DIABETES MELLITUS

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“ Every human being is the author of his own health or disease”- Buddha

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India world diabetes capital

ETYMOLOGY: 

ETYMOLOGY The word “diabetes” comes from Latin diabētēs , which literally means “a passer through; a siphon.” Ultimately, the word comes from Greek diabainein , meaning “to pass through," which is composed of dia , meaning “through” and bainein , meaning “to go”.

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The word “ mellitus ” comes from the classical Latin word mellitus , meaning “mellite” (i.e. sweetened with honey; honey-sweet). It was Thomas Willis who in 1675 added “mellitus” to the word “diabetes” as a designation for the disease, when he noticed that the urine of a diabetic had a sweet taste (glycosuria).

HISTORY: 

HISTORY Diabetes is one of the oldest known diseases. An Egyptian manuscript from c. 1550 BCE mentions the phrase “the passing of too much urine. The great Indian physician Sushruta ( 6th century BCE) identified the disease and classified it as Madhumeha . The ancient Indians tested for diabetes by observing whether ants were attracted to a person's urine, and called the ailment "sweet urine disease" (Madhumeha).

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The first complete clinical description of diabetes was given by the Ancient Greek physician Aretaeu of Cappadocia (1st century CE), who noted the excessive amount of urine which passed through the kidneys and gave the disease the name “diabetes.” Avicenna recognized a primary and secondary diabetes. The discovery of a role for the pancreas in diabetes is generally ascribed to Joseph von Mering and Oskar Minkowski.

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In 1910, Sir Edward Albert Sharpey-Schafer suggested that people with diabetes were deficient in a single chemical that was normally produced by the pancreas—he proposed calling this substance insulin , from the Latin insula , meaning island. Banting and laboratory director MacLeod received the Nobel Prize in Physiology or Medicine in 1923 for finding out insulin injection. Banting is honored by World Diabetes Day which is held on his birthday, November 14.

BURDEN OF DIABETES: 

BURDEN OF DIABETES Diabetes is the third leading cause of death in the United States after heart disease and cancer. Globally, the number of diabetes patients has risen sharply. While in 1985, 30 million people had diabetes, the number rose to 150 million in 2000. In 2010, 285 million people (6.6% of the global population in the age group 20-79) were found to be diabetic.

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In 2000, according to the World Health Organization, at least 171 million people worldwide suffer from diabetes, or 2.8% of the population. However, by 2030, an estimated 435 million people are expected to suffer from this disease -- 7.8% of the adult population. By 2030, India will have maximum no. of diabetics Only 7 out of every 100 adult Indians are diabetic Ahmedabad is also the diabetes capital of the country with highest diabetes prevalence rate

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20 million American adults have impaired glucose tolerance (IGT) 13-14 million Americans have impaired fasting glucose (IFG) 40-50 million Americans have metabolic syndrome

Diabetes Trends: 

Diabetes Trends 1990 2001

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What is diabetes? Diabetes mellitus is a group of metabolic diseases characterized by high blood sugar (glucose) levels, that result from defects in insulin secretion, or action, or both. Normally, blood glucose levels are tightly controlled by insulin, a hormone produced by the pancreas. Insulin lowers the blood glucose level.

Anatomy of the Pancreas: 

Anatomy of the Pancreas A gland that lies behind the stomach Clusters of cells inside the pancreas known as the islets of Langerhans produces three hormones. The islets contain 3 types of cells: Alpha, beta, and delta. Alpha cells produce glucagon Beta cells- produce insulin Delta cells- produce somatostatin

Insulin and the other hormones: 

Insulin and the other hormones Glucagon - Hormone that increases the amount of glucose in the blood when it is needed. Somatostatin - Hormone that can suppress both glucagon and insulin when needed. Insulin- Hormone that lowers blood glucose.

How Does Insulin Work?: 

How Does Insulin Work? A person normally secretes insulin in response to an elevated blood sugar level. It does this by accelerating blood sugars movement out of the blood and into the cells. Cells will not allow blood sugar in without insulin. - this can cause a problem.

PHYSIOLOGY OF SUGAR REGULATION: 

PHYSIOLOGY OF SUGAR REGULATION

Types of Diabetes: 

Types of Diabetes There are several types of diabetes: Type I - body does not produce any insulin. Type II- body is not making enough or is losing sensitivity to insulin made. Gestational Diabetes- diabetes during pregnancy. Impaired Glucose Tolerance- an intermediate between normal and diabetes.

Type I DIABETES MELLITUS: 

Type I DIABETES MELLITUS Usually diagnosed in children and young adults. Type I accounts for 5-10% of the population with diabetes. Two forms – Immune mediated—beta cells destroyed by autoimmune process – Idiopathic—cause of beta cell function loss unknown

Type 1 Diabetes Causes: 

Type 1 Diabetes Causes Immune-mediated Genetic predisposition Autoimmune reaction may be triggered by viral infection, toxins Destroys β -cells in pancreas that produce insulin Idiopathic (cause unknown) Strongly inherited African or Asian ancestry

Type 1 Diabetes Symptoms: 

Type 1 Diabetes Symptoms Hyperglycemia Excessive thirst (polydipsia) Frequent urination (polyuria) Significant weight loss Electrolyte disturbance Ketoacidosis

Type II Diabetes Mellitus: 

Type II Diabetes Mellitus The most common form of the disease accounting for 90% to 95% of diagnosed cases Approximately 50% of men and 70% of women are obese at the time of diagnosis. Combination of insulin resistance and beta cell failure (insulin deficiency) Progressive disease

Type 1 Diabetes Risk Factors: 

Type 1 Diabetes Risk Factors Family history of diabetes Older age Obesity, particularly intra-abdominal obesity Physical inactivity Prior history of gestational diabetes Impaired glucose homeostasis Race or ethnicity

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TYPE 2 DIABETES SYMPTOMS

Gestational Diabetes: 

Gestational Diabetes Pregnant women have a higher insulin level. If woman has hyperglycemia, her blood glucose crosses the placenta but her insulin does not. This can cause a high birth weight for baby.

Prediabetes (Impaired Glucose Homeostasis): 

Prediabetes (Impaired Glucose Homeostasis) Impaired fasting glucose (IFG) Fasting plasma glucose (FPG) above normal ( > 100 mg/dL and <126 mg/dL) Impaired glucose tolerance (IGT) Plasma glucose elevated after 75 g glucose load ( > 140 and <200 mg/dL)

Methods of Diagnosis: 

Methods of Diagnosis Fasting plasma glucose (FPG) Casual plasma glucose (any time of day) Oral glucose tolerance test (OGTT)*

Revised Diagnostic Criteria: 

Revised Diagnostic Criteria

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Hemoglobin A1c (A1c) A good indicator of blood glucose control. Gives a % that indicates control over the preceding 2-3 months. Performed 2 times a year. There are a number of conditions in which an A1c value may not be accurate. For example, with significant anemia, the red blood cell count is low, and thus the A1c is altered. This may also be the case in sickle cell disease and other hemoglobinopathies.

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There is a direct correlation between A1c levels and average blood sugar levels as follows. Hba1c Blood sugar mg/dl 6 135 7 170 8 205 9 240 10 275 11 310 12 345

Screening for DM: 

Screening for DM All persons > 45 years; repeat every 3 years High risk persons: screen at younger age and more frequently Overweight (BMI > 25) First-degree relative with diabetes High-risk ethnic population Delivered baby > 9 lb or diagnosed GDM Hypertensive HDL < 35 mg/dl or TG > 200 Prediabetes Polycystic ovary syndrome

Diabetes Complications: 

Diabetes Complications Diabetes complications are the seventh leading cause of death. They include: Blindness- caused by diabetic retinopathy. Kidney Disease- diabetic nephropathy Heart Disease and Stroke Nerve disease and amputations Impotence

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Avoid the 2 common diabetic problems, hypoglycemia and hyperglycemia

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MANAGEMENT FOR TYPE 1 DIABETES MELLITUS

Treatment Goals for Type I: 

Treatment Goals for Type I Match insulin to food intake. Type I Diabetes are encouraged to be precise and regular from day to day with food intake, insulin regimen, and activity. Exercise and Type I Diabetes Increases flexibility, muscular strength , and well being. Must monitor insulin and food intake to match exercise regimen. Increases insulin effectiveness and sensitivity in the body.

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MANAGEMENT FOR TYPE 2 DIABETES MELLITUS

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DIETARY MANAGEMENT NATUROPATHY MANAGEMENT EXERCISE YOGIC MANAGEMENT ACUPUNCTURE ACUPRESSURE HERBAL REMEDIES

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DIETARY MANAGEMENT

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A healthy diet consists of: 40% to 60% of calories from carbohydrates 20% from protein 30% or less from fat

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Carbohydrate High carbohydrate & high fibre diet improve insulin binding, &increase in monocyte receptor binding. Protein Consumption of carbohydrate with protein which lowers blood glucose concentration due to amino acid stimulation of insulin secretion. Phytic acid present in cereals & pulses may be a more dominant role in lower blood glucose than fibre.

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Chromium rich foods It reduce cell resistance of insulin receptors. Knolkhol,bottle gourd,onion stalks,areca nut. Magnesium rich foods It is useful for production of insulin Amaranthus, betal leaves,mint

Glycemic Index: 

Glycemic Index The blood glucose response of a given food compared to an equal amount of a CHO standard (typically glucose or white bread) Influenced by various factors Starch structure Fiber content Cooking methods Degree of processing Whether it is eaten in the context of a meal Presence or absence of fat

Glycemic Index and Glycemic Load of Foods: 

Glycemic Index and Glycemic Load of Foods Food Glycemic Index Glycemic Load Carrots 47 3 Potato baked 85 26 Sweet corn 60 11 Apple 38 6 Chocolate cake 38 20 Corn flakes 92 24 Oatmeal 42 9 Pumpkin 75 3 Sucrose 68 7

Special food for diabetics: 

Special food for diabetics Bitter gourd ( karela ) This vegetable contains a high dosage of 'plant insulin‘(charantin). It lowers the blood-sugar levels effectively Fenugreek ( methi ) It is the most common food used to control diabetes. It contain ‘trigonelline’, it reduce blood sugar. Indian blackberry (jamun) This fruit is very effective in preventing and controlling diabetes. it contains glucoside(jambulin), which prevents the conversion of starch into sugars.

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Garlic Garlic is rich in potassium and replaces the potassium which gets lost in urine. It also contains zinc and sulphur, which are components of insulin. Take about three to four flakes of freshly crushed garlic dail Onion Because of its diuretic and digestive properties, onion works against diabetes. Raw onion is more useful Flaxseed This is the richest source of Omega 3 fatty acids. It helps control diabetes because it maintains the sensitivity of the cell membrane, facilitates insulin, and thereby the uptake of glucose by the cells.

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Fibre Soluble fibre, found in apples, kidney beans, oatmeal, soyabean, etc, help control diabetes. These aid slow digestion and absorption of nutrients, resulting in a slow and steady release of glucose. They also help empty the stomach and trigger satiety that can help Type 2 diabetics to achieve weightloss goals. Lowers insulin requirements. Increse peripheral tissue insulin sensitvity

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Cinnamon Water extracts of cinnamon have been found to promote glucose metabolism and reduce cholesterol. Kovakkai (ivy gourd ) Coccinia cordifolia Indian substitute of plant insulin Cucumber It prevents polydipsia, because it contains plant insulin Vitamin C Controlling the damage that diabetes causes to your heart, kidneys, eyes, etc.

Foods you must avoid!: 

Foods you must avoid! Sugar Sucrose, a table sugar, provides nothing but calories and carbohydrates. Substitute sucrose with natural sugar, like honey, jaggery ( gur ), etc. Salt Salt is the greatest culprit for diabetics. You get enough salt from vegetables in inorganic form, so reduce the intake of inorganic salt.

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Fat Try and exclude fried items from your diet totally. Try and stop the intake of red meat completely. Try to go in for a vegetarian diet Whole milk and products Try to switch to low fat milk and its products like yogurt (curd). Replace high fat cheese with low fat cottage cheese

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Tea and coffee Do not have than two cups of the conventional tea or decaffeinated coffee every day. Try to switch to herbal teas. White flour and its products Replace these with whole grains, wholewheat or soya breads and unpolished rice. Foods with a high glycemic index Avoid white rice, potatoes, carrots, breads Alcohol

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Dried fruits Roots & Tubers Sapota, Jack fruits,& Mango

Reduce animal or saturated fat intake: 

Reduce animal or saturated fat intake Use low fat milk Use low fat spread instead of butter Use oil high in unsaturated fat, eg olive oil, rapeseed oil

Diet dos and don'ts for diabetics! : 

Diet dos and don'ts for diabetics! 1 . Eat food at fixed hours. 2 . Do not eat immediately after a workout. 3 . Do not overeat. 4 . If you are on insulin, make sure you have three proper meals with light snacks in between. 5 . Do not eat fast; masticate and munch your food well before you swallow.

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6 . Drink a lot of water that will help flush the toxins off your system. 7 . Make sure the gaps between your meals are short. 8 . Avoid fried foods and sweetmeats. 9 . Include fresh vegetable salad in every meal. 10 . Have at least 20 to 25 grams of raw onion daily. 11 . Add wheat bran to your wheat flour (50% wheat flour + 50% wheat bran). This helps increase fibre in your diet. . 12 . Include sprouts in the diet. Sprouts are a fountain of nutrient .

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NATUROPATHY NATUROPATHY

HYDROTHERAPY: 

HYDROTHERAPY Pancreatic pack Gastro hepatic pack Cold hip bath Hot and cold compress to abdomen Mud pack to abdomen

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EXERCISE

PHYSICAL ACTIVITY: 

PHYSICAL ACTIVITY Lowers Blood Sugar Improves insulin sensitivity in Type 2 diabetes Reduces hepatic glucose output Reduces cardiovascular risk factors Controls weight

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Increases blood flow to the heart Decreases or stops Diabetes complications Lowers Blood Cholesterol Raises HDL ( Protective or good Cholesterol) Lowers Blood Pressure Increased utilization of  glucose present in the blood, thus decreasing blood sugar levels. Decreasing body weight- thus increasing insulin sensitivity and decreasing blood pressure.

Hypoglycemia and Exercise in Insulin Users: 

Hypoglycemia and Exercise in Insulin Users Common after exercise Add 15 g CHO for every 30-60 minutes of activity over and above normal routines Ingest CHO after 40-60 minutes of exercise Drinks containing 6% or less of CHO can replace CHO and fluid Adjust fast-acting insulin dose 1-2U for strenuous activity lasting >45 to 60 minutes

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Ensure you take the following precautions: 1 . Check your blood-glucose levels before and after exercising. 2 . Avoid exercising when you have just taken your insulin shot. 3 . Avoid hot tubs and saunas immediately after exercise. 4 . Always carry a carbohydrate snack, candies /sweets or juice. 5 . Drink enough fluids to keep your body well hydrated. 6 . Avoid alcohol consumption before and immediately after exercise.

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Avoid exercise if fasting glucose levels are >250 mg/dl and ketosis is present, and use caution if glucose levels are >300 mg/dl and no ketosis is present. Ingest added carbohydrate if glucose levels are <100 mg/dl. Blood glucose monitoring before and after exercise Identify when changes in insulin or food intake are necessary. Learn the glycemic response to different exercise conditions

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YOGA THERAPY

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Diabetes is closely linked to stress- Cortisol the main stress hormone is also a Glucose counter regulatory hormone. Yoga is known to decrease blood cortisol levels, thus decreasing stress levels and providing the many beneficial effects. Excess abdominal fat- the main culprit of insulin resistance and obesity in Indians leads to development of type 2 Diabetes. Yoga is known to reduce excess fat from body & it correct body mass also.

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Sarvangasana (Shoulder Stand) Halasana (Plough pose)

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Child pose BHUJANGASANA

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Ardha Matsyendrasana (Half Spinal Twist) Paschimotasana(forward seated bend)

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YOGA MUDRASANA GOMUKASANA

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BHRAMARI SHEETKARI NADI SODHANA SHEETALI PRANAYAMA

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KUNJAL KRIYA

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ACUPUNCTURE

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LIVER-3 STOMACH-25

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STOMACH-36 SPLEEN 6 LIVER-13 GALLBLADDER-21

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ACUPRESSURE

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SOLAR PLEXUS CORRECTION

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MASSAGE

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CHROMOTHERAPY

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Yellow Colour solarised water Orange Colour solarised water Yellow & Orange Colour fruits & Vegetables

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HERBAL THERAPY

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Gymnema sylvest (INSULINPLANT) Reregeneration of islet cells and an increase in beta-cell function Gokshur (Tribulus terrestris) Saponin from Tribulue terrestris could significantly reduce the level of serum glucose . This plant has been referred to as ‘vegetable insulin'.

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Ocimum sanctum Herb could enhance the functioning of beta cells, and facilitate the insulin secretion process. Curcuma Longa (Turmeric) Turmeric treatments of diabetes as it lowers blood sugar, increases glucose metabolism and potentates insulin activity more than three-fold.

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Azadirachta indica (Neem) Oral doses of neem leaf extracts significantly reduced insulin requirements for insulin dependent diabetes. Vinca Rosea (Periwinkle) Flower and leaf have been found to regulate the blood sugar level

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Pterocarpus marsupium (KinoTree) A potent flavonoid in this tree has been shown to help regenerate beta cells in the pancreas as well.

STEVIA REBAUDIANA : 

STEVIA REBAUDIANA Research has shown that a whole leaf concentrate has a regulating effect on the pancreas and helps stabilize blood sugar levels. Stevia is therefore useful to people with diabetes, hypoglycemia,

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Eat your meals and snacks on a schedule Eat the same amount every day Exercise regularly Replace white flour with whole wheat flour or Soya flour. Unpolished rice is better than polished rice.

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Have regular checkups Check feet everyday for cuts and blisters Keep your diabetes emergency kit Drink enough fluids to avoid dehydration

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Do not Eat Processed or Fast Foods – Ever Avoid high glycemic index carbohydrates Control weight Don’t smoke. Don’t drink alcohol

How to treat Hypoglycemia: 

How to treat Hypoglycemia Quickest way to raise blood glucose is with some form of sugar. 3 glucose tablets, 1/2 cup of fruit juice, 5-6 pieces of candy. Wait 15-20 minutes and test blood sugar again. If still low retreat. If hypoglycemia goes untreated, patient could get worse and pass out! Stress the importance of a night time snack in older patients.

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THANK YOU DR.MGP,BNYS BY