Diabetes and YouDiabetes and You

Vidya Sundaram, MDVidya Sundaram, MD

Diabetes in Asian IndiansDiabetes in Asian Indians

The prevalence of diabetes in rural India The prevalence of diabetes in rural India is 2 percentis 2 percent

In urban India, the prevalence is 8 In urban India, the prevalence is 8 percentpercent

In Indians migrating to westernised In Indians migrating to westernised countries the prevalence is 4 times more countries the prevalence is 4 times more than those living in Indiathan those living in India

Indian Americans have higher risk than Indian Americans have higher risk than Americans of European descentAmericans of European descent

Diabetes in Asian IndiansDiabetes in Asian Indians

Some of the reasons for increased risk of Some of the reasons for increased risk of Diabetes are:Diabetes are:

Genetic predispositionGenetic predisposition Increased caloric intakeIncreased caloric intake Higher intake of processed carbohydrates, Higher intake of processed carbohydrates,

reduced fiber, increased animal fat intakereduced fiber, increased animal fat intake Abdominal obesity and insulin resistanceAbdominal obesity and insulin resistance Sedentary lifestyleSedentary lifestyle

Diabetes in Asian IndiansDiabetes in Asian Indians

32 million Indians with diabetes32 million Indians with diabetes This number is expected to double in This number is expected to double in

the next 30 yearsthe next 30 years

What is Diabetes

Your body is not able to use properly the energy from the food you eat because either:

The body makes very little or no insulin i.e. Type I Diabetes

Or, the cells are not responding to the insulin, called insulin resistance. This occurs in Type 2 Diabetes. Over time, insulin production decrease in Type 2 Diabetes

What is Diabetes

In both types of diabetes, sugar builds up in the blood stream because it cannot enter the cells

Without sugar for fuel in the cells, the body lacks energy

High blood sugar levels, damage over time, your blood vessels, leading to serious complications

Diagnosis of Diabetes

Two fasting blood sugars equal to, or greater than 126 mg/dL

Any random blood sugar greater than 200

On oral glucose tolerance test, if blood sugar is equal or greater than 200 mg/dL

Prediabetes

Fasting blood sugar between 101 to 126 mg/dL

On oral glucose tolerance test, if the blood sugar at 2 hours is between 141 to 199 mg/dL

Symptoms of Diabetes Increased thirst Increased frequency of urination Increased fluid intake Weight loss Blurred vision Numbness and tingling in hands and feet Frequent infections Delayed wound healing

Diabetes complications

Nerve damage: neuropathy Retinal bleeds, vision loss: retinopathy Kidney damage, kidney failure:

nephropathy 4 to 5 times increased risk for heart

attacks and strokes Foot ulcers, amputations Sexual dysfunction

Management of Diabetes

Lifestyle changes• Diet• Exercise• Weight loss• Medications

Grains Vegetables Fruits Milk Meat & Beans

Vegetarian food pyramid

Vegetarian diet

5 to 9 servings of cereals/grains or potatoes 2 or 3 servings of pulses, nuts & seeds 4 or 5 servings of fruit and vegetables Some yeast extract fortified with vitamin B12. A small amount of vegetable oil and margarine

or butter. 2 to 3 servings of milk, cheese, eggs or soy

products

Diet

It takes 3500 calories over and above your

daily caloric needs to gain ONE lb of weight.

1 gram fat = 9 calories 1 gram protein = 4 calories 1 g carbohydrate = 4 calories 1 g fiber = 0 calories

Management of Diabetes: Exercise

Brisk walking for 30min to 1 hour most days of the week

Check with your physician before starting an exercise program

Exercise lowers blood sugars

Management of Diabetes: Weight loss

Normal Body mass index (BMI) between 18-24

Overweight if BMI greater than 25 Obese: if BMI more than 29 Moderate to severe obesity: BMI 30-

39 Morbid obesity: BMI 40 or above

Management of Diabetes: Weight loss

If overweight : aim to lose atleast 10 percent of body weight

This will help control diabetes, and lower cardiovascular risk

The numbers game

Normal blood sugar : 70 – 100mg/dL Goals for Diabetes: fasting blood

sugar between 80-120mg/dL 2 Hours after a meal: less than

160mg/dL, ideally less than 140

The numbers game: HbA1C

HbA1c goals: less than 7% Uncontrolled Diabetes: if HbA1c

greater than 8%

The numbers game: Blood pressure

Goal: Less than 130/80 mm Hg If kidney disese is present, blood

pressure should be less than 125/80

The numbers game: Lipids

Total cholesterol less than 200mg/dL LDL cholesterol less than 100

mg/DL, preferably less than 70 Triglycerides less than 150mg/dL HDL cholesterol greater than

40mg/dL for men greater than 50mg/dL for women

Medicines in DiabetesMedicines in Diabetes

Increase insulin production: ie glipizide , glimeperide, nateglinide, Prandin

Insulin sensitizers: Metformin, Avandia, Actos Prolong action of Insulin: DPP4 inhibitors eg

Januvia, Byetta injections (GLP-1) Symlin injections: decreases glucagon and

delays gastric emptying Insulin

INSULININSULIN

Most people with Type 2 diabetes will eventually need insulin

Type I diabetics need insulin from the beginning

SummarySummary

Diabetes is:Diabetes is: CommonCommon ControllableControllable LifelongLifelong Self ManagedSelf Managed ProgressiveProgressive