diabetes presentation by dr.violet (de sa) pinto lecturer, department of psm

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DIABETES Presentation by DR.VIOLET (de Sa) PINTO Lecturer, Department of PSM

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Page 1: DIABETES Presentation by DR.VIOLET (de Sa) PINTO Lecturer, Department of PSM

DIABETES

Presentation by

DR.VIOLET (de Sa) PINTO

Lecturer, Department of PSM

Page 2: DIABETES Presentation by DR.VIOLET (de Sa) PINTO Lecturer, Department of PSM

Objectives

At the end of the session the student

shall have knowledge of :

Diabetes - definition, types and problem statement

Factors involved in causation

Screening for diabetes- Types and choice of tests

Prevention – Primary , secondary and tertiary levels.

Page 3: DIABETES Presentation by DR.VIOLET (de Sa) PINTO Lecturer, Department of PSM

A heterogeneous group of diseases,

characterized by chronic hyperglycemia,

resulting from a diversity of etiologies,

environmental and genetic, acting jointly.

Page 4: DIABETES Presentation by DR.VIOLET (de Sa) PINTO Lecturer, Department of PSM

PROBLEM STATEMENT

ICEBERG phenomenon of disease

Expected no. of cases will double in

2025, with greatest expected in India & China.

Now in younger age group also (including adolescents). Most productive period of life.

Page 5: DIABETES Presentation by DR.VIOLET (de Sa) PINTO Lecturer, Department of PSM

Major determinants for projected increase (developing countries)

• Population growth• Age structure• Urbanization • Ethnic• Amongst 5 major causes of cardiovascular

disease epidemic in Asia.• Lack of awareness about disease• Lack of awareness about existing interventions for

preventing disease & management• Inadequacy in primary health care systems to

cope.

Page 6: DIABETES Presentation by DR.VIOLET (de Sa) PINTO Lecturer, Department of PSM

Diabetes mellitus (D.M.)

1. Insulin dep. D.M. [I.D.D.M. type 1]

( abrupt inset, <30 years)

2. Non Insulin dep.D.M. [N.I.D.D.M. type 2]

( middle age, elderly)

3. Malnutrition related D.M.[M.R.D.M.]

4. Other (secondary to pancreatic ,hormonal, drug induced, genetic & other Abnormal)

Impaired Glucose tolerance (I.G.T.)

Gestational D.M.

CLASSIFICATION

Page 7: DIABETES Presentation by DR.VIOLET (de Sa) PINTO Lecturer, Department of PSM

Underlying cause is insulin deficiency- absolute in IDDM & partial in NIDDM

1. Pancreatic disorder- inflammatory or neoplastic2. Defects in insulin formation3. Destruction of β cells- viral infection, chemical

agents4. Decreased insulin sensitivity5. Genetic defects- mutation of insulin gene6. Auto immunity

AGENT

Page 8: DIABETES Presentation by DR.VIOLET (de Sa) PINTO Lecturer, Department of PSM

1. Age: NIDDM ,chance> with age Malnutrition related D.M. affects large no. of young people.2. Sex:SEAR, > in males , open to question3. Genetic factors: NIDDM - strong genetic componentIDDM – not totally a genetic entity4. Genetic markers:IDDM has > risk with HLA-DR 3 & DR4NIDDM not HLA associated

Page 9: DIABETES Presentation by DR.VIOLET (de Sa) PINTO Lecturer, Department of PSM

5. Immune mechanisms- Some evidence of activity against islet cells. Defects mechanism- environmental trigger – destroy

cells6. Obesity- central obesity – waist to hip ratio to NIDDM< insulin receptors on target cells7. Maternal diabetes – babies large at birth, obesity childhood, type 2diabetes early age.

Page 10: DIABETES Presentation by DR.VIOLET (de Sa) PINTO Lecturer, Department of PSM

1. Sedentary lifestyle-

alters the interaction

between insulin & receptors- NIDDM

2. Diet –

> saturated fat intake along with

total fat intake

3. Dietary fibre-

minimum of 20gm recommended

4. Malnutrition-

damage to β cells

5. Alcohol –

damage liver and pancreas & promote obesity

Page 11: DIABETES Presentation by DR.VIOLET (de Sa) PINTO Lecturer, Department of PSM

6. Viral Infections- Rubella, mumps, human coxsakie virus B4may trigger immunogenecity- β cell destruction.7. Chemical Agents- Alloxan, Streptozocin, Rodenticide VALCOR, (Cassava, certain beans, cyanide producing foods.) 8. Stress- Surgery, Trauma & Stress of situations, ‘bring out’ disease. 9. Other – Now even seen in low SE class – change in lifestyle.

Page 12: DIABETES Presentation by DR.VIOLET (de Sa) PINTO Lecturer, Department of PSM

SCREENING FOR DIABETES

1. Urine Examination• Urine examination for glucose 2 hours after

meal.• Lack of sensitivity – only 10-50 % of diseased

patients have a positive test. Yield many false negatives.

Specificity – 90% , therefore 10% may have a false positive.

Page 13: DIABETES Presentation by DR.VIOLET (de Sa) PINTO Lecturer, Department of PSM

SCREENING FOR DIABETES

2. Blood sugar testing• Standard oral glucose tolerance test + fasting

test• Target population:Age group 40 and >Those with family h/o of diabetes The obeseWomen who had baby >4.5kg( 3.5kg inconstitutionally small population) Women who show excess wt. gain in pregnancy.Patients with premature atherosclerosis.

Page 14: DIABETES Presentation by DR.VIOLET (de Sa) PINTO Lecturer, Department of PSM

VALUES

Glucose (mg/dl)

Whole blood CapillaryVenous capillary Venous capillary

Diabetes mellitisFasting ≥120 ≥120 ≥140 ≥140

2hrs after glu. ≥180 ≥200 ≥200 ≥200

Impaired glu. toleranceFasting <120 <120 <140 <140

2hrs after glu. 120-180 140-200 140-200 160-220

Page 15: DIABETES Presentation by DR.VIOLET (de Sa) PINTO Lecturer, Department of PSM

PREVENTION & CARE

TSec

Primary

Primordial

Page 16: DIABETES Presentation by DR.VIOLET (de Sa) PINTO Lecturer, Department of PSM

PRIMARY PREVENTION

1) POPULATION STRATEGY 2) HIGH RISK STRATEGY

(Mainly for NIDDM) Avoid sedentry lifestyle,PRIMORDIAL PREVENTION Avoid over nutrition, obesity

Normal body wt.maintenance Avoid alcohol

Nutrition, physical exercise Avoid oral contraceptivesAdequate protein intake Decrease smoking, B.P., Intake of dietary fibre cholesterol, TG levels.Avoid sweet foodsAvoid toxins

Page 17: DIABETES Presentation by DR.VIOLET (de Sa) PINTO Lecturer, Department of PSM

SECONDARY PREVENTION

Treatment based on:

1) Diet alone- small balanced, more frequently

2) Diet and oral drugs

3) Diet and insulin

1)Maintain blood glucose level as close to normal as

practical2)Maintain ideal body weight

Page 18: DIABETES Presentation by DR.VIOLET (de Sa) PINTO Lecturer, Department of PSM

DIET

Diabetics….1) Diet did not differ except in quality

2) Ate on an average 1000 kcal > than non diabetics

Glycemic Index• The blood glucose and insulin response to various

CHO is not similar.• Some increase blood glucose levels significantly.

Page 19: DIABETES Presentation by DR.VIOLET (de Sa) PINTO Lecturer, Department of PSM

Glycemic index of some foods:

• 100%- glucose• 80-90%- cornflakes , carrots, potatoes, honey,idli • 70-79%- bread(whole meal), millets, rice(white), upma• 60-69%- bread(white), paratha(wheat), rice briwn,sprout ,

beetroot, • 50- 59%- buck wheat, noodles, peas, pongal, sweet corn• 40-49%- noodles (whole meal), porridge oats dhalia,

bengal gram,• 30-39%- black eyed peas, chick peas, apple, tomato

soup• 20-29%- kidney beans, lentils, rajmaah• 10-19%- soya beans, groundnuts

Page 20: DIABETES Presentation by DR.VIOLET (de Sa) PINTO Lecturer, Department of PSM

PROPER MANAGEMENT

1) Routine checking of blood sugar- (glycosylated HB ½ yearly, levels 2-3 months,

home glucose monitoring- direct, haemoglucotest strip)

2) Urine for proteins,& ketones

3) Visual acuity

4) Weight

5) Feet examined for defective blood circulation

* PRIMARY HEALTH CARE

Page 21: DIABETES Presentation by DR.VIOLET (de Sa) PINTO Lecturer, Department of PSM

SELF CARE

Adherence to diet and drug regimen

Abstinence from alcohol

Examination of his own urine and self blood glucose testing

Self administration of insulin

Maintenance of optimum weight

Attending periodic checkups

Recognizing of symptoms of hypoglycemia etc.

Identification Card.

Page 22: DIABETES Presentation by DR.VIOLET (de Sa) PINTO Lecturer, Department of PSM

TERTIARY PREVENTION

Blindness, kidney failure, coronary thrombosis, gangrene of lower extremities.

Organize specialized clinics

Diagnostic & management skills of a high order

Basic, clinical & epidemiological research

Need for national & local registries for diabetes.

Page 23: DIABETES Presentation by DR.VIOLET (de Sa) PINTO Lecturer, Department of PSM