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Short Talk on

Diabetes
DR. NISHANT SINGH BENIWAL
M.B.B.S, M.D.(INTERNAL MEDICINE), DIP. DIABETES
CONSULTANT, YATHARTHA GROUP OF HOSPITALS, NOIDA

Diabetes

Prevalence of Diabetes:

Prevalence of Diabetes Mellitus


2000 171 million
2030 366 million

By 2025 India with most number of diabetic cases - 79


million
Metabolic Syndrome: Risk factors related to obesity.

Type I: Beta cells produce little or no insulin.

Type II: Fat, Liver, and muscle cells do not respond to


insulin (insulin resistance)

Gestational Diabetes: High sugars in Preg.

Top 10 Countries
2000
Country

2030
Persons
(millions)

Country

Persons
(millions)

1. India

31.7

India

79.4

2. China

20.8

China

42.3

3. USA

17.7

USA

30.3

4. Indonesia

8.4

Indonesia

21.3

5. Japan

6.8

Pakistan

13.9

6. Pakistan

5.2

Brazil

11.3

7. Russia

4.6

Bangladesh

11.1

8. Brazil

4.6

Japan

8.9

9. Italy

4.3

Philippines

7.8

10. Bangladesh

3.2

Egypt

6.7

Prevalance of Diabetes with amount


of work / activity.
Prevalence of diabetes [%]

20

15

17.0%

10

9.7%

5.6%
0
Heavy

Moderate
Physical activity grades

Light

Pathophysiology of Diabetes
When you eat, your body
breaks food down into
glucose. Glucose is a
type of sugar that is
your bodys
main source
of energy.

Pathophysiology of Diabetes

As blood glucose
rises, the body
sends a signal to
the pancreas, which
releases insulin.

Pathophysiology of Diabetes
Acting as a key, insulin
binds to a place on the
cell wall (an insulin
receptor), unlocking
the cell so glucose can
pass into it. There,
most of the glucose is
used for energy right
away.

Blood glucose regulation


Blood glucose
goes up and down
throughout the
day:
As your blood
glucose rises
(after a meal), the
pancreas releases
insulin.

Type 2 diabetes
Your pancreas may not
produce enough insulin
(insulin deficiency).

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Your cells dont use


insulin properly.
The insulin cant
fully unlock the
cells to allow
glucose to enter
(insulin resistance).

Natural
History
of Diabetes
Natural
History
of Type 2 Diabetes
Obesity

IGT*

Diabetes

Uncontrolled
Hyperglycemia

Post-Meal
Glucose

Plasma
Glucose

Fasting Glucose
120 (mg/dL)

Relative -Cell
Function

Insulin Resistance
100 (%)

Insulin Secretion

-20

-10

10

20

30

Years of Diabetes
*IGT = impaired glucose
tolerance.

Diagnosing diabetes
Fasting plasma glucose test
(FPG) results
diabetes

126 mg/dL or greater

pre-diabetes 125 mg/dL to 100 mg/dL


normal

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less than 100 mg/dL

Risk factors for type 2 diabetes


Type 2 is more common in people who:
Are overweight.
Are 45 or older.
Are physically inactive.
Have a parent or sibling with type 2
diabetes.
Are African American, Native American,
Hispanic American, or Pacific Islander.
Have abnormal cholesterol levels.

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Have had gestational diabetes, or given


birth to a baby greater than 9 lbs.
Have high blood pressure.

Blood Glucose Targets for


Adults

Pre-meal or fasting:

2 hours post-meal:

80-120

80-140

Bedtime: 80-140 or 100-140

When & How Often


Should I Be Testing?
On

insulin: 4
times per day.

Not

on insulin: 2
times per day.

Test at Alternating Times


of the Day
Before or 2 Hours After Eating
Day of the Breakfast Lunch
week
Mon.

Tues.
Wed.

Dinner
X

X
X

Bedtime

X
X

Meal plan works like this

Maximum

CHO

Breakfast

Lunch

Dinner

Meal plan works like this

CHO

Breakfast

CHO

Lunch

CHO

Dinner

Hypoglycemic Symptoms

How to care for yourself when


youre hypoglycemic
Eat or drink 15 grams of fast-acting,
low-fat carbohydrate right away.
Quick energy sources
The following items are quick energy sources that contain about
15 grams of carbohydrate:

96

cup fruit of orange, apple, or grapefruit juice


1/3 cup grape, prune, or cranberry juice
2 tbsp raisins
6 crackers
3-5 pieces hard candy
1 cup skim milk
1 piece bread
3-4 glucose tablets, or 1 tube glucose gel
cup regular soft drink (not diet)
11 jellybeans

HbA1c: the blood test with a


memory
What is HbA1c?
Hemoglobin is a protein that makes
your red blood cells red-colored.
When hemoglobin picks up glucose
from your bloodstream, the hemoglobin
becomes glycosylated.

HbA1c in your bloodstream.

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Glycosylated hemoglobin is HbA1c.


The HbA1c test measures the
percentage of HbA1c in your blood
a number that corresponds to your
average blood glucose for the previous
3 months.

Introduction to self-management
Key pieces of diabetes self-management:
Monitoring
blood glucose

Taking
medication

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Following a
meal plan

Getting regular
exercise

Good News About Physical Activity

Cant exercise?

Pools
Exercise balls or exercise bands
Walking tape
Stationary bikes
Exercise videos
Yoga
Local Recreation Centers or school facilities
TV Programs on fitness

Exercise is boring.

Vary your routine and dont be


afraid to try something new.

Participate in things you like to do.

Exercise with a friend

Use music or books on tape to


make the time pass more quickly.

Tips for Safe Physical Activity

Hyperglycemia Can Cause Serious


Long-Term Problems

Diabetes-CVD Facts
Nearly

all adults with diabetes


have one or more cholesterol
problems, such as:
high triglycerides
low HDL (good) cholesterol
high LDL (bad) cholesterol

ABCs

A A1c, or hemoglobin A1c test.

ADA goal is 7% or less.

AACE goal is 6.5% or less.

B Blood pressure

< 130/80 mmHg for non-pregnant adults.

C Cholesterol

HDL (good) cholesterol >40 mg/dl (men); >50 mg/dl


(women)

LDL (bad) cholesterol <100 mg/dl

Triglycerides <150 mg/dl

Good News for


Type 1 Diabetes

Good News for


Type 2 Diabetes

Take Steps to
Reduce Risk
Factors for Heart
Disease

Diabetes Can
Lead to Nerve
and Small Blood
Vessel Damage

Getting regular medical care


Schedule for routine medical care
HbA1c

2-4 times/year

Blood pressure

At least 2 times/year

Cholesterol

At least every other year

Dilated eye exam

1 time/year

Foot exam

At least 1 time/year

Dental exam

2 times/year

Urine microalbumin/
creatinine ratio

1 time/year

Flu shot

1 time/year

Pneumococcal vaccine

Once (repeat at age 65)

Take Home Message


Eat Well
Exercise Well
And Live Well
Choose Well

Find Diabetes Educators in Your


Area :- A good doctor and dietician

Thank You

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