Every year on November 14, World Diabetes Day brings diabetes

to the attention of the world.

November 14 is the birthday of Frederick Banting, one of the

discoverers of insulin.

(c) Banting House National Historic Site of Canada

The global symbol for diabetes was developed during the Unite for Diabetes campaign.

Why a circle?A positive symbol across cultures, the circle symbolizes life and health.

Why blue?The colour blue reflects the sky that unites all nations. The blue border of the circle reflects the colour of the sky and the flag of the United Nations. The blue circle signifies the unity of the global diabetes community in response to the diabetes epidemic.

http://www.diabetesbluecircle.org

Diabetes Mellitus

• The name “diabetes mellitus means sweet

urine. It stems from ancient times when

physicians would taste a patients urine as a

part of a diagnosis.

Definition

• Hyperglycemia due to Absolute or relative deficiency of insulin.

What is Diabetes?

• A condition in which the body cannot make or cannot use insulin properly

Diabetes

• A fast growing disease• Diabetes is a major chronic disease affecting

many individuals, for which very high growth rates are expected in the coming years.

• Due to changes in lifestyles more human beings are becoming diabetic patients.

• The number of diabetes cases is increasing day by day.

The Impact of Diabetes:

• Million lives are lost annually• Millions of $ lost income and Productivity.• 1 million amputation per year.• Diabetes kills 1 person in every 8 seconds.• Every 10 seconds, 2 people develop diabetes.

-IDF Bulletin; November 2011.

The diabetes epidemic

The Top 10s (number of people with diabetes)

Why are We Concerned about Diabetes?

Every 24 hours...• 3,600 new cases of diabetes are diagnosed• 580 people die of diabetes-related complications• 225 people have a diabetes-related amputation• 120 people with diabetes progress to end-stage renal

disease• 55 people with diabetes become blind

ADA -2002

INDIAN SCENARIO

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”

Classification of DiabetesType 1 7.6%Type 2 90.6%Others 1.9%

Demographics

Age Groups

0

25

50

<15 15-30 30-45 45-55 55-70 >70

Current Age Distribution

Current Mean Age 53.4 ± 13.0 (n= 2269) Mean Age at Onset of Diabetes 43.6 ± 12.2 (n= 2251)Mean Diabetes Duration 10.0 ± 6.9 (n= 2251)

DiabCare Asia India

Magnitude of the Problem

• Diabetic retinopathy: most common cause of blindness before age 65

• Nephropathy: most common cause of ESRD• Neuropathy: most common cause of non-

traumatic amputations• 2-3 fold increase in cardiovascular disease

Risk Factors for Diabetes Mellitus

• Family history of diabetes (i.e., parent or sibling with type 2 diabetes.• Obesity (BMI > 25 kg/m2) • Physical inactivity • Mental Stress• Race/ethnicity (e.g., African American, Latino, Native American, Asian

American, Pacific Islander) • Previously identified with IFG, IGT, or an A1C of 5.7–6.4% • History of GDM or delivery of baby >4 kg (9 lb) • Hypertension (blood pressure 140/90 mmHg) • HDL cholesterol level <35 mg/dL (0.90 mmol/L) and/or a triglyceride level

>250 mg/dL (2.82 mmol/L) • Polycystic ovary syndrome or acanthosis nigricans • History of cardiovascular disease

More Risk Factors

• Overweight (Abdominal)• Over 45 years old• Sedentary Lifestyle• Non-White Race• Family History of DB• Family History of High BP• History of High BP (self)• High Cholesterol• History of Gestational DB • Delivered a baby > 9 lbs. Goals:

Women < 35Men < 40

Something went wrong……………………

2.5 million years 50 years

Types of Diabetes Mellitus

Type 1 Type 2 Gestational DM

Type 1 Diabetes MellitusType 1 Diabetes Mellitus

• Formerly known as “juvenile onset” or “insulin dependent” diabetes

• Most often occurs in people under 30 years of age, but may occur at any age.

• Peak onset between ages 11 and 13

• Formerly known as “juvenile onset” or “insulin dependent” diabetes

• Most often occurs in people under 30 years of age, but may occur at any age.

• Peak onset between ages 11 and 13

Type 1 Diabetes MellitusEtiology and PathophysiologyType 1 Diabetes Mellitus

Etiology and Pathophysiology

• Progressive destruction of pancreatic cells

• Autoantibodies cause a reduction of 80% to 90% of normal cell function before manifestations occur

• Progressive destruction of pancreatic cells

• Autoantibodies cause a reduction of 80% to 90% of normal cell function before manifestations occur

Type 1 Diabetes MellitusEtiology and PathophysiologyType 1 Diabetes Mellitus

Etiology and Pathophysiology

• Causes:– Genetic predisposition– Exposure to a virus

• Causes:– Genetic predisposition– Exposure to a virus

Type 1 Diabetes MellitusOnset of Disease

Type 1 Diabetes MellitusOnset of Disease

• Manifestations develop when the pancreas can no longer produce insulin– Rapid onset of symptoms– Present at ER with impending or actual

ketoacidosis

• Manifestations develop when the pancreas can no longer produce insulin– Rapid onset of symptoms– Present at ER with impending or actual

ketoacidosis

Type 1 Diabetes MellitusOnset of Disease

Type 1 Diabetes MellitusOnset of Disease

• Weight loss• Polydipsia (excessive thirst)• Polyuria (frequent urination)• Polyphagia (excessive hunger)• Weakness and fatigue• Ketoacidosis

• Weight loss• Polydipsia (excessive thirst)• Polyuria (frequent urination)• Polyphagia (excessive hunger)• Weakness and fatigue• Ketoacidosis

Type 1 Diabetes MellitusOnset of Disease

Type 1 Diabetes MellitusOnset of Disease

• Diabetic ketoacidosis (DKA)– Life-threatening complication of Type 1 DM– Occurs in the absence of insulin– Results in metabolic acidosis

• Diabetic ketoacidosis (DKA)– Life-threatening complication of Type 1 DM– Occurs in the absence of insulin– Results in metabolic acidosis

Type 2 Diabetes MellitusType 2 Diabetes Mellitus

• Formerly known as “adult onset” or “ Non insulin dependent Diabetes”.

• Accounts for >90% of patients with diabetes

• Usually occurs in people over 30 years old

• 80-90% of patients are overweight

• Formerly known as “adult onset” or “ Non insulin dependent Diabetes”.

• Accounts for >90% of patients with diabetes

• Usually occurs in people over 30 years old

• 80-90% of patients are overweight

Obesity

Physical inactivity

Impaired fasting glucose levels

Impaired glucose tolerance (IGT)

• Age

• Race/ethnicity

• Previous gestational diabetes (GDM)• Family history of diabetes

Body fat distribution

Risk Factors for Type 2 Diabetes

Can be modified

What Happens in Type 2 DM

Liver puts too much sugar into the blood

Muscle cells and other tissues areresistant to insulin

Pancreas can’t make enough insulin

Stomach empties 50%faster than normal

Type 2

Diabetes

Type 2 Diabetes MellitusOnset of Disease

Type 2 Diabetes MellitusOnset of Disease

• Gradual onset• Person may go many years with undetected

hyperglycemia• Marked hyperglycemia (27.6 – 55.1 mmol/L)

• Gradual onset• Person may go many years with undetected

hyperglycemia• Marked hyperglycemia (27.6 – 55.1 mmol/L)

Clinical ManifestationsType 2 Diabetes MellitusClinical ManifestationsType 2 Diabetes Mellitus

• Non-specific symptoms• Fatigue• Recurrent infections• Prolonged wound healing• Visual changes

• Non-specific symptoms• Fatigue• Recurrent infections• Prolonged wound healing• Visual changes

Classification of DiabetesType I DM Type II DM

Aetiology Autoimmune (- cell destruction)

Insulin resistance and -cell dysfunction

Peak age 12 years 60 years

Prevalence 0.3% 6% (>10% above 60 years)

Presentation Osmotic symptoms, weight loss (days to weeks), DKAPatient usually slim

Osmotic symptoms, diabetic complications (months to years).Patient usually obese

Treatment Diet and insulin Diet, exercise (weight loss), oral hypoglycemics, Insulin later

Gestational DiabetesGestational Diabetes

• Develops during pregnancy • Detected at 24 to 28 weeks of gestation• Associated with risk for cesarean delivery,

perinatal death, and neonatal complications

• Develops during pregnancy • Detected at 24 to 28 weeks of gestation• Associated with risk for cesarean delivery,

perinatal death, and neonatal complications

Gestational DiabetesGestational Diabetes

• Develops during pregnancy • Detected at 24 to 28 weeks of gestation• Associated with risk for cesarean delivery,

perinatal death, and neonatal complications

• Develops during pregnancy • Detected at 24 to 28 weeks of gestation• Associated with risk for cesarean delivery,

perinatal death, and neonatal complications

Secondary DiabetesSecondary Diabetes

• Results from another medical condition or due to the treatment of a medical condition that causes abnormal blood glucose levels– Cushing syndrome (e.g. steroid administration)

– Hyperthyroidism– Parenteral nutrition

• Results from another medical condition or due to the treatment of a medical condition that causes abnormal blood glucose levels– Cushing syndrome (e.g. steroid administration)

– Hyperthyroidism– Parenteral nutrition

CLINICAL PRESENTATION

If you have any of the followingsymptoms you can be a DIABETIC

Excessive Thirst (POLYDIPSIA)

Excessive Hunger (POLYPHAGIA)

Excessive Urination (POLYUREA)

WEIGHT LOSS

FATIGUE

LIFE STYLE BALANCE INTERVENTION

WEIGHT LOSS GOAL. PHYSICAL ACTIVITY GOAL. DIETARY MODIFICATION.

150 mins / week moderate exercise. Intensity to brisk walking. Minimum 3 times/week. Minimum 10 mins per session. Maximum 75mins per session Evidence based, effective, feasible. Suitable for long term maintenance.

Preferred food choices