Stop Diabetes-Children.ppt

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Stop Diabetes-Children.ppt

  1. 1. DIABETES MELLITUS (DM) IN CHILDREN Dr. Shamanthakamani Narendran MD (Pead), PhD (Yoga Science) How yoga helps?
  2. 2. DIABETES IN CHILDREN <ul><li>Today, DM in children through out the world is growing with an alarming rate. </li></ul><ul><li>Has increased 3 times in last 30 years. </li></ul><ul><li>Type 1 diabetes is growing by 5% per year among pre-school children in India. It is estimated that 70,000 children, who are under 15 years, develop juvenile type 1 diabetes each year (almost 200 children a day!). </li></ul>
  3. 3. <ul><li>20% or more of new patients with diabetes in childhood and adolescence have type 2 diabetes mellitus, a change associated with increased rates of obesity. </li></ul>
  4. 4. <ul><li>Type 1 diabetes </li></ul><ul><li>Type 2 diabetes </li></ul><ul><li>Gestational diabetes </li></ul>Classification of Diabetes <ul><li>Other types of Diabetes </li></ul><ul><li>Genetic </li></ul><ul><li>Malnutrition related </li></ul><ul><li>Drug induced </li></ul>
  5. 5. Age <ul><li>Neonatal diabetes, including diagnosis in infants younger than 6 months, is most likely due to an inherited defect. </li></ul><ul><li>Respond well to sulphonylurea therapy. </li></ul><ul><ul><li>Early childhood - 4-6 years </li></ul></ul><ul><ul><li>Early puberty - 10-14 years. </li></ul></ul>
  6. 6. Mortality/Morbidity <ul><li>Metabolic control </li></ul><ul><li>Genetic susceptibility, </li></ul><ul><li>Lifestyle (eg, smoking, diet, exercise), </li></ul><ul><li>Pubertal status, and </li></ul><ul><li>Gender. </li></ul>
  7. 7. <ul><li>Long-term complications includes: </li></ul><ul><li>Retinopathy </li></ul><ul><li>Cataracts </li></ul><ul><li>Hypertension </li></ul><ul><li>Progressive renal failure </li></ul><ul><li>Early coronary artery disease </li></ul><ul><li>Peripheral vascular disease </li></ul><ul><li>Neuropathy, both peripheral and autonomic </li></ul><ul><li>Increased risk of infection </li></ul>
  8. 8. <ul><li>Associated autoimmune diseases are common with type 1 diabetes mellitus, particularly in children who have the human leukocyte antigen DR3 (HLA-DR3). </li></ul><ul><li>Some conditions may precede development of diabetes; others may develop later. </li></ul><ul><li>As many as 20% of children with diabetes have thyroid autoantibodies </li></ul>
  9. 9. <ul><li>Age below 30 years </li></ul><ul><li>Excessive urination </li></ul><ul><li>Excessive hunger </li></ul><ul><li>Excessive thirst </li></ul>Symptoms of Type 1 Diabetes <ul><li>Bed wetting in children </li></ul><ul><li>Unexplained weight loss </li></ul><ul><li>Dehydration </li></ul><ul><li>Coma </li></ul>
  10. 10. Symptoms <ul><li>Abdominal pains, headaches and behavior problems along with the usual symptoms of diabetes like weight loss, thirst, tiredness and frequent urination. </li></ul>
  11. 11. IDDM <ul><li>MAY PRESENT WITH </li></ul><ul><li>INFECTION </li></ul><ul><li>COMA </li></ul><ul><li>COMPLICATIONS </li></ul>EXCESS HUNGER EXCESS THIRST EXCESS URINE
  12. 12. IDDM EATS A LOT BUT DOES NOT GROW LOSS OF WEIGHT YOUNG 5 -35 Yrs
  13. 13. <ul><li>Frequent urination </li></ul><ul><li>Always hungry </li></ul><ul><li>Cave for extra liquids </li></ul><ul><li>Sexual dysfunction </li></ul><ul><li>Unexplained weight loss </li></ul><ul><li>Family history </li></ul>Symptoms of Type 2 Diabetes
  14. 14. Heredity
  15. 15. FOR INSULIN IDENTIFIED (CHROMOSOME 6) GENE
  16. 16. <ul><li>Values are internationally accepted for plasma glucose </li></ul><ul><li>Corresponding whole blood glucose values are lower </li></ul>Diagnostic range of blood sugar (plasma glucose) >200 >140, but <200 <140 2 hours after glucose load (mg/dL) 200 at least once <200 <200 Between 0-120 min (mg/dL) >126 110-126 <110 Fasting plasma glucose (mg/dL) Diabetes mellitus Impaired glucose tolerance Normal glucose tolerance
  17. 17. What are the consequences of untreated diabetes? 2 times higher risk of brain stroke 3-4 times higher risk of heart disease Increase risk of high BP Cause of leg amputations Cause of loss of sensations in limbs & other nerve damage 17 times of higher risk of kidney failure – common cause in India Affects the eye and vision 3 rd most common cause of blindness in India
  18. 18. <ul><li>Symptoms of type 1 DM secondary to </li></ul><ul><li>Hyperglycemia, </li></ul><ul><li>Glycosuria, and </li></ul><ul><li>Diabetic ketoacidosis (DKA). </li></ul>
  19. 19. KETOACIDOSIS <ul><li>Blood suger >240 mg/dL </li></ul><ul><li>Ketone bodies in blood </li></ul><ul><li>> Acidity in blood </li></ul>Symptoms: Slow, deep breathing with a fruity odor to the breath; confusion; frequent urination (polyuria); poor appetite; loss of consciousness.
  20. 20. Administration <ul><li>Of intravenous fluids, </li></ul><ul><li>Insulin, and </li></ul><ul><li>Glucose </li></ul>
  21. 21. <ul><li>Insulin resistance: </li></ul><ul><li>Insulin is reduced or blocked in the body. </li></ul><ul><li>Causes the pancreas to produce extra insulin. </li></ul><ul><li>After some time the body may stop making insulin. </li></ul>
  22. 22. Signs & symptoms <ul><li>Hungry all the time. </li></ul><ul><li>Tired and sluggish </li></ul>
  23. 23. Environmental factors <ul><li>Viral infection </li></ul><ul><li>Dietary factors are also relevant. </li></ul><ul><li>Breastfed infants have a lower risk for insulin-dependent diabetes mellitus (IDDM) </li></ul>
  24. 24. Chemical causes <ul><li>Rat poison - selectively damage islet cells and can cause type 1 diabetes mellitus. </li></ul>
  25. 25. Management <ul><li>Education. </li></ul><ul><li>Medication. </li></ul><ul><li>Regular physical activity. </li></ul><ul><li>Balanced diet. </li></ul><ul><li>Yoga </li></ul>
  26. 26. Medication <ul><li>Antidiabetic agents </li></ul><ul><li>Insulin detemir (Levemir) </li></ul><ul><li>Insulin lispro (Humalog) </li></ul><ul><li>Regular insulin (Humulin R, Novolin R) </li></ul><ul><li>Insulin NPH (Humulin N, Novolin N) </li></ul><ul><li>Insulin aspart (NovoLog) </li></ul><ul><li>Insulin glargine (Lantus) </li></ul><ul><li>Insulin glulisine (Apidra) </li></ul>
  27. 27. Medical Care <ul><li>Children with type 1 DM (T1DM) require insulin therapy. </li></ul><ul><li>Children with significant dehydration, persistent vomiting, or metabolic derangement, or with serious intercurrent illness, require inpatient management and intravenous rehydration. </li></ul><ul><li>A well-organized diabetes care team can provide all necessary instruction and support in an outpatient setting. </li></ul><ul><li>The only immediate requirement is to train the child or family to check blood glucose levels, to administer insulin injections, and to recognize and treat hypoglycemia. </li></ul><ul><li>The patient and/or family should have 24-hour access to advice and know how to contact the team. </li></ul>
  28. 28. Diet <ul><li>Diabetes is an energy metabolism disorder, and before insulin was discovered, children with diabetes could be kept alive by a diet severely restricted in carbohydrate and energy intake. </li></ul><ul><li>These measures led to a long tradition of strict carbohydrate control and unbalanced diets. </li></ul><ul><li>More recent dietary management of diabetes emphasizes a healthy, balanced diet, high in carbohydrates and fiber and low in fat. </li></ul>
  29. 29. <ul><li>The following are among the most recent consensus recommendations: </li></ul><ul><li>Carbohydrates should provide 50-55% of daily energy intake. (No more than 10% of carbohydrates should be from sucrose or other refined carbohydrates.) </li></ul><ul><li>Fat should provide 30-35% of daily energy intake. </li></ul><ul><li>Protein should provide 10-15% of daily energy intake. </li></ul>
  30. 30. <ul><li>Develop a diet plan for each child to suit individual needs and circumstances. </li></ul><ul><li>Regularly review and adjust the plan to accommodate the patient's growth and lifestyle changes. </li></ul>
  31. 31. <ul><li>Proper diet is very important – Helps control blood sugar, blood cholesterol, and weight </li></ul><ul><li>Cut down on fat, oils, sugar, alcohol and red meat. </li></ul><ul><li>Eat vegetables daily. </li></ul><ul><li>Avoid rich fried foods. </li></ul><ul><li>Take lots of foods like cereals and pulses </li></ul>Diabetic Diet Tips
  32. 32. Activity <ul><li>Type 1 diabetes mellitus requires no restrictions on activity; exercise has real benefits for a child with diabetes. </li></ul><ul><li>Most children can adjust their insulin dosage and diet to cope with all forms of exercise. </li></ul><ul><li>The current guidelines are increasingly sophisticated and allow children to compete at the highest levels in sport. </li></ul>
  33. 33. <ul><li>Children and their caretakers must be able to recognize and treat symptoms of hypoglycemia. </li></ul><ul><li>Hypoglycemia following exercise is most likely after prolonged exercise involving the legs, such as walking, running or cycling. It may occur many hours after exercise has finished and even affect insulin requirements the following day. </li></ul><ul><li>A large presleep snack is advisable following intensive exercise. </li></ul>
  34. 34. Consultations <ul><li>Always involve an experienced dietitian in the patient's care, typically as a regular member of the diabetes care team. </li></ul><ul><li>Ophthalmology review may be needed at diagnosis if a cataract is suspected. Children with diabetes aged 12 years and older need a careful annual eye examination. </li></ul><ul><li>Access to psychological counseling and support is desirable, preferably from a member of the diabetes care team. </li></ul>
  35. 35. <ul><li>Regular exercise is good for diabetes. </li></ul><ul><li>Exercise improves sugar and weight control, and increases a sense of well being </li></ul>Diabetic Exercise Tips <ul><li>Do’s </li></ul><ul><li>Can participate in active sports </li></ul><ul><li>Keep sugar or other carbohydrate source handy. </li></ul><ul><li>Don’ts </li></ul><ul><li>Avoid exercise soon after injecting insulin </li></ul><ul><li>Do not exercise on an empty stomach </li></ul>
  36. 36. <ul><li>Change daily into clean, soft socks or stockings which must neither be too big nor too small. </li></ul><ul><li>Keep the feet warm and dry. Preferably wear socks or stockings of cotton and leather shoes. </li></ul><ul><li>Never walk barefoot neither indoors nor outdoors. </li></ul><ul><li>Always wear shoes that fit. This applies also to sandals </li></ul><ul><li>Examine shoe everyday for cracks, pebbles, nails, and other irregularities which may irritate the skin. </li></ul>Special Attention for Foot
  37. 37. <ul><li>Wash feet daily with lukewarm water and soap, just as wash hands. </li></ul><ul><li>Dry feet well, also between the toes. </li></ul><ul><li>Cut nails straight across. Ingrown nails and calluses should receive expert attention. </li></ul><ul><li>Keep the skin supple with moisturizing lotion, but do not apply it between the toes. </li></ul>
  38. 38. <ul><li>If not diabetic, but at high risk, require to take care of health. </li></ul><ul><li>Should watch weight in particular waist line. </li></ul><ul><li>Exercise regularly. </li></ul><ul><li>Eat healthy – cut out fat, reduce refined rich fried food, avoid calorie dense sweets and red meat. </li></ul><ul><li>Eat cereals and pulses, vegetables and fruits, avoid or reduce alcohol intake and go for medical checkup regularly. </li></ul><ul><li>Avoid excessive psychological and physical stress. </li></ul>Can Diabetes be prevented ?
  39. 39. <ul><li>All types of diabetes are serious and require full attention. </li></ul><ul><li>Insulin is given from outside when insulin producing cells do not produce enough insulin </li></ul><ul><li>High blood sugar is toxic to the insulin producing cells. </li></ul><ul><li>Improperly controlled diabetes worsens the condition and further damages the already stressed insulin producing cells. </li></ul><ul><li>Controlling diabetes is important irrespective of whether one is treated with/without insulin </li></ul>Is Insulin requiring DM more serious ?
  40. 40. YOGA PRACTICES
  41. 41. Ride your Bumpy Camel COBRA POSE
  42. 42. ELEPHANT POSE FISH POSE
  43. 43. Running Train Air Walk Sliding Board
  44. 44. Birthday Candles Candle Pose
  45. 45. Deep Relaxation Jogging Through the Jungle
  46. 46. MEDITATION
  47. 48. PASSIVE YOGIC EXERCISES <ul><li>Infants below 3 to 4 years. </li></ul><ul><li>Children with neurological or muscular disabilities who are unable to do active asanas </li></ul>There are two ways to live your life. One is as through nothing is a miracle. The other is as though everything is a miracle. Albert Einstein (1879 - 1955)
  48. 49. PASSIVE YOGIC PRACTICES
  49. 50. 1 to 4 Months GRIP CHEST CROSS
  50. 51. 3 to 4 Months BICYCLE
  51. 52. 5 to 6 Months PULL-UP ELBOW STAND
  52. 53. 7 to 8 Months TOE TO EAR WHEELBARROW
  53. 54. 9 to 11 Months MOUNTAIN CLIMBING
  54. 55. 12 to 22 Months LAY-BACK
  55. 56. TOUCH AND HUG
  56. 57. SQUATTING
  57. 58. HIP LIFT
  58. 59. 12 to 22 Months HEAD-TO-TOES
  59. 60. TRAIN TRACKS
  60. 61. BALANCE BEAM WALK
  61. 62. BASIC PUSH-UP
  62. 63. ANGRY CAT
  63. 64. ROWING
  64. 66. Thank You

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