1
Knowledge of Diabetes
2
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
3
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
4
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
5
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
6
Diabetes
“Mild Disease” Serious consequences
7
Diabetes – A serious diseaseLeading cause of newcases of blindness 25 times more prone to eye problems
6 times higher risk forstroke
5 times more prone toKidney disease
20 times more prone tolower limb amputation
2-4 times higher risk forheart 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
8
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
10
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
2030366m
11
Diabetes is on the rise
Wild S et al. Diabetes Care 27:1047–1053, 2004
12
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
13
Why diabetes is increasing?
Sedentary lifestyle Increasing obesity
Unhealthy dietary habits
“Genes load the gun. Lifestyle pulls the trigger”Dr. Elliot Joslin
14
What if diabetes is increasing?
• Costly disease –$100 billion every year & 25% of Medicare in the USA
• Common disorder – 50% undiagnosed
High rates of hospitalizationHigh occurrence of
• angina• heart attack• blindness• kidney failure & • amputations
15
Managing diabetes • Not curable • But can be controlled with
• Education• Healthy Diet plan • Regular exercise• Proper medication • Regular check ups & visits
to doctor
16
4 Simple steps to control diabetes Healthy meal
plan Regular ExerciseTake your medicines as advised Regular
check ups
Dietary Recommendations Diabetes Food Pyramid
Cereals & Pulses8-12 Units
10-14 units (veg)
Fruits2-3 UnitsVegetables
3-4 Units
Milk & Milk Products2-3 Units
Meat & Fish1-2 Units
Fats, Oils & Nuts 2-3 Units
18
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
19
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
20
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
21
Exercise: Simple tipsPoints 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
22
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
24
Diabetes: Medication Type 1 Type 2 Diabetes
Initially tablets
• Most require insulin
• Earlier the better
• No role for tablets • Only insulin
25
Discovery of insulin (1)
“One of the greatest milestones in history of medicine”
26
Discovery of insulin (2)Experiments in Toronto
University
F Banting, surgeonC Best, medical college
student
30 July 1921
Banting & Best- extracted insulin from dog & proved that it controls symptoms of diabetes in dogs – 1921Insulin is injectable
27
The miracle of insulin
Patient J.L., December 15, 1922
February 15, 1923
28
Types of Insulin preparations
• Strength-40 units/ml, 100 units/ml• Devices-NovoPen, NovoLet, FlexPen etc.
Premixed insulin
29
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
30
Basic method of insulin delivery Insulin syringes
Insulin vials
31
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
32
Novo Nordisk Insulin Delivery Devices• NovoPen –World’s 1st insulin
pen (reusable) • NovoLet-World’s No. 1 Insulin
Delivery Device (disposable)• FlexPen-World’s most
preferred pen (disposable)• NovoFine needles & Many
more….
World’s broadest & most comprehensive portfolio of injection devices
33
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
34
Tomorrow’s 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
36
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
37
How to avoid these complications?
THE GOOD NEWS IS that these
COMPLICATIONS ARE PREVENTABLE
How?Good control
of sugars
38
Preventive measuresRegular
• Blood sugar testing• BP measurement• Body measurements• Foot examination • Urine test for presence of proteins
• Cholesterol testing • Eye examination • Dental check ups• ECG
39
When you reach the end of what you should know, you will be at the beginning of what you should sense. - Kahlil Gibran
40
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
41
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 ?
42
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
43
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
44
Foot CarePrevention 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
45
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)
TreatmentMild 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
JUICE COKE
48
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 result…rising 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 FoodSalt 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 ½ 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 choices—diet 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
65