Write Presentation Title Date in Footer

1
Diabetes Care
Management
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 new
cases of blindness
25 times more prone to
eye problems
6 times higher risk for
Paralysis (stroke)

5 times more prone to
Kidney failure
20 times more prone to
lower limb amputation
Nerve damage causes
loss of sensation
2-3 times higher risk for
heart attack
Diabetes
Indian 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 targets
Optimal 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
HYPERGLYCEMIA
NORMAL
HYPOGLYCEMIA
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 sulphonyureass dosage
Treatment
Mild 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
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 Groups
Food 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 & Pulses
8-12 Units
10-14 units (veg)
Fruits
2-3 Units
Vegetables
3-4 Units
Milk & Milk Products
2-3 Units
Meat & Fish
1-2 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
Write Presentation Title Date in Footer
46