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Understanding
Diabetes
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Why should we care about
diabetes?
– Diabetes is common.
– Diabetes is serious.
– Diabetes is costly
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How old is diabetes ?
• Aretaeus 2nd
century AD
First used the wordDiabetes
Ebers papyrus 1550 BC
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• Sushruta (Indian
Physician)
5th and 6th centuryAD
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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
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INDIA IS THE DIABETIC CAPITAL OFTHE WORLD WITH 35 MILLION
ADULTS WITH DIABETES TODAY
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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
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Pancreas and Insulin
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Location of the Pancreas
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Insulin
Banting and
Best discovered
insulin in 1921
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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
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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)
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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
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Type 2 diabetes is a progressive
metabolic disorder characterised by:
Insulin
resistance
Type 2
diabetesβ -cell
dysfunction
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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
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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
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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
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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
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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.
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Micro-vascular complications
1. Neuropathy (nerve disease)
2. Retinopathy (Vision problems)
3. Nephropathy (Kidney disease)
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Macro-vascular complications
1. Coronary artery disease (heart disease)
2. Cerebrovascular disease (stroke)
3. Peripheral vascular disease (PVD)
4. Foot complications
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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
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Diabetic Nephropathy
• 20-40% of all
diabetic patient
developsnephropathy
• Worldwide this is the
most frequent causeof end-stage renal
disease(ESRD)
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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.
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VISION WITH NORMAL AND
RETINOPATHY EYES
Normal Retinopathy
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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.
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Atheroscleroris the main culprit
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Stroke (Cerebro Vascular Disease)
• Reduce blood
supply to the
brain• Due to
atherosclerosis
• Rapture of blood
vessels (e.g.brain aneurysms)
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Peripheral Vascular Disease
• Atherosclerosis of theperipheral arteries(e.g. Femoral,
popliteal, dorsalispedis etc)
•Intermittentclaudication (Legattack) is thecommon symptom
Atherosclerosis
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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)
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Gangrenous third toe
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Constant Juggling:
Exercise
with:
Proper diet
Insulin/Medication
Diabetes Management 24/7
BGBG
BGBG
BGBG
&
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Management of Type 2 Diabetes
Non-Pharmacological management
Life style modification
Appropriate diet
Suitable exercise programme
Cessation of smoking and alcohol
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Diet and Exercise
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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
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Pharmacological management
Drug therapy
Oral hypoglycemic agents
Insulin (in certain individuals)
Antihypertensives
Antiplatelet agents
Lipid lowering agents
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Questions?
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