Diabetes is a chronic, metabolic disease characterized by elevated levels of blood glucose (or blood sugar), which leads over time to serious damage to the heart, blood vessels, eyes, kidneys and nerves. Diabetes is a chronic, metabolic disease characterized by elevated levels of blood glucose (or blood sugar), which leads over time to serious damage to the heart, blood vessels, eyes, kidneys and nerves. There are 3 types of diabetes 1. Type 1 diabetes 2. Type 2 diabetes 3. Gestational diabetes Worldwide status The number of people with diabetes rose from 108 million in 1980 to 422 million in 2014. Prevalence has been rising more rapidly in low- and middle-income countries than in high-income countries. Asia accounts for 60% of the world’s diabetic population. Diabetes is a major cause of blindness, kidney failure, heart attacks, stroke and lower limb amputation. People from South Asian communities are up to 6 times more likely to have diabetes than the general population and 2011 data reveals that almost 1/5th of the world’s population resides in South Asia. 2011 estimates indicate that 8.3% of the adult population, or 71.4 million people have diabetes, 61.3 million of whom are in India. SEA region has the second highest number of deaths attributable to diabetes with 1.16 million deaths in 2011 with represents 14.5% if all deaths for the region and 55% if these death occur in people under the age of 60. Burden of diabetes in Nepal According to Nepal Diabetes Association, the prevalence of diabetes in the people 20 years and above in urban areas is 14.6% and in rural areas is 2.5% In 2017, over 10, 000 individuals died due to T2DM or diabetes-related complications in Nepal, which is the 11th most common cause of disability in terms of disability-adjusted life years. In 2020, the prevalence of T2DM in Nepal was 8.5% which was higher than that of 8.4% in 2014. Similarly, in 2020 the prevalence of pre-diabetes was 9.2% compared to 2014, which was 10.3% Symptoms of diabetes Polyuria Polydipsia Polyphagia Weight loss Vision change Fatigue

1. DIABETES
PREPARED BY –
Dikshya Kandel
1

2. 1. Introduction
2. Types of diabetes
3. Burden of diabetes
4. Diagnosis
5. Risk Factors
6. Signs and Symptoms
7. Complications
8. Preventive Measures
CONTENTS
2

3. introduction
Diabetes is a chronic, metabolic disease
characterized by elevated levels of blood
glucose (or blood sugar), which leads over
time to serious damage to the heart, blood
vessels, eyes, kidneys and nerves.
3

4. Types of
diabetes
1. Type 1 diabetes
2. Type 2 diabetes
3. Gestational diabetes
4

5. Type 1 diabetes
• It is also called juvenile diabetes or insulin dependent
diabetes.
• It is a chronic condition in which the pancreas produces
little or no insulin by itself.
• Type 1 diabetes is usually diagnosed before the age of
40 and it’s usually diagnosed in children, teens, and
young adults.
5

6. Type 2 diabetes
• The most common type is type 2 diabetes, and it usually
occurs in adults.
• It occurs when the body becomes resistant to insulin or
doesn't make enough insulin.
• About 90-95% of people with diabetes have type 2.
6

7. Gestational diabetes
• Gestational diabetes is a type of diabetes that can
develop during pregnancy in women who don’t
already have diabetes.
• During pregnancy, your body makes more hormones
and goes through other changes, such as weight
gain. These changes cause your body’s cells to use
insulin less effectively, a condition called insulin
resistance. Insulin resistance increases your body’s
need for insulin.
7

8. Global burden
• The number of people with diabetes
rose from 108 million in 1980 to 422
million in 2014. Prevalence has been
rising more rapidly in low- and
middle-income countries than in
high-income countries.
• Asia accounts for 60% of the world’s
diabetic population.
• Diabetes is a major cause of
blindness, kidney failure, heart
attacks, stroke and lower limb
amputation. 8

9. 463
million
Adults were living with diabetes in 2019
The number of people living with diabetes is expected
to rise to 578 million by 2030
9

10. Cont…
• Between 2000 and 2016, there was a 5% increase in
premature mortality from diabetes.
• In 2017 there were 9 million people with type 1
diabetes; the majority of them live in high-income
countries.
• In 2019, diabetes was the ninth leading cause of
death with an estimated 1.5 million deaths directly
caused by diabetes.
• The prevalence of diabetes is higher in men than in
women and more in urban areas than in rural areas.
10

11. Cont…
• People from South Asian communities are up to 6 times
more likely to have diabetes than the general population
and 2011 data reveals that almost 1/5th of the world’s
population resides in South Asia.
• 2011 estimates indicate that 8.3% of the adult population,
or 71.4 million people have diabetes, 61.3 million of
whom are in India.
• SEA region has the second highest number of deaths
attributable to diabetes with 1.16 million deaths in 2011
with represents 14.5% if all deaths for the region and 55%
if these death occur in people under the age of 60.
11

12. Burden of diabetes
in nepal
• According to Nepal Diabetes Association, the
prevalence of diabetes in the people 20 years
and above in urban areas is 14.6% and in rural
areas is 2.5%
• In 2017, over 10, 000 individuals died due to
T2DM or diabetes-related complications in
Nepal, which is the 11th most common cause of
disability in terms of disability-adjusted life
years.
12

13. Cont…
• In 2020, the prevalence of T2DM in Nepal was
8.5% which was higher than that of 8.4% in 2014.
Similarly, in 2020 the prevalence of pre-diabetes
was 9.2% compared to 2014, which was 10.3%
13

14. Cont…
● According to Annual Report (2076/77) published by DoHS,
Diab
etes
Mellit
us
(DM)
Per-
iod
1 2 Bag-
mati
Gand-
aki
5 Karn
-ali
Su.
Pa.
Nepal
72/73 18700 5310 43906 26860 17599 977 2764 116116
73/74 25847 10637 74541 28128 17236 1098 3862 161349
74/75 32127 9436 95781 32287 22851 1972 4659 199113
75/76 55461 15520 90419 38903 38922 5859 6512 251596
76/77 80201 21562 92812 38841 53665 5995 8259 301339
14

15. diagnosis
Blood and urine test is done to check for blood glucose level.
15

16. A1c test
• The A1C test measures your average blood sugar
level over the past 2 or 3 months. An A1C below 5.7%
is normal, between 5.7 and 6.4% indicates you have
prediabetes, and 6.5% or higher indicates you have
diabetes.
16

17. Fasting blood sugar
test
• This measures your blood sugar after an overnight
fast (not eating). A fasting blood sugar level of 99
mg/dL or lower is normal, 100 to 125 mg/dL
indicates you have prediabetes, and 126 mg/dL or
higher indicates you have diabetes.
17

18. Glucose tolerance test
• This measures your blood sugar before and after you
drink a liquid that contains glucose.
• At 2 hours, a blood sugar level of 140 mg/dL or lower
is considered normal, 140 to 199 mg/dL indicates you
have prediabetes, and 200 mg/dL or higher indicates
you have diabetes
18

19. Random blood sugar test
• This measures your blood sugar at the time you’re
tested. You can take this test at any time and don’t
need to fast (not eat) first. A blood sugar level of 200
mg/dL or higher indicates you have diabetes
19

20. Blood sugar chart
Category
Fasting Value (mg/dl) Postprandial (mg/dl)
Min. Value Max. Value Value 2h after eating glucose
Normal 70 100 Less than 140
pre Diabetes 101 126 140 to 200
Diabetes More than 126 - More than 200
20

21. 1. Urine glucose test can be used to help determine if blood
glucose levels are too high, which may be a sign of diabetes.
2. The level of glucose is then determined by observing the
change in color of the testing strip.
Urine test
21

22. 22

23. 23

24. 1. Type 1 diabetes is thought to be caused by an autoimmune
reaction (the body attacks itself by mistake) that destroys the
cells in the pancreas that make insulin, called beta cells.
2. Family history: Your risk increases if a parent or sibling has
type 1 diabetes.
3. Environmental factors: Circumstances such as exposure to a
viral illness likely play some role in type 1 diabetes.
4. Geography: Certain countries, such as Finland and Sweden,
have higher rates of type 1 diabetes.
RISK FACTORS FOR TYPE 1
DIABETES
24

25. • Weight: The more fatty tissue you have, the more resistant
your cells become to insulin.
• Inactivity: The less active you are, the greater your risk.
Physical activity helps you control your weight, uses up
glucose as energy and makes your cells more sensitive to
insulin.
• Family history: Your risk increases if a parent or sibling has
type 2 diabetes.
Risk factors for type 2
diabetes
25

26. • Age: Your risk increases as you get older. This may be
because you tend to exercise less, lose muscle mass and
gain weight as you age. But type 2 diabetes is also
increasing among children, adolescents and younger adults.
• Gestational diabetes: If you developed gestational diabetes
when you were pregnant, your risk of developing
prediabetes and type 2 diabetes increases. If you gave birth
to a baby weighing more than 9 pounds (4 kilograms),
you're also at risk of type 2 diabetes.
Cont…
26

27. • Polycystic ovary syndrome: For women, having polycystic
ovary syndrome — a common condition characterized by
irregular menstrual periods, excess hair growth and obesity
— increases the risk of diabetes.
• High blood pressure: Having blood pressure over 140/90
millimeters of mercury (mm Hg) is linked to an increased
risk of type 2 diabetes.
Cont…
27

28. • Abnormal cholesterol and triglyceride levels: If you have
low levels of high-density lipoprotein (HDL), or "good,"
cholesterol, your risk of type 2 diabetes is higher.
Triglycerides are another type of fat carried in the blood.
People with high levels of triglycerides have an increased
risk of type 2 diabetes.
Cont…
28

29. • Stress: If you’re feeling stressed, your body releases stress
hormones like cortisol and adrenaline. This should give you
an energy boost for a ‘fight or flight’ response. But the
hormones actually make it harder for insulin to work
properly, known as insulin resistance. As energy can’t get
into your cells, your blood sugar levels rise.
Cont…
29

30. • Accident: One medical Network points out that the correlation
between diabetes and spinal cord injury is about 20%.
• It is even possible for survivors of to develop diabetes without
specifically experiencing a spinal cord injury. After a crash,
especially a severe crash, the body's inflammatory response could
trigger and mobilize fluid to wounds where it begins the repair
process. But if that inflammatory response doesn't go exactly as it
should, it attacks the body instead. When the inflammatory
system turns and attacks the body, it's likely to cause damage to
the pancreas, which would cause it to have trouble or to outright
stop producing insulin.
Cont…
30

31. • Age: Women older than age 25 are at increased risk.
• Weight: Being overweight before pregnancy increases your
risk.
• Family or personal history. Your risk increases if you have
prediabetes or if a close family member, has type 2
diabetes. You're also at greater risk if you had gestational
diabetes during a previous pregnancy, if you delivered a very
large baby or if you had an unexplained stillbirth.
RISK FACTORS FOR GESTATIONAL
DIABETES
31

32. SYMPTOMS OF DIABETES
HUNGRY
Change in
WEIGHT
DIZZINESS
tingling
THIRSTY
32

33. 1. Polyuria
2. Polydipsia
3. Polyphagia
4. Weight loss
5. Vision change
6. Fatigue
33

34. Complication OF DIABETES
heart
Diabetic retinopathy
Cardiovascular
diseases
feet
Nerve damage
Nephropathy
eyes
kidney
34

35. • Cardiovascular disease: Diabetes increases the risk of
various cardiovascular problems, including coronary artery
disease with chest pain (angina), heart attack, stroke and
narrowing of arteries (atherosclerosis). If you have diabetes,
you're more likely to have heart disease or stroke.
COMPLICATIONS OF DIABETES
35

36. • Nerve damage (neuropathy): Excess sugar can injure the
walls of the tiny blood vessels (capillaries) that nourish your
nerves, especially in your legs. This can cause tingling,
numbness, burning or pain that usually begins at the tips of
the toes or fingers and gradually spreads upward.
• If left untreated, you could lose all sense of feeling in the
affected limbs. Damage to the nerves related to digestion
can cause problems with nausea, vomiting, diarrhea or
constipation.
• For men, it may lead to erectile dysfunction.
36

37. • Kidney damage (nephropathy): The kidneys contain millions
of tiny blood vessel clusters (glomeruli) that filter waste
from your blood. Diabetes can damage this delicate filtering
system. Severe damage can lead to kidney failure or
irreversible end-stage kidney disease.
37

38. • Eye damage (retinopathy):Diabetic retinopathy (DR)
affects 1 in 3 people with diabetes and remains the leading
cause of blindness in working-aged adults. Diabetes can
damage the blood vessels of the retina potentially leading
to blindness. Diabetes also increases the risk of other
serious vision conditions, such as cataracts and glaucoma.
38

39. • Alzeihmer’s disease: A growing body of research indicates
that AD is linked to diabetes mellitus (DM) and suggests
that impaired insulin signaling acts as a crucial risk factor in
determining the progression of this devastating disease.
Many studies suggest people with diabetes, especially type
2 diabetes, are at higher risk of eventually developing
Alzheimer's dementia or other dementias.
39

40. • Most women who have gestational diabetes deliver healthy
babies. However, untreated or uncontrolled blood sugar
levels can cause problems for pregnant women and their
baby.
• Type 2 diabetes later in life: Babies of mothers who have
gestational diabetes have a higher risk of developing
obesity and type 2 diabetes later in life.
• Death: Untreated gestational diabetes can result in a baby's
death either before or shortly after birth.
COMPLICATIONS OF
GESTATIONAL DIABETES
40

41. • Preeclampsia: This condition is characterized by high blood
pressure, excess protein in the urine, and swelling in the
legs and feet. Preeclampsia can lead to serious or even life-
threatening complications for both mother and baby.
• Subsequent gestational diabetes: Once you've had
gestational diabetes in one pregnancy, you're more likely to
have it again with the next pregnancy. You're also more
likely to develop diabetes — typically type 2 diabetes — as
you get older.
41

42. PREVENTIve
measures 42

43. Simple lifestyle measures have been shown to be effective
in preventing or delaying the onset of type 2 diabetes. Some
of the measures are ;
1. Achieve and maintain a healthy body weight;
2. Be physically active – doing at least 30 minutes of regular,
moderate-intensity activity on most days. More activity is
required for weight control.
3. Eat a healthy diet, avoiding sugar and saturated fats; and
4. Avoid tobacco use – smoking increases the risk of diabetes
and cardiovascular disease.
43

44. Public health intervention
● Some of the ways we, as a public health graduate can help
to prevent diabetes/complications of diabetes are by
following the concept of P3CE
● Health promotion
● Prevention
● Protection
● Control epidemic
● Encourage for early treatment
● Make primary health care facilities and testing available,
accessible and affordable.
44

45. • Organizing a ‘Learn about diabetes’ event in schools.
• Organizing or participating in a local diabetes awareness
walk.
• Conduct screening programs/camps in rural areas and
encourage people to be screened for diabetes at three-year
intervals beginning at age 45.
• Engaging in local or national policy-makers to ensure that
all people with diabetes have access to the care they need.
45

46. • World Diabetes Day is celebrated every year on November
14.
• The theme for World Diabetes Day 2021-23 is access to
diabetes care.
• Different screening tests and awareness programs are
conducted on diabetes day.
WORLD DIABETES DAY
46

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49. Thank
you!!
49