Dr.Shreeram VaidyaDr.Shreeram Vaidya

•Diabetes, Yes We can control

What is Diabetes Mellitus?What is Diabetes Mellitus?

• 1500 BC Ebers Papyrus First Described Diabetes

• Diabetes means to siphon .The most obvious sign of diabetes is excessive urination

• Mellitus means sweet like a honey.• It is a disorder of carbohydrate metabolism. • In which body’s blood sugar (glucose) • Level remains too high and causes problems.• Insulin allows body’s cells to use glucose as a

fuel .

400 BC Sushrut 400 BC Sushrut

• Diabetes Causes• Genetical• Environmental

In 1889 MinkowskiIn 1889 Minkowski• In 1889 Minkowski, with

the German physiologist Joseph von Mering (1849-1908), discovered that dogs subjected to removal of their pancreas develop the symptoms of diabetes, leading Minkowski to postulate that the pancreas is the site of secretion of an «antidiabetic» substance, now known to be insulin.

Noble story of Insulin 1921Noble story of Insulin 1921

• DR Banting & DR Best isolated insulin

• From pancreas of dog• Insulin injected to a

diabetic dog showed fall in glucose levels

First insulin use Jan 11 1922First insulin use Jan 11 1922

• On January 11, 1922, a 14-year-old with type 1 diabetes named Leonard Thompson received an experimental injection at the Toronto General Hospital that would change history. At the time, type 1 diabetes was thought to be a death sentence. Thompson's life was extended by an additional 13 years using insulin.

PancreasPancreas

• The pancreas has an exocrine portion that secretes digestive enzymes that are carried through a duct to the duodenum. The endocrine portion consists of the pancreatic islets, Paul Langerhans 1869 Described clusters of cells (islets )

• In the pancreas which secrete Glucagon and insulin.

Types Of Diabetes MellitusTypes Of Diabetes Mellitus

• Type I DM Insulin Dependent Diabetes

• 5-10% of diabetic patients. Usually affects

• Children.

• In this condition pancreas of the patients

• Produce practically no insulin. The patient’s survival is dependent on external insulin.

Types of Diabetes contTypes of Diabetes cont

• Type II Diabetes : Non Insulin Dependent

• Diabetes

• Causes

• Genetically

• Environmental

• Insulin is insufficient or insensitive

Diabetes in the WorldDiabetes in the World

millions

India

79.479.4

China

42.342.3

USA

30.330.3

Indonesia

21.321.3

Japan

8.98.9

YearYear20102010

Reference: Wild S, Roglic G, Green A, Sicree R, King H. Global prevalence of diabetes. Diabetes Care. 2004; 27(5): 1047-1053.

Symptoms of DM Symptoms of DM • Excessively Thirsty (polydypsia)

• Passing a lot of urine (Polyuria)

• Excessive eating ( Polyphagia)

• Delayed wound healing

• Tiredness leg pains and numbness in the foot.

• Person may not have any symptom

• REGULAR CHECKING IS THE KEY

Diagnosis Diagnosis

• Fasting Glucose >126mg%

• Post Lunch (2Hrs) >/ 200mg%

TreatmentTreatment

• Dietary restrictions

• Exercise: Burns fats controls obesity

• Drugs : Oral or insulin

• Once diabetic Diet restrictions and exercise always required

Diet for Diabetics Diet for Diabetics

• Avoid ice-creams, barfis,pedas,jams, jellies, chocolates ,soft drinks, these items cause a sudden rise in blood glucose.

• Avoid also butter ,ghee, cream, paneer, deep fried food, coconut.

• Fruits to be avoided mangoes bananas , chickoos.

Diet contDiet cont

• Diet

• Lots of salad Carrots cabbage cucumber

• Chapati Bhakari (Rotala)

• Do not apply ghee or oil over roti

• Vegetables can be had in sufficient quantities

Sweet story Sweet story

• For One Jelebi or Gulab Jamun

Sugar present Approximately 20grams

• Capable of raising blood glucose at least to 400mgs but Your beta cells produce more insulin and solve the problem .

• But once they are sick they stop working and take outsider’s help i.e. may be insulin inj

BODY MASS INDEXBODY MASS INDEXBMI = weight in Kg /HT in Meter BMI = weight in Kg /HT in Meter 22

CLASSIFICATION ASIANS RISK COMORBIDIES

UNDER WT <18.5 LOW

NORMAL RANGE 18.5-22.9 AVERAGE

OVERWT >23 INCREASED

OBESE I >25 MODERATE

OBSE II >30 SEVERE

Wrong beliefsWrong beliefs

• Diabetes can eat wheat but not rice

• Both wheat and rice raise the blood sugar to similar extent .

• It should not matter whether one takes wheat or rice , as long as the total quantity

• Is restricted .

Diabetic complicationsDiabetic complications

• Hypoglycemia Blood glucose <50mg%• Retinopathy : screen of eye gets affected• Neuropathy: Found in 50 % diabetic , Tingling

numbness, burning sensation (Feet) • Nephropathy: Kidney damage • Heart attacks : 2-3 times higher than non

diabetics• Hyperglycemia: Blood glucose above 140mg%

Hypoglycemia SymptomsHypoglycemia Symptoms

• Increased appetite

• Weakness

• Sweating

• Restlessness

• Palpitation

• Giddiness

HypoglycemiaHypoglycemia

• Predisposing Factors

1 Delaying or skipping meals

2 Heavy alcohol consumption

3 Decreased carbohydrate consumption

4 Decreased in Insulin requirements

(after elimination of stress)

DIABETIC FOOTDIABETIC FOOT

Make checking your feet part of your daily routine ,just like brushing your teeth.

Watch for red spots swelling ,cuts and calluses.

Use mirror so that you can see heel ,sole

Wash your feet with warm water every day .to avoid burns test water temp with your elbow.

DIABETES YES WE CAN DIABETES YES WE CAN CONTROLCONTROL

HDL Cholesterol (Good Cholesterol)

>45

LDL cholesterol Bad cholesterol)

<100mg%

Triglycerides <150mg%

Waist measurement <90cms for male

<85cms for females

DIABETES YES WE CAN DIABETES YES WE CAN CONTROLCONTROL

Fasting blood glucose 80-120mg%

Post lunch (2Hours) <140mg%

HbA1c <7%

BMI 18.5-23

Cholesterol <200mg%

DIABETES YES WE CAN DIABETES YES WE CAN CONTROLCONTROL

B.P. <130/80 mmHg

Smoking Say no as it kills insulin producing cells

alcohol No as it will harm in the control

Say no to papad pickle Helps in controlling DM

Regular TestsRegular Tests

• Examination of Retina

• Urinary Microalbumin : early detection of kidney damage

• Lipid profile

• HbA1c Quarterly

• B.P . Feet examination at each Doctor visit