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Let us know diabetes and prevent it

Updated on May 21, 2016
Worldwide estimation of diabetes.  Age group(years) in graph diagram: 1:    20-44, 2:    45-64, 3:    65+
Worldwide estimation of diabetes. Age group(years) in graph diagram: 1: 20-44, 2: 45-64, 3: 65+

Age group(years) in graph diagram:

1: 20-44
2: 45-64
3: 65+

Diabetes occurs worldwide and the incidence of diabetes is rising.It is estimated that,in the year 2000,171 million people had diabetes and this is expected to double by 2030.This global pandemic principally involves type 2 diabetes to which several factors contribute,including obesity,unsatisfactory diet,sedentary lifestyle and increasing urbanisation.Many cases of type 2 diabetes remain undetected.The prevelance of known diabetes in Britain is around 2-3%,but is higher in the Middle East(12% in the Indian subcontinent).

Source: From Davidson's Principles and Practice of Medicine

To Control Diabetes....

Get more physical activity.

Get plenty of fiber.

Go for whole grains.

Lose that unnecessary weight.

From Dr Diabetes


Diabetes
Diabetes

Normally,our body breaks down carbohydrates into a special sugar called glucose.Glucose gives the energy to cells in our body.But our cells need insulin.Insulin is a hormone in our bloodstream that is responsible to take in glucose and use it for producing energy.

When we have diabetes,either the body is not capable of making enough insulin,or the insulin it produces cannot be used or both.

These changes lead to the development of complication of diabetes which characteristically affect the eye,the kidney and the nervous system.

The current cost of Diabetes in UK

  • 10-30% reduction in life expectancy.
  • Most common cause of blindness in age group 20-65 years.
  • Use of hospital beds increased to sixfold.
  • 1000 patients per annum reach end-stage renal failure.
  • 5-7% of total National Health Service budget.

Source: From Davidson's Principles and Practice of Medicine

In humans,blood glucose is maintained within a narrow range.A balance is preserved between the entry of glucose into the circulation from the liver,supplemented by intestinal absorptionafter meals,and glucose uptake by peripheral tissues,particularly skeletal muscle.A continuous supply of glucose is essential for the brain,which cannot oxidise free fatty acids and relies upon glucose as its principal metabolic fuel.

When intestinal glucose absorption declines between meals,liver glucose output is increased in response to low insulin levels of the counter regulatory hormones,glucagon and adrenaline.The liver produces glucose by gluconeogenesis and glycogen breakdown.

After meals,blood insulin levels rise.Insulin lowers blood glucose by suppressing liver glucose production and stimulating glucose uptake in skeletal muscle and fat,mediated by the glucose transporter.

There are 2 major types of diabetes:

1. Type 1 diabetes

2. Type 2 diabetes


Type 1 diabetes is autoimmune in nature.Here the antibodies of our body attack it's own pancreas.As a result,the pancreas don't make insulin.

In type 1 diabetes we can damage the tiny blood vessels in our eyes.This is called diabetic retinopathy.

We can also damage tiny blood vessels in our kidney called as diabetic nephropathy.

Tiny blood vessels in nerves can also be damaged calledas diabetic neuropathy.

There is also an increased risk to our heart.


Type 2 diabetes is a more complex condition than type 1 diabetes because there is a combination of resistance to the actions of insulin in liver and muscle together with impaired pancreatic beta cell function leading to relative insulin deficiency.Insulin resistance appears to come first and leads to elevated insulin secretion in order to maintain normal blood glucose levels.However,in susceptible individuals the pancreatic beta cells are unable to sustain the increased demand for insulin and a slowly progressive insulin deficiency develops.

Examination of the patient with Diabetes

Diabetes can affect almost every system in the body.In routine,examination of the patient with diabetes is focused on examination of the:

1.hands

3.blood pressure

7.eyes

8.insulin injection sites

11.feet

examination of patient with Diabetes
examination of patient with Diabetes

Examination of the hands

Limited joint mobility may be present.This is the inability to extend to 180o.The effect can be demonstrated in the 'prayer sign'.It causes painless stiffness in the hands.

'Prayer sign'
'Prayer sign'

Examination of the feet

Lumps called callus may be formed on weight bearing areas.

Lump formation in feet
Lump formation in feet

Diabetic eye disease

Background diabetic retinopathy showing blot haemorrhages, exudates,venous changes and neovascularisation.


Diabetic eye disease
Diabetic eye disease

Hyperglycaemia and Hypoglycaemia

Hyperglycaemia occurs when blood glucose levels are high.Persistent hyperglycaemia can affect almost every system of the body.When blood vessels which are large are affected,it can result in:

  1. Stroke
  2. Circulation disorders
  3. Heart attack

When blood vessels which are small are affected,it can result in:

  1. Kidney disease
  2. Eye disease
  3. Nerve disease

Hypoglycaemia occurs when blood glucose levels are dangerously low,they drop below 70 mg/dL.The symptoms of hypoglycaemia are:

  1. Sweating
  2. Headache
  3. Difficulty in concentration
  4. Dizziness,weakness
  5. Rapid pulse
  6. Blurred vision


Diagnosis of Diabetes

Glycosylated Hemoglobin,Blood
%
Non Diabetic range
4.0-6.0
American Diabetic Association Target
7.0
Action Suggested
Greater than 8.0
Glycosylated hemoglobin range

Mean Plasma glucose:

Non Diabetic range:65.0 - 135.0 mg/dL

Note:

Increased levels of glycosylated Hemoglobin may need clinical correlation with compliance with anti diabetic therapy.High glycosylated hemoglobin may be observed in chronic renal failure,abnormal haemoglobinpathy and thalasaemia.

Management

The methods of treatment of diabetes are:

1.Lifestyle/dietary modification

2.Insulin by injection

3.Oral anti-diabetic agents.

Treatment

In treating diabetes blood glucose levels have to be decreased without causing abnormally low levels of glucose to occur.

Type 1 diabetes is treated by exercise,a healthy diet and insulin.

Type 2 diabetes requires weight reduction,exercise and a healthy diet.

When these fail oral medication can be taken.If oral medication fails,insulin treatment is given.

The American diabetic association(ADA) prescribes a diet that is balanced,nutritious and low in cholestrol,simple sugars and fat.

Weight reduction and exercise are very helpful in treatment of diabetes.

Patient education for Foot care

Foot care tips:

1.Take care of diabetes. Keep your blood glucose levels within normal range.

2.Inspection of feet is required everyday.

3.Bare feet should be checked everyday for cuts,swelling,blisters & red spots.

4.Mirror should be used to check bottom of feet.

5.Changes in temperature should be checked.

6.Feet should be washed everyday.

7.Feet should be washed in warm water.

-Feet should be dried.Toes should be dried.

-Feet should be soaked.

--Water temperature should not be checked with feet. Thermometer or elbow should be used.

8.Skin should be kept soft & ooth.Rub lotion over top & bottom of feet,not between toes.

9.Gently smooth calluses & corn.

-you can use pumice stone to smooth calluses & corn.

10.You should trim your toenails every week.

-Trim toenails straight across & file edges with Emery board.

11.Always wear socks & shoes.

-Dont walk bare foot.

-Shoes should be comfortable. They should fit well & protect feet.

-Feel inside shoes to check that there is no object inside.

12.Protect feet from hot & cold.

-Wear shoes on hot pavement & beach.

-Wear socks at night if you feel cold by feet.

13. You should keep the blood flowing to feet.

-In sitting position,keep your feet up.

-Wiggle tows & move ankles up & down 5 times2 or 3 times in a day.

- Legs should not be crossed for long periods of time.

- You should not smoke.

14.Check with the health care provider.

-Let your health care provider check your bare feet to find whether you are likely to serious foot problems.

-Call health care provider if cut,bruise,blister on foot does not begin healing after 1 day.

-Follow advice of health care provider about foot care.

-Do not use home remedies or self medicate.

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a2 milk that is produced by Desi Cows , protects us from Diabetes!

If you want to protect yourself from diabetes, ensure that you drink Desi ( indigenous) cow's milk.

Milk has Beta Casein protein which is of a1 and a2 type. a1 protein is harmful to health whereas a2 protein is good for health.

Desi cow breeds genes produce a2.Exotic cows have a1 protein producing genes which causes risk of diabetes.

a2 milk is easier to digest than regular cow's milk.

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