stop diabetes-children.ppt
TRANSCRIPT
DIABETES MELLITUS (DM) IN
CHILDREN
Dr. Shamanthakamani NarendranMD (Pead), PhD (Yoga Science)
How yoga helps?
DIABETES IN CHILDREN
Today, DM in children through out the world is growing with an alarming rate.Has increased 3 times in last 30 years. 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!).
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.
Type 1 diabetes
Type 2 diabetes
Gestational diabetes
Classification of Diabetes
Other types of Diabetes Genetic
Malnutrition related Drug induced
Age
Neonatal diabetes, including diagnosis in infants younger than 6 months, is most likely due to an inherited defect.Respond well to sulphonylurea therapy.
Early childhood - 4-6 years Early puberty - 10-14 years.
Mortality/Morbidity
Metabolic control Genetic susceptibility, Lifestyle (eg, smoking, diet, exercise), Pubertal status, and Gender.
Long-term complications includes:RetinopathyCataractsHypertensionProgressive renal failureEarly coronary artery diseasePeripheral vascular diseaseNeuropathy, both peripheral and autonomicIncreased risk of infection
Associated autoimmune diseases are common with type 1 diabetes mellitus, particularly in children who have the human leukocyte antigen DR3 (HLA-DR3). Some conditions may precede development of diabetes; others may develop later. As many as 20% of children with diabetes have thyroid autoantibodies
Age below 30 years Excessive urination Excessive hunger Excessive thirst
Symptoms of Type 1 Diabetes
Bed wetting in children Unexplained weight loss Dehydration Coma
Symptoms
Abdominal pains, headaches and behavior problems along with the usual symptoms of diabetes like weight loss, thirst, tiredness and frequent urination.
MAY PRESENT WITH
• INFECTION
• COMA
• COMPLICATIONS
EXCESS HUNGEREXCESS THIRSTEXCESS URINE
IDDM
IDDM
EATS A LOT BUT DOES NOT GROW
LOSS OF WEIGHT
YOUNG
5 -35 Yrs
Frequent urination Always hungry Cave for extra liquids Sexual dysfunction Unexplained weight
loss Family history
Symptoms of Type 2 Diabetes
Heredity
FOR INSULIN IDENTIFIED (CHROMOSOME 6)
GENE
Values are internationally accepted for plasma glucose Corresponding whole blood glucose values are lower
Diagnostic range of blood sugar (plasma glucose)
>200>140, but <200
<1402 hours after glucose load (mg/dL)
200 at least once
<200<200Between 0-120 min (mg/dL)
>126110-126<110Fasting plasma glucose (mg/dL)
Diabetes mellitus
Impaired glucose tolerance
Normal glucose tolerance
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 damage17 times of higher risk
of kidney failure – common cause in India
Affects the eye and vision3rd most common causeof blindness in India
Symptoms of type 1 DM secondary to Hyperglycemia, Glycosuria, and Diabetic ketoacidosis (DKA).
KETOACIDOSIS
Blood suger >240 mg/dLKetone bodies in blood> Acidity in blood
Symptoms: Slow, deep breathing with a fruity odor to the breath; confusion; frequent urination (polyuria); poor appetite; loss of consciousness.
Administration
Of intravenous fluids, Insulin, and Glucose
Insulin resistance: Insulin is reduced or blocked in the body. Causes the pancreas to produce extra insulin. After some time the body may stop making insulin.
Signs & symptoms
Hungry all the time. Tired and sluggish
Environmental factors
Viral infection Dietary factors are also relevant. Breastfed infants have a lower risk for insulin-dependent diabetes mellitus (IDDM)
Chemical causes
Rat poison - selectively damage islet cells and can cause type 1 diabetes mellitus.
Management
Education.Medication.Regular physical activity. Balanced diet.Yoga
Medication
Antidiabetic agentsInsulin detemir (Levemir)Insulin lispro (Humalog)Regular insulin (Humulin R, Novolin R)Insulin NPH (Humulin N, Novolin N)Insulin aspart (NovoLog)Insulin glargine (Lantus)Insulin glulisine (Apidra)
Medical Care
Children with type 1 DM (T1DM) require insulin therapy.Children with significant dehydration, persistent vomiting, or metabolic derangement, or with serious intercurrent illness, require inpatient management and intravenous rehydration.A well-organized diabetes care team can provide all necessary instruction and support in an outpatient setting. 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. The patient and/or family should have 24-hour access to advice and know how to contact the team.
Diet
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. These measures led to a long tradition of strict carbohydrate control and unbalanced diets. More recent dietary management of diabetes emphasizes a healthy, balanced diet, high in carbohydrates and fiber and low in fat.
The following are among the most recent consensus recommendations:Carbohydrates should provide 50-55% of daily energy intake. (No more than 10% of carbohydrates should be from sucrose or other refined carbohydrates.)Fat should provide 30-35% of daily energy intake.Protein should provide 10-15% of daily energy intake.
Develop a diet plan for each child to suit individual needs and circumstances. Regularly review and adjust the plan to accommodate the patient's growth and lifestyle changes.
Proper diet is very important – Helps control blood sugar, blood cholesterol, and weight
Cut down on fat, oils, sugar, alcohol and red meat.
Eat vegetables daily. Avoid rich fried foods. Take lots of foods like cereals and
pulses
Diabetic Diet Tips
Activity
Type 1 diabetes mellitus requires no restrictions on activity; exercise has real benefits for a child with diabetes.Most children can adjust their insulin dosage and diet to cope with all forms of exercise.The current guidelines are increasingly sophisticated and allow children to compete at the highest levels in sport.
Children and their caretakers must be able to recognize and treat symptoms of hypoglycemia.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.A large presleep snack is advisable following intensive exercise.
Consultations
Always involve an experienced dietitian in the patient's care, typically as a regular member of the diabetes care team.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.Access to psychological counseling and support is desirable, preferably from a member of the diabetes care team.
Regular exercise is good for diabetes. Exercise improves sugar and weight
control, and increases a sense of well being
Diabetic Exercise Tips
Do’s Can participate in
active sports Keep sugar or
other carbohydrate source handy.
Don’ts Avoid exercise
soon after injecting insulin
Do not exercise on an empty stomach
Change daily into clean, soft socks or stockings which must neither be too big nor too small.
Keep the feet warm and dry. Preferably wear socks or stockings of cotton and leather shoes.
Never walk barefoot neither indoors nor outdoors.
Always wear shoes that fit. This applies also to sandals
Examine shoe everyday for cracks, pebbles, nails, and other irregularities which may irritate the skin.
Special Attention for Foot
Wash feet daily with lukewarm water and soap, just as wash hands.
Dry feet well, also between the toes. Cut nails straight across. Ingrown nails
and calluses should receive expert attention.
Keep the skin supple with moisturizing lotion, but do not apply it between the toes.
If not diabetic, but at high risk, require to take care of health.
Should watch weight in particular waist line. Exercise regularly. Eat healthy – cut out fat, reduce refined rich
fried food, avoid calorie dense sweets and red meat.
Eat cereals and pulses, vegetables and fruits, avoid or reduce alcohol intake and go for medical checkup regularly.
Avoid excessive psychological and physical stress.
Can Diabetes be prevented ?
All types of diabetes are serious and require full attention.
Insulin is given from outside when insulin producing cells do not produce enough insulin
High blood sugar is toxic to the insulin producing cells.
Improperly controlled diabetes worsens the condition and further damages the already stressed insulin producing cells.
Controlling diabetes is important irrespective of whether one is treated with/without insulin
Is Insulin requiring DM more serious ?
YOGA PRACTICES
Ride your Bumpy Camel
COBRA POSE
ELEPHANT POSE
FISH POSE
Running Train
Air Walk Sliding Board
Birthday Candles
Candle Pose
Deep Relaxation
Jogging Through the Jungle
MEDITATION
PASSIVE YOGIC EXERCISES
Infants below 3 to 4 years.
Children with neurological or muscular disabilities who are unable to do active asanas
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)
PASSIVE YOGIC PRACTICES
1 to 4 MonthsGRIP
CHEST CROSS
3 to 4 Months
BICYCLE
5 to 6 Months
PULL-UP ELBOW STAND
7 to 8 Months
TOE TO EAR WHEELBARROW
9 to 11 Months
MOUNTAIN CLIMBING
12 to 22 MonthsLAY-BACK
TOUCH AND HUG
SQUATTING
HIP LIFT
12 to 22 Months
HEAD-TO-TOES
TRAIN TRACKS
BALANCE BEAM WALK
BASIC PUSH-UP
ANGRY CAT
ROWING