Welcome

2009-2013: Education And Prevention

Presented By: III Yr B.Sc.(N)

What is Diabetes?
Diabetes is a group of metabolic diseases characterised by elevated levels glucose in the blood (hyperglycemia) resulting from defects in insulin secretion, insulin action or both

Incidence

The number of cases of diabetes worlwide in 2000 among adults 20 years of age is estimated to be ~ 17.1 million. India has the dubious distinction of having the largest number of people with diabetes. Recent studies have shown that for every person known to have diabetes, there are more than 2 people who have diabetes but are unaware of it.

 Global prevalence of diabetes

Fig-1: Estimated number of adults with diabetes by age-group, year, and countries for the developed and developing categories and for the world.

List of countries with the highest numbers of estimated cases of diabetes for 2000 and 2030

Ranking

Country

People with diabetes (millions)

2000 2030 79.4 42.3 30.3 21.3 31.7 20.8 17.7 8.4

1 2 3 4

India China U.S. Indonesia

5
6

Japan
Pakistan

6.8
5.2

8.9
13.9

7
8 9 10

Russian Federation
Brazil Italy Bangladesh

4.6
4.6 4.3 3.2

11.3 11.1

Types of Diabetes

Type 1 diabetes - commonly diagnosed in children and young adults, but its a lifelong condition; insulin dependent
Type 2 diabetes - the most common type of diabetes about 9 out of 10 people with diabetes have type 2 diabetes; non-insulin dependent Gestational diabetes - occurs during pregnancy; usually goes away when the pregnancy is over

Who gets diabetes?

- Type 1 diabetes occurs at about the same rate in men and women - Type 2 diabetes is more common in older people, mainly in people who are overweight

What causes diabetes?

Type 1 and type 2 diabetes The exact causes of both types of diabetes are still not known For both types, genetic factors make it possible for diabetes to develop Most people who get type 2 diabetes are overweight Gestational diabetes changing hormones and weight gain in pregnancy make it hard to keep up with the need for insulin

Type 1diabetes pathophysiology

Type 2 diabetes pathophysiology

Risk Factors

The risk factors for Type 1 are unknown

Risk for Type 2 include Age being older than 45 Overweight or obesity Family history having a mother, father, brother, or sister with diabetes Race/ethnicity Having a baby with a birth weight more than 9 pounds High blood pressure 140/90 mmHg or higher High cholesterol total cholesterol over 240 mg/dL Inactivity Lack of adequate exercise Abnormal results in a prior diabetes test Having other health conditions that are linked to insulin use, like Polycystic Ovarian Syndrome Having a history of heart disease or stroke

What are the signs of diabetes?

Being very thirsty Urinating a lot Feeling very hungry Feeling very tired Loosing weight without trying Having sores that are slow to heal Having dry, itchy skin Having tingling in the hands or feet Having blurry vision Having more infection than usual

Diagnostic Evaluation?

History
General examination Fasting Plasma Glucose Test (FPGT) - measures blood glucose in a person who has not eaten anything for at least 8 hr Oral Glucose Tolerance Test (OGTT) - measures blood glucose after a person fasts at least 8 hrs and 2 hrs after the person drinks a glucose-containing beverage Random Plasma Glucose Test (RPGT) measures blood glucose without regard to when the person being tested last ate. HbA1c less than 7 (glycosylated Hb) LDL less than 100mg/dl HdL greater than 40mg/dl Triglyceride less than 150mg/dl

FPG Test
Plasma Glucose Result (mg/dL) Diagnosis

99 or below

Normal

100 125

Pre-diabetes (impaired fasting glucose)

126 or above

Diabetes*

* Must be confirmed on more than 1 occasion

OGT Test
Plasma Glucose Result (mg/dL) Diagnosis

139 or below

Normal

140 199

Pre-diabetes (impaired fasting glucose)

200 or above

Diabetes*

* Must be confirmed on more than 1 occasion

Gestational Diabetes
When Plasma Glucose Result (mg/dL)

Fasting

95 0r higher

At 1 hour
At 2 hours At 3 hours

180 or higher
155 or higher 140 or higher

* Must be confirmed on more than 1 occasion

RPG Test
A random, or casual, blood glucose level of 200 mg/dL or higher, plus the presence of the following symptoms, can mean person has diabetes:

Increased urination Increased thirst Unexplained weight loss

Other symptoms can include fatigue, blurred vision, increase hunger, and sores that do not heal

* Must be confirmed on more than 1 occasion

Diabetes Treatment

Self care at home

Diet key to controlling blood sugar levels and preventing complications; consistent, well-balanced diet high in fibre, low in saturated fat and concentrated sweets Exercise regular exercise reduces risk and complications Moderate or eliminate alcohol consumption Abstain from smoking Self-monitored blood glucose

Self insulin injection

Medical Treatment

Highly individualized, depending on the type of diabetes

Type 1 diabetes

Involves daily injection of insulin Rapid acting e.g insulin lispro humalog ,insulin glulisine short-acting insulin e.g insuline regular- lispro (Humalog) or aspart (Novolog) Intermediate acting e.g insulin NPH longer acting insulin (for example, NPH, Lente, glargine, detemir, or ultralente)

Type 2 diabetes
Depending on how elevated the patients blood sugar and glycosylated haemoglobin (HbA1c) are at the time of diagnosis, they may be given a chance to lower blood sugar level without medication Loose weight Healthy diet

Type 2 Diabetes medication

Medication to keep blood sugar level under control
- Class I :Makes the body more sensitive to the insulin e.g Thiazolidinedion,Avandia(Rosiglitazone)and Actose(Pioglitazone)

- Class II : Stimulates the Beta Cells to release more insulin e.g Sulfonylureas (Acetohexamide), Amaryl,Glucotrol,Diabeta,Glynase & Orinase
- Class III : Breakdown of Starches & certain sugars is blocked or slow down e.g Alpha-glucosidase inhibitors,Precose (acarbose) and Glyset (meglitol)

Measures to Prevention Diabetes

Stop smoking Limit the amount of alcohol you drink Eat plenty of vegetables and fruits Cut down salt( papad, pickle and soda) Have regular physical examination Have regular blood and urine tests Exercise regularly to your doctors recommendation

Measures to control diabetes

Regular check-up is a must Proper control no negligent eating habit; no smoking, alcohol or drugs Proper care keep a constant control over the blood glucose, blood pressure, and cholesterol level Keeping a track of the disease regular consultations, timely medication and regular exercise Proper treatment most essential step; periodical tests to check the status of the disease

Complications of diabetes

Diabetes, Heart disease and Stroke Diabetic Neuropathies: the nerve damage of diabetes Diabetic Retinopathy (Eye disease) Erectile Dysfunction Hypoglycemia Renal Disease & Failure Sexual & Urologic problems Stomach Nerve Damage (Gastroparesis)

Dietary Management

Low gylcaemic index foods - Wholegrian - Bran oats - Pulses - Sprouts - Soyabean - Leafy vegetables - Fruits and Vegetables with skin - Fenugreek seeds - Nuts Avoid simple starch - White starch: Polished rice,maida,potato,noodles, pasta,pizza - Simple sugar: Sugar , honey, jaggery , sweets, sweetened drink - Fruit juices - Cola - Bakery products

Diabetes Education

Key component of diabetes management Enhance knowledge and foster behaviour change in order to promote selfmanagement Educators role is to help people with diabetes learn to manage their disease Main challenges availability of education, disease perception and cost of diabetes education More skilled educators required to meet growing need