1. Diabetes and You Vidya Sundaram, MD

2. Diabetes in Asian Indians The prevalence of diabetes in rural India is 2 percent The prevalence of diabetes in rural India is 2 percent In urban India, the prevalence is 8 percent In urban India, the prevalence is 8 percent In Indians migrating to westernised countries the prevalence is 4 times more than those living in India In Indians migrating to westernised countries the prevalence is 4 times more than those living in India Indian Americans have higher risk than Americans of European descent Indian Americans have higher risk than Americans of European descent

3. Diabetes in Asian Indians Some of the reasons for increased risk of Diabetes are: Some of the reasons for increased risk of Diabetes are: Genetic predisposition Genetic predisposition Increased caloric intake Increased caloric intake Higher intake of processed carbohydrates, reduced fiber, increased animal fat intake Higher intake of processed carbohydrates, reduced fiber, increased animal fat intake Abdominal obesity and insulin resistance Abdominal obesity and insulin resistance Sedentary lifestyle Sedentary lifestyle

4. Diabetes in Asian Indians 32 million Indians with diabetes 32 million Indians with diabetes This number is expected to double in the next 30 years This number is expected to double in the next 30 years

5. What is Diabetes Your body is not able to use properly the energy from the food you eat because either: The body makes very little or no insulin i.e. Type I Diabetes Or, the cells are not responding to the insulin, called insulin resistance. This occurs in Type 2 Diabetes. Over time, insulin production decrease in Type 2 Diabetes

6. What is Diabetes In both types of diabetes, sugar builds up in the blood stream because it cannot enter the cells Without sugar for fuel in the cells, the body lacks energy High blood sugar levels, damage over time, your blood vessels, leading to serious complications

7. Diagnosis of Diabetes Two fasting blood sugars equal to, or greater than 126 mg/dL Any random blood sugar greater than 200 On oral glucose tolerance test, if blood sugar is equal or greater than 200 mg/dL

8. Prediabetes Fasting blood sugar between 101 to 126 mg/dL On oral glucose tolerance test, if the blood sugar at 2 hours is between 141 to 199 mg/dL

9. Symptoms of Diabetes Increased thirst Increased frequency of urination Increased fluid intake Weight loss Blurred vision Numbness and tingling in hands and feet Frequent infections Delayed wound healing

10. Diabetes complications Nerve damage: neuropathy Retinal bleeds, vision loss: retinopathy Kidney damage, kidney failure: nephropathy 4 to 5 times increased risk for heart attacks and strokes Foot ulcers, amputations Sexual dysfunction

11. Management of Diabetes Lifestyle changes Diet Exercise Weight loss Medications

12. Grains Vegetables Fruits Milk Meat & Beans

13. Vegetarian food pyramid

14. Vegetarian diet 5 to 9 servings of cereals/grains or potatoes 2 or 3 servings of pulses, nuts & seeds 4 or 5 servings of fruit and vegetables Some yeast extract fortified with vitamin B12. A small amount of vegetable oil and margarine or butter. 2 to 3 servings of milk, cheese, eggs or soy products

15. Diet 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

16. Management of Diabetes: Exercise Brisk walking for 30min to 1 hour most days of the week Check with your physician before starting an exercise program Exercise lowers blood sugars

17. Management of Diabetes: Weight loss Normal Body mass index (BMI) between 18-24 Overweight if BMI greater than 25 Obese: if BMI more than 29 Moderate to severe obesity: BMI 30-39 Morbid obesity: BMI 40 or above

18. Management of Diabetes: Weight loss If overweight : aim to lose atleast 10 percent of body weight This will help control diabetes, and lower cardiovascular risk

19. The numbers game Normal blood sugar : 70 – 100mg/dL Goals for Diabetes: fasting blood sugar between 80-120mg/dL 2 Hours after a meal: less than 160mg/dL, ideally less than 140

20. The numbers game: HbA1C HbA1c goals: less than 7% Uncontrolled Diabetes: if HbA1c greater than 8%

21. The numbers game: Blood pressure Goal: Less than 130/80 mm Hg If kidney disese is present, blood pressure should be less than 125/80

22. The numbers game: Lipids Total cholesterol less than 200mg/dL LDL cholesterol less than 100 mg/DL, preferably less than 70 Triglycerides less than 150mg/dL HDL cholesterol greater than 40mg/dL for men greater than 50mg/dL for women

23. Medicines in Diabetes Increase insulin production: ie glipizide, glimeperide, nateglinide, Prandin Insulin sensitizers: Metformin, Avandia, Actos Prolong action of Insulin: DPP4 inhibitors eg Januvia, Byetta injections (GLP-1)‏ Symlin injections: decreases glucagon and delays gastric emptying Insulin

24. INSULIN Most people with Type 2 diabetes will eventually need insulin Type I diabetics need insulin from the beginning

25. Summary Diabetes is: Diabetes is: Common Common Controllable Controllable Lifelong Lifelong Self Managed Self Managed Progressive Progressive