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Life style modifications in Diabetes
 

Life style modifications in Diabetes

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

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

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    Life style modifications in Diabetes Life style modifications in Diabetes Presentation Transcript

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