WHY DIABETES CLINIC

WHAT IS DIABETES ???

DIABETES MEAN
HIGHER SUGAR IN
BLOOD
IDF 2017
Top ten countries

84.22 %
44.08 %
Every 6 seconds a person dies from
diabetes (5.0 million deaths)
Every 30 seconds a
lower limb is lost to
diabetes somewhere
in the world
THE RULE OF HALVES

100

50

25

12.5

6.25
 The Most
Successful Man In
Life Is The Man
Who Has The
Best Information
HOW SUGAR RISES

6
BRAIN
3
PANCREAS
1
FOOD 4
INSULIN
ENE
BLOOD
RGY
5
KIDNEY URINE
SUGAR
2
LIVER

IMMUNITY
 What is diabetes?
INSULIN
INSULIN
INSUFFICIENCY
RESISTANCE
INSULIN
DEFICIENCY
The body
The pancreas prevents the
The
does not make insulin that is
pancreas
enough insulin being made
does not OR OR
make any from correctly
(this gets working
insulin
worse with pancreas
time)

Department of Health and Human Services. Centers for Disease Control and Prevention. National Diabetes Fact Sheet, 2007.
cdc.gov/diabetes/pubs/pdf/ndfs_2007.pdf..
Types
• Type 1

• Type 2

• Gestational DM

• Other: MODY,
LADA, FCPD,

• Secondary
Normal Type 2 DM Type 1 DM
 Who is at risk?
• Age 30 or older • High blood pressure
• Overweight • Pre-diabetes
• Inactive • High blood fats
• South Asian population • Polycystic ovary syndrome
• Family history of diabetes
• • History of Gestational
Excess abdominal fat
Diabetes or large baby
Why is Diabetes & Obesity on the increase?

• Inactivity
• Overweight
• Poor eating habits
• Living longer
• Increase in ethnic diversity
The main Reason Behind
Diabetes & Obesity
When do we say a person has
diabetes?

Type 1 diabetes Type 2 diabetes

• Frequent urination • Frequent infections
• Unusual thirst • Blurred vision
• Extreme hunger • Cuts/bruises that are slow
• Unusual weight loss to heal
• Extreme fatigue and • Tingling/numbness in the
Irritability hands/feet
• Recurring skin, gum, or
bladder infections

Many People have NO Symptoms!!

 COMPLICATIONS
Stroke Visual impairment:
(cerebrovascular disease) diabetic retinopathy,
cataract and glaucoma

Heart disease
(cardiovascular disease)
Bacterial and fungal Kidney disease
infections of the skin (diabetic nephropathy)
Severe hardening of
the arteries (atherosclerosis) Autonomic neuropathy
(including slow emptying
Sexual dysfunction
of the stomach and diarrhea)

Poor blood supply to lower limbs

(peripheral vascular disease)

Necrobiosis lipidoica
Sensory impairment
(peripheral neuropathy)
Gangrene
Ulceration
 Diabetes Complications

Cardiovascular and renal complications are the main cause of death in people
with diabetes around the world and this can be avoided by appropriate
treatment.

Mothers with GDM or with hyperglycaemia in pregnancy are at high risk for
causing transgenerational effects for their offspring (higher risk of obesity,
diabetes, hypertension and kidney disease).

Diabetes complications can be present at the moment of diagnosis in people
with type 2 diabetes and early (around 5 years) after onset of type 1 diabetes
and therefore should be screened accordingly.

Albuminuria is the earliest marker of kidney disease in diabetes and a strong
predictor for CVD, therefore it should be examined when screening for
complications – indeed a very cheap marker to measure.

Patient self-management is an important part of successfully preventing or
delaying diabetes complications.
ARE YOU AT RISK ?
CHECK URSELF
HIGH BMI
INCREASED WAIST CIRCUMFERENCE
HIGH W/H RATIO
BUFFALO HUMP

DOUBLE CHIN

ACANTHOSIS NIGRICANS

SKIN TAG OR ACHROCORDON

XANTHELASMA
Body Mass Index (BMI)
Waist circumference
 Waist circumference
Waist circumference Country / Ethnic group
cm 94 Male *Europids
In the USA, the ATP III values ( 102 cm male; 88
cm 80 Female cm female) are likely to continue to be used for
clinical purposes
cm 90 Male South Asians
cm 80 Female Based on a Chinese , Malay and Asian-Indian
population
cm 90 Male Chinese
cm 80 Female
cm 90 Male **Japanese
cm 80 Female
Use South Asian recommendations until Ethnic South and Central Americans
more specific data are available
Use European data until more specific Sub-Saharan Africans
data are available
Use South Asian recommendations EMME ( Arab) populations
until more specific data are available
Waist-to-Hip ratio
BUFFALO HUMP
DOUBLE CHIN
ACANTHOSIS AND SKIN TAGS
Xanthelasma
INDIAN DIABETES RISK SCORE
MORE SIMPLY

IF YOUR WAIST IS
MORE THAN HALF
OF YOUR HEIGHT
YOU ARE AT RISK OF
DEVELOPING
DIABETES
 DIAGNOSIS

• FBS: FASTING BLOOD SUGAR

• PPBS: POST PRANDIAL BLOOD SUGAR

• HbA1C: GLYCOSELATED HEMOGLOBIN

 IF I HAVE DIABETES, WHAT TO DO

• WHY YOU HAVE DIABETES ??

• WHAT IS THE SEVERITY ??

• IS THERE ANY COMPLICATIONS AT PRESENT ??

• IS THERE ANY COMORBIDITIES PRESENT ??

• WHAT IS BEST LINE OF THERAPY ??

OTHER REPORTS

• FASTING C-PEEPTIDE LEVEL

• FASTING LIPID PROFILE
• S. CREATININE
• S. TSH, VITAMIN B12, VITAMIN D3
• URINE ALBUMIN CREATININE RATIO
• ECG & TMT
• USG ABDOMEN WITH BL RENAL & CAROTID DOPPLER
• NEUROPATHY SCREENING AND NERVE CONDUCTION
• FUNDUS EXAMINATION
 તપાસ કઇ રીતે ? ક્યારે ?
ભૂખ્યા પેટે ટાઇપ-ર દર મહિને
FBS લોહીની તપાસ ટાઇપ-૧ રોજ કે
એકાંતરો
જમ્યા પછી ર ટાઇપ-ર દર મહિને
PPBS કલાકે લોહીની ટાઇપ-૧ રોજ કે
તપાસ એકાંતરો
HbA1C લોહીની તપાસ દર ૩ મહિને
યુરીન
માઇક્રોઆલબ્યુ પેશાબની તપાસ દર છ મહિને
મીન
S. Creatinine 
સીરમ લોહીની તપાસ દર છ મહિને
ક્રીએટીનીન
S. Iipid profile
લીપીડ પ્રોફાઇલ લોહીની તપાસ દર છ મહિને
(કોલેસ્ટ્રોલ)
ઇસીજી હૃદયની પટ્ટી દર વર્ષે એક વાર
ફન્ડોસ્કોપી
(આંખના પડદાની ટીપાં નાખી દર વર્ષે એક વાર
આંખની તપાસ
તપાસ)
પગની નસોની તપાસ ડોક્ટર દ્વારા દર મહિને એક વાર
 Treatment

Diet &
exercise

Education
Drugs

Reduced
blood
glucose
levels

A healthful eating pattern, regular physical activity, & often

pharmacotherapy are key components of diabetes
management. Evert AB et al. Diabetes Care 2013 Oct 9. [Epub ahead of print]
High Fat Low Fat
 What we can DO ???

Risk factors that cannot Risk factors that can

be changed include: be changed:
 Parent, brother, or  Overweight

sister with diabetes  High blood pressure

 High-risk ethnic population

 Physical inactivity

(South Asians and Indians)  Stress!!!

 History of heart disease


In women: delivery of baby
4 kg, or diabetes during
pregnancy

American Diabetes Association. Diabetes Care. 2010;33(suppl 1):S11-S61.

 The good news…

• Research shows that lifestyle

changes can be very effective
in preventing or delaying
DIABETES
NEWS
Does diabetes patient require specific diet
than normal population ???
YES or NO
EATING BASICS

•How to eat ???

•What to eat ???
FIRST BASIC PRINCIPLE IS
EAT ONLY WHEN YOU ARE
HUNGRY
How we are eating ???

Three most vulnerable hunger

pattern..
•Sensory type
•Emotional type
•Habitual type
 HUNGER PATTERN
  QUIZ YES NO
S1 Do you get significantly distracted when you see or smell    

 
certain foods?
 
 
 
 
 

S2 Do you audibly moan after eating certain foods (or even    

 
smelling them)?
 
 
 
 
 

E1 Do you eat when you feel bad OR When you feel happy?    
       

E2 What kinds of foods do you tend to go for when you are    

 
unhappy?
 
 
 
 
 

E3 Do you use food to numb your emotions (FLAB)?    

     

H1 Do you eat at set times every day, whether or not you are    

 
hungry?  
 
 
 

 
H2 Do you eat when other people insist on it?
 
 
 
 
 
4 CORE PRICIPLES

1. USE SMALL PLATES

2. SERVE SEQUENTIALLY
3. REMOVE TEMPTATION
4. ENFORCE A RHYTHM
Nutrition

Eat healthy… stay healthy…

DO NOT FAST
TAKE BREAKFAST DAILY 
Eat right amount of food at
right time
Do not overeat
Take small frequent meals

 The Plate Method

http://www.tops.org/images/plate.gif
 EXERCISE

• Reduces weight
• Improves cardiovascular function
• Increases fitness
• Increases physical working capacity
• Improves sense of well-being /quality of life
Exercise

Do’s and Don’ts…

Drink plenty of fluids

Develop a routine… exercise daily

Use proper footwear

Don’t do vigorous exercises

Follow your doctor’s advice

 Suggested Exercise :
What to do to burn1000 Calories ?

Running
11 miles Cycling 22 miles
Gardening
5 hours

Walking Dancing 3
12 miles hours
 Standard Approach to the Management of T2DM:
Treatment Intensification

ges Insulin
n
Cha
y l e
est
Lif Oral + Insulin + +

Oral Combination +

Diet, Exercise, Oral Drugs

Adapted from Riddle MC. Endocrinol Metab Clin North Am. 2005; 34: 77–98.
ખોટી માન્યતાઓ

"બાજુવાળા તો એક જ ટીકડી ખાય છે. મને ડોક્ટર

કેમ ત્રણ ટીકડી આપે છે.“

કોઇ બે દર્દીઓના ડાયાબિટીસ સરખાં નથી. વળી

દર્દીનું વજન, ખોરાક, કસરત અને ઈન્સ્યુલીન
ઉત્પન્ન કરવાની ક્ષમતા પરથી દવાઓની
જરૂરીયાત નક્કી થાય છે માટે કોઇ બીજા
દર્દીની સારવાર સાથે તમારી દવાની સરખામણી ન
કરશો.
 ખોટી માન્યતાઓ
"ડાયાબિટીસની દવાઓ ઝાઝો ટાઇમ ન
લેવાય, નહીં તો કિડની ફેઇલ થઇ
જાય..."

સત્ય હકીકત તો બિલકુલ આ

માન્યતાથી ઉંધી છે. જે લોકો
નિયમિત દવા નથી લેતા અને
ડાયાબિટીસ કાબુમાં નથી રાખી
શકતા તેમને માત્ર કિડની જ નહિં
પણ હૃદય, આંખના પડદા, પગનાં
જ્ઞાનતંતુઓ પર અસર થવા સંભવ છે.
આથી વિપરીત ડાયાબિટીસની દવાઓ
વર્ષો સુધી લેવા છતાં શરીરને
ઝાઝુ નુકશાન નથી આપતી, પણ ખૂબ
 WHAT!?
Did you say
INSULIN?!
 Barriers to Insulin use
Patient Barriers Solutions
 Fear of injections  Improved comfort & convenience
 Fear of hypoglycemia  Sever hypoglycemia is rare
 Fear of weight gain  Weight gain seen with most Rxs.
 Only for ‘Severe DM’  Glucose normalization is the key
Provider Barriers Solutions
 Insulin is atherogenic?  No !!, DIGAMI, UKPDS, DCCT
 Difficulty in convincing  Improved devices, Dr education
 Complex to adjust dose  Simplify regimens and dosing
 Benefits of Insulin Therapy
1. Prevention of acute metabolic crises
2. Quick return to ‘health’
3. ↓ ↓ symptoms of glucosuria and hyperglycemia
4. Sense of well-being
5. Anabolic & anti–catabolic effects of insulin
6. Restoration of -cell function
7. -cell protection from apoptosis & preservation

8. Postponement of ‘Secretory Failure’

Things to Remember

•Right Insulin

•Right Dose

•Right Time

•Right
Technique
ઈન્સ્યુલીનઃ ખોટી
માન્યતાઓ

(1) "ઈન્સ્યુલીન" લેવાથી તેની આદત પડી જાય છે....

અને કાયમ લેવું પડે છે."
આ બિલકુલ ખોટો ખ્લાય છે. ઈન્સ્યુલીન કોઇ
કેફી દ્રવ્ય નથી કે નશાકારક દવા નથી કે
તેની આદત પડી જાય... માત્ર જે દર્દીઓના
શરીરમાં ઈન્સ્યુલીનની ઊણપ છે તે ઉણપ કાયમ
માટે હોય છે અને સાજા રહેવા દર્દીએ કાયમ
માટે આ ઉકેલ કરવો પડે છે અને હંમેશા
ઈન્સ્યુલીનના ઇંજેકશન લેવા જરૂરી બને છે.
(૨) "મને ગમે તેવી ભારે
ઈન્સ્યુલીનઃ ખોટીઅને ગમે તેટલી
ભારે ટીકડી આપો પણ ઈન્સ્યુલીન
માન્યતાઓ
ઇંજેકશન તો નહિ જ."
જ્યારે ડાયાબિટીસના દર્દીના
શરીરમાં થોડું પણ ઈન્સ્યુલીન હોય
ત્યાં સુધી મોઢેથી લેવાની ટીકડીઓ
કામ કરી શકે છે. જે દર્દીઓના શરીરમાં
ઈન્સ્યુલીન ન હોય અથવા સાવ જ ઓછું
હોય તેમણે ઇન્સ્યુલીન ઇંજેક્શન
લેવાં જરૂરી છે, કારણ કે ટીકડીઓ
શરીરના જ ઈન્સ્યુલીન પાસેથી વધારે
કામગીરી લેવાનું જ કામ કરે છે. આવે
વખતે ઝાઝી ટીકડી કે ભારે ટીકડી
 Myths

“Eating too much sugar causes diabetes. ”

“You can catch diabetes from someone else.”
“I'll know if I have diabetes because I'll feel sick.”
“I'll have to eat all those horrible diabetic foods.”
“I don't have a family history of diabetes, so I won‘t get
it. ”
“Say no to fruits.”
 Thank you
Have a stress free life