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Diabetes and You

Diabetes and You. Vidya Sundaram, MD. Diabetes in Asian Indians. The prevalence of diabetes in rural India is 2 percent In urban India, the prevalence is 8 percent In Indians migrating to westernised countries the prevalence is 4 times more than those living in India

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Diabetes and You

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  1. Diabetes and You Vidya Sundaram, MD

  2. Diabetes in Asian Indians • The prevalence of diabetes in rural India is 2 percent • In urban India, the prevalence is 8 percent • In Indians migrating to westernised countries the prevalence is 4 times more than those living in India • Indian Americans have higher risk than Americans of European descent

  3. Diabetes in Asian Indians • Some of the reasons for increased risk of Diabetes are: • Genetic predisposition • Increased caloric intake • Higher intake of processed carbohydrates, reduced fiber, increased animal fat intake • Abdominal obesity and insulin resistance • Sedentary lifestyle

  4. Diabetes in Asian Indians • 32 million Indians with diabetes • This number is expected to double in the next 30 years

  5. What is Diabetes • Your body is not able to use properly the energy from the food you eat because either: • The body makes very little or no insulin i.e. Type I Diabetes • Or, the cells are not responding to the insulin, called insulin resistance. This occurs in Type 2 Diabetes. Over time, insulin production decrease in Type 2 Diabetes

  6. What is Diabetes • In both types of diabetes, sugar builds up in the blood stream because it cannot enter the cells • Without sugar for fuel in the cells, the body lacks energy • High blood sugar levels, damage over time, your blood vessels, leading to serious complications

  7. Diagnosis of Diabetes • Two fasting blood sugars equal to, or greater than 126 mg/dL • Any random blood sugar greater than 200 • On oral glucose tolerance test, if blood sugar is equal or greater than 200 mg/dL

  8. Prediabetes • Fasting blood sugar between 101 to 126 mg/dL • On oral glucose tolerance test, if the blood sugar at 2 hours is between 141 to 199 mg/dL

  9. Symptoms of Diabetes • Increased thirst • Increased frequency of urination • Increased fluid intake • Weight loss • Blurred vision • Numbness and tingling in hands and feet • Frequent infections • Delayed wound healing

  10. Diabetes complications • Nerve damage: neuropathy • Retinal bleeds, vision loss: retinopathy • Kidney damage, kidney failure: nephropathy • 4 to 5 times increased risk for heart attacks and strokes • Foot ulcers, amputations • Sexual dysfunction

  11. Management of Diabetes • Lifestyle changes • Diet • Exercise • Weight loss • Medications

  12. Grains Vegetables Fruits Milk Meat & Beans

  13. Vegetarian food pyramid

  14. Vegetarian diet • 5 to 9 servings of cereals/grains or potatoes • 2 or 3 servings of pulses, nuts & seeds • 4 or 5 servings of fruit and vegetables • Some yeast extract fortified with vitamin B12. • A small amount of vegetable oil and margarine or butter. • 2 to 3 servings of milk, cheese, eggs or soy products

  15. Diet • It takes 3500 calories over and above your • daily caloric needs to gain ONE lb of weight. • 1 gram fat = 9 calories • 1 gram protein = 4 calories • 1 g carbohydrate = 4 calories • 1 g fiber = 0 calories

  16. Management of Diabetes: Exercise • Brisk walking for 30min to 1 hour most days of the week • Check with your physician before starting an exercise program • Exercise lowers blood sugars

  17. Management of Diabetes: Weight loss • Normal Body mass index (BMI) between 18-24 • Overweight if BMI greater than 25 • Obese: if BMI more than 29 • Moderate to severe obesity: BMI 30-39 • Morbid obesity: BMI 40 or above

  18. Management of Diabetes: Weight loss • If overweight : aim to lose atleast 10 percent of body weight • This will help control diabetes, and lower cardiovascular risk

  19. The numbers game • Normal blood sugar : 70 – 100mg/dL • Goals for Diabetes: fasting blood sugar between 80-120mg/dL • 2 Hours after a meal: less than 160mg/dL, ideally less than 140

  20. The numbers game: HbA1C • HbA1c goals: less than 7% • Uncontrolled Diabetes: if HbA1c greater than 8%

  21. The numbers game: Blood pressure • Goal: Less than 130/80 mm Hg • If kidney disese is present, blood pressure should be less than 125/80

  22. The numbers game: Lipids • Total cholesterol less than 200mg/dL • LDL cholesterol less than 100 mg/DL, preferably less than 70 • Triglycerides less than 150mg/dL • HDL cholesterol greater than 40mg/dL for men greater than 50mg/dL for women

  23. Medicines in Diabetes • Increase insulin production: ie glipizide , glimeperide, nateglinide, Prandin • Insulin sensitizers: Metformin, Avandia, Actos • Prolong action of Insulin: DPP4 inhibitors eg Januvia, Byetta injections (GLP-1)‏ • Symlin injections: decreases glucagon and delays gastric emptying • Insulin

  24. INSULIN • Most people with Type 2 diabetes will eventually need insulin • Type I diabetics need insulin from the beginning

  25. Summary • Diabetes is: • Common • Controllable • Lifelong • Self Managed • Progressive

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