SIMPLYFYING DIABETES

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SIMPLYFYING DIABETES

• Dr. S. K. Wangnoo
• Apollo Centre for Obesity, Diabetes and
  Endocrinology (ACODE)
• Apollo Hospital, New Delhi

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WHAT IS DIABETES

• Commonly known as having Sugar Diabetes or
  Madhumeh in Hindi.
• It is a disease in which the body either does not
  produce enough insulin or is unable to use the
  insulin the way it should be.
• Insulin is a hormone produced in the pancreas,
  that helps the body to convert the glucose into
  energy.

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Types of Diabetes

• TYPE 1 OR INSULIN DEPENDENT DIABETES.
• TYPE 2 OR NON INSULIN DEPENDENT
• GESTATIONAL DIABETES

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Symptoms of Diabetes

• Many Patients are asymptomatic
• Symptoms when present are
• Polyuria (excessive urination)
• Polydipsia (excessive thirst)
• Polyphagia (excessive appetite)
• Unexplained weight loss
• Recurrent intermittent blurred vision.
• Generalized pruritis or vulvo vaginitis
• Peripheral neuropathy
• Sexual dysfunction such as ED.
• Recurrent skin infections

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Diagnosis

• Fasting plasma glucose 126 or above on at least 2
  separate occasions.
• Random plasma glucose of 200 mg/dl or more on 2
  separate occasions.
• Abnormal GTT (Plasma Glucose of 200 mg or more at
  2 hours)

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Risk factors

• Age 45 and over
• Family Hx ( first degree relatives with type 2)
• Ethnicity ( African American, Hispanic, South
  Asian, Pacific Islander, and Native American)
• Hx of gestational diabetes.
• Delivery of infants weighing 9 or more lbs.
• Polycystic Ovary Syndrome ( PCOS )
• Overweight esp. with abdominal obesity
• Presence of cardio vascular disease,
  hypertension, impaired glucose
• Physical inactivity

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What is Pre-Diabetes?

• Fasting Blood sugar 110 to 125 mg on 2
• separate occasions
• 2 hour OGTT 140 to 199 mg
• Usually asymptomatic

• What is Significance of detecting Pre-diabetes?
• Converts to diabetes in 4 to 7 years
• Can be delayed with life style changes and
  weight loss of 5 to 10 of body weight
• Medication use may be indicated
• Early treatment can delay complications from
  diabetes

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How Bad is Type 2 Diabetes, Really?

• Increases your risk of.
• Heart disease, high blood pressure and stroke by
  about two times.
• Other complications include blindness, numbness,
  amputation, impotence, and kidney failure!

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SYMPTOMS OF HYPOGLYCEMIA

• Confusion
• Blurred vision or double vision
• Anxiety and tremulousness
• Sweating and cold and clammy hands
• Light headedness or fainting
• Rapid pulse / heart rate
• Seizures or convulsion

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Symptoms of Hyperglycemia

• Polyuria and polydypsia
• Marked fatigue
• Nausea / vomiting
• Mental stupor progressing to coma if
• Untreated
• Fruity smell in breath
• Serious complication is Diabetic Ketoacidosis

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TREATMENT OPTIONS

• LIFE STYLE CHANGES
• WEIGHT REDUCTION
• DIET
• DIET EXERCISE
• DIET EXERCISE MEDICINES

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REGULAR MONITORING

• Weight
• BP
• Foot examinations
• Pulse rate
• Sores, calluses
• Test for sensations

• Annual eye exams by ophthalmologist
• Hemoglobin A1C every 3 to 6 months
• Annual fasting lipid panels
• Urine test for presence of proteins

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Public Awareness

• Survey on 2,000 People with Diabetes
• (Fall 2001)
• Findings
• 68 do not consider cardiovascular disease to be
  complication of diabetes
• 50 dont feel risk for heart condition or
  stroke
• 60 dont feel at risk for high blood pressure or
  cholesterol
• Awareness lowest among elderly, minorities

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The Good News

• By managing the ABCs of diabetes, people with
  diabetes can reduce their risk for heart disease
  and stroke.
• A stands for A1C
• B stands for Blood pressure
• C stands for Cholesterol
• D stands for diet and lifestyle changes
• E stands for exercise

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Ask About Your A1C

• A1C measures average blood glucose over the last
  three months.
• Get your A1C checked at least twice a year.

A1C Goal less than 7
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Key Steps for Lowering A1C

• Eat the right foods.
• Get daily physical activity.
• Test blood glucose regularly.
• Take medications as prescribed.

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Beware of Your Blood Pressure

• High blood pressure raises your risk for heart
  attack, stroke, eye problems and kidney disease.
• Get your blood pressure checked at every visit.
• Target BP less than 130/80

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Key Steps for Lowering Blood Pressure

• Eat more fruits and vegetables!
• Reduce the amount of salt in diet.
• Lose weight.
• Lower alcohol intake.
• Quit smoking.
• Take blood pressure pills.
• many people require more than one pill

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Check Your Cholesterol

• Several kinds of blood fats
• LDL (bad) cholesterol - can narrow or block
  blood vessels
• HDL (good) cholesterol - helps remove
  cholesterol deposits
• Triglycerides - can raise your risk for heart
  attacks/stroke

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ADA Goals for Cholesterol
Target LDL less than 100 Target HDL above 40
(men) above 50
(women) Target triglycerides less than 150
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Key Steps for Controlling Your Cholesterol

• Eat less saturated fat
• Foods high in saturated fat fatty meats,
  high-fat dairy products, tropical oils
• Eat foods high in fiber
• Examples oatmeal, beans, peas,
• citrus fruits
• Take cholesterol-lowering medication
• Exercise regularly

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Exercise

• A little bit goes a long way
• Try being more active throughout the day.
• Examples work in the garden, play with the
  kids, take the stairs
• Walk - work up to at least 30 minutes of walking
  on most days you can even split this into a
  10-minute walk after each meal.

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Other Strategies

• Get help to quit smoking.
• Talk to your health care provider about taking
  aspirin and other medications to reduce your risk
  for heart disease and stroke.

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Managing Medications

• On managing your medications
• Ask when to take each medicine make sure
  instructions and labels are clear.
• Link as many medicines as possible to recurring
  daily events getting up, eating, brushing
  teeth, bedtime.
• Put a reminder note where youll see it.
• Set your watch, computer, or a kitchen timer as a
  reminder.
• Use a daily or weekly pill box.
• Make a chart showing when each medicine should be
  taken.
• Talk to your health care provider about what you
  should do if you miss a dose.

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General Tips

• Take steps to lower your risk of complications
• A1C lt 7.
• Blood pressure lt 130/80.
• Cholesterol (LDL) lt 100.
• Cholesterol (HDL) gt 40 (men) and gt 50 (women).
• Triglycerides lt 150.
• Get help to quit smoking.
• Be active.
• Make healthy food choices.
• Talk to your doctor about medication.

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Thanks!