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  • Diabetes is a disease in which blood glucose, or sugar levels in the blood are too high Glucose comes from the food you eat. Insulin is a hormone that helps the glucose get into your cells to give them energy Diabetes occurs when there is low or no insulin production or improper use of insulin According to International Diabetes Federation, the total number of people with diabetes in 2010 was found to be around 50.8 million in India, rising to 87.0 million by 2030
  • Types of DiabetesType 1: Type 1 diabetes is usually found in children and young adults. In this type of diabetes the cells that protect the body (immune cells)attack and destroy the cells in the pancreas that make insulin. Individuals with type 1 diabetes depend on insulin injections to liveType 2: Type 2 diabetes was once called “adult onset diabetes.” It is the most common form of diabetes, making up 90 to 95 percent of all diagnosed cases. It begins when the cells of the body are not able to use insulin. As a result, glucose does not get into the cells to produce energy. The pancreas work to make more insulin, but eventually it loses the ability to produce enough insulinGestational diabetes: Gestational diabetes is a type of diabetes that occurs only in pregnant women. If a woman develops diabetes when she is pregnant, but never had it before, then she has gestational diabetes
  • In diagnosing diabetes, physicians primarily depend upon the results of specific glucose tests.  However, test results are just part of the information that goes into the diagnosis of Type 1 or Type 2 diabetes. Doctors also take into account your physical exam, presence or absence of symptoms, and medical history.Fasting plasma glucose Test :The “fasting blood glucose” test must have the individual fasting for at least 8 hours. Normal levels for this test are 99mg/dL or below. Higher levels indicate prediabetes and higher than 126 mg/dL suggest diabetes either Type1 or Type2 and suggest further testing.Postprandial Plasma Glucose Test:It is a blood test often used in conjunction with the Fasting Plasma Glucose Test, again looking at the effectiveness of the body’s carbohydrate metabolism and the ability to produce insulin.A blood test is taken two hours after a meal.
  • HbA1C Test:According to ADA( American Diabetes Association)The HbA1C test measures average blood glucose control for the past 2 to 3 monthsIt is determined by measuring the percentage of glycated hemoglobin, or HbA1c, in the bloodCheck your HbA1C at least twice a year, or more frequently when necessaryIt does not replace daily self-testing of blood glucoseRandom Plasma Glucose Test: Measures blood glucose without regard to when the person being tested last ate
  • Having high blood glucose over a period of time can damage large and small blood vessels and nerves in the bodyDamage to large blood vessels may lead to: Poor circulation Heart attack Strokes Damage to small blood vessels may lead to: Eye disease Kidney disease Damage to nerves may lead to: Pain Loss of feeling in the hands, legs and feet Weak muscles
  • Diabetes is a complex condition that affects many different aspects of your life. Patient should learn about the goals for diabetes management, how to monitor blood sugar and what to do in special circumstances – such as low blood sugar or when one is sick.Glycemic goals should be individualized, based on a patient’s duration of diabetes, age, life expectancy, comorbid conditions, known cardiovascular disease (CVD) or advanced microvascular complications, unawareness of hypoglycemia, and other considerations Treatment goals are: Control blood glucose levels Prevent complications Improve quality of life These can be achieved by the 4 pillars of Diabetes Management
  • Self-management of diabetes can be done by Having a well balanced diet Regular exercising Taking medications/Insulin Monitoring blood glucose
  • Carbohydrate:Carbohydrates are the principal sources of energy The carbohydrate in food is broken down to glucose which provides energy Sources: Cereals, whole pulses, fruits Avoid: Refined food like maida-based products, sugar, honey, jaggery and sweetsProtein:Proteins help in building & strengthening body tissues Vegetarian sources – Pulses like Soya beans, kidney beans, low fat milk and milk productsNon Vegetarian sources – Fish, chicken, egg
  • Fat:Fat is a calorie dense nutrient providing 9 calories / gram Sources: Vegetable oils (groundnut oils, mustard oil, sunflower oil etc.) butter, ghee, cheese, cream, egg yolk etc.Avoid: Fried foods, ghee, butter, egg yolk. Restrict Oil use to 3 tsp/ dayFibers: A part of plant foods which cannot be digested They help in improving blood glucose control Sources: Whole grains (ragi, jowhar, barley, oats etc.), whole pulses, soybean, green leafy vegetables and fenu-greek seedsVitamins & Minerals:Whole fruits & Vegetables are good sources Whole fruits are recommended in moderation (1serving/ day), however, very sweet fruits (mango, banana, chikoo, grapes, custard apple) and fruit juices should be avoided
  • KEY MESSAGE: Regular physical activity provides numerous physical and psychological benefits for people with diabetes.An individualized plan of regular physical activity can help people with diabetes to:Lose weight or maintain a stable body weight: Regular physical activity can enhance weight loss or aid in weight maintenance, especially when combined with an appropriate calorie-controlled nutrition plan. Physical activity helps the body burn more calories and may increase metabolism by building muscle mass Reduce the risk of cardiovascular disease: Regular physical activity strengthens the heart and blood vessels helping to lower blood pressure and heart rate, provides more oxygen to the blood, and improves blood lipids, especially high-density lipoprotein (HDL) cholesterol.These and other favorable effects of physical activity reduce the risk of heart attack and stroke Achieve better blood glucose control: During and after physical activity, glucose is removed from the blood for energy, which lowers blood glucose levels. Regular physical activity also can increase insulin sensitivity in target tissues, which may reduce or eliminate the need for diabetes medications in some people Improve physical and mental well-being: Patients who are physically active gain energy, strength, and stamina. Regular physical activity can boost self-esteem and reduce stress, encouraging people to take further positive steps toward diabetes self-management
  • Exercise checklist for people who have Diabetes Talk to your doctor about the right exercise for you Check your blood sugar level before and after exercising Check your feet for blisters or sores before and after exercising Drink plenty of fluid before, during and after exercising Warm up before exercising and cool down after exercisingHave a snack handy in case your blood sugar level drops too low
  • Self-monitoring of blood glucose (SMBG) has been accepted as an important instrument that allows people with diabetes to measure their blood sugar at home and achieve therapeutic goals SMBG, as a critical component of overall diabetes management, should be used as adjunct therapy with pharmacological treatments Knowing the results of SMBG is useful for patients in evaluating their response to therapy; the findings can help prevent hypoglycemiaand aid in adjusting medications, medical nutrition therapy, and physical activityIt is recommended that most patients withtype-1 diabetes and pregnant women who are using insulin perform SMBG three or more times daily
  • Insulin Therapy – It is an important part of diabetes treatmentRole of insulin Regulate sugar in your bloodstream. The main job of insulin is to keep the level of sugar in the bloodstream within a normal rangeStorage of excess glucose for energy. After a meal when insulin levels are high — excess glucose is stored in the liver in the form of glycogenBetween meals — when insulin levels are low — the liver releases glycogen into the bloodstream in the form of sugar. This keeps blood sugar levels within a narrow range
  • Hypoglycemia (low blood sugar) is a condition in which there is an abnormally low level of glucose (sugar) in your bloodThe amount of sugar or glucose in the blood is below 70 mg/dL Hypoglycemia is most common among people with diabetes, as too much insulin can cause blood sugar levels to fall (an insulin reaction) Left untreated, hypoglycemia can cause permanent neurological damage and deathCommon causes of low blood sugar include the following:Overmedication with insulin or anti-diabetic pillsUse of alcohol Missed meals
  • Symptoms of hypoglycemia include the following:Trembling Dizziness Sweating Hunger Headache Pale skin color Blurred visionTingling sensations around the mouth
  • To treat low blood sugar the 15/15 rule is usually appliedEat 15 grams of carbohydrate and wait for 15 minutes The following foods will provide about 15 grams of carbohydrate:3 glucose tabletsHalf cup (4 ounces) of fruit juice or regular soda6 or 7 hard candies1 tablespoon of sugarAfter the carbohydrate is eaten, the person should wait for about 15 minutes for the sugar to get into their blood. If the person does not testwithin a good range in 15 minutes, more carbohydrate can be consumed. Their blood sugar should be checked every 15 minutes until it has come within a safe range
  • Foot problems in persons with diabetes are usually the result of three primary factors: neuropathy, poor circulation, and decreased resistance to infection Also, foot deformities and trauma play major roles in causing ulcerations and infections in the presence of neuropathy or poor circulation Nerve damage can lead to loss in sensation which in turn can cause foot injuries/ulcers eventually resulting in amputation if left untreated
  • Diabetic retinopathy is a complication of diabetes that results from damage to the blood vessels of the light-sensitive tissue at the back of the eye (retina). At first, diabetic retinopathy may cause no symptoms or only mild vision problems Eventually, however, diabetic retinopathy can result in blindness Symptoms of diabetic retinopathy include: Seeing spots or floaters in your field of vision Blurred vision Having a dark or empty spot in the center of your vision Difficulty seeing well at night
  • Long-standing diabetes causes changes in small blood vessels that can damage the kidneys This damage can result in severe kidney failure The first symptom of kidney disease is often fluid buildup Other symptoms of kidney disease include: Loss of sleep Poor appetite Upset stomach Weakness Difficulty in concentrating
  • Diabetic neuropathy occurs as a result of damage to the nerves that allows you to feel sensations such as pain They can affect nerves throughout the body , causing numbness and pain in the hands , arms , feet or legs Persistently elevated blood glucose levels for many years can damage the blood vessels that supply oxygen to these nervesSymptoms include: Numbness, tingling, or pain in the toes, feet, legs, hands, arms, and fingers Indigestion, nausea or vomiting Diarrhea or constipation Dizziness or faintness due to a drop in blood pressure after standing or sitting up Problems with urination
  • Diabetic complications can be prevented through tight control of blood glucose and blood pressureFour ways to lower your blood pressure are Losing weight Eating less salt Avoiding alcohol and tobacco Regular exerciseDrugs:Take your medications (pills and/or insulin) as prescribed by your doctorDiet: Follow a sensible diet. Do not skip meals

Cme ppt final with images Cme ppt final with images Presentation Transcript

  • Caring for people with Diabetes Understanding diabetes, supporting the individual and planning care
  • Table of Contents
  • Understanding Diabetes Diabetes is a disease in which blood glucose, or sugar levels in the blood are too high Glucose comes from the food you eat Insulin is a hormone that helps the glucose get into your cells to give them energy Diabetes occurs as a result of : 1. Insufficient insulin production 2. No insulin production 3. Improper use of insulin Blood stream The total number of people with diabetes in 2010 was around 50.8 million in India, rising to 87.0 million by 2030A Ramachandran1, AK Das, SR Joshi, CS Yajnik, S Shah, and KM Prasanna Kumar. Current Status of Diabetes in India and Need for Novel Therapeutic Agents. [Cited on 9th January, 2011] Available from:http://www.japi.org/june_special_issue_2010/Article_02.pdf
  • Types of DiabetesNational Institute of health. Eunice Kennedy Shriver. National Institute of Child health and human development. [Cited on 9th January, 2011] Available from:http://www.nichd.nih.gov/health/topics/gestational_diabetes.cfm
  • Common symptoms of DiabetesCommon symptoms of diabetes include: o Excessive urination o Excessive thirst and hunger o Fatigue o Blurred vision o Tingling in hands and feet o Itchy dry skin o Sores and cuts that don’t heal or heal very slowly
  • Diagnosing DiabetesNational Diabetes Information Clearinghouse. Diagnosis of Diabetes. [Cited on 9th January, 2011] Available from: http://diabetes.niddk.nih.gov/dm/pubs/diagnosis/diagnosis.pdf
  • Diagnosing Diabetes (cont..)Richard J. Schrot. Targeting Plasma Glucose: Preprandial Versus Postprandial. Clinical Diabetes. 2004;22: 4 169-172.National Diabetes Information Clearinghouse. Diabetes overview [Online]. [cited 9th jan, 2011]; Available from: URL:http://www.diabetes.niddk.nih.gov/dm/pubs/overview/index.htm
  • Dangers of DiabetesHaving high blood glucose over a period of time can damagelarge and small blood vessels; and nerves in the body Damage to large blood vessels may lead to: o Poor circulation o Heart attack o Strokes Damage to small blood vessels may lead to: o Eye disease o Kidney disease Damage to nerves may lead to: o Pain o Loss of feeling in the hands, legs and feet o Weak muscles
  • Management of Diabetes
  • Treatment GoalsTreatment goals are : o Control blood glucose levels o Prevent complications o Improve quality of lifeThis can be achieved by the 4 pillars of Diabetes Management
  • 4 Pillars of Diabetes Management
  • Diet and Diabetes - Nutrients Carbohydrate: Carbohydrates are the principal sources of energy o The carbohydrate in food is broken down to glucose which provides energy o Sources: Cereals, whole pulses, fruits o Avoid: Refined food like maida-based products, sugar, honey, jaggery and sweets Protein: Proteins help in building & strengthening body tissues o Sources: Vegetarian sources – Pulses like soya beans, kidney beans, low fat milk and milk products Non Vegetarian sources – Fish, chicken, eggGuidelines for the management of type 2 diabetes . [Online] . [cited January 11, 2012]; Available from URL: http://www.icmr.nic.in/guidelines_diabetes/guide_diabetes.htm
  • Diet and Diabetes – Nutrients (cont..) Fat: Fat is a calorie dense nutrient providing 9 calories / gram o Sources: Vegetable oils (groundnut oils, mustard oil, sunflower oil etc.) butter, ghee, cheese, cream, egg yolk etc. o Avoid: Fried foods, ghee, butter, egg yolk. Restrict oil use to 3 tsp/ day Fibers: A part of plant foods which cannot be digested o They help in improving blood glucose control o Sources: Whole grains (ragi, jowhar, barley, oats etc.), whole pulses, soybean, green leafy vegetables and fenu-greek seeds Vitamins & Minerals: Whole fruits & vegetables are good sources o Whole fruits are recommended in moderation (1 serving/ day), however, very sweet fruits (mango, banana, chikoo, grapes, custard apple) and fruit juices should be avoidedGuidelines for the management of type 2 diabetes . [Online] . [cited January 11, 2012]; Available from URL: http://www.icmr.nic.in/guidelines_diabetes/guide_diabetes.htm
  • Exercise / Activity and DiabetesType 2 Diabetes and Exercise. [cited January 11, 2012]; Available from: http://diabetes.webmd.com/guide/exercise-guidelines
  • Exercise / Activity and Diabetes (cont..)Exercise checklist for Diabetics Talk to your doctor about the right exercise for you Check your blood sugar level before and after exercising Check your feet for blisters or sores before and after exercising Drink plenty of fluids before, during and after exercising Warm up before exercising and cool down after exercising Have a snack handy in case your blood sugar level drops too low
  • Self-Monitoring of Blood Glucose (SMBG)Evan M. Benjamin. Self-Monitoring of Blood Glucose: The Basics. Clinical Diabetes. 2002;20:1:45-47.
  • How is SMBG Done?• Wash your hands with mild soap/ sterilize the finger with an alcohol swab. Allow it to dry• Insert a test strip into your Contour TS meter• Use your lancing device on the side of your fingertip to get a drop of blood• Gently massage your finger until a drop of blood forms
  • How is SMBG Done? (cont..)• Hold the edge of the test strip to the drop of blood. Contour TS strip will automatically sip in the blood drop• Your blood glucose level will appear on the meters display within 8 seconds• Wipe away the blood on your finger with a sterilized cotton ball
  • SMBG use and Frequency o Perform SMBG three or more times per day o Adjust intensity of monitoring to intensity of insulin therapy o Perform SMBG three or more times every day when multiple doses of insulin are administered every day o The exact frequency is undetermined o Perform SMBG at a sufficient rate to reach glucose goals o If taking insulin therapy, perform SMBG three or more times each day o Perform SMBG three or more times each dayAmerican Diabetes Association. Standards of Medical Care in Diabetes. Diabetes Care 2005;28:S4–S36.
  • Pharmacological Treatment For Diabetes Oral Anti-diabetic drugsGuidelines for the management of type 2 diabetes . [Online] . [cited january 11, 2011]; Available from URL: http://www.icmr.nic.in/guidelines_diabetes/guide_diabetes.htm
  • Pharmacological Treatment For Diabetes (cont..) Insulin therapy Insulin therapy is an important part of diabetes treatment Role of insulin Regulate sugar in your bloodstream. The main job of insulin is to keep the level of sugar in the bloodstream within a normal range Storage of excess glucose for energy. After a meal when insulin levels are high — excess glucose is stored in the liver in the form of glycogenMayo clinic. Diabetes. [Cited online January 25, 2012] Available from: http://www.mayoclinic.com/health/diabetes-treatment/DA00010
  • Pharmacological Treatment For Diabetes (cont..) Types of Insulin There are many forms of insulin to treat diabetes. They are classified by how fast they start to work and how long their effects lastWeb.MD. Types of Insulin for Diabetes Treatment. [Cited online January 25, 2012] Available from: http://diabetes.webmd.com/diabetes-types-insulin
  • Pharmacological Treatment For Diabetes (cont..)Injection Site Selection The needle is to be inserted at a slight angle so that the injection is in the subcutaneous tissue The most common injection site is the abdomen The back of the upper arms, the upper buttocks or hips and the outer side of the thighs are also used These sites are the best to inject into for two reasons: o They have a layer of fat just below the skin to absorb the insulin o They make it easier to inject into the subcutaneous tissue, where insulin injection is recommended
  • Complications of Diabetes
  • Hypoglycemia (low blood sugar)Hypoglycemia is a condition in which there is an abnormally low level of glucose(sugar) in the bloodThe amount of sugar or glucose in the blood is below 70 mg/dLCommon causes of low blood sugar include the following: o Overmedication with insulin or anti-diabetic pills o Use of alcohol o Missed meals
  • Hypoglycemia (low blood sugar) (cont..)Symptoms of Hypoglycemia
  • Hypoglycemia (low blood sugar) (cont..) Act quickly
  • How to treat Hypoglycemia ADA recommends the 15/15 Rule for treating low blood sugarAmerican Diabetes Association. The 15/15 Rule for Treating Lows. [Cited online January 25, 2012] Available from: http://community.diabetes.org/t5/Lizzy-s-Lounge/The-15-15-Rule-for-Treating-Lows/ba-p/113685
  • HypoglycemiaThe following items are quick energy sources that contain about 15 gramsof carbohydrate o ½ cup fruit of orange, apple or grapefruit juice o 1/3 cup grape, prune or cranberry juice o 2 tbsp raisins o 3-5 pieces hard candy o 1 cup skim milk o 1 piece bread o 3-4 glucose tablets or 1 tube glucose gel
  • Diabetic Foot careFoot problems in persons with diabetes are usuallythe result of three primary factors: o Neuropathy o Poor circulation o Decreased resistance to infectionNerve damage can lead to loss in sensation whichin turn can cause foot injuries/ ulcers eventuallyresulting in amputation if left untreated
  • Diabetic RetinopathyDiabetic retinopathy is caused by damage toblood vessels of the retinaIf left untreated, diabetic retinopathy cancause blindnessSymptoms of diabetic retinopathy include: o Seeing spots or floaters in your field of vision o Blurred vision o Having a dark or empty spot in the center of your vision o Difficulty seeing well at night
  • Diabetes and Kidney Problems Long-standing diabetes causes changes in small blood vessels that can damage the kidneys This damage can result in severe kidney failure The first symptom of kidney disease is often fluid buildup Other symptoms of kidney disease include: o Loss of sleep o Poor appetite o Upset stomach o Weakness o Difficulty in concentratingAmerican Diabetes Association. Kidney Disease (Nephropathy) [cited January 11, 2012]; Available from: http://www.diabetes.org/living-with-diabetes/complications/kidney-disease-nephropathy.html
  • Diabetic NeuropathyDiabetes damages the nerves that allows you to feelsensations such as painElevated blood glucose levels damage the bloodvessels that supply oxygen to these nervesSymptoms of nerve damage include o Numbness, tingling, or pain in the toes, feet, legs, hands, arms, and fingers o Indigestion, nausea or vomiting o Diarrhea or constipation o Dizziness or faintness due to a drop in blood pressure after standing or sitting up o Problems with urination
  • Prevention of Diabetic complicationsSelf-care Diabetic complications can be prevented through tight control of blood glucose and blood pressure Four ways to lower your blood sugar and blood pressure are o Losing weight o Avoiding alcohol and tobacco o Eating less salt o Regular exercise Drugs : Take your medications (pills and/or insulin) as prescribed by your doctor Diet : Follow a sensible diet. Do not skip meals
  • Diabetes has a major impact on quality of life and life expectancyThere are three main types of diabetes: Type 1, Type 2 and gestational diabetesNormal values for Fasting sugar should be below 99mg/dL and for PPBS should bebelow 140 mg/dLFour corner stones of diabetes management are diet, exercise, SMBG &medication/ insulinSelf-monitoring of blood glucose (SMBG) has been accepted as an importantinstrument to measure their blood sugar at home and achieve therapeutic goalsDiabetic complications can be prevented with healthy lifestyle and by keeping theblood sugar under control