logging in or signing up Life Style Modifications in Diabetes draswinikumars Download Post to : URL : Related Presentations : Share Add to Flag Embed Email Send to Blogs and Networks Add to Channel Uploaded from authorPOINT lite Insert YouTube videos in PowerPont slides with aS Desktop Copy embed code: (To copy code, click on the text box) Embed: URL: Thumbnail: WordPress Embed Customize Embed The presentation is successfully added In Your Favorites. Views: 1705 Category: Education License: All Rights Reserved Like it (3) Dislike it (0) Added: August 30, 2009 This Presentation is Public Favorites: 2 Presentation Description Powerpoint presented in the Indian Medical Association, Karunagappally Branch of Kerala on 30-08-2009 Comments Posting comment... By: drhardik42 (9 month(s) ago) good one,if you can send it to: drhardik42@yahoo.co.in thankyou Saving..... Post Reply Close Saving..... 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MD Case Study 1: Ms. Aparna : Case Study 1: Ms. Aparna 15 year old Girl Weight: 95kg FBS: 325 PPBS: 450 Family doctor referred her after starting on OHA THE NEW YOUNG DIABETIC Case Study 2: Ms. Aswathy : Case Study 2: Ms. Aswathy 12 year old Girl Weight: 65kg FBS: 110 PPBS: 140 Presented with complaints of Abdominal distension PREDIABETIC Can You prevent Diabetes Mellitus? : Can You prevent Diabetes Mellitus? YES Definition : Definition A metabolic disorder of multiple aetiology characterized by chronic hyperglycaemia with disturbances of CHO, fat and protein metabolism resulting from defects in insulin secretion, insulin action or both” Associated with risk of developing late diabetic complications Microvascular (retinopathy, nephropathy) Macrovascular (atherosclerosis, coronary artery disease, Neuropathy (peripheral, autonomic) World-wide Epidemic : World-wide Epidemic India: 2008:32 mill 2020: 81 mill Increasing mortality from Diabetes : Increasing mortality from Diabetes 60 50 40 30 20 10 0 0-3 4-7 8-11 12-15 16-19 20-23 Duration of Follow-up (yrs) CHD Mortality/1,000 With Diabetes* Without Diabetes Male Male Female Female Am J Med 90(2A): 56S-61S,1991 * Diagnosed between 35 and 65 years of age The ContinuUM OF CVD RISK IN DM : The ContinuUM OF CVD RISK IN DM WHAT IF DIABETIC DEVELOPES CVD : WHAT IF DIABETIC DEVELOPES CVD Coronary Events Multivessel disease Complications PC Interventions Diabetic ketosis Bypass surgery Why is the prevalence of DM2 increasing? : Why is the prevalence of DM2 increasing? Aging of the population Urbanization especially in the developing countries More sedentary lifestyle Food consumption patterns More foods with high fat content More refined carbohydrates Why should we prevent diabetes? : Why should we prevent diabetes? To reduce human suffering Improve Quality of Life of individuals Reduce the number of hospitalization To reduce human suffering Reduce mortality from diabetes Prevent Sudden cardiac death Levels of Prevention in Type 2 DM : Levels of Prevention in Type 2 DM Primary: Includes activities aimed at preventing diabetes from occurring in susceptible individuals or populations Secondary: Early diagnosis and effective control of diabetes in order to avoid or at least delay the progress of the disease Tertiary: Includes measures taken to prevent complications and disabilities due to diabetes Natural History of Diabetes : Natural History of Diabetes Type 2 diabetes Years from diagnosis 0 5 -10 -5 10 15 Pre-diabetes Onset Diagnosis Insulin resistance Postprandial glucose Macrovascular complications Fasting glucose Microvascular complications Diagnostic Criteria for DM2 : Diagnostic Criteria for DM2 Fasting blood sugar > 126 mg/dl 2 hour glucose tolerance > 200 mg/dl Impaired Glucose Tolerance - “Pre-diabetes” Impaired Fasting: Level between >100 mg/dl and <126 mg/dl Impaired Post prandial glucose: During 2 hour glucose tolerance test Level between >140 and <200 mg/dl What are the goals? : What are the goals? ADA and ACE/ AACE differ from each other ADA Goals FBS - 70-130 PPBS - <180 HbA1c - <7.0 ACE/AACE Goals FBS - <110 PPBS - <140 HbA1c - ≤6.5 Hb A1c : Hb A1c Excellent test to judge overall glycemic control Gives idea of average blood sugar Over a period of previous 120 days Because RBC Life Span is 121 days Ideally done every 3-4 months Normal < 6.5 Good <7.0 Fair <8.0 Poor<9.0 Bad >10 Disadvantages: Costly – Rs. 250 per test Falsely high values – Renal failure Falsely low values – RBC life span Exercise : Exercise Advantages Benefits glycemic control Improves insulin sensitivity Builds physical fitness Optimizes body weight Gives psychological well being Disadvantages Carry some risk also Strains the compromised CVS Injuries to musculoskeletal system Predisposes to hypoglycemia May exacerbate complications Energy expenditure : Energy expenditure Calories spent /minute Lying down, sleeping, sitting 1 Standing, desk work, driving 2 Level walking, level bicycling 3 Social doubles badminton 4 Social singles badminton 5 Gardening , swimming 6 Competitive badminton 7 Jogging 8 Basketball 9 Running 1km in 10min 10 Calories Spent in Various Activities : Calories Spent in Various Activities Walking, 3.0 miles/hr 275/hr Walking 5 miles/hr 420/hr Cycling, 8 miles/hour 325/hr Mopping, vacuuming 240/hr Scrubbing floors 300/hr Gardening 220/hr Vigorous dancing 500/hr Exercise : Exercise Regular Exercise Daily at least 5 days/wk Isotonic Exercise - Yes Isometric - No 20 What prevents one from Walking : What prevents one from Walking Traffic, heavy rain or dogs on the street Choose Vellayambalam Museum or Gandhi Park 21 Precautions : Precautions Correct foot wear Comfortable loose clothes Close inspection of feet every day Carry snacks as protection from hypoglycemia How it should be: Patient should be able to carry out a normal conversation while exercising without getting breathless 22 Physique Exercise Treadmill : Physique Exercise Treadmill 23 Medical Nutrition Therapy : Medical Nutrition Therapy Diet prescription Main stay of treatment Shall be individualized, realistic flexible & suitable to patients life style preferably Indian diet Patient educated and at regular intervals compliance judged 24 Weight Management : Weight Management 25 . Record height - Record weight - Calculate BMI Read against ready made charts – To get BMI Healthy value 20-25 Above 25 – Overweight Above 30 – Obese EAT HEALTHY FOOD : EAT HEALTHY FOOD Glycemic Index of Common Food items : Glycemic Index of Common Food items Measure of the effects of carbohydrates on blood glucose levels Diet Control : Diet Control Principle less food – Better insulin action No sugars sweets tubers Otherwise USUAl food 28 CHOOSE FROM THE FOOD PYRAMID : CHOOSE FROM THE FOOD PYRAMID Diabetes – What not to eat : Diabetes – What not to eat Sugar Sweets Pastry Vada Mutton Beef fry Chips Colas Diet and Diabetes – A days menu : Diet and Diabetes – A days menu 06.30 am Tea without 08.30am Break fast 10.30am Snack 01.30pm Lunch 02.30pm Fruits 04.30pm Tea without 06.30pm Green salad 08.30pm Dinner Benefits of 10% Weight Loss : Benefits of 10% Weight Loss 20% fall in total mortality 30% fall in diabetes related death 40% fall in obesity related death 20% fall in Systolic BP 10% fall in Total Cholesterol 15% fall in LDL 8% increase in HDL 30% fall in Triglyceride 50% fall Fasting Glucose 10% fall in Diastolic BP Avoid all fried foods : Avoid all fried foods 33 Microvascular and Macrovascular Complications of Diabetes : Microvascular and Macrovascular Complications of Diabetes Heart Attack Sudden Blindness Stroke Autonomic Neuropathy Chronic Kidney Disease Type 2 Diabetes Peripheral Neuropathy It’s a Nightmare! Aswini Kumar. MD Peripheral Occlusive Vascular Disease 34 Tertiary Prevention : Tertiary Prevention Actions taken to prevent and delay the development of acute or chronic complications Acute complications: such as hypoglycemia, severe hyperglycemia Diabetic ketoacidosis and infections Chronic complications: such as atherosclerosis, retinopathy, nephropathy, neuropathy and foot problem Examples of socio-cultural barriers: : Examples of socio-cultural barriers: Tackling socio-cultural barriers: : Tackling socio-cultural barriers: Take Home Messages : Take Home Messages DM2 is a major challenge to human health Type 2 diabetes can be prevented Primary prevention is suitable and affordable lifestyle interventions are effective in prevention Barriers for prevention should be addressed Diabetes can be managed with life style alone Healthy eating and regular exercise are needed You do not have the permission to view this presentation. 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Life Style Modifications in Diabetes draswinikumars Download Post to : URL : Related Presentations : Share Add to Flag Embed Email Send to Blogs and Networks Add to Channel Uploaded from authorPOINT lite Insert YouTube videos in PowerPont slides with aS Desktop Copy embed code: (To copy code, click on the text box) Embed: URL: Thumbnail: WordPress Embed Customize Embed The presentation is successfully added In Your Favorites. Views: 1705 Category: Education License: All Rights Reserved Like it (3) Dislike it (0) Added: August 30, 2009 This Presentation is Public Favorites: 2 Presentation Description Powerpoint presented in the Indian Medical Association, Karunagappally Branch of Kerala on 30-08-2009 Comments Posting comment... By: drhardik42 (9 month(s) ago) good one,if you can send it to: drhardik42@yahoo.co.in thankyou Saving..... Post Reply Close Saving..... Edit Comment Close By: hore (14 month(s) ago) i like your ppt sir... plz send me my mail id is amol.hore@rediffmail.com Saving..... Post Reply Close Saving..... Edit Comment Close By: sana.star (18 month(s) ago) nice one Saving..... Post Reply Close Saving..... Edit Comment Close By: srisha250205 (23 month(s) ago) very informative. could you please share this sir. Dr.Sripriya Shaji, Consultant Psychologist srisha250205@gmail.com Saving..... Post Reply Close Saving..... Edit Comment Close By: Alyaa (25 month(s) ago) nice work please i need that please send me lovemeyoudo@live.com Saving..... Post Reply Close Saving..... Edit Comment Close loading.... See all Premium member Presentation Transcript Life style modifications in the prevention and management of Dm2 : Life style modifications in the prevention and management of Dm2 Dr. S. Aswini Kumar. MD Case Study 1: Ms. Aparna : Case Study 1: Ms. Aparna 15 year old Girl Weight: 95kg FBS: 325 PPBS: 450 Family doctor referred her after starting on OHA THE NEW YOUNG DIABETIC Case Study 2: Ms. Aswathy : Case Study 2: Ms. Aswathy 12 year old Girl Weight: 65kg FBS: 110 PPBS: 140 Presented with complaints of Abdominal distension PREDIABETIC Can You prevent Diabetes Mellitus? : Can You prevent Diabetes Mellitus? YES Definition : Definition A metabolic disorder of multiple aetiology characterized by chronic hyperglycaemia with disturbances of CHO, fat and protein metabolism resulting from defects in insulin secretion, insulin action or both” Associated with risk of developing late diabetic complications Microvascular (retinopathy, nephropathy) Macrovascular (atherosclerosis, coronary artery disease, Neuropathy (peripheral, autonomic) World-wide Epidemic : World-wide Epidemic India: 2008:32 mill 2020: 81 mill Increasing mortality from Diabetes : Increasing mortality from Diabetes 60 50 40 30 20 10 0 0-3 4-7 8-11 12-15 16-19 20-23 Duration of Follow-up (yrs) CHD Mortality/1,000 With Diabetes* Without Diabetes Male Male Female Female Am J Med 90(2A): 56S-61S,1991 * Diagnosed between 35 and 65 years of age The ContinuUM OF CVD RISK IN DM : The ContinuUM OF CVD RISK IN DM WHAT IF DIABETIC DEVELOPES CVD : WHAT IF DIABETIC DEVELOPES CVD Coronary Events Multivessel disease Complications PC Interventions Diabetic ketosis Bypass surgery Why is the prevalence of DM2 increasing? : Why is the prevalence of DM2 increasing? Aging of the population Urbanization especially in the developing countries More sedentary lifestyle Food consumption patterns More foods with high fat content More refined carbohydrates Why should we prevent diabetes? : Why should we prevent diabetes? To reduce human suffering Improve Quality of Life of individuals Reduce the number of hospitalization To reduce human suffering Reduce mortality from diabetes Prevent Sudden cardiac death Levels of Prevention in Type 2 DM : Levels of Prevention in Type 2 DM Primary: Includes activities aimed at preventing diabetes from occurring in susceptible individuals or populations Secondary: Early diagnosis and effective control of diabetes in order to avoid or at least delay the progress of the disease Tertiary: Includes measures taken to prevent complications and disabilities due to diabetes Natural History of Diabetes : Natural History of Diabetes Type 2 diabetes Years from diagnosis 0 5 -10 -5 10 15 Pre-diabetes Onset Diagnosis Insulin resistance Postprandial glucose Macrovascular complications Fasting glucose Microvascular complications Diagnostic Criteria for DM2 : Diagnostic Criteria for DM2 Fasting blood sugar > 126 mg/dl 2 hour glucose tolerance > 200 mg/dl Impaired Glucose Tolerance - “Pre-diabetes” Impaired Fasting: Level between >100 mg/dl and <126 mg/dl Impaired Post prandial glucose: During 2 hour glucose tolerance test Level between >140 and <200 mg/dl What are the goals? : What are the goals? ADA and ACE/ AACE differ from each other ADA Goals FBS - 70-130 PPBS - <180 HbA1c - <7.0 ACE/AACE Goals FBS - <110 PPBS - <140 HbA1c - ≤6.5 Hb A1c : Hb A1c Excellent test to judge overall glycemic control Gives idea of average blood sugar Over a period of previous 120 days Because RBC Life Span is 121 days Ideally done every 3-4 months Normal < 6.5 Good <7.0 Fair <8.0 Poor<9.0 Bad >10 Disadvantages: Costly – Rs. 250 per test Falsely high values – Renal failure Falsely low values – RBC life span Exercise : Exercise Advantages Benefits glycemic control Improves insulin sensitivity Builds physical fitness Optimizes body weight Gives psychological well being Disadvantages Carry some risk also Strains the compromised CVS Injuries to musculoskeletal system Predisposes to hypoglycemia May exacerbate complications Energy expenditure : Energy expenditure Calories spent /minute Lying down, sleeping, sitting 1 Standing, desk work, driving 2 Level walking, level bicycling 3 Social doubles badminton 4 Social singles badminton 5 Gardening , swimming 6 Competitive badminton 7 Jogging 8 Basketball 9 Running 1km in 10min 10 Calories Spent in Various Activities : Calories Spent in Various Activities Walking, 3.0 miles/hr 275/hr Walking 5 miles/hr 420/hr Cycling, 8 miles/hour 325/hr Mopping, vacuuming 240/hr Scrubbing floors 300/hr Gardening 220/hr Vigorous dancing 500/hr Exercise : Exercise Regular Exercise Daily at least 5 days/wk Isotonic Exercise - Yes Isometric - No 20 What prevents one from Walking : What prevents one from Walking Traffic, heavy rain or dogs on the street Choose Vellayambalam Museum or Gandhi Park 21 Precautions : Precautions Correct foot wear Comfortable loose clothes Close inspection of feet every day Carry snacks as protection from hypoglycemia How it should be: Patient should be able to carry out a normal conversation while exercising without getting breathless 22 Physique Exercise Treadmill : Physique Exercise Treadmill 23 Medical Nutrition Therapy : Medical Nutrition Therapy Diet prescription Main stay of treatment Shall be individualized, realistic flexible & suitable to patients life style preferably Indian diet Patient educated and at regular intervals compliance judged 24 Weight Management : Weight Management 25 . Record height - Record weight - Calculate BMI Read against ready made charts – To get BMI Healthy value 20-25 Above 25 – Overweight Above 30 – Obese EAT HEALTHY FOOD : EAT HEALTHY FOOD Glycemic Index of Common Food items : Glycemic Index of Common Food items Measure of the effects of carbohydrates on blood glucose levels Diet Control : Diet Control Principle less food – Better insulin action No sugars sweets tubers Otherwise USUAl food 28 CHOOSE FROM THE FOOD PYRAMID : CHOOSE FROM THE FOOD PYRAMID Diabetes – What not to eat : Diabetes – What not to eat Sugar Sweets Pastry Vada Mutton Beef fry Chips Colas Diet and Diabetes – A days menu : Diet and Diabetes – A days menu 06.30 am Tea without 08.30am Break fast 10.30am Snack 01.30pm Lunch 02.30pm Fruits 04.30pm Tea without 06.30pm Green salad 08.30pm Dinner Benefits of 10% Weight Loss : Benefits of 10% Weight Loss 20% fall in total mortality 30% fall in diabetes related death 40% fall in obesity related death 20% fall in Systolic BP 10% fall in Total Cholesterol 15% fall in LDL 8% increase in HDL 30% fall in Triglyceride 50% fall Fasting Glucose 10% fall in Diastolic BP Avoid all fried foods : Avoid all fried foods 33 Microvascular and Macrovascular Complications of Diabetes : Microvascular and Macrovascular Complications of Diabetes Heart Attack Sudden Blindness Stroke Autonomic Neuropathy Chronic Kidney Disease Type 2 Diabetes Peripheral Neuropathy It’s a Nightmare! Aswini Kumar. MD Peripheral Occlusive Vascular Disease 34 Tertiary Prevention : Tertiary Prevention Actions taken to prevent and delay the development of acute or chronic complications Acute complications: such as hypoglycemia, severe hyperglycemia Diabetic ketoacidosis and infections Chronic complications: such as atherosclerosis, retinopathy, nephropathy, neuropathy and foot problem Examples of socio-cultural barriers: : Examples of socio-cultural barriers: Tackling socio-cultural barriers: : Tackling socio-cultural barriers: Take Home Messages : Take Home Messages DM2 is a major challenge to human health Type 2 diabetes can be prevented Primary prevention is suitable and affordable lifestyle interventions are effective in prevention Barriers for prevention should be addressed Diabetes can be managed with life style alone Healthy eating and regular exercise are needed