CHANGED PRINCIPLES NIMA lect

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diabetes self management

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CHANGED PRINCIPLES OF MANAGEMEANT OF DIABETES:

CHANGED PRINCIPLES OF MANAGEMEANT OF DIABETES DR AJIT MOKASHI MBBS; BAM&S;D.DIABETOLOGY Consultant Diabetologist Membr-RSSDI,New Delhi Founder member- Madhumeh Anusandhaan Nyaas,Baramati DIRECTOR-DIABETES MANAGEMENT CENTER DR.MOKASHI HOSPITAL,SUBHASH CHOWK, BARAMATI

GURU VANDANA:

GURU VANDANA My Parents. He told me that books are good friends and learning continues till your life Forced me to focus on work, MONEY FOLLOWS, it deed. Many of you have seen my mother first and your mother later if you were born in our hospital.

GURU VANDANA:

GURU VANDANA PROF.DR. O P KAPOOR HE TOUGHT ME HOW TO USE SCIENCE IN THIS PERTICULAR CASE.

GURU VANDANA:

GURU VANDANA DR MMS AHUJA FATHER OF INDIAN DIABETOLOGY & RSSDI Friend of my father, I was handed over to him after graduation. I ran away after 1 month thinking that diabetes is made a BAGUL-BUWA Told me 30 years back that today or tomorrow you will devote yourself to Diabetology. It became truth at my age of 60 years. . Today, I have learned that diabetes is a silent killer, affecting 1 out of 5 people by year 2025,

GURU VANDANA:

GURU VANDANA Dr Raghoo and his team Attended W H O meet on N C D in 1998 (Geneva convention) Predicted that diabetes is a TSUNAMI IN SLOW MOTION for India Designed strategy to fight back

GURU VANDANA:

GURU VANDANA If you find something interesting, and useful, then all credit is of these great people They may be scotch sipping, Mercedes driven, suit wearing people, but in my mind they are no less than Charak, Wagbhat, Sushrut or Dhanvanatri or Hnniman Himself Any shortcomings are totally mine, they will be rectified next time.

WHAT IS DIABETES:

WHAT IS DIABETES W H O definition says: It is a metabolic syndrome Either due to insulin deficiency (Type-1,in15%) or insulin inaction (type2,in85%people) Causing faulty metabolism of Carbohydrates and Fats from diet Effecting in raised blood sugar Affecting EVERY cell of body.

What happens when blood sugar is more:

What happens when blood sugar is more Concentrated solution of sugar and lipids affects the pipe that carries blood It causes INFLAMMATION of inner wall of pipe (Endothelium) Big vessels become hard (Arteriosclerosis) Small vessels ( capillaries ) become leaking DIABETES IS A DISEASE OF BLOOD VESSELS.

If Diabetes is not under control, then:

If Diabetes is not under control, then 20% people will get heart attack 5% people will get kidney failure 3% people will get blindness 3%people will get amputation

Can we prevent these bad things happening to our patients?:

Can we prevent these bad things happening to our patients? YES If we know what are risk factors of diabetes

Risk Factors of Diabetes:

Risk Factors of Diabetes Modifiable Non Modifiable Blood Sugar Age ( advancing age ) Blood Pressure Sex (female are more prone) Bloods Lipids Genetics and Heredity Body Mass Index ( Body Weight) Hip/Waist Ratio Calories eaten Calories used by activity

Risk Factors of Diabetes:

Risk Factors of Diabetes Overweight/Obesity High Blood Glucose Hypertension Abnormal Lipid Metabolism Inflammation & Hyper coagulation Physical Inactivity Smoking

PowerPoint Presentation:

Diabetes - Rule of Halves Total Diabetes Half are Diagnosed Half received recommended care Half achieve treatments targets Half have desired outcomes Patient Education - Why

setting targets:

setting targets Instead of setting blood sugar as a single target, we have to set targets according to modifiable risk factors These targets are Ideal body weight Hip/waist ratio Calories consumed in a day Steps walked in a day

setting targets:

setting targets Frequent monitoring and recording blood sugar by glucometer Frequent monitoring and recording Blood Pressure PERSON OR PATENT CAN BE TRAINED TO DO ALL THESE EXAMINATIONS

Baramati Pattern Modern targets for Diabetes control:

Baramati Pattern Modern targets for Diabetes control 1 Weight IBW=Ideal body weight =Height in cms minus100 Desired body weight Should be achievable target

Baramati Pattern Modern targets for Diabetes control:

Baramati Pattern Modern targets for Diabetes control 1 Weight 2 BMI Body Mass Index Calculated by dividing weight in kg by square of height in meters 16-21 normal 21-23 raised 23-25 obese 25-27 obese needing treatment <35 surgery

Baramati Pattern Modern targets for Diabetes control:

Baramati Pattern Modern targets for Diabetes control 1 Weight 2 BMI 3 W/H ratio Waist circumference /Hip circumference For Males-0.90 For Females-0.85 It Shows apple shaped or pear shaped obesity Apple shaped obesity is more prone for heart attack.

Baramati Pattern Modern targets for Diabetes control:

Baramati Pattern Modern targets for Diabetes control 1 Weight 2 BMI 3 H/W ratio 4 Foot Examination Foot is to be examined every day with hand held mirror Proper footwear to be used

Baramati Pattern Modern targets for Diabetes control:

Baramati Pattern Modern targets for Diabetes control 1 Weight 2 BMI 3 H/W ratio 4 Foot Examination Blood Sugar Normal Raised Diabetes Fasting 65 to100 101 to124 Above 125 P P Up to 140 141 to 199 Above 200

Baramati Pattern Modern targets for Diabetes control:

Baramati Pattern Modern targets for Diabetes control 1 Weight 2 BMI 3 H/W ratio 4 Foot Examination 4 Blood Sugar 5 Blood Pressure Diabetes is a disease affecting blood vessels Blood Pressure is also a disease affecting blood vessels B P and Diabetes is a double sided weapon for blood vessels

Baramati Pattern Modern targets for Diabetes control:

Baramati Pattern Modern targets for Diabetes control 1 Weight 2 BMI 3 H/W ratio 4 Foot Examination 5 Blood Sugar 6 Blood Pressure 7 Calories eaten per day Every body should write down what he has eaten in 24 hrs at least once in a month Charts can be referred to know calories Diet should be restricted to 1700 cal A Diabetic can eat anything giving 1700 cal/day

Baramati Pattern Modern targets for Diabetes control:

Baramati Pattern Modern targets for Diabetes control 1 Weight 2 BMI 3 H/W ratio 4 Foot Examination 4 Blood Sugar 5 Blood Pressure 6 Calories eaten per day 7 Calories used per day Podometer is a useful instrument Everybody should walk 10000 steps per day 1Km makes 1600 steps Everybody normally walks 4000 steps per day

Baramati Pattern Modern targets for Diabetes control Lab Tests ( Yearly):

Baramati Pattern Modern targets for Diabetes control Lab Tests ( Yearly) 1 Hb A1c Sugar from RBCs/Hb can be measured Blood sugar is dissolved sugar HbA1c is average sugar of 3 months of life of RBC Normal Range 4 to 6.5

Baramati Pattern Modern targets for Diabetes control Lab Tests ( Yearly):

Baramati Pattern Modern targets for Diabetes control Lab Tests ( Yearly) 1 Hb A1c Selection of drug and dose depends on average sugar 1% reduction in HbA1c will reduce: Heart risk by 20% Kidney risk by 50% Amputation risk by 40% Blindness risk by60%

Baramati Pattern Modern targets for Diabetes control Lab Tests ( Yearly):

Baramati Pattern Modern targets for Diabetes control Lab Tests ( Yearly) 1 Hb A1c

Baramati Pattern Modern targets for Diabetes control Lab Tests ( Yearly):

Baramati Pattern Modern targets for Diabetes control Lab Tests ( Yearly) 1 Hb A1c 2 UMA Urinary Micro Albumin Diabetes affects filtering system of kidneys Proteins start leaking Yearly UMA test shows Kidney function Level should be up to 20 Level above 200 need nephrologists opinion

Baramati Pattern Modern targets for Diabetes control Lab Tests ( Yearly):

Baramati Pattern Modern targets for Diabetes control Lab Tests ( Yearly) 1 Hb A1c 2 UMA 3 Lipid Profile Cholesterol is important risk factor It is modifiable by Diet Exercise And Drugs if necessary

Baramati Pattern Modern targets for Diabetes control Lab Tests ( Yearly):

Baramati Pattern Modern targets for Diabetes control Lab Tests ( Yearly) 1 Hb A1c 2 UMA 3 Lipid Profile Total Cholesterol 150 HDL Good CHL Males 45 Females 50 LDL Bad CHL Up to 100 Tri Glycerides Up to 150

Baramati Pattern Modern targets for Diabetes control:

Baramati Pattern Modern targets for Diabetes control 1 2 3 4 5 6 7 8 9 To be done by patient/Doctor 1 Recording Weight Monthly 2 Circumference of Hip & Waist Monthly 3 BMI Monthly 4 H/W Ratio Monthly 5 Foot Examination Monthly 6 Blood Sugar Monthly/ Oftenly 7 Blood Pressure Monthly/ Oftenly 8 3 Months Sugar (HbA1c) Yearly 9 UMA Yearly 10 Lipid Profile Yearly

Baramati Pattern Modern targets for Diabetes control:

Baramati Pattern Modern targets for Diabetes control Examination by Doctor Physician or Primary Care Doctor For evaluation of clinical evidence Selecting drugs and right dosage Motivation for Diet and Exercise Examines Foot & legs Yearly

Baramati Pattern Modern targets for Diabetes control:

Baramati Pattern Modern targets for Diabetes control Examination by Doctor Eye Surgeon Yearly eye examination can prevent blindness duje to diabetes Retinal examination after dilated pupils is mandatory for any diabetic person

Baramati Pattern Modern targets for Diabetes control:

Baramati Pattern Modern targets for Diabetes control Examination by Doctor Cardiollogist Yearly recording of E C G gives information on effect of B P and Diabetes on heart Heart attack and diabetic heart disease can be prevented

Baramati Pattern Modern targets for Diabetes control:

Baramati Pattern Modern targets for Diabetes control Examination by Doctor Dentist Diabetes affects teeth and gums Timely management by dentist can prevent oral complications of diabetes

PowerPoint Presentation:

Baramati Pattern Modern targets for Diabetes control MANAGING DIABETES IS A TEAM WORK

PowerPoint Presentation:

Eye doctor Kidney Doctor dietician Diabetic patient physician Dentist Exercise Trainer Podiatrist Diabetes Educator Baramati Pattern Modern targets for Diabetes control MANAGING DIABETES IS A TEAM WORK

Income potential from diabetes:

Income potential from diabetes Medicine is a procedure oriented source Dressing, Injection ,gives 20/- I.V fluids ,C L W suturing 300/- Delivery 1500/- L S C S, Hysrectomy , Laprotomy 3000/- I C U per day 5000/-

Income potential from diabetes:

Income potential from diabetes E C G 200/- Foot Examination 300/- Glucometer reading 50/- Monthly Examination Rs 50 *12 600/- Fellowships and Tie ups ??? Retaing family clients ??? Total per patient around Rs 1500

Cost saving to Patients:

Cost saving to Patients Heart attack 2,00,000 Kidney failure 5,00,000 Amputation 50,000 Blindness ??,??? Sexual dysfunction ??,???

O P Kapoor said:

O P Kapoor said Lady A—Both our husbands eat similar food, work at same company then why your husbands parameters are good? Lady B– It Very simple We have made a rule in family. Sex will begin exactly at 9.30pm Whether you are there or not Believe me, My husband returns exactly at 8pm

PowerPoint Presentation:

Give Fish to a hungry man is kindness to a Hungry Man, you are giving him Food for that Day Teach him Fishing giving him a way of livelihood for Entire Living T.P.E – Take home message

PowerPoint Presentation:

Thank You Catch them young Educate Empower End Point - Take the reward

PowerPoint Presentation:

THANK YOU.........

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