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Knowledge of Diabetes

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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

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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

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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

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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

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Diabetes

“Mild Disease” Serious consequences

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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

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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

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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

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Diabetes is on the rise

Wild S et al. Diabetes Care 27:1047–1053, 2004

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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

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Why diabetes is increasing?

Sedentary lifestyle Increasing obesity

Unhealthy dietary habits

“Genes load the gun. Lifestyle pulls the trigger”Dr. Elliot Joslin

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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

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Managing diabetes • Not curable • But can be controlled with

• Education• Healthy Diet plan • Regular exercise• Proper medication • Regular check ups & visits

to doctor

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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

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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

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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

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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

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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

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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

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Diabetes: Medication Type 1 Type 2 Diabetes

Initially tablets

• Most require insulin

• Earlier the better

• No role for tablets • Only insulin

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Discovery of insulin (1)

“One of the greatest milestones in history of medicine”

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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

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The miracle of insulin

Patient J.L., December 15, 1922

February 15, 1923

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Types of Insulin preparations

• Strength-40 units/ml, 100 units/ml• Devices-NovoPen, NovoLet, FlexPen etc.

Premixed insulin

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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

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Basic method of insulin delivery Insulin syringes

Insulin vials

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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

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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

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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

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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

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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

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How to avoid these complications?

THE GOOD NEWS IS that these

COMPLICATIONS ARE PREVENTABLE

How?Good control

of sugars

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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

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When you reach the end of what you should know, you will be at the beginning of what you should sense. - Kahlil Gibran

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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

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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 ?

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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

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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

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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

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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

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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

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