Welcome
2009-2013: Education And Prevention
Presented By:
III Yr B.Sc.(N)
What is Diabetes?
Diabetes is a group of
metabolic diseases
characterised by
elevated levels
glucose in the blood
(hyperglycemia)
resulting from defects
in insulin secretion,
insulin action or both
Incidence
The number of cases of diabetes
worlwide in 2000 among adults ≥
20 years of age is estimated to
be ~ 17.1 million.
India has the dubious distinction
of having the largest number of
people with diabetes. Recent
studies have shown that for
every person known to have
diabetes, there are more than 2
people who have diabetes but
are unaware of it.
Global prevalence of diabetes
Fig-1: Estimated number of adults with diabetes by age-group, year, and countries
for the developed and developing categories and for the world.
List of countries with the highest numbers of estimated
cases of diabetes for 2000 and 2030
Ranking Country People with
diabetes (millions)
2000 2030
1 India 31.7 79.4
2 China 20.8 42.3
3 U.S. 17.7 30.3
4 Indonesia 8.4 21.3
5 Japan 6.8 8.9
6 Pakistan 5.2 13.9
7 Russian 4.6 -
Federation
8 Brazil 4.6 11.3
9 Italy 4.3 -
10 Bangladesh 3.2 11.1
Types of Diabetes
Type 1 diabetes - commonly
diagnosed in children and young
adults, but it’s a lifelong condition;
insulin dependent
Type 2 diabetes - the most
common type of diabetes — about
9 out of 10 people with diabetes
have type 2 diabetes; non-insulin
dependent
Gestational diabetes - occurs
during pregnancy; usually goes
away when the pregnancy is over
Who gets diabetes?
- Type 1 diabetes occurs at
about the same rate in
men and women
- Type 2 diabetes is more
common in older
people, mainly in
people who are
overweight
What causes diabetes?
Type 1 and type 2 diabetes —
The exact causes of both types
of diabetes are still not known
For both types, genetic factors
make it possible for diabetes to
develop
Most people who get type 2
diabetes are overweight
Gestational diabetes –
changing hormones and weight
gain in pregnancy make it hard
to keep up with the need for
insulin
Type 1diabetes pathophysiology
Type 2 diabetes pathophysiology
Risk Factors
The risk factors for Type 1 are unknown
Risk for Type 2 include –
Age — being older than 45
Overweight or obesity
Family history — having a mother, father,
brother, or sister with diabetes
Race/ethnicity
Having a baby with a birth weight more than 9
pounds
High blood pressure – 140/90 mmHg or higher
High cholesterol – total cholesterol over 240
mg/dL
Inactivity – Lack of adequate exercise
Abnormal results in a prior diabetes test
Having other health conditions that are linked
to insulin use, like Polycystic Ovarian
Syndrome
Having a history of heart disease or stroke
What are the signs of
diabetes?
Being very thirsty
Urinating a lot
Feeling very hungry
Feeling very tired
Loosing weight without trying
Having sores that are slow to heal
Having dry, itchy skin
Having tingling in the hands or feet
Having blurry vision
Having more infection than usual
Diagnostic Evaluation?
History
General examination
Fasting Plasma Glucose Test (FPGT) - measures blood glucose in a person
who has not eaten anything for at least 8 hr
Oral Glucose Tolerance Test (OGTT) - measures blood glucose after a person
fasts at least 8 hrs and 2 hrs after the person drinks a glucose-containing
beverage
Random Plasma Glucose Test (RPGT) – measures blood glucose without
regard to when the person being tested last ate.
HbA1c less than 7 (glycosylated Hb)
LDL less than 100mg/dl
HdL greater than 40mg/dl
Triglyceride less than 150mg/dl
FPG Test
Plasma Glucose Result Diagnosis
(mg/dL)
99 or below Normal
Pre-diabetes
100 – 125 (impaired fasting glucose)
126 or above Diabetes*
* Must be confirmed on more than 1 occasion
OGT Test
Plasma Glucose Result Diagnosis
(mg/dL)
139 or below Normal
Pre-diabetes
140 – 199 (impaired fasting glucose)
200 or above Diabetes*
* Must be confirmed on more than 1 occasion
Gestational Diabetes
When Plasma Glucose Result
(mg/dL)
Fasting 95 0r higher
At 1 hour 180 or higher
At 2 hours 155 or higher
At 3 hours 140 or higher
* Must be confirmed on more than 1 occasion
RPG Test
A random, or casual, blood glucose level of 200 mg/dL or higher, plus
the presence of the following symptoms, can mean person has
diabetes:
• Increased urination
• Increased thirst
• Unexplained weight loss
•Other symptoms can include fatigue, blurred vision, increase hunger,
and sores that do not heal
* Must be confirmed on more than 1 occasion
Diabetes Treatment
Self care at home
Diet – key to controlling
blood sugar levels and
preventing complications;
consistent, well-balanced diet
high in fibre, low in saturated
fat and concentrated sweets
Exercise – regular exercise
reduces risk and
complications
Moderate or eliminate
alcohol consumption
Abstain from smoking
Self-monitored blood glucose
Self insulin injection
Medical Treatment
Highly individualized, depending on
the type of diabetes
Type 1 diabetes
Involves daily injection of insulin
Rapid acting e.g insulin lispro humalog
,insulin glulisine
short-acting insulin e.g insuline
regular- lispro (Humalog) or aspart
(Novolog)
Intermediate acting e.g insulin NPH
longer acting insulin (for example,
NPH, Lente, glargine, detemir, or
ultralente)
Type 2 diabetes
Depending on how elevated
the patient’s blood sugar and
glycosylated haemoglobin
(HbA1c) are at the time of
diagnosis, they may be given a
chance to lower blood sugar
level without medication
Loose weight
Healthy diet
Type 2 Diabetes medication
Medication to keep blood sugar level under
control
- Class I :Makes the body more sensitive to the insulin e.g
Thiazolidinedion,Avandia(Rosiglitazone)and Actose(Pioglitazone)
- Class II : Stimulates the Beta Cells to release more insulin
e.g Sulfonylureas (Acetohexamide),
Amaryl,Glucotrol,Diabeta,Glynase & Orinase
- Class III : Breakdown of Starches & certain sugars is
blocked or slow down e.g Alpha-glucosidase inhibitors,Precose
(acarbose) and Glyset (meglitol)
Measures to Prevention Diabetes
Stop smoking
Limit the amount of alcohol you drink
Eat plenty of vegetables and fruits
Cut down salt( papad, pickle and
soda)
Have regular physical examination
Have regular blood and urine tests
Exercise regularly to your doctor’s
recommendation
Measures to control diabetes
Regular check-up is a must
Proper control – no negligent eating
habit; no smoking, alcohol or drugs
Proper care – keep a constant control
over the blood glucose, blood
pressure, and cholesterol level
Keeping a track of the disease –
regular consultations, timely
medication and regular exercise
Proper treatment – most essential
step; periodical tests to check the
status of the disease
Complications of diabetes
Diabetes, Heart disease
and Stroke
Diabetic Neuropathies: the
nerve damage of diabetes
Diabetic Retinopathy (Eye
disease)
Erectile Dysfunction
Hypoglycemia
Renal Disease & Failure
Sexual & Urologic
problems
Stomach Nerve Damage
(Gastroparesis)
Dietary Management
Low gylcaemic index foods –
- Wholegrian
- Bran oats
- Pulses
- Sprouts
- Soyabean
- Leafy vegetables
- Fruits and Vegetables with skin
- Fenugreek seeds
- Nuts
Avoid simple starch
- White starch: Polished rice,maida,potato,noodles, pasta,pizza
- Simple sugar: Sugar , honey, jaggery , sweets, sweetened drink
- Fruit juices
- Cola
- Bakery products
Diabetes Education
Key component of diabetes
management
Enhance knowledge and foster
behaviour change in order to
promote self-management
Educator’s role is to help people
with diabetes learn to manage
their disease
Main challenges – availability of
education, disease perception
and cost of diabetes education
More skilled educators required
to meet growing need
