Life style modifications in Diabetes


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Powerpoint presented in the Indian Medical Association, Karunagappally Branch of Kerala on 30-08-2009

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Life style modifications in Diabetes

  1. 1. Life style modifications in the prevention and management of Dm2<br />Dr. S. Aswini Kumar. MD<br />
  2. 2. Case Study 1: Ms. Aparna<br />15 year old Girl<br />Weight: 95kg<br />FBS: 325 PPBS: 450<br />Family doctor referred her after starting on OHA<br />THE NEW YOUNG DIABETIC<br />
  3. 3. Case Study 2: Ms. Aswathy<br />12 year old Girl<br />Weight: 65kg<br />FBS: 110 PPBS: 140<br />Presented with complaints of Abdominal distension<br />PREDIABETIC<br />
  4. 4. Can You prevent Diabetes Mellitus?<br />YES<br />
  5. 5. Definition<br />A metabolic disorder of multiple aetiologycharacterized by chronic hyperglycaemia with disturbances of CHO, fat and protein metabolismresulting from defects in insulin secretion, insulin action or both”<br />Associated with risk of developing late diabetic complications<br />Microvascular (retinopathy, nephropathy)<br />Macrovascular (atherosclerosis, coronary artery disease, <br />Neuropathy (peripheral, autonomic)<br />
  6. 6. World-wide Epidemic<br /> India:<br />2008:32 mill<br />2020: 81 mill<br />
  7. 7. Increasing mortality from Diabetes<br />Male<br />60<br />50<br />40<br />30<br />20<br />10<br /> 0<br />With Diabetes*<br />Female<br />Without Diabetes<br />CHD Mortality/1,000<br />Male<br />Female<br /> 0-3 4-7 8-11 12-15 16-19 20-23 <br />Duration of Follow-up (yrs)<br />* Diagnosed between 35 and 65 years of age<br />Am J Med 90(2A): 56S-61S,1991<br />
  8. 8. The ContinuUM OF CVD RISK IN DM<br />
  9. 9. WHAT IF DIABETIC DEVELOPES CVD<br />Coronary Events<br />Multivessel disease<br />Complications<br />PC Interventions<br />Diabetic ketosis<br />Bypass surgery<br />
  10. 10. Why is the prevalence of DM2 increasing?<br />Aging of the population<br />Urbanization especially in the developing countries<br />More sedentary lifestyle<br />Food consumption patterns<br />More foods with high fat content<br />More refined carbohydrates<br />
  11. 11. Why should we prevent diabetes?<br />To reduce human suffering<br />Improve Quality of Life of individuals<br />Reduce the number of hospitalization<br />To reduce human suffering<br />Reduce mortality from diabetes<br />Prevent Sudden cardiac death<br />
  12. 12. Levels of Prevention in Type 2 DM<br />Primary: <br />Includes activities aimed at preventing diabetes from occurring in susceptible individuals or populations<br />Secondary: <br />Early diagnosis and effective control of diabetes in order to avoid or at least delay the progress of the disease<br />Tertiary: <br />Includes measures taken to prevent complications and disabilities due to diabetes<br />
  13. 13. Natural History of Diabetes<br />Insulin secretion<br />Years from <br />diagnosis<br />0<br />10<br />5<br />15<br />-10<br />-5<br />Onset<br />Diagnosis<br />Insulin resistance<br />Postprandial glucose<br />Fasting glucose<br />Microvascular complications<br />Macrovascular complications<br />Pre-diabetes<br />Type 2 diabetes<br />
  14. 14. Diagnostic Criteria for DM2<br />Fasting blood sugar &gt; 126 mg/dl<br />2 hour glucose tolerance &gt; 200 mg/dl<br />Impaired Glucose Tolerance - “Pre-diabetes”<br />Impaired Fasting: <br />Level between &gt;100 mg/dl and &lt;126 mg/dl<br />Impaired Post prandial glucose:<br />During 2 hour glucose tolerance test<br />Level between &gt;140 and &lt;200 mg/dl<br />
  15. 15. What are the goals?<br />ADA and ACE/ AACE differ from each other<br />ADA Goals<br />FBS - 70-130 <br />PPBS - &lt;180<br />HbA1c - &lt;7.0<br />ACE/AACE Goals<br />FBS - &lt;110<br />PPBS - &lt;140<br />HbA1c - ≤6.5<br />
  16. 16. Hb A1c<br />Excellent test to judge overall glycemic control<br />Gives idea of average blood sugar <br />Over a period of previous 120 days<br />Because RBC Life Span is 121 days<br />Ideally done every 3-4 months<br />Normal &lt; 6.5 Good &lt;7.0 Fair &lt;8.0 Poor&lt;9.0 Bad &gt;10<br />Disadvantages:<br />Costly – Rs. 250 per test <br />Falsely high values – Renal failure<br />Falsely low values – RBC life span<br />
  17. 17. Exercise<br />Advantages<br />Benefits glycemic control<br />Improves insulin sensitivity<br />Builds physical fitness<br />Optimizes body weight<br />Gives psychological well being<br />Disadvantages <br />Carry some risk also<br />Strains the compromised CVS<br />Injuries to musculoskeletal system<br />Predisposes to hypoglycemia<br />May exacerbate complications<br />
  18. 18. Energy expenditure<br />Calories spent /minute<br />Lying down, sleeping, sitting 1<br />Standing, desk work, driving 2<br />Level walking, level bicycling 3<br />Social doubles badminton 4<br />Social singles badminton 5<br />Gardening , swimming 6<br />Competitive badminton 7<br />Jogging 8<br />Basketball 9<br />Running 1km in 10min 10 <br />
  19. 19. Calories Spent in Various Activities <br /><ul><li>Walking, 3.0 miles/hr 275/hr
  20. 20. Walking 5 miles/hr 420/hr
  21. 21. Cycling, 8 miles/hour 325/hr
  22. 22. Mopping, vacuuming 240/hr
  23. 23. Scrubbing floors 300/hr
  24. 24. Gardening 220/hr
  25. 25. Vigorous dancing 500/hr</li></li></ul><li>Exercise<br />Regular Exercise<br />Daily at least 5 days/wk <br />Isotonic Exercise - Yes<br />Isometric - No<br />20<br />
  26. 26. What prevents one from Walking<br />Traffic, heavy rain or dogs on the street<br />Choose Vellayambalam Museum or Gandhi Park<br />21<br />
  27. 27. Precautions<br />Correct foot wear<br />Comfortable loose clothes<br />Close inspection of feet every day<br />Carry snacks as protection from hypoglycemia<br />How it should be:<br />Patient should be able to carry out a normal conversation while exercising without getting breathless<br />22<br />
  28. 28. Physique Exercise Treadmill<br />23<br />
  29. 29. Medical Nutrition Therapy<br /> Dietprescription<br /> Main stay of treatment<br />Shall be individualized,<br /> realistic<br /> flexible &<br /> suitable to patients life style<br /> preferably Indian diet<br />Patient educatedand at regular <br /> intervals compliance judged<br />24<br />
  30. 30. Weight Management<br />25<br /><ul><li>Record height - Record weight - Calculate BMI
  31. 31. Read against ready made charts – To get BMI
  32. 32. Healthy value 20-25
  33. 33. Above 25 – Overweight
  34. 34. Above 30 – Obese</li></ul>.<br />
  35. 35. EAT HEALTHY FOOD<br />
  36. 36. Glycemic Index of Common Food items<br />Measure of the effects of carbohydrates onblood glucose levels<br />
  37. 37. Diet Control<br />Principle less food – <br />Better insulin action<br />No sugars sweets tubers <br />Otherwise USUAl food<br />28<br />
  39. 39. Diabetes – What not to eat<br />Vada<br />Sweets<br />Pastry<br />Sugar<br />Mutton<br />Beef fry<br />Colas<br />Chips<br />
  40. 40. Diet and Diabetes – A days menu<br />06.30 am Tea without<br />08.30am Break fast<br />10.30am Snack<br />01.30pm Lunch<br />02.30pm Fruits<br />04.30pm Tea without<br />08.30pm Dinner<br />06.30pm Green salad<br />
  41. 41. Benefits of 10% Weight Loss<br />20% fall in total mortality<br />30% fall in diabetes related death<br />40% fall in obesity related death<br />20% fall in Systolic BP<br />10% fall in Diastolic BP<br />50% fall Fasting Glucose<br />10% fall in Total Cholesterol<br />15% fall in LDL<br />8% increase in HDL<br />30% fall in Triglyceride<br />
  42. 42. Avoid all fried foods<br />33<br />
  43. 43. Microvascular and Macrovascular Complications of Diabetes<br />Type 2 Diabetes<br />It’s a Nightmare!<br /> Chronic <br />Kidney Disease<br />Peripheral <br />Occlusive <br />Vascular <br />Disease<br />Autonomic<br />Neuropathy <br />Stroke<br />Sudden<br />Blindness<br />Heart Attack<br />Peripheral <br />Neuropathy <br />34<br />Aswini Kumar. MD<br />
  44. 44. Tertiary Prevention<br />Actions taken to prevent and delay the development of acute or chronic complications<br />Acute complications: such as<br />hypoglycemia, <br />severe hyperglycemia<br />Diabetic ketoacidosis and infections<br />Chronic complications: such as<br />atherosclerosis, <br />retinopathy, <br />nephropathy, <br />neuropathy and<br />foot problem<br />
  45. 45. Examples of socio-cultural barriers:<br />
  46. 46. Tackling socio-cultural barriers:<br />
  47. 47. Take Home Messages<br />DM2 is a major challenge to human health<br />Type 2 diabetes can be prevented<br />Primary prevention is suitable and affordable<br />lifestyle interventions are effective in prevention<br />Barriers for prevention should be addressed<br />Diabetes can be managed with life style alone<br />Healthy eating and regular exercise are needed <br />