1.
Dr.Shreeram Vaidya <ul><li>Diabetes, Yes We can contro l </li></ul>

2.
What is Diabetes Mellitus? <ul><li>1500 BC Ebers Papyrus First Described Diabetes </li></ul><ul><li>Diabetes means to siphon .The most obvious sign of diabetes is excessive urination </li></ul><ul><li>Mellitus means sweet like a honey. </li></ul><ul><li>It is a disorder of carbohydrate metabolism. </li></ul><ul><li>In which body’s blood sugar (glucose) </li></ul><ul><li>Level remains too high and causes problems. </li></ul><ul><li>Insulin allows body’s cells to use glucose as a fuel . </li></ul>

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400 BC Sushrut <ul><li>Diabetes Causes </li></ul><ul><li>Genetical </li></ul><ul><li>Environmental </li></ul>

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In 1889 Minkowski <ul><li>In 1889 Minkowski, with the German physiologist Joseph von Mering (1849-1908), discovered that dogs subjected to removal of their pancreas develop the symptoms of diabetes, leading Minkowski to postulate that the pancreas is the site of secretion of an «antidiabetic» substance, now known to be insulin. </li></ul>

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Noble story of Insulin 1921 <ul><li>DR Banting & DR Best isolated insulin </li></ul><ul><li>From pancreas of dog </li></ul><ul><li>Insulin injected to a diabetic dog showed fall in glucose levels </li></ul>

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First insulin use Jan 11 1922 <ul><li>On January 11, 1922, a 14-year-old with type 1 diabetes named Leonard Thompson received an experimental injection at the Toronto General Hospital that would change history. At the time, type 1 diabetes was thought to be a death sentence. Thompson's life was extended by an additional 13 years using insulin. </li></ul>

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Pancreas <ul><li>The pancreas has an exocrine portion that secretes digestive enzymes that are carried through a duct to the duodenum. The endocrine portion consists of the pancreatic islets, Paul Langerhans 1869 Described clusters of cells (islets ) </li></ul><ul><li>In the pancreas which secrete Glucagon and insulin . </li></ul>

10.
Types Of Diabetes Mellitus <ul><li>Type I DM Insulin Dependent Diabetes </li></ul><ul><li>5-10% of diabetic patients. Usually affects </li></ul><ul><li>Children. </li></ul><ul><li>In this condition pancreas of the patients </li></ul><ul><li>Produce practically no insulin. The patient’s survival is dependent on external insulin. </li></ul>

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Types of Diabetes cont <ul><li>Type II Diabetes : Non Insulin Dependent </li></ul><ul><li>Diabetes </li></ul><ul><li>Causes </li></ul><ul><li>Genetically </li></ul><ul><li>Environmental </li></ul><ul><li>Insulin is insufficient or insensitive </li></ul>

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Diabetes in the World millions Year 2010 Reference: Wild S, Roglic G, Green A, Sicree R, King H. Global prevalence of diabetes. Diabetes Care. 2004; 27(5): 1047-1053 . India 79.4 China 42.3 USA 30.3 Indonesia 21.3 Japan 8.9

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Symptoms of DM <ul><li>Excessively Thirsty (polydypsia) </li></ul><ul><li>Passing a lot of urine (Polyuria) </li></ul><ul><li>Excessive eating ( Polyphagia) </li></ul><ul><li>Delayed wound healing </li></ul><ul><li>Tiredness leg pains and numbness in the foot. </li></ul><ul><li>Person may not have any symptom </li></ul><ul><li>REGULAR CHECKING IS THE KEY </li></ul>

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Diagnosis <ul><li>Fasting Glucose >126mg% </li></ul><ul><li>Post Lunch (2Hrs) >/ 200mg% </li></ul>

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Treatment <ul><li>Dietary restrictions </li></ul><ul><li>Exercise: Burns fats controls obesity </li></ul><ul><li>Drugs : Oral or insulin </li></ul><ul><li>Once diabetic Diet restrictions and exercise always required </li></ul>

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Diet for Diabetics <ul><li>Avoid ice-creams, barfis,pedas,jams, jellies, chocolates ,soft drinks, these items cause a sudden rise in blood glucose. </li></ul><ul><li>Avoid also butter ,ghee, cream, paneer, deep fried food, coconut. </li></ul><ul><li>Fruits to be avoided mangoes bananas , chickoos. </li></ul>

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Diet cont <ul><li>Diet </li></ul><ul><li>Lots of salad Carrots cabbage cucumber </li></ul><ul><li>Chapati Bhakari (Rotala) </li></ul><ul><li>Do not apply ghee or oil over roti </li></ul><ul><li>Vegetables can be had in sufficient quantities </li></ul>

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Sweet story <ul><li>For One Jelebi or Gulab Jamun </li></ul><ul><li>Sugar present Approximately 20grams </li></ul><ul><li>Capable of raising blood glucose at least to 400mgs but Your beta cells produce more insulin and solve the problem . </li></ul><ul><li>But once they are sick they stop working and take outsider’s help i.e. may be insulin inj </li></ul>

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BODY MASS INDEX BMI = weight in Kg /HT in Meter 2 SEVERE >30 OBSE II MODERATE >25 OBESE I INCREASED >23 OVERWT AVERAGE 18.5-22.9 NORMAL RANGE LOW <18.5 UNDER WT RISK COMORBIDIES ASIANS CLASSIFICATION

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Wrong beliefs <ul><li>Diabetes can eat wheat but not rice </li></ul><ul><li>Both wheat and rice raise the blood sugar to similar extent . </li></ul><ul><li>It should not matter whether one takes wheat or rice , as long as the total quantity </li></ul><ul><li>Is restricted . </li></ul>

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Diabetic complications <ul><li>Hypoglycemia Blood glucose <50mg% </li></ul><ul><li>Retinopathy : screen of eye gets affected </li></ul><ul><li>Neuropathy: Found in 50 % diabetic , Tingling numbness, burning sensation (Feet) </li></ul><ul><li>Nephropathy: Kidney damage </li></ul><ul><li>Heart attacks : 2-3 times higher than non diabetics </li></ul><ul><li>Hyperglycemia: Blood glucose above 140mg% </li></ul>

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Hypoglycemia Symptoms <ul><li>Increased appetite </li></ul><ul><li>Weakness </li></ul><ul><li>Sweating </li></ul><ul><li>Restlessness </li></ul><ul><li>Palpitation </li></ul><ul><li>Giddiness </li></ul>

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Hypoglycemia <ul><li>Predisposing Factors </li></ul><ul><li>1 Delaying or skipping meals </li></ul><ul><li>Heavy alcohol consumption </li></ul><ul><li>Decreased carbohydrate consumption </li></ul><ul><li>Decreased in Insulin requirements </li></ul><ul><li>(after elimination of stress) </li></ul>

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DIABETIC FOOT <ul><li>Make checking your feet part of your daily routine ,just like brushing your teeth. </li></ul><ul><li>Watch for red spots swelling ,cuts and calluses. </li></ul><ul><li>Use mirror so that you can see heel ,sole </li></ul><ul><li>Wash your feet with warm water every day .to avoid burns test water temp with your elbow. </li></ul>

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DIABETES YES WE CAN CONTROL <150mg% Triglycerides <85cms for females <90cms for male Waist measurement <100mg% LDL cholesterol Bad cholesterol) >45 HDL Cholesterol (Good Cholesterol)

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DIABETES YES WE CAN CONTROL <7% HbA1c <200mg% Cholesterol 18.5-23 BMI <140mg% Post lunch (2Hours) 80-120mg% Fasting blood glucose

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DIABETES YES WE CAN CONTROL Helps in controlling DM Say no to papad pickle No as it will harm in the control alcohol Say no as it kills insulin producing cells Smoking <130/80 mmHg B.P.

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Regular Tests <ul><li>Examination of Retina </li></ul><ul><li>Urinary Microalbumin : early detection of kidney damage </li></ul><ul><li>Lipid profile </li></ul><ul><li>HbA1c Quarterly </li></ul><ul><li>B.P . Feet examination at each Doctor visit </li></ul>