1. Diabetes and Occupational Health
• By
• Dr.Ashok laddha
• Occupational Health
Physician
• MBBS, PGDC ,PGDD,
PGDEM, AFIH
• Diploma in Workplace
Health and safety. MBAHA(In –Progress

2. Diabetes Mellitus
• Diabetes--------siphon-----excessive urination
• Mellitus---------Honey-------passing excessive
sweet urine

3. Indian scenario
• India is Home to over 61 million Diabetic
patient
• Expected 100 million –by 2030
• Economic burden is very high
• Accounted 15% of hospital cost
• Every 5th person with diabetes will be Indian

4. Types of Diabetes
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Type 1 and type2
Type 2
Other specific
Gestational

5. Diabetes type-1
• The body does not produce insulin. Some people may refer to this
type as insulin-dependent diabetes, juvenile diabetes, or earlyonset diabetes.
• People usually develop type 1 diabetes before their 40th
year, often in early adulthood or teenage years.
• It is autoimmune disorder
• Results in total insulin deficiency.
• Autoimmunity occurs in islet of Langerhans against the beta cells...
• Approximately 10% of all diabetes cases are type 1..
• Type 1 diabetes is caused by a T cell–mediated autoimmune
destruction of the pancreatic beta cells
• Life long insulin treatment

6. Future Plan ?
• Type-1 Diabetes is currently non-preventable but…
• Drugs?
Diet?
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… Mostly in experimental stages. Further
research is required.
• Pancreas transplantation?
• Islet cell transplantation?

7. Diabetes type-2
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Common
Affecting 90 to 95% of all diabetic population
Insulin resistance and relative insulin deficiency
Metabolic disorder
Obesity is the primary cause
Lack of sleep has been linked to type 2
Can be prevented or delayed through proper diet
and structured exercise
• Life style intervention is more effective

8. Diagnosis
• The WHO definition of diabetes (both type 1
and type 2) is for a single raised glucose
reading with symptoms, otherwise raised
values on two occasions, of either
• Fasting blood sugar 126 mg/dl
• Random blood sugar more than 200 mg/dl
• Hb1AC more than 6.5

9. Other specific Type-1
• Genetic defects affecting beta cell function:
MODY; mitochondrial DNA mutations; Wolfram’s
syndrome
• • Genetic defects affecting insulin action: insulin
receptor mutations; lipodystrophies
• • Diseases of pancreas: CF; iron overload
syndromes; neoplasia; pancreatitis, trauma
• • Endocrine disorders: glucagonoma, Cushing’s,
pheochromocytoma, hyperthyroidism,
acromegaly, somatostatinoma

10. Other specific type-2
• Drugs: calcineurin inhibitors, sirolimus, thiazides,
beta-blockers, corticosteroids, niacin, atypical
antipsychotics, pentamidine
• Infections: congenital rubella, mumps; CMV
• Other immune mediated diabetes: anti-insulin
receptor antibodies
• Other genetic syndromes: Down’s, Klinefelter’s,
Turner’s,
Friedreich’s
ataxia,
Myotonia
dystrophica, Huntington’s chorea, porphyria,
Prader-Willi, Lawrence-Moon-Biedl, Bardet-Biedl

11. Pre-Diabetic
• High risk of developing diabetes and heart
disease
• Blood sugar is high but not enough to labelled
as diabetes
• Impaired plasma fasting sugar -100-125 mg/dl
• Impaired glucose tolerence-144-199 mg/dl

12. who should be screened for prediabetes
• are habitually physically inactive
• have previously been identified as having IFG (impaired fasting
glucose) or IGT (impaired glucose tolerance)
• have a family history of diabetes
• are members of certain ethnic groups (including Asian
American, African-American, Hispanic American, and Native
American)
• have had gestational diabetes or have given birth to a child
weighing more than 9 pounds
• have elevated blood pressure
• have an HDL cholesterol level (the “good” cholesterol) of 35 mg/dl
or lower and/or triglyceride level of 250 mg/dl or higher
• have polycystic ovary syndrome
• have a history of vascular disease

13. Gestational Diabetes
• Gestational diabetes is a condition in which women
without previously diagnosed diabetes exhibit high
blood glucose levels during pregnancy.
• This is likely due to pregnancy-related factors such as
the presence of Human placental lactogen that
interferes with susceptible insulin receptors. This in
turn causes inappropriately elevated blood sugar
levels.
• Gestational diabetes generally has few symptoms and
it is most commonly diagnosed by screening during
pregnancy
• Gestational diabetes affects 3-10% of pregnancies

14. Risk factors for GDM
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Classical risk factors for developing gestational diabetes are:
Polycystic Ovary Syndrome
A previous diagnosis of gestational diabetes or prediabetes, impaired glucose
tolerance, or impaired fasting glycaemia
A family history revealing a first-degree relative with type 2 diabetes
Maternal age - a woman's risk factor increases as she gets older (especially for
women over 35 years of age).
Ethnic background (those with higher risk factors include African-Americans, AfroCaribbeans, Native Americans, Hispanics, Pacific Islanders, and people originating
from South Asia)
Being overweight, obese or severely obese increases the risk by a factor 2.1, 3.6
and 8.6, respectively.[9]
A previous pregnancy which resulted in a child with a macrosomia (high birth
weight: >90th centile or >4000 g (8 lbs 12.8 oz))
Previous poor obstetric history
Other genetic risk factors: There are at least 10 genes where certain polymorphism
are associated with an increased risk of gestational diabetes, most notably

15. MODY
• Diabetes result from mutations in a single gene and are called
monogenic
• Monogenic forms of diabetes account for about 1 to 5 percent of all
cases of diabetes in young people.
• Genetic testing can diagnose most forms of monogenic diabetes
• Neonatal diabetes mellitus (NDM) and maturity-onset diabetes of
the young (MODY) are the two main forms of monogenic diabetes.
• MODY is much more common than NDM.
• People with MODY are generally not overweight
• MODY can often be treated with oral diabetes medications
• hyperglycemia may only be discovered during routine blood tests
• people with MODY typically have a family history of diabetes in
multiple successive generations,

16. LADA
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A proportion of patients ranging from 5-20% with a clinical diagnosis of type 2
diabetes have been found to possess islet auto-antibodies, most typically
GADA, and patients in this category progress more rapidly to insulin treatment.
This is referred to as Latent Autoimmune Diabetes of the Adult (LADA) and occurs
in individuals with a clinical phenotype resembling type 2 diabetes.
Immunologically LADA is characterized by islet directed auto-antibodies and is
considered a form of type 1 diabetes.
People with LADA do not require insulin for the first 3 to 6 months following
diagnosis, but up to 80% will require insulin within the next five years. Some
physicians treat LADA electively with insulin before metabolic decompensation has
occurred, but the evidence for this is contested and most patients are treated
according to standard management guidelines for type 2 diabetes.
Latent autoimmune diabetes in adults (LADA) is a form of diabetes that usually
affects people who are over 30 years old. People with LADA are often initially
thought to have type 2 diabetes, but as the disease progresses, it becomes clear
that their condition is actually type 1 diabetes.

17. Symptoms-1
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frequent urination, especially at night
increased thirst
fatigue
blurred vision
weight loss
itchiness, particularly around the genitals
recurrent infections of the skin and mucous
membranes

18. Symptoms-2
• Slow-healing sores or cuts
• Itching of the skin (usually around the vaginal or groin
area)
• Frequent yeast infections
• Recent weight gain
• Velvety dark skin changes of the neck, armpit and
groin, called acanthosis nigricans
• Numbness and tingling of the hands and feet
• Decreased vision
• Sexual dysfunction, such as erectile dysfunction in
men.

19. Risk factors for diabetes
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Smoking
Tobacco
Alcohol
Chemicals
Drugs
Stress

20. Risk factors for diabetes
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age 45 or older
overweight or obese
physically inactive
parent or sibling with diabetes
family background that is African American, Alaska Native, American Indian, Asian
American, Hispanic/Latino, or Pacific Islander American
history of giving birth to a baby weighing more than 9 pounds
history of gestational diabetes
high blood pressure—140/90 or above—or being treated for high blood pressure
high-density lipoprotein (HDL), or good, cholesterol below 35 milligrams per
deciliter (mg/dL), or a triglyceride level above 250 mg/dL
polycystic ovary syndrome, also called PCOS
prediabetes—an A1C level of 5.7 to 6.4 percent; a fasting plasma glucose test
result of 100–125 mg/dL, called impaired fasting glucose; or a 2-hour oral glucose
tolerance test result of 140–199, called impaired glucose tolerance
acanthosis nigricans, a condition associated with insulin resistance, characterized
by a dark, velvety rash around the neck or armpits
history of CVD

21. Causes of Diabetes
• Type 1 diabetes is a T cell autoimmune
disorder
• People with type 2 diabetes have two defects
– insulin resistance and relative beta cell
Failure.
• Obesity is the main environmental factor for
the insulin resistance

22. Chemical causes
• Medical science has discovered how sensitive the insulin
receptor sites are to chemical poisoning.
• Metals such as cadmium, mercury, arsenic, lead, fluoride
and possibly aluminum may play a role in the actual
destruction of beta cells through stimulating an autoimmune reaction to them after they have bonded to these
cells in the pancreas.
• It is because mercury and lead attach themselves at highly
vulnerable junctures of proteins that they find their great
capacity to provoke morphological changes in the body..

23. Potential risk factors for type-1
diabetes
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Nitrates,
Nitrites, and
Nitrosoamines
Polychlorinated Biphenyls

24. Potential risk factors for type-2
diabetes
• 2,3,7,8-Tetrachlorodibenzo-p-dioxin
• Aresenic

25. Facts
• Non-communicable disease
• Life long chronic disease
• Diet/exercise/health education and team
approach is the foundation of treatment
program
• Stay up-to-date with vaccination
• Get flu shot every year

26. Short term complications
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Hypoglycemia
Hyperosmolar coma
Diabetic ketoacidosis
Catabolic State
Susceptibility to infections

27. Long Term Complications
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Cardiovascular disease
Heart attack—silent—without warning signal
End stage kidney disease
Diabetic foot
Amputation
Gangrene
Blindness
Psychiatric illness
Increases risk of cancer
Increases risk for opportunistic infection-like TB AND
MANY MORE

28. Mainstay of treatment
• Team approach which consist
1. Patient himself
2. wife
3. Diet/Exercise/weight control
4. Family doctor
5. Physician
6. Diabetologist
7. Dietician
8. Compliance

29. Cornerstone of Management
• Vigorous management of hyperglycemia
i.e. High blood sugar should be brought down to
normal level within 48 hrs or as early as
possible (except in rare cases) will reduce
Mortality and morbidity
• Life style modification
• Control of cardiovascular risk factors like Blood
pressure ,lipid and smoking

30. Employment disqualification ?
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Armed forces
Fire service
Ambulance service /rivers
Prison service
Airline pilots and Airline Cabin crew
Air traffic control
Offshore work
Working at height
Working in confined space
Dangerous occupation
Crane operators etc

31. Why-Concern-Organization point of
view
• Cause
1. You are important
2. They(near and dear) needs you
3. Organization needs you

32. Take home message
• Small step
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Big Rewards
Prevent type 2 diabetes