The Silent Killer

Dr. Bakht Jamal Shaikh

Munich Re. Seminar at Hotel Sheraton KarachiDecember 20, 2012.

Diabetes is Chronic Metabolic Syndrome caused due to absence or resistance to Insulin hormone, resulting more Glucose in blood.

Dr. BJS

Pancreas

35-50% people do not know that they are Diabetic.

•2500 year old disease

•400 BC: Sushruta Sweet odor/taste

Statue of Sushruta in IndiaDr. BJS

•250 BC: Word “Diabetes” was used first time by Greek Physician Aretaeus, means “Siphon” or “Drain”.

•Flushing out the muscleand water from the body.

Aretaeus of CappadociaDr. BJS

•1674 AD: Dr Thomas Willis, Physician of King Charles-I first used the word “Diabetes Mellitus”

Mellitus (Latin) honey sweet

Dr. Thomas WillisDr. BJS

•1869 AD: Berlin Medical student Paul Langerhans discovered that beta cells of Pancreas secret Insulin, now known as “Islets of Langerhans”

Insulin Island

Paul LangerhansDr. BJS

•1889 AD: German Dr. Joseph Von Mering removed pancreas of dog and it became Diabetic.

Dr. Joseph Von MeringDr. BJS

•1921 AD: Sir Fredrick Banting and his friend Best of Canada discovered Insulin.

Sir Fredrick BantingDr. BJS

It took almost 23 centuries for effective treatment of Diabetes Mellitus.

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CELLS

ENERGY

LIVER

GLYCOGENOLYSIS

GLUCOSE

GLYCOGEN

INSULIN

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Lack of Insulin

Increased Blood

Glucose

Less Energy

Weight loss + Fatigue

Frequent urination

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•Life Long Disease•Life Style Disease•Preventable•Irreversible•No Cure•Controllable•Full of Complications

•Decrease 5-10 years of Life•40 million DALYs (Disability Adjusted Life Years) wasted annually•Pakistan average age at onset lower i.e. 33 years•Hepatitis C virus enhance the chances of early onset

•50% cases lead to Heart Attack•10-20% to Kidney Failure•2% to Blindness•More prevalence in men but more death in women due to lack of attention

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•Causes more deaths than AIDS + Breast Cancer

•13,000 people die daily

•1 die every 7 seconds (500 die during this session)

•Pre-Diabetes: 281 m or 4% of population

•DM : 558 m or 8% of total population (187 m unknown)

•Top 1 country is Micronesia: 37 %

•Bottom country is Mali: 1.7%

•World Annual Cost US$ 471 B (26 annual Pak Budget)

Source: IDF

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World

•Death 84,336 p.a. 50% Death below 60.

•8th. Cause of Death

•10.25 m suffer from DM (3.65 m unaware)

• TOP 10th in World in number (#)

• TOP 7th. in World in percentage (%)i.e. 10.5% of Adult (20-79) Population

•IGT: 7.42 Million

Source: IDF

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Pakistan

•Middle & Lower Income: 80%

•Males:51% Female: 49%

•Rural:57% Urban: 43%

•Age 40-59: 49%20-39: 27%60-79: 24%

Source: IDF

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Pakistan

1. Age2. Gender3. Race4. Family History

5. Obesity6. High Blood Pressure7. Sedentary Life Style8. High Cholesterol in Blood9. Stress

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TYPE 1 (IDDM) Juvenile Onset TYPE 2 (NIDDM) Maturity Onset

Genetic (a) autoimmunity (b) virus

Lean

Children & adolescent < 40 Peak age 14

White Race & cold weather

Absence of insulin

Treatment with Insulin

Abrupt

Prevalence 5%

Environment (strong family history)

Obese

Adults > 40

Black Race and warm weather

Resistance to insulin

OHGA + Insulin

Progressive

Prevalence 95%

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New TYPE 1.5 (Latent Autoimmune Adult onset)

Both parents DM 50% Risk1 Parent before 50 14% Risk1 Parent after 50 7% Risk

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• Polyuria Frequent Urination

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• Polydipsia increased thirst

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• Polyphagia increased hunger

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• Weight loss

• Infection & Delayed healing

• Fatigue

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A1C (90 Days)Result Random Blood Sugar

(RBS)

101-126 mg% Impaired 141-200 mg% 5.7 to 6.4 %

Up to 100 mg% Normal Up to 140 mg% Up to 5.6 %

Above 126 mg% Diabetic Above 200 mg% Above 6.4%

Fasting Blood Sugar

(FBS)

Source: ADA

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•Eyes loss of vision

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•Brain Stroke

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•Heart Heart Attack

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•Kidney Kidney Failure

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Diabetic Nephropathy

•Diabetic Keto-Acidosis

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•Nerves Peripheral Neuropathy(Numbness)

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•Diabetic Foot Amputation

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Obesity + F/HPre-Diabetic

(Candidate)DIABETIC Complications DEATH

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Underwriting Approach

Case of DM Presented as:

1. Family History (see Age, Obesity & Rate)

2. Glycosuria (Postpone till Diagnosis & Rx)

3. I.G.T (see Profile & rate or further invest.)

4. Unaware but suffering Diabetes M.

5. Known Diabetic under control. (Accept +EM)

6. Known Diabetic out of control/comp. (Dec)

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1. Age at onset: Earlier the age more the mortality risk

At age 35: 300%At age 65: 150%

2. Type: (I or II) I riskier than II.

3. Duration since onset: More duration, more riskier.

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4. Control (A1c): 6.5%-10% ) Above 10%D.

5. Systolic Blood Pressure: Above 160 D110 mm Hg = 100% (Standard)155 = 200% (Twice)165 = 400% (Four times)

6. Protienuria: Micro/Macro (++++)+ -->D

7. Complication: Heart Attack, Stroke, Kidney Failure, Blindness, Amputation,Diabetic Keto-Acidosis.

8. Smoking: Mild or Moderate.

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Conversion from mg% to mmol/L

mg% / 18 = mmol/L

180 mg% / 18 = 10 mmol/L

Conversion from A1c% to mg%

A1c% * 33.3 – 86 = mg%

e.g. 6.5% A1c * 33.3 less 86

= 130 mg%.

Conversion from A1c% to mmol/mol

(A1c% - 2.15) *10.929

e.g. (A1c 6.5% less 2.15) *10.929

= 4.35 *10.929

= 47.54 say 48 mmol/mol.

Dr. BJS