Diabetes as a global problem, foot care and nutrition management as presented by clinical nutritionist. Cheruiyot Sambu at Kapkatet county hospital. stay tuned
2. Ministries of Health
Definition
Diabetes mellitus is a chronic metabolic
disorder characterized by hyperglycemia
(high blood glucose) due to:-
◦ Defects in insulin production usually
caused by destruction of beta cells
(autoimmune or otherwise)
◦ Insulin resistance - impaired action of
insulin on target cells
◦ Both of these mechanisms
3. Ministries of Health
The Classification of Diabetes Based on
Etiology (WHO)
Type 1 diabetes Results from destruction of the pancreatic beta cells
most commonly autoimmune. Insulin is required for
survival.
Type 2 diabetes Characterized by insulin resistance and/or abnormal
insulin secretion, either of which may predominate,
but both of which are usually present. It is the most
common type of diabetes.
Other specific
types of
Diabetes
These are less common and include genetic
disorders, infections, and diseases of the exocrine
pancreas, endocrinopathies or as a result of drugs.
Gestational
diabetes
Diabetes diagnosed in the second or third trimester
in a woman who was previously not known to have
diabetes. It typically resolves after delivery..
4. Ministries of Health
Epidemiology of diabetes
Globally:
Diabetes is one of the largest global health
emergencies of the 21st century
Over 415 million people are living with
diabetes (1 out of 11 of adults)
75% of people with diabetes live in low and
middle income countries
More than 46.5% of adults with diabetes are
undiagnosed
Every 6 seconds someone dies from
diabetes
5. Ministries of Health
Epidemiology of diabetes
In Kenya:
Prevalence of DM is 4.7% (2.7%
in the rural and 10.7% in urban
areas), expected to rise to 7% by
2030
6 out of 10 adults with diabetes
are undiagnosed
6. Ministries of Health
Global projections; International Diabetes
Federation (IDF Atlas)
171 million
194
million
247
million
415
million
642 million
2000
2003
2007
2015
2040
285 million
2010
7. Ministries of HealthRisk factors for diabetes
Risk factors for type 1
DM are not well known.
Type 2 diabetes has
several risk factors
divided into:
◦ Non-modifiable risk
factors
◦ Modifiable risk factors
8. Ministries of HealthRisk factors for diabetes
A. Non-modifiable risk factors
− Age > 40 years
− Family history/genetic predisposition
− Member of high risk population (Ethnicity /race
e.g. Pima Indians)
− History of impaired glucose tolerance, impaired
fasting glucose
− History of gestational diabetes or delivery of a
macrosomic baby
− Polycystic ovary disease
9. Ministries of Health
Risk Factors - Modifiable
9
Unhealthy diet
Tobacco use
Excessive alcohol consumption
Physical inactivity Overweight and Obesity
Increasing age
10. Ministries of Health
Signs and symptoms
10
Excessive
thirst Extreme
hunger
Frequent urination
Blurred vision
Increased
fatigue
Impotence
11. Ministries of Health
Signs and symptoms
11
Unexplained weight loss
Irritability
Non healing wounds
Numbness or tingling sensation
of the feet
12. Ministries of Health
Benefits of healthy eating
and active living?
Those who do not find time for
exercise will have to find time for
illness. (Edward Smith-Stanley)
13. Ministries of Health
Commercial ‘Diabetic’ foods
There are many commercially prepared diabetic
food substances in the market
They are not recommended because:
–They are expensive
–They are high in trans fatty acids
–They contain sugars other than glucose/sucrose
–They do not have a role in a healthy eating plan
Before using these foods, one must consult with a
dietician
Avoid chronic use of artificial sweeteners
17. Ministries of Health
Environment
Think for a minute about the food:
◦ in grocery stores
◦ in corner stores
◦ in movie theatres
◦ at fast food restaurants
◦ at sports events
◦ at school
You pray for good health and a body that
will be strong in old age. Good — but your
rich foods block the gods’ answer and tie
Jupiter’s hands. (Persius)
18. Ministries of Health
Today we find…
Majority addicted to excessive drinking, smoking,
totally sedentary, overeating “wrong” foods, overly
stressed.
Others may occasionally exercise have a high ego.
A minority try to follow all the rules of eating, exercise,
sleep etc.
Almost extinct - exceptionally knowledgeable &
disciplined.
Analyse your lifestyle
19. Ministries of Health
The Plate Model
The plate model is a simple way to planning a
balanced diet through appropriate portion
sizes without measuring
Fill the plate (20 cm diameter) to match the
amount of
◦ Vegetables- ½ of the plate
◦ Starches ¼ of the plate
◦ Meat ¼ of the plate
◦ Then add a piece of fruit and/or a glass of milk
22. Ministries of Health
22
Assessment of the foot -
8 Clinical features
1. Neuropathy
2. Ischemia
3. Deformity
4. Callus
5. Swelling
6. Skin
breakdown
7. Infection
8. Necrosis
Reference from managing the Diabetic foot : M Edmonds and A Foster