6066167 patient education slides

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Understanding

Diabetes



Why should we care about

diabetes?

– Diabetes is common.

– Diabetes is serious.

– Diabetes is costly



How old is diabetes ?

• Aretaeus 2nd

century AD

First used the wordDiabetes

Ebers papyrus 1550 BC



• Sushruta (Indian

Physician)

5th and 6th centuryAD



171

0

100

200

300

400

No of Patients in

Million

31.7

366

79.4

2000 2030

Epidemiology of Diabetes

World

India

Diabetes Care; 2004 ; 27(5): 1047-1053



INDIA IS THE DIABETIC CAPITAL OFTHE WORLD WITH 35 MILLION

ADULTS WITH DIABETES TODAY



What does Diabetes mellitus

mean?The term "diabetes

mellitus" was derived

from 2 terms :

The Greek word

Diabetes = to Siphon

or pass through

and the Latin word

mellitus = sweet as

honey



Pancreas and Insulin



Location of the Pancreas



Insulin

Banting and

Best discovered

insulin in 1921



What is Insulin Resistance ?

• Insulin resistance is a condition in which the tissues

of the body fail to respond normally to insulin.

• It affects

glucose uptake in muscle and fat tissue

suppression of production of glucose by the

liver



What is Pre-diabetes ?

In Pre-diabetes

person's blood glucose levelsare higher than normal

but not high enough to bediagnosed as diabetes.

Also know as:

Impaired Glucose Tolerance

(IGT) or Impaired Fasting Glucose(IGT)



What are the Types of Diabetes ?

There are four major types of diabetes:

• Type 1 diabetes• Type 2 diabetes

• Gestational diabetes

• Other specific types of diabetes



Type 2 diabetes is a progressive

metabolic disorder characterised by:

Insulin

resistance

Type 2

diabetesβ -cell

dysfunction



What are Symptoms of Type 2

Diabetes ?

• increased thirst (Polydipsia)

• increased urination (Polyuria)

• increased appetite (Polyphagia)• fatigue

• blurred vision

• frequent and/or slow-healing infections (including

bladder, vaginal, skin)• weight loss despite increased appetite

• erectile dysfunction in men



What are the Risk Factors for

Diabetes ?

• Family history is the biggest risk factor of all.

• Race

• Age (greater than 45)

• Obesity

• Lifestyle changes due to urbanization



What are the ADA Diagnostic criteria for type 2

diabetes?

Diagnostic Criteria of Diabetes

Blood Glucose Normoglycemia IFG or IGT Diabetes

FBG <100mg/dl ≥ 100 ≥ 126mg/dl<126 mg/dl

2 hr PG <140mg/dl ≥ 140 and ≥ 200

<200 mg/dl mg/dl

Diabetes Care 2004; Suppl 27: S11-14



What are the tests for diagnosing type 2

diabetes ?

• Fasting plasma glucose test (FPG)

≥ 126 mg/dL on two occasions

• Oral Glucose Tolerance Test (OGTT)

≥ 200 mg/dL

• Post Prandial Glucose Test (PP)

> 200 mg/dl

• Random Blood Sugar Test (RBS)

> 200 mg/dl



What is HbA1c ?

HbA1c stands for

Glycosalated haemoglobin or

Glycated haemoglobin

HbA1c is called as the blood test with a memory.

It gives a persons average blood glucose controlfor 2-3 month period before the test.



Micro-vascular complications

1. Neuropathy (nerve disease)

2. Retinopathy (Vision problems)

3. Nephropathy (Kidney disease)



Macro-vascular complications

1. Coronary artery disease (heart disease)

2. Cerebrovascular disease (stroke)

3. Peripheral vascular disease (PVD)

4. Foot complications



Diabetic Neuropathy

• Damage to the nerves

• 50% of diabetics suffer from neuropathy

• Rarely develops prior to 5 years of disease

• Highest incidence in diabetics over 25 years of

disease



Diabetic Nephropathy

• 20-40% of all

diabetic patient

developsnephropathy

• Worldwide this is the

most frequent causeof end-stage renal

disease(ESRD)



Diabetic Retinopathy

• Diabetic retinopathy is a complication of the eye.

• It affects the retina(innermost layer of the eye)

• It is a leading cause of blindness in diabeticindividuals.

• During the first two decades of disease, nearly allpatients with type1 diabetes and >60% of patientswith type 2 diabetes have retinopathy.



VISION WITH NORMAL AND

RETINOPATHY EYES

Normal Retinopathy



Diabetes and Cardiovascular

Disease

• CVD is a leading cause of death in

diabetes

• Diabetics are at a 2-4 fold increase

risk of CAD

•2 out of 3 people with diabetes diefrom heart disease and stroke.



Atheroscleroris the main culprit



Stroke (Cerebro Vascular Disease)

• Reduce blood

supply to the

brain• Due to

atherosclerosis

• Rapture of blood

vessels (e.g.brain aneurysms)



Peripheral Vascular Disease

• Atherosclerosis of theperipheral arteries(e.g. Femoral,

popliteal, dorsalispedis etc)

•Intermittentclaudication (Legattack) is thecommon symptom

Atherosclerosis



Diabetic Foot Complications

• 15% of all diabetes develop serious footcondition

Common problems

• Callus formation• Ulceration

• Gangrene

• Charcot’s joints

Ulceration and Gangrene are serious problemsand they may lead to amputation (removal of limbs)



Gangrenous third toe



Constant Juggling:

Exercise

with:

Proper diet

Insulin/Medication

Diabetes Management 24/7

BGBG

BGBG

BGBG

&



Management of Type 2 Diabetes

Non-Pharmacological management

Life style modification

Appropriate diet

Suitable exercise programme

Cessation of smoking and alcohol



Diet and Exercise



Tips in being active throughout the

day

• Walk instead of drive or public transport

whenever possible

• Take the stairs instead of the elevator

• Work in the garden, rake leaves, or do

some housecleaning every day



Pharmacological management

Drug therapy

Oral hypoglycemic agents

Insulin (in certain individuals)

Antihypertensives

Antiplatelet agents

Lipid lowering agents



Questions?

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