OBT356 LIFESTYLE DISEASES

UNIT IV

DIABETES AND OBESITY

Types of Diabetes mellitus; Blood glucose regulation; Complications of diabetes –

Paediatric and adolescent obesity – Weight control and BMI

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DIABETES:

Diabetes is a condition that happens when your blood sugar (glucose) is too high.
It develops when your pancreas doesn’t make enough insulin or any at all, or when your
body isn’t responding to the effects of insulin properly. Diabetes affects people of all
ages. Most forms of diabetes are chronic (lifelong), and all forms are manageable with
medications and/or lifestyle changes

Glucose (sugar) mainly comes from carbohydrates in your food and drinks. It’s
your body’s go-to source of energy. Your blood carries glucose to all your body’s cells to
use for energy..

When glucose is in your bloodstream, it needs help — a “key” — to reach its final
destination. This key is insulin (a hormone). If your pancreas isn’t making enough
insulin or your body isn’t using it properly, glucose builds up in your bloodstream,
causing high blood sugar (hyperglycemia).

Over time, having consistently high blood glucose can cause health problems,
such as heart disease, nerve damage and eye issues

The technical name for diabetes is diabetes mellitus. Another condition shares
the term “diabetes” — diabetes insipid us — but they’re distinct. They share the name
“diabetes” because they both cause increased thirst and frequent urination. Diabetes
insipid us is much rarer than diabetes mellitus.

Types:

There are several types of diabetes. The most common forms include
Type 2 diabetes: With this type, your body doesn’t make enough insulin and/or your
body’s cells don’t respond normally to the insulin (insulin resistance). This is the most
common type of diabetes. It mainly affects adults, but children can have it as well

Prediabetes: This type is the stage before Type 2 diabetes. Your blood glucose levels
are higher than normal but not high enough to be officially diagnosed with Type 2
diabetes

Type 1 diabetes: This type is an autoimmune disease in which your immune

system attacks and destroys insulin-producing cells in your pancreas for unknown
reasons. Up to 10% of people who have diabetes have Type 1. It’s usually diagnosed in
children and young adults, but it can develop at any age

Gestational diabetes: This type develops in some people during pregnancy. Gestational
diabetes usually goes away after pregnancy. However, if you have gestational diabetes,
you’re at a higher risk of developing Type 2 diabetes later in life

Type 3c diabetes: This form of diabetes happens when your pancreas experiences
damage (other than autoimmune damage), which affects its ability to produce
insulin. Pancreatitis, pancreatic cancer, cystic fibrosis and hemochromatosis can all lead
to pancreas damage that causes diabetes. Having your pancreas removed
(pancreatectomy) also results in Type 3c

Latent Autoimmune diabetews in Adults[LADA]:Like Type 1 diabetes, LADA also

results from an autoimmune reaction, but it develops much more slowly than Type 1.
People diagnosed with LADA are usually over the age of 30.

Maturity Onset diabetes of Young[MODY]: MODY, also called monogenic diabetes,

happens due to an inherited genetic mutation that affects how your body makes and
uses insulin. There are currently over 10 different types of MODY. It affects up to 5% of
people with diabetes and commonly runs in families

Neonatal Diabetes: This is a rare form of diabetes that occurs within the first six
months of life. It’s also a form of monogenic diabetes. About 50% of babies with
neonatal diabetes have the lifelong form called permanent neonatal diabetes mellitus.
For the other half, the condition disappears within a few months from onset, but it can
come back later in life. This is called transient neonatal diabetes mellitus

Brittle diabetes: Brittle diabetes is a form of Type 1 diabetes that’s marked by frequent
and severe episodes of high and low blood sugar levels. This instability often leads to
hospitalization. In rare cases, a pancreas transplant may be necessary to permanently
treat brittle diabetes
Symptoms::

 Increased thirst (polydipsia) and dry mouth

 Frequent urination
 Fatigue
 Blurred vision
 Unexplained weight loss
 Numbness or tingling in your hands or feet
 Slow-healing sores or cuts
 Frequent skin and/or vaginal yeast infections

CAUSES:

Insulin Resistance:Type 2 diabetes mainly results from insulin resistance. Insulin

resistance happens when cells in your muscles, fat and liver don’t respond as they
should to insulin. Several factors and conditions contribute to varying degrees of insulin
resistance, including obesity, lack of physical activity, diet, hormonal imbalances,
genetics and certain medications

Autoimmune Disease:Type 1 diabetes and LADA happen when your immune system
attacks the insulin-producing cells in your pancreas

Hormonal Imbalance: During pregnancy, the placenta releases hormones that cause
insulin resistance. You may develop gestational diabetes if your pancreas can’t produce
enough insulin to overcome the insulin resistance. Other hormone-related conditions
like acromegaly and Cushing syndrome can also cause Type 2 diabetes

Pancreatic Damage: Physical damage to your pancreas — from a condition, surgery or

injury — can impact its ability to make insulin, resulting in Type 3c diabetes.

Genetic Mutation: Certain genetic mutations can cause MODY and neonatal diabetes

Long-term use of certain medications can also lead to Type 2 diabetes,

including HIV/AIDS medications
COMPLICATIONS OF DIABETES:

Diabetes can lead to acute (sudden and severe) and long-term complications — mainly
due to extreme or prolonged high blood sugar levels

Acute Diabetic Complications:

Acute diabetes complications that can be life-threatening include

 Hyperosmolar hyperglycaemic state[HHS]:This complication mainly affects

people with Type 2 diabetes. It happens when your blood sugar levels are very
high (over 600 milligrams per deciliter or mg/dL) for a long period, leading to
severe dehydration and confusion. It requires immediate medical treatment
 Diabetes related ketoacidosis[DKA]: This complication mainly affects people
with Type 1 diabetes or undiagnosed T1D. It happens when your body doesn’t
have enough insulin. If your body doesn’t have insulin, it can’t use glucose for
energy, so it breaks down fat instead. This process eventually releases
substances called ketones, which turn your blood acidic. This causes labored
breathing, vomiting and loss of consciousness. DKA requires immediate medical
treatment
 Severe low blood sugar [hypoglycaemia]: Hypoglycemia happens when your
blood sugar level drops below the range that’s healthy for you. Severe
hypoglycemia is very low blood sugar. It mainly affects people with diabetes who
use insulin. Signs include blurred or double vision, clumsiness, disorientation
and seizures. It requires treatment with emergency glucogen and/or medical
intervention

Long term diabetes complications:

 Blood glucose levels that remain high for too long can damage your body’s
tissues and organs. This is mainly due to damage to your blood vessels and
nerves, which support your body’s tissues
 Cardiovascular (heart and blood vessel) issues are the most common type of
long-term diabetes complication. They include
 Coronary artery disease
 Heart attack
 Stroke
 Atherosclerosis
 Other diabetes complications include:
 Nerve damage (neuropathy), which can cause numbness, tingling and/or pain
 Nephropathy, which can lead to kidney failure or the need for
dialysis or transplant Retinopathy :, which can lead to blindness
 Diabetes related foot conditions
 Skin infections
 Gastro paresis
 Hearing loss
 Oral health issues like gum disease
 Depression
 Amputations
DIAGNOSIS:

Healthcare providers diagnose diabetes by checking your glucose level in a blood test.
Three tests can measure your blood glucose level

 Fasting blood glucose test: For this test, you don’t eat or drink anything except
water (fast) for at least eight hours before the test. As food can greatly affect
blood sugar, this test allows your provider to see your baseline blood sugar
 Random Glucose test:Random” means that you can get this test at any time,
regardless of if you’ve fasted.
 A1c: This test, also called HbA1C or glycated hemoglobin test, provides your
average blood glucose level over the past two to three months
 To screen for and diagnose gestational diabetes, providers order an oral glucose
tolerance test

The following test results typically indicate if you don’t have diabetes, have
prediabetes or have diabetes. These values may vary slightly. In addition, healthcare
providers rely on more than one test to diagnose diabetes

Type of test
Fasting blood glucose test
In-range (mg/dL)
Less than 100.
Prediabetes (mg/dL)
100 to 125.
Diabetes (mg/L)
126 or higher.
Random blood glucose test
In-range (mg/dL)
N/A.
Prediabetes (mg/dL)
N/A.
Diabetes (mg/L)
200 or higher (with classic symptoms of
hyperglycemia or hyperglycemic crisis).
A1c
In-range (mg/dL)
Less than 5.7%.
Prediabetes (mg/dL)
5.7% to 6.4%.
Diabetes (mg/L)
6.5% or higher.
MANAGEMENT AND TREATMENT:

Diabetes is a complex condition, so its management involves several strategies. In

addition, diabetes affects everyone differently, so management plans are highly
individualized
The four main aspects of managing diabetes include:

Blood sugar monitoring: Monitoring your blood sugar (glucose) is key to determining
how well your current treatment plan is working. It gives you information on how to
manage your diabetes on a daily — and sometimes even hourly — basis. You can
monitor your levels with frequent checks with a glucose meter and finger stick and/or
with a continuous glucose monitor (CGM). You and your healthcare provider will
determine the best blood sugar range for you

Oral diabetes medications: Oral diabetes medications (taken by mouth) help manage
blood sugar levels in people who have diabetes but still produce some insulin — mainly
people with Type 2 diabetes and prediabetes. People with gestational diabetes may also
need oral medication. There are several different types. Metformin is the most common.

Insulin: People with Type 1 diabetes need to inject synthetic insulin to live and manage
diabetes. Some people with Type 2 diabetes also require insulin. There are several
different types of synthetic insulin. They each start to work at different speeds and last
in your body for different lengths of time. The four main ways you can take insulin
include injectable insulin with a syringe (shot), insulin pens, insulin pumps and rapid-
acting inhaled insulin

Diet: Meal planning and choosing a healthy diet for you are key aspects of diabetes
management, as food greatly impacts blood sugar. If you take insulin, counting carbs in
the food and drinks you consume is a large part of management. The amount of carbs
you eat determines how much insulin you need at meals. Healthy eating habits can also
help you manage your weight and reduce your heart disease risk.

Due to the increased risk for heart disease, it’s also important to maintain a healthy::

Weight

Blood Pressure

Cholesterol

OBESITY:

Obesity is commonly defined as having too much body mass. A BMI of 30 or higher is
the usual benchmark for obesity in adults
ADOLESCENT OBESITY

Although genetics and some disorders cause obesity, most adolescent obesity results
from a lack of physical activity and consuming more calories than needed for activity
level.

The diagnosis is based on a BMI at or over the 95th percentile for age and gender.

Eating a nutritious diet and increasing exercise help treat obesity, and some children
may be given medication for weight loss or weight-loss surgery.

Obesity is defined by the body mass index (BMI). Adolescents whose BMI is in the top
5% for their age and gender are considered to have obesity. Being in the top 5% means
their BMI is higher than 95% of their peers (at or over the 95th percentile).

Obesity is twice as common among adolescents as it was 30 years ago. Although most of
the complications of obesity occur in adulthood, adolescents with obesity are more
likely than their peers to have high blood pressure and type 2 diabetes. Although fewer
than one third of adults with obesity were obese as adolescents, most adolescents with
obesity become adults with obesity.

Despite many treatment approaches, obesity is one of the most difficult problems to
treat, and long-term success rates remain low.

Causes of obesity in Adolescents:

The factors that influence obesity among adolescents are the same as those among
adults.

Hormonal disorders, such as an underactive thyroid gland (hypothyroidism) or

overactive adrenal glands, may result in obesity but are rarely the cause. Adolescents
with weight gain caused by hormonal disorders are usually short and most often have
other signs of the underlying disorder. Any adolescent with obesity who is short and has
high blood pressure should be tested for the hormonal disorder Cushing syndrome.

Genetics play a role, which means that some people are at greater risk of obesity than
others, and obesity may be more common among members of the same family.

Because of society’s stigma against obesity, many adolescents with obesity have a poor
self-image and may become socially isolated.

Treatment:

 Healthy eating and exercise habits

 For adolescents 12 years old and older with a BMI at or over the 95th percentile,
weight-loss medications
 For adolescents 13 years old and older with a BMI significantly over the 95th
percentile, evaluation for weight-loss surgery
 All children and adolescents with obesity are given intensive strategies to help
them develop healthy eating and exercise habits and make changes to their
health behavior.
 Reducing calorie intake and burning calories are two ways to meet these goals.

Calorie intake is reduced by

 Establishing a well-balanced diet of ordinary foods

 Making permanent changes in eating habits

Calorie burning is increased by

 Increasing physical activity

 Adolescents 12 years old and older with obesity (BMI at or over the 95th
percentile for age and gender) may be given medications for weight loss.
 Adolescents 13 years old and older with severe obesity (BMI significantly above
the 95th percentile for age and gender) may be referred to a surgeon who
specializes in this area for a full evaluation for weight-loss surgery (bariatric
surgery).
 Counseling to help adolescents cope with social problems, including poor self-
esteem, may be helpful.

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PAEDIATRIC OR CHILDHOOD OBESITY

Childhood obesity is a serious medical condition that affects children and adolescents.
It's particularly troubling because the extra pounds often start children on the path to
health problems that were once considered adult problems — diabetes, high blood
pressure and high cholesterol. Childhood obesity can also lead to poor self-esteem and
depression.
One of the best strategies to reduce childhood obesity is to improve the eating and
exercise habits of your entire family. Treating and preventing childhood obesity helps
protect your child's health now and in the future

Symptoms
Not all children carrying extra pounds are overweight. Some children have larger than
average body frames. And children normally carry different amounts of body fat at the
various stages of development. So you might not know by how your child looks if weight
is a health concern.

The body mass index (BMI), which provides a guideline of weight in relation to height, is
the accepted measure of overweight and obesity. Your child's doctor can use growth
charts, the BMI and, if necessary, other tests to help you figure out if your child's weight
could pose health problems.

CAUSES

Lifestyle issues — too little activity and too many calories from food and drinks — are
the main contributors to childhood obesity. But genetic and hormonal factors might
play a role as well.

 Socioeconomic factors. People in some communities have limited resources

and limited access to supermarkets. As a result, they might buy convenience
foods that don't spoil quickly, such as frozen meals, crackers and cookies. Also,
people who live in lower income neighborhoods might not have access to a safe
place to exercise.

 Certain medications. Some prescription drugs can increase the risk of

developing obesity. They include prednisone, lithium, amitriptyline, paroxetine
(Paxil), gabapentin (Neurontin, Gralise, Horizant) and propranolol (Inderal,
Hemangeol).
  overweight. These children are also more likely to develop obstructive sleep
apnea, a potentially serious disorder in which a child's breathing repeatedly
stops and starts during sleep.

 Nonalcoholic fatty liver disease (NAFLD). This disorder, which usually causes
no symptoms, causes fatty deposits to build up in the liver. NAFLD can lead to
scarring and liver damage.

PREVENTION
To help prevent excess weight gain in your child, you can:

 Set a good example. Make healthy eating and regular physical activity a family
affair. Everyone will benefit and no one will feel singled out.

 Have healthy snacks available. Options include air-popped popcorn without

butter, fruits with low-fat yogurt, baby carrots with hummus, or whole-grain
cereal with low-fat milk.

 Offer new foods multiple times. Don't be discouraged if your child doesn't
immediately like a new food. It usually takes multiple exposures to a food to gain
acceptance.

 Choose nonfood rewards. Promising candy for good behavior is a bad idea.

 Be sure your child gets enough sleep. Some studies indicate that too little
sleep may increase the risk of obesity. Sleep deprivation can cause hormonal
imbalances that lead to increased appetite.

Also, be sure your child sees the doctor for well-child checkups at least once a year.
During this visit, the doctor measures your child's height and weight and calculates his
or her BMI. A significant increase in your child's BMI percentile rank over one year may
be a possible sign that your child is at risk of becoming overweight.

Risk factors
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WEIGHT CONTROL:

The effort to achieve and maintain a certain weight through diet, exercise, or both is
known as weight control. It involves keeping a balance between the energy, or calories,
consumed in food and the calories expended in physical activity

Eating healthy foods, staying physically active, and getting quality sleep are examples of
healthy lifestyle behaviors that can help you manage your weight and avoid obesity.
Managing stress, controlling food portions, and eating mindfully are other behaviors
that can help you maintain a healthy weight

What affects weight

Excess weight generally results from an energy imbalance. This is where the energy
taken in from eating and drinking is higher than the energy used through physical
activity.

But overweight and obesity is a complex issue, influenced by many factors, including:

 genetics
 cultural background
 medical conditions and disability
 mental ill-health – which can affect appetite and motivation to shop and cook
healthy food or be active
 some medicines – which can increase appetite or slow the metabolism
 eating disorders
 drugs, tobacco or alcohol
 where people live, go to school and work
 the media
 availability of convenience foods
 portion sizes
 time pressures – which can make it hard to cook healthy meals and exercise
 lifestyle
 shift work – due to disrupted sleep and eating patterns
 inadequate sleep – people who sleep less than 6 hours a night are more likely to
gain weight.

Behavior Modification
Changing unhealthy behaviors is crucial for long-term weight management success.
Practicing portion control, mindful eating, and keeping a food diary can help you
develop a better understanding of your eating patterns. Identifying triggers and
adopting healthier alternatives can support sustainable weight loss.

Incorporating Medical Weight Loss

For individuals facing significant challenges in weight management, medically
supervised weight loss can provide additional support. You may be wondering, what is
medical weight loss? These weight loss programs are designed and supervised by
healthcare professionals specializing in weight management. They offer personalized
approaches tailored to individual needs and medical considerations.

Comprehensive Evaluation
How does medical weight loss work? Medical weight loss programs typically start with
a comprehensive evaluation. This includes a thorough assessment of medical history,
current health conditions, and lifestyle factors. The healthcare provider will analyze
factors such as metabolism, body composition, and potential underlying issues that may
contribute to weight gain or difficulty losing weight.

Customized Treatment Plans

Based on the evaluation, a customized treatment plan is developed. This plan may
include a combination of approaches such as dietary modifications, physical activity
recommendations, behavior therapy, and, in some cases, medications or medical
procedures. The goal is to address the underlying factors contributing to weight gain
and create a sustainable path towards weight management.

Ongoing Support and Monitoring

One of the key advantages of medical weight loss programs is the ongoing support and
monitoring provided by healthcare professionals. Regular check-ins, progress tracking,
and adjustments to the treatment plan ensure that individuals receive the necessary
guidance and support throughout their weight management journey.
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BMI

Body mass index. A measure that relates body weight to height. BMI is sometimes used
to measure total body fat and whether a person is a healthy weight

Formula: weight (kg) / height (m)2

The formula for BMI is weight in kilograms divided by height in meters squared. If
height has been measured in centimeters, divide by 100 to convert this to meters.

Example: If a person weighs 65 kg and the person’s height is 165 cm (1.65 m), the BMI
is calculated as 65 ÷ (1.65)2 = 23.87 kg/m2, which means that the person has a BMI of
23.87 kg/m2 and is considered to have a healthy weight.
When calculating in pounds and inches, if a person weighs 120 lbs and the person’s
height is 5 feet 6 inches (66 inches), the BMI is calculated as 703 x 120/(66)2 = 19.3
kg/m2, which means that the person has a BMI of 19.3 kg/m2 and is considered to have
a healthy weight