Diabetes Mellitus

1. Diabetes Mellitus OVERVIEW

2. What is Diabetes • Types of Diabetes • Risk Factors • Body & Alcohol • Side effects of Alcohol • Effects of Alcohol • Factors to cause diabetes • Pancreas and its function Overview

3. Chronic metabolic Disorder • Prevents the body to utilise glucose completely or partially • Most of the food we eat turns into glucose or sugar for our bodies to use for energy • A person with diabetes does not make enough insulin &/or cannot use his own insulin as well as he should What is Diabetes

4. Type 1 • Type 2 • Gestational Diabetes Types of Diabetes

5. Types(Classification) • Type 1 diabetes---previously called insulin-dependent diabetes (IDDM) or juvenile-onset diabetes. • Type 2 diabetes---previously called non-insulin-dependent diabetes (NIDDM) or adult-onset diabetes • Gestational diabetes---A form of glucose intolerance that is diagnosed in some women during pregnancy. • Pre diabetes---Term used to distinguish people who are at in increased risk for developing diabetes

6. Risk factors- Type 2 Diabetes • Genetics-Family History • Stress • Poor diet habit • Life style • Age • Abdominal fat • Obesity • Certain Drugs • Lack of physical activity • High B.P • Cholesterol abnormality

7. Body and Alcohol Alcohol is not broken down in stomach and reaches blood very quickly, within minutes Highest level reached between 30-90 minutes Alcohol is metabolized in the liver Blood carries alcohol to other body-parts if it is consumed faster than it takes to break it down Brain cells are easy targets which is why people get a buzz from alcohol

8. Side Effect of Alcohol Causes weight gain/ makes weight loss difficult Increases triglycerides Increases risk of developing neuropathy If neuropathy already exists; increases the pain, numbness and tingling sensation Increases blood pressure Dehydrates the body Damages liver over time Makes diabetic eye disease worse

9. Effects of smoking NOT RELATED TO DM • Prone to cold and respiratory infections • Oral /lung cancer DM-RELATED • Increases blood sugar • Increases cholesterol • Lowers HDL-C • Increases BP • Reduces oxygen supply to vital organ • Constricts blood vessels leg & foot infections • Prone to get nerve and kidney damage • 3 times increased risk of death by CVD than non-DM

10. Pancreas and its functions Organ located in the abdomen Role in converting the food we eat into fuel for the body cells Functions Regulates blood sugar Helps in digestion Islets of Langerhans cell Beta cell Alpha cell Regulating glucose level in blood by allowing glucose to enter into the cell Insulin Glucagon

11. Rice ,Fruits,Sweets,Meatetc Food Protein CHO fat Amino acid Fatty acids Glucose What happens to the food we eat ENERGY

12. Food enters stomach Digestion of Food Food is converted into glucose Glucose enters Blood stream Pancreas Releases insulin Glucose Enters blood stream

13. Insulin helps the glucose to enter into the cell. Action of Insulin

14. Type 1 Diabetes Food is converted into glucose Food enters stomach Glucose enters blood stream Pancreas produce no insulin Glucose rises in the Blood

15. Type 2 Diabetes Food is converted into glucose Food enters stomach Glucose enters blood stream Pancreas releases very less insulin Insulin is less effective Glucose rises in the Blood Glucose enters cell

16. Glucose Metabolism Glycolysis energy Glucose Glycogenesis extra glucose converted to Glycogen Lipolysis Remaining glucose is stored as Lipids

17. Symptoms of Hyperglycemia • Weakness • Loss of strength • Increased urination • Depression • Fruity smell • Decreased healing capacity

18. Normal : 70-100 mg/dL • Pre-Diabetic: FBS: 100-125 mg/dL • PPBS: 140-199 mg/dL • IFG(impaired fasting Glucose) : 100-125 mg/dL • IGT(impaired Glucose tolerance) : 140-199 mg/dL • Diabetic : FBS:80-127 mg/dL • PPBS:100-145 mg/dL • HbA1C : 6.5 mg/dL The American Diabetes Association recommends the following: Target Blood Sugar Values *Plasma Glucose Values

19. Heart diseases • Eye problems • Kidney failure • Loss of sensation and painful feet (nerve disease) • Sexual dysfunction • Lower leg amputations 70% of people with diabetes will die of cardiovascular disease Long-term Complications of Diabetes-Why do we care?

20. Symptoms Hypoglycemia (Blood sugar is less than the normal level ) • Blurred vision • Fluid and electrolyte imbalance • Lack of sleep • Depression • Confused • Hungry • Rapid heart beat • Head ache • Sweaty

21. Management of Hypoglycemia • The quickest way to raise your blood sugar and treat hypoglycemia is with some form of sugar, such as: • Glucose • ½ cup of fruit juice • 5-6 pieces of hard candy

22. DRUGS • DIET • EXERCISE • MONITORING • LIFE STYLE MODIFICATIONS Diabetes Management

23. Blood sugar • Learn how to use a glucometer • Ask your doctor how often and when you should test. This can vary for patients • Write down the results in a diary • HbA1c: • Clearer picture of sugar control • Average sugar levels over 8-12 weeks • Atleast every 3-6 months Blood sugar testing

24. Help body use its own insulin better (biguanides, TZD's) • Help body release more of its own insulin (sulfonylureas & meglitinides) • Slow the digestion of starches (alpha glucosidase inhibitors) • Keep liver from sending extra sugar (biguanides) Oral Medications

25. All patients with Type 1 Diabetes need insulin to survive • Most people with type 2 diabetes will eventually need insulin • Recent studies show that more people with diabetes can achieve better control if insulin were started earlier Insulins

26. Reduces stress, increases energy and gives a feeling of well being • Helps control your BP and blood fats (lipids) • Makes your insulin work better Exercise

27. Understanding how different foods and the amount eaten affect blood sugar • Choosing healthy foods • Eating regular meals at the right times Meal Planning

28. Food Guide Pyramid

29. Hospitalization is necessary • Only intravenous (preferably) or intramuscular insulin will be effective. • IV fluids will be required in large quantities • Electrolyte balance is critical • Sodium bicarbonate might be required • Important to identify cause of DKA and treat it Management of DKA

30. DIABETIC DIET

31. BALANCED MEAL

32. Reduce oil/fat intake to 3-5 tsp (15-25g) per day • Recommended oils include rice bran oil, groundnut oil, soyabean oil, olive oil or mustard oil. Avoid butter, cheese and dalda. • Avoid sugar,jaggery & honey completely. • Avoid coconut (dry/fresh) and groundnut . • Exercise for 30-45mts every day. • Avoid all bakery products, pickles, chutney, junk/fast food, sauces and ketchup, namkeen, cooking and baking soda, dried sea food, processed cheese, papad and Chinese food. • Include sources of omega-3 fatty acids like walnuts, flaxseeds, fish, dark green leafy vegetables and soyabean in the diet • Can consume non-vegetarian foods like fish, chicken (without skin) or egg whites 2-3 times a week. Preparation should not be deep-fried or in coconut gravy. Avoid shell fish like prawns, crabs, lobsters. • Avoid consumption of sago, potato, yam, tapioca, sweet potato. • Avoid alcohol and smoking • Keep minimum gap of 30 mins between meal and tea/coffee General advice

33. Its the ability of a food to raise blood sugar levels after it is digested It depends on • Amount and form of fiber • Amount of protein and fat • Time and type of processing and cooking GLYCEMIC INDEX

34. Rice • Sugar • Honey • French fries • Potato • Corn Flakes • White bread HIGH GLYCEMIC INDEX FOODS

35. Cereals Whole wheat Basmati rice Semolina roasted Brown rice Oatmeal Popcorn Fruits and Vegetables Mango Pomegranate Custard apple Banana Pineapple Black grapes Raisins Beetroot MEDIUM GLYCEMIC INDEX FOODS

36. Cereals &Pulses Parboiled rice Barley Green peas Lentils kidney beans Soy-beans Milk & milk products Skim milk Curd Soy milk Vegetables & Fruits Raw carrots Apple Plum Orange Papaya Guava Above ground vegetables LOW GLYCEMIC INDEX FOODS

37. A SMALL AND FREQUENT MEAL PATTERN(3 main meals+ 2-3 mini meals)

38. “Let Food be the Medicine and Let Medicine be the Food”

39. DIABETES IS CONTROLLABLE – ITS IN YOUR HANDS YOU CAN DO IT!