1

Diabetes Care Management

Write Presentation Title Date in Footer

What is Diabetes?
Diabetes is a condition in which there is too much sugar (glucose) in the blood. Although sugar is needed to provide energy for the body, when in excess, it causes problem.

Persons with diabetes have excess sugar because they lack or have deficient supply of insulin.

What is Insulin?
Insulin is a substance produced by pancreas, an organ situated behind the stomach. Insulin is required for sugar (glucose) to enter the cells of the body where it is utilized.

It is as if insulin is the key which opens the door to allow sugar (glucose) to enter.

When sugar is absent or deficient or is defective, sugar remains in the blood in high amounts.

Diabetes

Mild Disease Serious consequences

Diabetes Mellitus A Serious Disease

Leading cause of new cases of blindness 25 times more prone to eye problems 6 times higher risk for Paralysis (stroke)

2-3 times higher risk for heart attack

20 times more prone to lower limb amputation Nerve damage causes loss of sensation

5 times more prone to Kidney failure

Diabetes Indian context

High prevalence

Life style changes further accentuate the high genetic predisposition

Under diagnosed due to low awareness Perhaps occurs a decade earlier Non obese/lean Type II fairly common

Treated less seriously as considered Mild Disease

Differences between Type 1 & Type 2

Type 1 Develops at an early age <30 years Patient are young, lean, and thin Type 2 Develops later in life after >30 years Often over weight and have an apple shape

Illness develops rapidly

Dependant on insulin for life

Illness develops slowly

Insulin may be required for achieving good diabetes control

High risk to develop Ketoacidosis

Low risk to develop Ketoacidosis

Treatment of Type 1 Diabetes

Insulin Exercise

Monitoring Education Diet

Treatment of Type 2 Diabetes

Insulin Exercise

Monitoring Education Diet

Oral Agents

How You Manage Your Diabetes

Follow a Healthy Meal Plan Regular Exercise

Take your Medication

Test blood sugar Regularly

Self Management

Self Management

Keeping Track of your Blood Sugar Take an active part in the treatment of your Diabetes

Taking Charge of your Diabetes

It means keeping your Blood Sugar as normal as possible Your blood sugar may alter because of :

Eating

Tablets or Insulin administration

Exercise Illness Stress

Benefits of Normal Blood Sugar

It makes you feel normal, and comfortable in your daily life It will help prevent the long term complication of the Diabetes

Learning Self Management

It requires your time and efforts It requires your full participation in the treatment It requires self care practice in your daily life It requires close co-ordination with your Doctor and Diabetes Care Team

How to do Self- Management?

Test Your Blood Sugar regularly Record your Blood sugar readings in the Diary Identify the Blood Sugar Patterns Use your Blood Sugar results to adjust your diet and Insulin Take help of your Doctor and Diabetes Care Team

Setting your blood Sugar targets

Optimal blood sugar levels are :

Blood Good Borderline Poor Sugar Fasting 80-110 111-140 > 140 mg/dl Post 80-144 145-180 > 180 Prandial mg/dl

Setting your blood Sugar targets

Keeping your blood sugar in this range help you to prevent the long term complications of the Diabetes i.e. eye, kidney and nerve damage. Use Insulin, if advised.

Diabetes and Emergencies

Hypoglycemia
Reduction in Plasma glucose concentration below the normal value of 60 mg/dl (3.3mmol/L)

Symptoms:

Hunger pains Excessive sweating and anxiousness Weakness

Palpitation/Trembling
Headache Blurring of vision Irritability/Confusion Sleepiness Faintness/loss of consciousness (coma)

Hypoglycemia
HYPERGLYCEMIA
Defined as blood glucose < 2.1 mmol/L Some diabetes develop hypoglycemia when BG > 2.1 mmol/L Some diabetics do not have symptoms at very low BG
NORMAL

Hypoglycemic unawareness

HYPOGLYCEMIA

Causes of Hypoglycemia
Taking more exercise than usual Delay or omission of a snack or main meal Administration of too much medication Eating insufficient carbohydrate Over-indulgence in alcohol Mistake in sulphonyureass dosage

Treatment Mild Hypoglycemia

Relieved by : 1 glass of fruit juice or soft drink 3 heaped teaspoons of sugar, honey or 3 - 5 sweets Repeat if symptoms not relieved after 5 to 10 minutes If next meal not immediately due, take 30 g complex carbohydrate

COKE

Diabetic Ketoacidosis
DKA is an acute life threatening complication of diabetes and occurs as a result of excessive production of ketones due to uncontrolled (or undiagnosed) hyperglycemia. Symptoms Excessive urination and thirst Nausea, vomiting and abdominal pain Deep rapid breathing Mental confusion Fruity Smell

Management Goal
Results of animal studies, retrospective analysis of large patient populations, and prospective clinical trials suggested a link between degree of hyperglycemia and risk of late diabetic complications.

DCCT conclusively proved that late diabetic complications can be prevented, onset delayed and progression retarded by Good Metabolic Control.

Management Goal
Achieve as good a control as possible. Within constraints of individual ability and willingness, patients should be encouraged to aim for best possible control without increasing risk of serious hypoglycemia. Every incremental improvement in control translates into concrete benefits for patients. Take insulin, if advised.

Diabetes and Diet

Importance of Nutrition Advice

Nutrition therapy is an integral part of management Diabetes is a metabolic disorder affecting carbohydrate, fat and protein metabolism

Effective tool in combination with physical exercise and preferable to pharmacological therapy

For patients with IGT; those at risk of; or in early stages of type 2 diabetes

Inappropriate nutrition can make best planned pharmacological intervention ineffective

Food Groups Food Exchange

Cereals Pulses Milk and Milk products Vegetables Fruits Fat, Oils and Nuts Meat, Fish and Eggs

Cereals
Cereals are the staple diet in most cultures. They are rich in carbohydrate and a fair source of minerals and B Group vitamins.

Commonly used cereals are Wheat Flour, Rice, Maize, Bajra, Jowar,Ragi etc Processed cereal based food items are Roti, Paratha, Puri, Idli, Dosai, Biscuit, Bread, Dinner Roll, Macaroni, Noodles etc

Pulses
Pulses (legumes and Dals) are an important source of protein for Vegetarians

Some of the common pulses are whole and/or, dehusked and split

dals, Green gram, Bengal gram, Rajmah, Black gram, Cow pea, Red gram dal etc.

Milk and Milk Products

Milk is an universal food for all age groups. Milk contains good quality protein. Buffalo milk is richer in fat as compared to Cow's Milk.

Milk is also consumed in the form of Yogurt,

Cheese, Cottage Cheese (paneer), Milk Powder etc.

Vegetables
Vegetables are important for their mineral, vitamins and fibre content. Vegetables classified into 3 groups.

Green Leafy Vegetables: like Spinach, Lettuce, Cabbage, Fenugreek etc. Roots And Tubers: like Potato, Onion, Yam, Carrot, Beet root, Radish, Turnip etc Other Vegetables: They are Peas, Brinjal, Cauliflower, Ladyfinger, Gourd etc.

Fruits
Fruits are a rich source of Vitamin C, most fruits are also good source of carbohydrates. Yellow fruits like Mango and Papaya are rich in carotene.

Common fruits are apple, banana, grapes, orange, guava

etc.

Fat,Oils & Nuts

Oilseeds and nuts are rich source of fat, energy, vitamins and minerals. In addition they also provide proteins.

Peanuts, Pistachios, Almonds, Cashew, Coconut, Walnut are part of this group Visible fats commonly consumed in India are butter, Ghee, hydrogenated oils, and various vegetable oils. Fats are a concentrated source of energy providing 9 kcal/g.

Meat, Fish & Egg

Rich in protein, vitamins, iron and phosphorous. Egg is considered the best quality protein. It contains all the essential amino acids in adequate proportions. Flesh foods are also a good source of vitamin B12.

Common sources are mutton, chicken, fish, egg, pork, beef etc

Food Exchanges
Food exchanges are food equivalent units designed to facilitate easy variation in diet.

Exchange lists with specified caloric values are made by experts. These lists contain specified quantities (weight/size/measure) of food items which are units .

A single unit within the group has the same caloric value and

therefore can be interchanged.

Food Exchanges
Thus one unit of a cereal exchange - one medium

chappati, can be exchanged for three-fourth katori

cooked rice or one idli or two medium slices of bread.

One chappati cannot be exchanged for two spoons of Ghee although calories from both is the same.

Dietary Recommendations Diabetes Food Pyramid

Fats, Oils & Nuts 2-3 Units Milk & Milk Products 2-3 Units Meat & Fish 1-2 Units

Vegetables 3-4 Units

Fruits 2-3 Units

Cereals & Pulses 8-12 Units 10-14 units (veg)

Dietary Recommendations
Carbohydrates: 55-65%

mainly complex carbohydrates

Fats: 20-30%

saturated 10% poly-unsaturated 10% mono-unsaturated 10% cholesterol < 300 mg/day

Protein: 12-20% Sodium: < 6 g/day

hypertensive diabetic< 3 g/day

Free Foods
Foods that have few or no calories and can be consumed

in large quantity to satisfy hunger are called free foods

Raw vegetables like tomato, cabbage, lettuce, cucumber etc

Tea, coffee without milk or sugar

Plain lemon juice (nimbu pani) without sugar Clear vegetable soups

Practical Guidelines
Utilize food exchanges to introduce variety
Use household measures Make corrections on existing meal plan and pattern rather than introduce new regimen Meal timings, frequency and quantity to be adjusted according to activity and insulin/drug regimens

Foods to be Avoided / Restricted

Refined sugars and products made from it

sugar, gur, honey, glucose, jam, jelly, sweet chutney, cake, pastry, mithai, jalebi, ice cream, gulabjamun, barfi chocolates, toffees, sweets, soft drinks, sherbets, squash, and sweetened fruit juices

Fried Foods

like pakora, samosa, puri, kachori, sev, chiwra, salted nuts, mixture etc

Summary Diabetic diet

A person with diabetes can eat almost any healthy food that other people normally eat provided

the food is balanced within the permissible caloric limits, and daily requirements are adequately distributed between the

different meals and during the day

Good Management of Diabetes Requires Balancing Food intake, Exercise and Medication

46

Write Presentation Title Date in Footer