DiabetesIntroduction Statistics Symptoms Causes Diagnosis prevention

Introduction to Diabetes Diabetes is a very big topic

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Diabetes is a medical disorder, characterized by varying or persistent hyperglycemia (high blood sugar levels), especially after eating. Diabetes is a chronic condition that needs close attention. It is a condition in which the body either does not produce or properly use insulin.3

Word Origin Aretaeus the Cappadocian, the immortal Alexandrian physician of the second century, was confronted with a patient exhibiting excessive urination. He chose a Greek word signifying siphon. Dia means through or entirely; baino meaning to go.4

The word mellitus however, is a word of Latin origin. Mellis, in Latin means honey (and also refers to the bee) The true Latin word for sweet is dulcis.

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Statistics According to information recently released by the International Diabetes Federation, people diagnosed with diabetes have increased from 30 million to 246 million over the last two decades, a staggering figure.6

While diabetes in the United States has always been well documented, the federations data reveals that the 7 out of 10 countries with the highest number of diabetics are in the developing world, with China and India leading the way.7

In some countries in the Caribbean and the Middle East, the percentage of the diabetic population ranges from 12 to 20%.8

Statistics 2007

In 2007, the five countries with the largest numbers of people with diabetes are 1. India (40.9 million) 2. China (39.8 million) 3. United States (19.2 million) 4. Russia (9.6 million) 5. Germany (7.4 million).9

In 2007, the five countries with the highest diabetes prevalence in the adult population are 1. 2. 3. 4. 5. Nauru (30.7%) United Arab Emirates (19.5%) Saudi Arabia (16.7%) Bahrain(15.2%) Kuwait (14.4%).10

By 2025, the largest increases in diabetes prevalence will take place in developing countries. Each year a further 7 million people develop diabetes. Each year 3.8 million deaths are attributable to diabetes. An even greater number die from cardiovascular disease made worse by diabetesrelated lipid disorders and hypertension. Every 10 seconds a person dies from diabetesrelated causes. Every 10 seconds two people develop diabetes. Diabetes is the fourth leading cause of global death by disease.11

At least 50% of all people with diabetes are unaware of their condition. In some countries this figure may reach 80%. Up to 80% of type 2 diabetes is preventable by adopting a healthy diet and increasing physical activity. Diabetes is the largest cause of kidney failure in developed countries and is responsible for huge dialysis costs. Type 2 diabetes has become the most frequent condition in people with kidney failure in countries of the Western world. The reported incidence varies between 30% and 40% in countries such as Germany and the USA.12

10% to 20% of people with diabetes die of renal failure. It is estimated that more than 2.5 million people worldwide are affected by diabetic retinopathy. Diabetic retinopathy is the leading cause of vision loss in adults of working age (20 to 65 years) in industrialized countries. On average, people with type 2 diabetes will die 5-10 years before people without diabetes, mostly due to cardiovascular disease.

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Cardiovascular disease is the major cause of death in diabetes, accounting for some 50% of all diabetes fatalities, and much disability. People with type 2 diabetes are over twice as likely to have a heart attack or stroke as people who do not have diabetes. Indeed, people with type 2 diabetes are as likely to suffer a heart attack as people without diabetes who have already had a heart attack.14

History In the writings of Aretaios (Aretaeus) of Cappadocia, a Greek physician who lived during the period 120-200 A.D., there is a reference to Diabetes. References to this are also found in Indian, Egyptian medicine.15

The Papyrus of Ebers, written probably in the first half of the 16th Century B.C. in Egypt, mentions the passing of excessive urine amongst the other ailments.16

Surprisingly there is no reference of Diabetes in Chinese, Persian and Greco-Arabic (Unani) medicine. In Charaka Samhita, ancient Hindu physicians had referred this disorder as Madhu Meha.17

Long period of several centuries between 3rd and early 17th Century A.D. did not evoke any special interest amongst medical men, till after the Renaissance.18

Insulin Insulin is a hormone that is produced by pancreas. It is needed to convert sugar, starches and other food into energy needed for daily life. Insulin is normally secreted by the beta cells (a type of islet cells) of the pancreas. The stimulus for insulin secretion is a HIGH blood glucose

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Glucagon Glucagon is also a hormone secreted by the alpha cells of the pancreatic islets. This hormone is secreted when blood glucose goes LOW

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The important roles of insulin and Glucagon: Diabetes and Hypoglycemia

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The human body wants blood glucose (blood sugar) maintained in a very narrow range. Insulin and Glucagon are the hormones which make this happen. Both insulin and Glucagon are secreted from the pancreas, and thus are referred to as pancreatic endocrine hormones.22

Pancreas

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Islet cells of Pancreas

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Major Types of Diabetes Type 1 or IDDM (Insulin Dependent Diabetes Mellitus) Type 2 or NIDDM (Non-Insulin Dependent Diabetes Mellitus) Gestational Diabetes (GDM) Other Types are MODY (Maturity Onset Diabetes Mellitus in Young Adults) YD (Young Diabetics a kind of type 2 diabetes) Impaired Glucose Tolerance (IGT) (Pre-Diabetic state)25

What is Insulin? Insulin is a hormone. Like many hormones, insulin is a protein. Insulin is secreted by groups of cells within the pancreas called islet cells. The pancreas is an organ that sits behind the stomach and has many functions in addition to insulin production26

What if insulin is not secreted? Without insulin, you can eat lots of food and actually be in a state of starvation since many of our cells cannot access the calories contained in the glucose very well without the action of insulin. That is why Type 1 diabetics who do not make insulin can become very ill without insulin shots. Insulin is a necessary hormone.27

Insulin Resistance More commonly, people will develop insulin resistance (Type 2 Diabetes) rather than a true deficiency of insulin. In this case, the levels of insulin in the blood are similar or even a little higher than in normal, non-diabetic individuals.28

Many cells of Type 2 diabetics respond sluggishly to the insulin they make and therefore their cells cannot absorb the sugar molecules well. This leads to blood sugar levels which run higher than normal. Occasionally Type 2 diabetics also need insulin shots but most of the time other methods of treatment will work.

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Insulin was the first hormone to be identified Late in 1920, a medical doctor and his student (Banting and Best) discovered insulin by tying a string around the pancreatic duct of several dogs which won them the Noble Prize. I assume that they might have killed several dogs to invent this life saving protein compound.30

Pancreas The bulk of the pancreas is an exocrine secreting pancreatic fluid into the duodenum after a meal. It helps in digestion. However, scattered through the pancreas are several hundred thousand clusters of cells called islets of Langerhans.31

Islets of Langerhans The islets are endocrine clusters of cells called islets of Langerhans.

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The islets are endocrine tissue containing four types of cells.

Beta cells, which secrets insulin and amylin; Alpha cells, which secrete glucagon; Delta cells, which secrete somatostatin, and Gamma cells, which secrete a polypeptide of unknown function.33

What are the symptoms? Diabetes mellitus is an endocrine disorder characterized by many signs and symptoms. Excessive hunger Excessive thirst Excessive urination Loss of weight Tiredness Irritability Itching in the genitals Delayed wound healing

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Primary among these symptoms are: 1. A failure of the kidney to reclaim glucose so that glucose spill over into urine 2. A resulting increase in the volume of urine because of the osmotic effect of this glucose (it reduces the return of water to the blood)35

DIAGNOSTIC CRITERIA FOR DIABETES(Non-Pregnant) Venous plasma glucose (mg/dl) Fasting Normal IGT Diabetes

110Two hours after 75 grams glucose

126 140 -199200

139

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Alcohol If you have diabetes and take insulin shots or oral diabetes pills, you risk low blood sugar when you drink alcohol. To protect yourself, never drink on an empty stomach.37

What are the risks of taking excess alcohol...? Drinking alcohol may result in your judgement being impaired. Many of the early warning symptoms of hypoglycaemia are mimicked by alcohol. Your friends may also mistake these hypoglycaemic symptoms for effects of alcohol and may not seek help until you lose consciousness. Your close friends should know that you are on treatment and that hypoglycaemia and drunken behaviour share many common features 38

Alcohol has about 7 calories per gram. These are considered "empty" calories because alcohol contains no beneficial nutrients, such as vitamins and minerals.39

Environmental Factors of Diabetes Food habits Sedentary life style Cold weather Smoking Stress Alcoholism40

What if I take sweets?

If you like sweets, but also want to lose weight, you can try these tips: Satisfy your sweet tooth with fresh or dried fruit Eat a small serving of your favorite dessert, instead of something ordinary When you are eating out, split desserts with a friend or family member41

Try new recipes for lower-calorie sweets Choose lower-calorie, lower-fat versions of your favorite desserts Cut back on the amounts of sugar and fat in your recipe favorites Use a low-calorie sweetener instead of sugar for your coffee or tea42

Complications of Diabetes Diabetes can cause long-term complications such as Heart kidney Eye Foot Skin and nerve disease

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Adults with diabetes are at high risk for cardiovascular disease (CVD). In fact, at least 65 percent of those with diabetes die from heart disease or stroke.44

Managing diabetes is more than keeping blood glucose levels under control. It is also important to manage blood pressure and cholesterol levels through 1. Healthy eating 2. Physical activity 3. Use of medications (if needed) 4. Aspirin therapy, if recommended by the health care team 5. Smoking cessation45

Does it affect my sexual life? Diabetes can affect many aspects of your health, including your sex life. Sex is an important part of life and relationships. But diabetes can affect a woman's sex life Some men with diabetes have impotence, also called erectile dysfunction or ED46

Is it contagious? Diabetes is not contagious. People cannot catch it from each other.47

Hypoglycemia Before I move on to the next topic I feel it is important to talk about hypoglycemia, a condition in which the blood sugar drops too low suddenly. A person can become nervous, shaky and confused. Judgement can be impaired and if blood glucose falls too low, fainting can occur48

What are the precautions to be taken to avoid hypoglycemic conditions People must take responsibility for their day-today care. Much of the daily care involves keeping blood glucose levels from going too low. Always keep chocolates or candy in your bag to chew during hypoglycemic conditions Take divided doses of meal Take lot of fibrous food items Drink lot of water49

Prevention of Diabetes

Is it possible to delay or even prevent type 2 diabetes from ever developing?50

Yes it is.There is a lot you can do yourself to know your risks for prediabetes and to take action to prevent diabetes if you have, or are at risk for, pre-diabetes.51

Diabetes Prevention Program (DPP) The recently completed Diabetes Prevention Program (DPP) proved that type 2 diabetes can be prevented or delayed by keeping weight in control by increasing physical activity diet changes life style changes Cessation of smoking & alcohol.52

Nutrition and Life Style Advices

Come on ..Get MovingGetting started is the hardest part about beginning any exercise program but once youve got into the habit of working out and feeling better about yourself then there is no turning back.

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1. 2. 3. 4.

The following are among the many health benefits of regular physical activity Overall improvement of body composition Better blood glucose control Increase in insulin sensitivity Improvement of blood lipid values (low LDL or bad cholesterol and high HDL or good cholesterol)54

5. Decrease in blood pressure 6. Decrease risk of heart disease 7. Gradual weight loss and or weight management in combination with dietary management 8. Building stronger muscles and bones

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Before starting any exercise program, you should always consult physician and or diabetes health care team about any necessary precautions and or specific guidelines that need to be taken.56

Points to keep in mind: 1. It is very important to self monitor your blood glucose levels before, during (if the work out is of long duration) and after exercising. 2. There is an increased rate of hypoglycemic episodes. Thus carry fastacting carbohydrate is a must 3. Remember to stay hydrated at all times57

Never Exercised before? It is never too late; you can start by just briskly walking for about 5-10 minutes a day and then gradually increase your exercise routine to about 30 minutes a day. It is really important to try to be active all day long.

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Ways to incorporate physical activity throughout the day:1. Take the stair instead of the elevator or escalator 2. Park your car farther away in the parking lot you will benefit from a five minute walk 3. Be active with your family and kids; enjoy outdoor activities 4. Ride a bike or go jogging on the Corniche.

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5. Try different exercise classes such as kick-boxing, aqua-aerobics or circuit training 6. If you work at a desk all day long, take a break for five minutes every hour or so and just move around 7. Be active around the house 8. Enjoy dancing

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Ten important tips1. 2. 3. 4. 5. 6. 7. 8. 9. 10. Maintain a healthy weight Eat regularly Include slowly absorbed starchy foods Take fruits and vegetables Cut down fat Cut down sugar Cut down sweetened beverages Include oily fish Cut down on salt Keep active61

Are you at a healthy body weight?One easy tool used by physicians and other health care professionals to assess an individuals weight in relation to their height is Body Mass Index (BMI). The BMI is not a direct measurement of a persons body fat. It is calculated by dividing ones weight in kg by their height in metres squared.62

BMI = weight in kg/height in metres squared

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Thank You65

Wish you a SweetDiabetes Free Life66

ByShanthi Christian67