
Believed to occur a decade
earlier compared to the West
India: Diabetes Capital of the world
King H et al Diabetes Care 1998; 21: 1414-1431
2000
171m
2030
366m
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Diabetes is on the rise
Wild S et al. Diabetes Care 27:10471053, 2004
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The Problem of Diabetes in India
India has the largest number of persons with diabetes
This number is expected to increase
Indians are more prone to develop diabetes and its
complications at a younger age
Lower purchasing power
Inadequate access to health care facilities
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Why diabetes is increasing?
Sedentary lifestyle Increasing obesity
Unhealthy dietary habits
Genes load the gun. Lifestyle pulls the trigger
Dr. Elliot Joslin
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What if diabetes is increasing?
Costly disease $100 billion every year &
25% of Medicare in the USA
Common disorder 50% undiagnosed
High rates of hospitalization
High occurrence of
angina
heart attack
blindness
kidney failure &
amputations

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Managing diabetes
Not curable
But can be controlled with
Education
Healthy Diet plan
Regular exercise
Proper medication
Regular check ups & visits
to doctor
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4 Simple steps to control diabetes
Healthy meal
plan
Regular Exercise
Take your
medicines
as advised
Regular
check ups
Dietary Recommendations Diabetes
Food Pyramid
Cereals & Pulses
8-12 Units
10-14 units (veg)
Fruits
2-3 Units
Vegetables
3-4 Units
Milk & Milk Products
2-3 Units
Meat & Fish
1-2 Units
Fats, Oils & Nuts
2-3 Units
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Simple Diet tips
Small regular meals with healthy snacks
Use skimmed milk, vegetable oils
Change cooking methods-boiled, grilled & steamed
Avoid
Excess intake of fats & fat products like ghee, butter, fried
foods like puris, kachoris etc.
Fatty meat
Excess intake of refined sugars like sugar, jaggery, honey,
jams, cakes & chocolates

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Exercise Regularly
Single most important thing you can
do successfully
Benefits are endless
Its never too late to start
Helps you enjoy life & avoid diseases
Can help reduce risk of dying
prematurely by almost half
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Benefits of exercise are many
helps reduce weight
improves circulation of blood
builds confidence
builds muscle
strengthens your heart
improves sleep
reduces stress
controls your appetite
adds years to your life
you feel great & feel energized
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Exercise: Simple tips
Points to remember
Consider a check up
Start slowly & increase gradually
Enjoy your exercise
Aim for 30 min or more on most
days of the week
Be creative
Pace yourself
Know when to stop
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What exercise to do?
There are many ways to exercise every
day without going to the gym or to a
fitness club.. such as:

Park farther away from work, the grocery store,
or the shopping mall
Take your dog for a 20-30 minute walk every
other day
Add exercise into your weekend plans
Turn your coffee break into a walking break
Use the stairs instead of the elevator/escalator.
Good Management of Diabetes Requires Balancing
Food intake, Exercise and Medication
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Diabetes: Medication
Type 1 Type 2 Diabetes
Initially
tablets
Most require
insulin
Earlier the
better
No role for tablets
Only insulin
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Discovery of insulin (1)
One of the greatest milestones in history of medicine
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Discovery of insulin (2)
Experiments in Toronto University
F Banting, surgeon
C Best, medical college student
30 July 1921
Banting & Best- extracted insulin from dog
& proved that it controls symptoms of
diabetes in dogs 1921
Insulin is injectable
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The miracle of insulin
Patient J.L., December 15, 1922 February 15, 1923
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Types of Insulin preparations
Insulin
Duration of action Source Purity
Short-acting (soluble)
Intermediate-acting (cloudy)
Long-acting
Bovine (cow)
Porcine (pig)
Human (rDNA)
Conventional
Highly purified
Monocomponent
Strength-40 units/ml, 100 units/ml
Devices-NovoPen, NovoLet, FlexPen etc.
Premixed insulin
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Taking Insulin Injections
Can be taken
Abdomen (front of stomach)
Buttocks
Upper arm
Thigh- front & outer half
Rotate the site of injection around a selected area
Can use Syringe or Devices to administer insulin
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Basic method of insulin delivery
Insulin syringes
Insulin vials
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Advanced method of insulin delivery-
Pen-like Devices
Using pens
Wide range of pens are available
Disposable
Reusable
Better than syringe / vial in many
ways
Offer multiple advantages/
benefits to patient
Less/ no pain on injection
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Novo Nordisk Insulin Delivery Devices
NovoPen Worlds 1
st
insulin
pen (reusable)
NovoLet-Worlds No. 1 Insulin
Delivery Device (disposable)
FlexPen-Worlds most
preferred pen (disposable)
NovoFine needles
& Many
more.
Worlds broadest & most comprehensive portfolio of injection devices
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Advantages with Pen-like devices
Simplicity - Simple to operate and inject
Accuracy accurate dose
Reliability - High quality materials and finish
Discreeteness - Non-medical, non-syringe design
All-in-one: Pen + insulin cartridge + needles
Portability - Small & compact, robust carrying case -
with space for extra needles and cartridge
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Tomorrows Insulin Devices
InnoLet
Innovo
InDuo
Methods of Self-monitoring
Home monitoring and recording of
blood sugar using glucose meters, or color strips
urine sugar and ketones using strips or reagents
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What if sugar is not controlled?
Serious consequences of diabetes
Eye problems- loss of vision
(blindness)
Kidney problems (kidney
failure need for
transplantation)
Nerve problems (painful, could
lead to wounds need to
amputate limb)
Heart problems-heart attack
Stroke paralysis
Foot problems
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How to avoid these complications?
THE GOOD NEWS IS
that these
COMPLICATIONS
ARE PREVENTABLE
How?
Good control
of sugars
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Preventive measures
Regular
Blood sugar testing
BP measurement
Body measurements
Foot examination
Urine test for presence
of proteins
Cholesterol testing
Eye examination
Dental check ups
ECG
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When you reach the end of what you should
know, you will be at the beginning of what you
should sense.
- Kahlil Gibran
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Keep an eye on your eye
Why eye care is important when you have Diabetes
Diabetes is the third most important cause of new blindness in adults
Serious eye problems often develop without warning symptoms
Blurring of vision is often the only symptom when blood sugar is
high
Consistent high blood sugar causes severe loss of vision
Diabetes and Your Eyes
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Children >10 years and Within 3-5 years of diagnosis and
adults < 30 years thereafter once a year


Adults > 30 years At the time of diagnosis and
thereafter once a year

When to get your eyes Tested ?
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Visual acuity (sharpness of vision) test: eye chart test measures how
well we can see at various distances
Ophthalmoscopy: Examination of the inside of the eye with a
fundoscope (instrument). Sometimes the Dr. may put eye drops to
widen the pupil (central hole in the iris the curtain of the eye) so that he
can look at the retina better for signs of diabetic retinopathy
Tonometry: A test that determines the fluid pressure in the eye to check
for glaucoma


Common Tests done to Check the Eyes
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These changes cause no uncomfortable symptoms at first, but if
allowed to continue over the years can result in serious loss of vision

Strict control of diabetes is most important to prevent these changes

Regular eye examinations are essential to detect and treat these
changes at an early stage
How to Prevent Eye Problems
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Foot Care
Prevention Is Better Than Cure
Learn to take good care of your
feet
Practice what you learn every day
Foot problems must be detected
and treated properly
Take help of a Foot Care specialist
or your Diabetes Care Team
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Daily Foot Care
You can prevent major foot problems, if you
Learn to recognize signs of early foot problems
Inspect your feet daily
Keep your feet clean and dry
Trim your toenails carefully
Protect you feet with appropriate footwear
Have your doctor or nurse examine your feet regularly
(especially if you have any loss of sensation in your feet
or toes or have a poor eyesight)
Achieve good blood sugar control - save your
feet
Take Insulin, if advised
Hypoglycemia
Reduction in Plasma glucose concentration below the normal
value of 60 mg/dl
Symptoms:
Hunger pains
Excessive sweating and anxiousness
Weakness
Palpitation/Trembling
Headache
Blurring of vision
Irritability/Confusion
Sleepiness
Faintness/loss of consciousness (coma)
Treatment
Mild Hypoglycemia
Relieved by :
1 glass of fruit juice or soft drink
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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Modern Eating
Restaurant Eating
Modern Living and Eating habits
Are they causing a health havoc?
Mismatch between need and supply

Modern living with limited physical activity does not need
food which is refined :
high simple sugar
calorie dense
high fat

This is the type of food we normally eat

Modern Diet
The resultrising occurence of :

Heart disease
Diabetes
High Blood Pressure (BP)
Obesity

What is healthy food ?
Food that helps attain and maintain normal weight &
growth

Is not harmful or does not increase risk of an illness

Provides satisfaction

Supplies daily requirement of :
Calories
Correct proportion of CHO, Protein & Fat
Vitamins & Minerals
Roughage
Water
Healthy Food Vs Tasty Food
Often the two are considered to be non compatible

Often good healthy food is made unhealthy by the way we process it

Need of the hour is to ensure that we give the right concepts and
change behaviour

You are the trend setters for eating habits and food choices
Signal system based on traffic light concept

Red Preferable to avoid :
Biryani, Fried rice, Puri, Paratha etc

Yellow Not a healthy choice :
Biscuits, Bun, White Bread

Green Healthy choice :
Chappati, Rice, Whole Wheat Bread, Idli
Healthy Food Choices
Problem with Restaurant
Food : Fats and Oils
The biggest problem in food is high amount of fat used in cooking
Saturated fats ( ghee and oils that freeze at room temp) are most
dangerous
Vanaspati is one of the most unhealthy cooking medium
Repeated use of oil for frying changes its composition and makes it
atherogenic (cis-trans)
No one type of oil is best combinations of oils are better

Problem with Restaurant Food
Salt And Sodium
Another important element of unhealthy food -
most Indian gravies and curries contain high amount of salt

Salt also used for marination and pickling

Baking powder is often used and contains high sodium

Most chutneys and pickles are rich in salt

Ajinomoto is often used in Chinese and Thai cooking

Modern Life Requires Eating out
Eating out is very common today - for some a way of
life
Work takes us away from home
Eating at work
Special occasions like birthdays, anniversaries, festivals, or success
Too tired to cook, parties or Friends drop in suddenly so a take out meal
is ordered

With each of these special occasions becoming more and
more common our diabetes and heart conditions are
worsening, waistlines increasing and blood pressures
shooting up

Eating Out
Should people with diabetes or heart ailments
Stop eating in restaurants?
Stop going out and isolate themselves?

Are there no healthy choices while eating out?

Is it possible to eat healthy in a restaurant?

What you should know about eating healthy?
Beverages
Healthy choices for beverages are:

Tomato juice
Plain Nimbu pani
Unsweetened fruit juice
Raw vegetable juice like raddish,carrot etc
Lassi (without sugar)
Tea/coffee (without sugar)

Guidelines for Alcohol Consumption
Preferable to restrict alcohol
The ADA recommends
one drink per day for women
two drinks per day for men
If drinking alcohol several times a week, the doctor should be
aware
To prevent hypoglycemia, alcohol should be consumed with
meal
Guidelines for Alcohol Consumption
No alcohol to be taken in presence of pregnancy, pancreatitis,
dyslipidemia, neuropathy
Do not drive or plan to drive for several hours after you drink
alcohol

Alcohol contains 7 calories per gram and is utilized by the
body like fats. Calculate alcoholic drink as part of calorie
intake, substitute it for fats in the meal plan.

For example: 1 alcoholic drink equals 1 fat exchange (90
calories)

(One alcoholic beverage is 12 oz. light beer, 5 oz. wine or 1
oz. distilled spirits such as, vodka, whiskey, gin, etc.)
Guidelines for Alcohol Consumption
Guidelines for Alcohol Consumption
Healthy Tips to Sip By

Drink only if blood glucose is under control
Test blood glucose to decide if you should drink alcohol
For drink mixers, use calories-free choicesdiet soda, club
soda, diet tonic water, or water
Drink alcohol with a snack or a meal not empty stomach
Quench thirst with water or a no calorie beverage and not
alcohol
Wear Diabetes identification card that notes you have diabetes
Healthy choice for snacks - fat free popcorn, crackers, or
salads
Nutritive and Non Nutritive Sweetener
Non Nutritive (Artificial) sweeteners
Saccharin - Bitter after taste
Aspartame - Has a delayed sweetness taste, is unstable at high
temperatures

Nutritive sweeteners
Fructose 4 cal/g
Sorbitol 4 cal /g
Mannitol- 2 cal/g

Artificial Sweeteners is added to tea and coffee, used
to make sweets/ desserts at home
Eating out in India
People with diabetes or heart ailments can eat in restaurants
with your care and understanding

They can get healthy choices while eating out -with your
expertise

Give your client the option to choose a healthy meal

Put it on your menu card

Experiment and popularize healthier Indian curries

Be the trend setters and your clients will follow and appreciate
your initiatives
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