Diabetes mellitusDiabetes mellitus

““Basic Basic approach”approach”

Dr Sajith.V.SDr Sajith.V.S

MBBS,MD (Gen Med )MBBS,MD (Gen Med )

DiabetesDiabetes

affect nearly every organ system in affect nearly every organ system in the body.the body.

It has been projected that It has been projected that 300 million300 million individuals would be affected with individuals would be affected with diabetes by the year 2025. diabetes by the year 2025.

In India it is estimated that presently In India it is estimated that presently 19.4 million19.4 million individuals are affected by individuals are affected by this deadly disease, which is likely to this deadly disease, which is likely to go up to go up to 57.2 million57.2 million by the year 2025. by the year 2025.

reasonsreasons changes in lifestyle,changes in lifestyle,

people living longer people living longer than before (ageing) than before (ageing)

low birth weight low birth weight

could lead to could lead to diabetes during diabetes during adulthood. adulthood.

SugaSugarr

Provides energy to all cells in the bodyProvides energy to all cells in the body Brain depends glucose as fuelBrain depends glucose as fuel

InsulinInsulin

Diabetes related complications areDiabetes related complications are coronary artery disease, coronary artery disease, peripheral vascular disease, peripheral vascular disease, neuropathy, neuropathy, retinopathy, retinopathy, nephropathy,nephropathy, People with diabetes are People with diabetes are 25 times more likely to develop blindness,25 times more likely to develop blindness, 17 times more likely to develop kidney disease,17 times more likely to develop kidney disease, 30-40 times more likely to undergo amputation, 30-40 times more likely to undergo amputation, two to four times more likely to develop myocardial two to four times more likely to develop myocardial

infarction and twice as likely to suffer a stroke than infarction and twice as likely to suffer a stroke than non-diabetics. non-diabetics.

Types of diabetesTypes of diabetes

Type 1Type 1 ( 5-10% ( 5-10% of all

diabetes mellitus cases)

XXX

Type 2 (Type 2 (90% to 95% of all diabetes mellitus cases )

X

↓↓

↓

Gestational diabetesGestational diabetes

Other causesOther causes

Risk Factors for Prediabetes and Diabetes Mellitus Family history of diabetes Cardiovascular disease Overweight or obese state Sedentary lifestyle impaired glucose tolerance or impaired fasting glucose Hypertension Increased levels of triglycerides, low concentrations of

high-density lipoprotein cholesterol, or both History of gestational diabetes History of delivery of an infant with a birth weight >9

pounds Polycystic ovary syndrome Psychiatric illness

Criteria for the diagnosis of diabetes mellitus Symptoms of diabetes polyuria, polydipsia, and unexplained weight loss + casual plasma glucose concentration >200

mg/dl. OR FPG >126 mg/dl.

OR 2-hour postload glucose >200 mg/dl during

an OGTT (75 g anhydrous glucose dissolved in water).

“pre-diabetes”

FPG 100 mg/dl =normal ● FPG 100–125 mg/dl =IFG

(impaired fasting glucose high risk for development of

diabetes in these patient

PREVENTION OF TYPE 2 DIABETES MELLITUS

Perform screening with either the 2-hour oral glucose tolerance test or fasting plasma glucose test to establish a diagnosis of diabetes mellitus or to identify prediabetes mellitus • Initiate interventions that include lifestyle modifications

Weight reduction goal: 5% to10% of total body weight

Nutrition goals: reduce fat intake to less than 30% of total energy intake; reduce saturated fat intake to less than 10% of total energy intake; and increase fiber intake to 15 g/1000 kcal or more

Prescribe regular physical activity (approximately 150 minutes per week)

Treat hypertension and dyslipidemia aggressively;

Basic foodsBasic foods