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