What You Need To Know About Diabetes: Raj K Mishra, MD Facp Internist

WHAT YOU NEED TO KNOW ABOUT DIABETES
RAJ K MISHRA, MD FACP INTERNIST

WHAT IS DIABETES Commonly known as having Sugar Diabetes or Madhumeh in Hindi. It is a disease in which the body either does not produce enough insulin or is unable to use the insulin the way it should be. Insulin is a hormone produced in the pancreas, that helps the body to convert the glucose into energy.

TYPES OF DIABETES: TYPE 1 OR INSULIN DEPENDENT DIABETES. TYPE 2 OR NON INSULIN DEPENDENT OR MATURITY ONSET DIABETES. GESTATIONAL DIABETES

TODAY WE WILL TALK ABOUT TYPE 2 DIABETES. It is estimated that 20.8 million people in US or 7% of the population has diabetes. Nearly 1/3 are unaware of it and are undiagnosed. Throughout the world, estimate is 150 million people have diabetes. 80 to 90% have Type 2 diabetes.

Many Patients are asymptomatic
Symptoms when present are:
Polyuria Polydypsia Polyphagia Weight gain Unexplained weight loss Recurrent intermittent blurred vision. Generalized pruritis or vulvo vaginitis Peripheral neuropathy Sexual dysfunction such as ED. Recurrent skin infections
Type 2 DIABETES
Diagnosis: Fasting plasma glucose 126 or above on at least 2 separate occasions. Random plasma glucose of 200 mg/dl or more on 2 separate occasions. Abnormal GTT (Plasma Glucose of 200 mg or more at 2 hours)
TYPE 2 DIABETES
Co- morbid conditions: Hypertension Dyslipidemia Athero sclerosis Coronary artery disease Peripheral vascular disease

Risk factors : Age 45 and over Family Hx ( first degree relatives with type 2) Ethnicity ( African American, Hispanic, South Asian, Pacific Islander, and Native American) Hx of gestational diabetes. Delivery of infants weighing 9 or more lbs. Poly Cystic Ovary Syndrome ( PCOS ) Overweight esp. with abdominal obesity Presence of cardio vascular disease, hypertension, impaired glucose Physical inactivity
SYMPTOMS OF HYPOGLYCEMIA
Confusion Blurred vision or double vision Anxiety and tremulousness Sweating and cold and clammy hands Light headedness or fainting Rapid pulse / heart rate Seizures or convulsion
SYMPTOMS OF HYPERGLYCEMIA
Polyuria and polydypsia Marked fatigue Nausea / vomiting Mental stupor progressing to coma if untreated Fruity smell in breath Serious complication is Diabetic Keto acidosis
TREATMENT OPTIONS
LIFE STYLE CHANGES WEIGHT REDUCTION DIET DIET + EXERCISE DIET + EXERCISE + MEDICINES
MANAGEMENT OF LIFE STYLE CHANGES

PROFESSIONAL COUNSELLING WITH A REGISTERED DIETICIAN CONSULTATION WITH YOUR DOCTOR BEFORE STARTING ANY EXERCISE PROGRAM CONSULTATION or SUPERVISON IN DESIGN OF PHYSICAL FITNESS PROGRAM STRESS MANAGEMENT AND YOGA
DIET FACTS
It takes 3500 calories over and above your daily caloric needs to gain ONE lb of weight. 1 gram fat = 9 calories 1 gram protein = 4 calories 1 g carbohydrate = 4 calories 1 g fiber = 0 calories
Food Guide Pyramid: Asian
Food Pyramid: Vegetarian

What You Should Eat Every Day on a Vegetarian Diet.
3 or 4 servings of cereals/grains or potatoes 4 or 5 servings of fruit and vegetables 2 or 3 servings of pulses, nuts & seeds 2 servings of milk, cheese, eggs or soy products A small amount of vegetable oil and margarine or butter. Some yeast extract fortified with vitamin B12.
Food Serving sizes

Breads And Grains: Cooked pasta or oatmeal =1/2 cup or 1 ice cream scoop Whole-wheat bread =1 slice Whole-wheat crackers =6 whole
Food Serving sizes

Fruits One cup of mixed berries, cherries or cubed cantaloupe equals one serving. One cup is about the size of a tennis ball. Other serving sizes of fruit include: Apple, pear or banana =1 small 100 percent fruit juice =1/2 cup
Food Serving sizes

Vegetables Until you're comfortable judging serving sizes, you may need to use measuring cups and spoons. A half a cup of cooked carrots, for example, equals one serving. Here are the recommended serving sizes for other vegetables: Raw leafy vegetables =2 cups Chopped, cooked or canned vegetables =1/2 cup
Food Serving sizes

Dairy products Serving sizes of dairy products may be smaller than you think. For example, one serving of low-fat cheddar cheese is 2 ounces or about the size of two dominoes. Here are serving sizes for other dairy products: Low-fat or fat-free milk or yogurt =1 cup Part-skim mozzarella cheese =1 1/2 ounces or about 1/3 cup shredded
Food Pyramid:
Protein
Women need about 45g of protein a day more if pregnant, lactating or very active. Men need about 55g again more if very active.
Food Serving sizes

Meat and Poultry Familiar objects can help you picture proper portions for some meats and beans. For example, a portion of meat about the size of a deck of cards is 3 ounces. Here are the serving sizes for meat and meat substitutes: Cooked skinless poultry or fish =3 ounces or the size of a deck of cards Cooked lean meat =1 1/2 ounces Egg =1 medium

Vegetarians obtain protein from: Nuts -- Hazels, brazils, almonds, cashews, walnuts, pine kernels. Seeds -- Sesame, pumpkin, sunflower, linseeds. Pulses -- Peas, beans, lentils, peanuts. Grains and Cereals -- Wheat (in bread, flour, pasta), barley, rye, oats, millet, corn, rice. Soya products -- Tofu, veggie burgers, soy milk. Dairy products -- Milk, cheese, yogurt.
Food Serving sizes

Beans And Legumes: One serving size of cooked legumes or dried beans =1/2 cup or about the size of an ice cream scoop
MEDICATIONS USED TO TREAT TYPE 2 DIABETES

Sulfonylureas: Tolbutamide or Orinase Tolazamide or Tolinase Chlorprpamide or Diabenese

Second generation Sulfonylyreas: Glipizide or Glucotrol, Glucotrol XL Glyburide or Diabeta, Micronas Glimepiride or Amaryl

Biguanides Metformin or Glucophage Metformin ER or Glucophage XR

Thiazolidinediones: Rosiglitazone or Avandia Pioglitazone or Actos

Alpha glucosidase inhibitors: Acarbose or Precose Miglitol or Glyset

Combination oral anti diabetic meds on the market Glucovance ( Glyburide + Metformin) Avandamit (Rosiglitazone + Metformin)

Insulin Injections Short acting like Humolog and Novolog Long acting like NPH and Lente Glarzine (Lantus) once daily
BMI or Body Mass Index

Calculated by weight in kilos divided by height in meters squared Normal BMI =18.5 to 24.9 Over weight= 25 to 29.9 Class I obesity= 30 to 34.9 Class II obesity= 35 to 39.9 Class III obesity or Morbid obesity is BMI of 40 and over
METABOLIC SYNDROME
Hypertension Dyslipidemia (low HDL, High TG) Waist measurement more than 35 for women and more than 40 for men For Asian women, waist more than 32.5 and higher than 35 for men Insulin resistance
PRE DIABETES
Fasting Blood sugar 120 to 125 on 2 separate occasions 2 hour OGTT 140 to 199 Usually asymptomatic
SIGNIFICANCE OF DETECTING PRE DIABETES

Converts to diabetes in 4 to 7 years Can be delayed with life style changes and weight loss of 5 to 10% of body weight. Medication use may be indicated Early treatment can delay complications from diabetes
REGULAR MONITORING
Weight BP Foot examinations Pulse rate Sores, calluses Test for sensations
REGULAR MONITORING
Annual eye exams by ophthalmologist Hemoglobin A1 C every 3 to 6 months Annual fasting lipid panels Urine test for presence of proteins
GOALS FOR TREATMENT

Control of Blood Sugar (HgA1C below7) Prevent end organ damage Decrease morbidity
Best wishes for your health. THANKS FOR TAKING CARE OF YOURSELVES.

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WHAT YOU NEED TO KNOW ABOUT DIABETES

RAJ K MISHRA, MD FACP INTERNIST