Understanding the Diabetic Epidemic in India: Causes, Prevention, and Management

1. Diabetes Dr Prasad Honap M.D.

2. Sushrut (1000 B.C.) Charak ( 100 B.C.)

3. 1000 B.C. • Sushruta described diabetes (madhumeha) as a disease characterized by passage of large amount of urine, sweet in taste, hence the name “madhumeha” — honey like urine. • He goes on to say that diabetes primarily affects obese people who are sedentary and emphasized the role of physical activity in amelioration of diabetes.

4. Diabetes Epidemic in India • The prevalence of diabetes increased tenfold, from 1.2% to 12.1%, between 1971 and 2000 • It is estimated that 61.3 million people aged 20-79 years live with diabetes in India (2011 estimates). This number is expected to increase to 101.2 million by 2030. • 77.2 million people in India are said to have pre-diabetes • About 1 million people died from diabetes in India in 2012

5. The annual cost for India due to diabetes was about $38 billion in 2011 $38 billion = 247,000 Crores One Diabetic patient’s care consumes 25% of Total Family Income

6. Why is Diabetes rising? 1971 :1.2% 2017 : 12% Two wheeler Low Physical Activity Rampant Obesity Fast Food consumption More Stressful life • Bicycle Commonest Transport • More Physical Activity • Lower Incidence of Obesity • Home Food Consumption • Less Stressful life So It’s All about Changing Life Style !!

7. What is Diabetes • It’s a disease of Metabolism • Sugar can not enter into the cells to provide energy to cells. • So sugar accumulates in Blood but cells remain hungry • Insulin drives sugar from blood into the cells • If Insulin is deficient or inefficient person gets Diabetes

8. Types of Diabetes • Type 1 Diabetes • Type 2 Diabetes • Gestational Diabetes • Stress Diabetes • Secondary Diabetes

9. Pre-Diabetes Higher Blood Sugar Levels but not in the range of Diabetes Higher Risk of Type 2 Diabetes and IHD or Stroke Good News !! Can be delayed or Prevented

10. How to Prevent or Delay Diabetes? • Change the Life style • Eat properly • Optimum exercise • Increase Physical Activity • Control the Blood Fats • Medication with Doctor’s advice

11. Diabetes : Symptoms • Being very thirsty or hungry • Feeling tired for no reason • Urinating (going to the bathroom) more than usual • Losing weight for no reason • Having cuts or bruises that are slow to heal • Having trouble seeing (blurry vision) • Losing feeling or having tingling in your hands or feet

12. A large number of Diabetics DO NOT HAVE ANY SYMPTOMS AT ALL !!

13. Who Is At the Risk? • Are over age 40 • Are overweight or obese • Have a parent or sibling with diabetes • Are African American, Hispanic or Latino, Native American, Alaska Native, Asian American, or Pacific Islander • Have had gestational diabetes or given birth to a baby who weighed more than 9 pounds • Have polycystic ovary syndrome (when a woman's ovaries produce more male hormones than usual) • Have high blood pressure or cholesterol • Exercise less than 3 times a week • Have pre-diabetes

14. What is the Danger? • Heart Attack • Stroke • Blindness • Kidney failure • Risk of amputations

15. Diagnosis of Diabetes

16. Gestational Diabetes Pregnant women who have never had diabetes before, but have high blood sugar levels during pregnancy are said to have gestational diabetes. 

17. Who is at Risk? • Obesity - with a BMI of 30 or over - losing about 20% of your body weight can reduce your risk  • Family history of Type 2 diabetes • If you are an older mom - age 35 or over • If you previously delivered larger babies (between 8 lbs. 5 oz and 9 lbs. 14 oz.) • If you have high blood pressure • You are Hispanic, African American, Native American, South or East Asian, or of Pacific Island descent. • If you have unhealthy cholesterol  • If you smoke • If you do not get enough physical activity  • If you are an unhealthy eater 

18. Consequences • Large Babies leading to difficult labour or CS • High Chances of Childhood obesity and Type 2 DM • Increased chances for Mom to get Type 2 DM

19. How Can You Lower Your Risk? • Loose Weight • Increase Activity and exercise Level • Eat Healthy • Be under Medical Supervision

20. After Diabetes What?

21. Life Style Modification Physical Activity Exercise At Least 150 minutes in a week Aerobic exercise Muscle strengthening exercises Stretches Yoga Sports • Increase Physical Activity • Do Household chores yourself • Avoid Elevators , Climb • Avoid Scooters ,walk • Take a break every hour and do stretching

22. Life Style Modification • Quit Smoking • Control Alcohol Intake • Cut down on Fast Food

23. Eat Properly MEASURE YOUR WEIGHT AND HEIGHT ESTIMATE YOUR OPTIMAL BODY WEIGHT DECIDE WHAT CHANGES IN YOUR WEIGHT YOU WILL NEED TO MAKE CALCULATE THE CALORY INTAKE NEEDED TO MAINTAIN YOUR PRESENT WEIGHT WITH THE DIET YOU EAT AND YOUR ACTIVITY LEVELS ESTIMATE THE CALORY REQUIREMENTS TO GRADUALLY REACH OPTIMAL WEIGHT 

24. Eat properly If you spend 7700 Calories you will loose 1Kg of your weight.

25. Eat properly • Eat small Frequent (5 /6) meals • Follow the advice of your Dietician • Include fibre • Restrict Oil/ Ghee/Fat • Try to keep the Balance

26. Trying to Loose weight? • Gradual is wise • No Fancy Diets Please • Remember it’s Diet and Exercise , Not diet alone • Over enthusiasm is dangerous!! • Learn proper Technique

27. Medication • Medication is only as an adjutant to Life Style Modification • On Medication you need to eat as advised and not to skip meals. • Ask about the side effects of the medications • Do not refill the prescription without doctor’s advice

28. Self- Monitoring of BloodGlucose • Helps the Doctor to adjust the medication timing and Dosage : Better Control • Allows patient to make day-to-day adjustment to dosage especially Insulin • Avoids sudden lowering of Blood Sugar Level, as well as persistent High levels • Better Patient Education

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