As era is changing global health is shifting from communicable disease to non-communicable disease like diabetes, hypertension, gout, psychiatric illness, obesity, heart disease, stroke and many more. Diabetes is widely becoming prevalent in this decade. It will be surprising to know that diabetes is more common in developing nations like India than developed nation.
Why is diabetes common in developing nation??
- Acculturation -- it means mixing of culture of different societies, indian society is adopting western society. Irony here is we are not taking good habits but offcouse bad ones.
- Junk food -- it consists more of saturated fat and carbs, less of proteins and unsaturated fat.
- Sedentary lifestyle -- as economic development is occuring we are not doing enough physical activity. Today era is like anything is just few clicks away.
- Alcoholism and smoking -- they both go hand by hand.
Types of diabetes
- Insulin dependent diabetes mellitus
- Non insulin dependent diabetes mellitus
- Gestation diabetes ( in pregnant ladies)
- Diabetes due to secondary cause like corticosteroids.
Insulin dependent Diabetes mellitus
- Occurs due to insulin deficiency ( insulin hormone increase body utilization of glucose thereby prevent from diabetes development)
- In young age group
- Genetic history
- Also called as type 1 diabetes
Non insulin dependent diabetes mellitus
- Occurs due insulin resistance (our body doesn't respond to insulin)
- Very common
- Occur in adults after 30 years of age
- Also know as Type 2 diabetes
Symptoms of diabetes mellites
- Polydypsia (excessive urge to drink water)
- Polyuria (excessive urination)
- Weight gain
Complications related to diabetes
- Diabetic neuropathy (nerves of foot and hand are involved, tingling and numbness)
- Diabetic retinopathy (eye involvement, there is decreased vision)
- Diabetic kidney disease (kidney involvement, chronic renal failure)
- Amputation of limbs (limb is cut down due severe foot infection)
- Athrerosclerosis
Gestational diabetes
- Develops during pregnancy
- Get treated after delivery of baby
- Gestational diabetic female have a high risk of developing type 2 diabtes in future
- Baby born to such mother have high birth weight
Rule of halves
According to this rule,
50% population is diabetic, of these 50% only 50% population know there diabetic status, of this 50% only 50% are taking medicine, of this 50% only 50% having diabetes in control.
Diagnosis
Random blood sugar level - >200mg/dl
Fasting blood sugar >126mg/dl
HbA1C levels >6.5 %
Prediabetic stage
Random blood sugar - 140-200 mg/dl
Fasting blood glucose - 100-125mg/dl
HbA1C - 5.7-6.4 mg%
Management
> Non pharmacological management (Advice for diabetic patient)
- Exercise - as per WHO. a)everyday exercise of 30-45 minutes for atleast 5 days per week is suffient. b)By exercise we mean brisk walking. c) Can be done in morning or evening but more beneficial if done in morning
- Daily intake of fruits - a)3-5 serving per day. b) Fruit should be of low glycemic index ( increase body sugar level slowly) eg- banana, apple, orange. c) AVOID high glycemic index fruits ( increase blood sugar levels very rapidly and fastly) eg- cheeko, watermelon, potato, grapes.
- Use cooking oil rich in unsaturated fatty acids- eg- mustard oil, saffola oil, sunflower oil, groundnut oil. These are rich source of essential fatty acid. Two of more cooking oil should be used with rotation. AVOID dalda and saturated fat oil
- AVOID animal oil - animal oil is rich in saturated fatty acid. Except fish oil which beneficial for health
- Prefer chicken over meat
- Eat less of junk food and packed and processed food - they contain large amount of trans fatty acid that increase blood cholesterol
- WEIGHT LOSS
- Take frequent but short meals
- Foot care - use soft sleepers
- Wound care
REGULAR EXAMINATION
- Eye examination (yearly)
- Nerve examination
- Urine examination
Pharmalogical management
Metformin
drug of choice for type 2 diabtes
Dose - 500mg twice a day , in morning and evening
Insulin
Drug of choice for type 1 diabetes mellites
Subcutaneous injection in abdomen
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