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Diabetes Care Diabetes Care ManagementManagement

What 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.

What 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, sugar

remains in the blood in high amounts.

Diabetes

“Mild Disease”

Serious consequences

Diabetes Mellitus A Serious Disease

Leading cause of newcases of blindness 25 times more prone to eye problems

6 times higher risk forParalysis (stroke)

5 times more prone toKidney failure

20 times more prone tolower limb amputationNerve damage causes loss of sensation

2-3 times higher risk forheart attack

DiabetesIndian context

High prevalence

Life style changes further accentuate the high genetic predisposition

Under diagnosed due to low awareness

Perhaps occurs a decade earlier

Non obese/lean Type II fairly common

Treated less seriously as considered “Mild Disease”

Differences between Type 1 & Type 2

Type 1 Type 2

Develops at an early age <30 years

Develops later in life after >30 years

Patient are young, lean, and thin Often over weight and have an apple shape

Illness develops rapidly Illness develops slowly

Dependant on insulin for life Insulin may be required for achieving good diabetes control

High risk to develop Ketoacidosis

Low risk to develop Ketoacidosis

Insulin

Monitoring

Diet

Education

Exercise

Treatment of Type 1 Diabetes

Insulin

Monitoring

Diet

Education

Exercise

Treatment of Type 2 Diabetes

Oral Agents

How You Manage Your Diabetes

Follow a Healthy

Meal Plan

Take your

Medication

Regular Exercise

Test blood sugar

Regularly

Self Management

Self Management

Keeping Track of your Blood Sugar

Take an active part in the treatment of your Diabetes

Taking Charge of your Diabetes

It means keeping your Blood Sugar as normal as possible

Your blood sugar may alter because of : Eating

Tablets or Insulin administration

Exercise

Illness

Stress

Benefits of Normal Blood Sugar

It makes you feel normal, and comfortable in your daily life

It will help prevent the long term complication of the Diabetes

Learning Self Management

It requires your time and efforts

It requires your full participation in the treatment

It requires self care practice in your daily life

It requires close co-ordination with your Doctor and Diabetes Care Team

How to do Self- Management?

Test Your Blood Sugar regularly

Record your Blood sugar readings in the Diary

Identify the Blood Sugar Patterns

Use your Blood Sugar results to adjust your diet and Insulin

Take help of your Doctor and Diabetes Care Team

Setting your blood Sugar targetsOptimal blood sugar levels are :

Blood Sugar

Good Borderline Poor

Fasting mg/dl

80-110 111-140 > 140

Post Prandial mg/dl

80-144 145-180 > 180

Setting 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.

Diabetes and Emergencies

Hypoglycemia Reduction in Plasma glucose concentration below the normal value of 60 mg/dl (3.3mmol/L)

Symptoms: Hunger pains

Excessive sweating and anxiousness

Weakness

Palpitation/Trembling

Headache

Blurring of vision

Irritability/Confusion

Sleepiness

Faintness/loss of consciousness (coma)

Hypoglycemia

Defined as blood glucose < 2.1 mmol/L

Some diabetes develop hypoglycemia when

BG > 2.1 mmol/L

Some diabetics do not have symptoms at

very low BG

Hypoglycemic unawareness

HYPERGLYCEMIAHYPERGLYCEMIA

NORMALNORMAL

HYPOGLYCEMIAHYPOGLYCEMIA

Causes of Hypoglycemia

Taking more exercise than usual

Delay or omission of a snack or main meal

Administration of too much medication

Eating insufficient carbohydrate

Over-indulgence in alcohol

Mistake in sulphonyureas’s dosage

TreatmentMild Hypoglycemia

Relieved by : 1 glass of fruit juice or soft drink 3 heaped teaspoons of sugar, honey or 3 - 5 sweets

Repeat if symptoms not relieved after 5 to 10 minutes If next meal not immediately due, take 30 g complex

carbohydrate

JUICE COKE

Diabetic 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.

Symptoms

• Excessive urination and thirst

• Nausea, vomiting and abdominal pain

• Deep rapid breathing

• Mental confusion

• Fruity Smell

Management Goal

Results of animal studies, retrospective analysis of large

patient populations, and prospective clinical trials suggested a

link between degree of hyperglycemia and risk of late diabetic

complications.

DCCT conclusively proved that late diabetic complications can

be prevented, onset delayed and progression retarded by

Good Metabolic Control.

Management 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.

Diabetes and Diet

Importance of Nutrition Advice

Nutrition therapy is an integral part of management

Diabetes is a metabolic disorder affecting carbohydrate, fat and

protein metabolism

Effective tool in combination with physical exercise and

preferable to pharmacological therapy For patients with IGT; those at risk of; or in early stages of type 2 diabetes

Inappropriate nutrition can make best planned pharmacological

intervention ineffective

Food GroupsFood Exchange

Cereals

Pulses

Milk and Milk products

Vegetables

Fruits

Fat, Oils and Nuts

Meat, Fish and Eggs

Cereals are the staple diet in most cultures. They are rich in

carbohydrate and a fair source of minerals and B Group

vitamins.

Commonly used cereals are Wheat Flour, Rice,

Maize, Bajra, Jowar,Ragi etc

Processed cereal based food items are Roti,

Paratha, Puri, Idli, Dosai, Biscuit, Bread,

Dinner Roll, Macaroni, Noodles etc

Cereals

Pulses

Pulses (legumes and Dals) are an important source of

protein for

Vegetarians

Some 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.

Milk and Milk Products

Milk 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.

Vegetables Vegetables are important for their mineral, vitamins and fibre content. Vegetables classified into 3 groups.

Green Leafy Vegetables: like Spinach, Lettuce, Cabbage, Fenugreek etc.

Roots And Tubers: like Potato, Onion, Yam, Carrot, Beet root, Radish, Turnip etc

Other Vegetables: They are Peas, Brinjal, Cauliflower, Ladyfinger, Gourd etc.

Fruits Fruits are a rich source of Vitamin C, most fruits are also good

source of carbohydrates. Yellow fruits like Mango and Papaya

are rich in carotene.

Common fruits are apple, banana, grapes, orange, guava

etc.

Fat,Oils & Nuts Oilseeds 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 group

Visible 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.

Meat, Fish & Egg Rich 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

Food Exchanges Food 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.

Food Exchanges

Thus 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.

Dietary Recommendations Diabetes Food Pyramid

Cereals & Pulses8-12 Units

10-14 units (veg)

Fruits2-3 UnitsVegetables

3-4 Units

Milk & Milk Products2-3 Units

Meat & Fish1-2 Units

Fats, Oils & Nuts 2-3 Units

Dietary Recommendations

Carbohydrates: 55-65% mainly complex carbohydrates

Fats: 20-30% saturated 10%

poly-unsaturated 10%

mono-unsaturated 10%

cholesterol < 300 mg/day

Protein: 12-20%

Sodium: < 6 g/day hypertensive diabetic< 3 g/day

Free Foods Foods that have few or no calories and can be consumed

in large quantity to satisfy hunger are called free foods

Raw vegetables like tomato, cabbage, lettuce, cucumber etc

Tea, coffee without milk or sugar

Plain lemon juice (nimbu pani) without sugar

Clear vegetable soups

Practical Guidelines

Utilize food exchanges to introduce variety

Use household measures

Make corrections on existing meal plan and pattern rather than

introduce new regimen

Meal timings, frequency and quantity to be adjusted according to

activity and insulin/drug regimens

Foods to be Avoided / Restricted

Refined sugars and products made from it

sugar, 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 juices

Fried Foods

like pakora, samosa, puri, kachori, sev, chiwra, salted nuts, mixture

etc

Summary Diabetic diet

A person with diabetes can eat almost any healthy food that

other people normally eat provided

the food is balanced

within the permissible caloric limits, and

daily requirements are adequately distributed between the

different meals and during the day

Good Management of Diabetes Requires Balancing Food intake, Exercise and

Medication

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