Presentation on theme: "Diabetes Care Management"— Presentation transcript:
1Diabetes Care Management Write Presentation Title • Date in Footer
2What is Diabetes?Diabetes is a condition in which there is too much sugar (glucose) in the blood. Although sugar is needed to provide energy for the body, when in excess, it causes problem.Persons with diabetes have excess sugar because they lack or have deficient supply of insulin.
3What is Insulin?Insulin is a substance produced by pancreas, an organ situated behind the stomach. Insulin is required for sugar (glucose) to enter the cells of the body where it is utilized.It is as if insulin is the key which opens the door to allow sugar (glucose) to enter.When sugar is absent or deficient or is defective, sugarremains in the blood in high amounts.
5Diabetes Mellitus A Serious Disease Leading cause of newcases of blindness25 times more prone toeye problems6 times higher risk forParalysis (stroke)2-3 times higher risk forheart attack5 times more prone toKidney failure20 times more prone tolower limb amputationNerve damage causesloss of sensation
6Diabetes Indian context High prevalenceLife style changes further accentuate the high genetic predispositionUnder diagnosed due to low awarenessPerhaps occurs a decade earlierNon obese/lean Type II fairly commonTreated less seriously as considered “Mild Disease”
7Differences between Type 1 & Type 2 Develops at an early age <30 yearsDevelops later in life after >30 yearsPatient are young, lean, and thinOften over weight and have an apple shapeIllness develops rapidlyIllness develops slowlyDependant on insulin for lifeInsulin may be required for achieving good diabetes controlHigh risk to develop KetoacidosisLow risk to develop Ketoacidosis
8Treatment of Type 1 Diabetes InsulinExerciseMonitoringEducationDiet
9Treatment of Type 2 Diabetes InsulinExerciseMonitoringEducationDietOral Agents
10How You Manage Your Diabetes Follow a HealthyMeal PlanRegular ExerciseTake yourMedicationTest blood sugarRegularly
12Self Management Keeping Track of your Blood Sugar Take an active part in the treatment of your Diabetes
13Taking Charge of your Diabetes It means keeping your Blood Sugar as normal as possibleYour blood sugar may alter because of :EatingTablets or Insulin administrationExerciseIllnessStress
14Benefits of Normal Blood Sugar It makes you feel normal, and comfortable in your daily lifeIt will help prevent the long term complication of the Diabetes
15Learning Self Management It requires your time and effortsIt requires your full participation in the treatmentIt requires self care practice in your daily lifeIt requires close co-ordination with your Doctor andDiabetes Care Team
16How to do Self- Management? Test Your Blood Sugar regularlyRecord your Blood sugar readings in the DiaryIdentify the Blood Sugar PatternsUse your Blood Sugar results to adjust your diet and InsulinTake help of your Doctor and Diabetes Care Team
17Setting your blood Sugar targets Optimal blood sugar levels are : GoodBorderlinePoorFasting mg/dl80-110> 140Post Prandial mg/dl80-144> 180
18Setting your blood Sugar targets Keeping your blood sugar in this range help you to prevent the long term complications of the Diabetes i.e. eye, kidney and nerve damage. Use Insulin, if advised.
20HypoglycemiaReduction in Plasma glucose concentration below the normalvalue of 60 mg/dl (3.3mmol/L)Symptoms:Hunger painsExcessive sweating and anxiousnessWeaknessPalpitation/TremblingHeadacheBlurring of visionIrritability/ConfusionSleepinessFaintness/loss of consciousness (coma)
21Hypoglycemia HYPERGLYCEMIA HYPOGLYCEMIA Defined as blood glucose < 2.1 mmol/LSome diabetes develop hypoglycemia when BG > 2.1 mmol/LSome diabetics do not have symptoms at very low BGHypoglycemic unawarenessNORMALHYPOGLYCEMIA
22Causes of Hypoglycemia Taking more exercise than usualDelay or omission of a snack or main mealAdministration of too much medicationEating insufficient carbohydrateOver-indulgence in alcoholMistake in sulphonyureas’s dosage
23Treatment Mild Hypoglycemia Relieved by :1 glass of fruit juice or soft drink3 heaped teaspoons of sugar, honey or sweetsRepeat if symptoms not relieved after 5 to 10 minutesIf next meal not immediately due, take 30 g complex carbohydrateJUICECOKE
24Diabetic Ketoacidosis DKA is an acute life threatening complication of diabetes and occurs as a result of excessive production of ketones due to uncontrolled (or undiagnosed) hyperglycemia.SymptomsExcessive urination and thirstNausea, vomiting and abdominal painDeep rapid breathingMental confusionFruity Smell
25Management GoalResults of animal studies, retrospective analysis of largepatient populations, and prospective clinical trials suggested alink between degree of hyperglycemia and risk of late diabeticcomplications.DCCT conclusively proved that late diabetic complications canbe prevented, onset delayed and progression retarded byGood Metabolic Control.
26Management Goal Achieve as good a control as possible. Within constraints of individual ability and willingness, patients should be encouraged to aim for best possible control without increasing risk of serious hypoglycemia.Every incremental improvement in control translates into concrete benefits for patients. Take insulin, if advised.
28Importance of Nutrition Advice Nutrition therapy is an integral part of managementDiabetes is a metabolic disorder affecting carbohydrate, fat and protein metabolismEffective tool in combination with physical exercise and preferable to pharmacological therapyFor patients with IGT; those at risk of; or in early stages of type 2 diabetesInappropriate nutrition can make best planned pharmacological intervention ineffective
29Food Groups Food Exchange CerealsPulsesMilk and Milk productsVegetablesFruitsFat, Oils and NutsMeat, Fish and Eggs
30Cereals Cereals are the staple diet in most cultures. They are rich in carbohydrate and a fair source of minerals and B Groupvitamins.Commonly used cereals are Wheat Flour, Rice,Maize, Bajra, Jowar,Ragi etcProcessed cereal based food items are Roti,Paratha, Puri, Idli, Dosai, Biscuit, Bread,Dinner Roll, Macaroni, Noodles etc
31PulsesPulses (legumes and Dals) are an important source of protein forVegetariansSome of the common pulses are whole and/or, dehusked and split dals, Green gram, Bengal gram, Rajmah, Black gram, Cow pea, Red gram dal etc.
32Milk and Milk ProductsMilk is an universal food for all age groups. Milk contains good quality protein. Buffalo milk is richer in fat as compared to Cow's Milk.Milk is also consumed in the form of Yogurt, Cheese, Cottage Cheese (paneer), Milk Powder etc.
33Vegetables Vegetables are important for their mineral, vitamins and fibre content. Vegetables classifiedinto 3 groups.Green Leafy Vegetables: like Spinach, Lettuce, Cabbage, Fenugreek etc.Roots And Tubers: like Potato, Onion, Yam, Carrot, Beet root, Radish, Turnip etcOther Vegetables: They are Peas, Brinjal, Cauliflower, Ladyfinger, Gourd etc.
34FruitsFruits are a rich source of Vitamin C, most fruits are also goodsource of carbohydrates. Yellow fruits like Mango and Papayaare rich in carotene.Common fruits are apple, banana, grapes, orange, guava etc.
35Fat,Oils & NutsOilseeds and nuts are rich source of fat, energy, vitamins and minerals. In addition they also provide proteins.Peanuts, Pistachios, Almonds, Cashew, Coconut, Walnut are part of this groupVisible fats commonly consumed in India are butter, Ghee, hydrogenated oils, and various vegetable oils.Fats are a concentrated source of energy providing 9 kcal/g.
36Meat, Fish & EggRich in protein, vitamins, iron and phosphorous. Egg is considered the best quality protein. It contains all the essential amino acids in adequate proportions. Flesh foods are also a good source of vitamin B12.Common sources are mutton, chicken, fish, egg, pork, beef etc
37Food ExchangesFood exchanges are food equivalent units designed to facilitate easy variation in diet.Exchange lists with specified caloric values are made by experts. These lists contain specified quantities (weight/size/measure) of food items which are units .A single unit within the group has the same caloric value and therefore can be interchanged.
38Food ExchangesThus one unit of a cereal exchange - one medium chappati, can be exchanged for three-fourth katori cooked rice or one idli or two medium slices of bread.One chappati cannot be exchanged for two spoons of Ghee although calories from both is the same.
41Free FoodsFoods that have few or no calories and can be consumed in large quantity to satisfy hunger are called free foodsRaw vegetables like tomato, cabbage, lettuce, cucumber etcTea, coffee without milk or sugarPlain lemon juice (nimbu pani) without sugarClear vegetable soups
42Practical Guidelines Utilize food exchanges to introduce variety Use household measuresMake corrections on existing meal plan and pattern rather thanintroduce new regimenMeal timings, frequency and quantity to be adjusted according toactivity and insulin/drug regimens
43Foods to be Avoided / Restricted Refined sugars and products made from itsugar, gur, honey, glucose, jam, jelly, sweet chutney, cake, pastry, mithai, jalebi, ice cream, gulabjamun, barfi chocolates, toffees, sweets, soft drinks, sherbets, squash, and sweetened fruit juicesFried Foodslike pakora, samosa, puri, kachori, sev, chiwra, salted nuts, mixture etc
44Summary Diabetic dietA person with diabetes can eat almost any healthy food thatother people normally eat providedthe food is balancedwithin the permissible caloric limits, anddaily requirements are adequately distributed between the different meals and during the day
45Good Management of Diabetes Requires Balancing Food intake, Exercise and Medication