Diagnosis and Treatment of Diabetes

Synopsis of today's programme.
Subject: Diagnosis and Treatment of Diabetes.
Date: 31.08.2019
Venue: Jayabharat Sabhagruha, Bhubaneswar
Chief Guest: Dr M M Padhi, Retd Dy Director General, Ministry of AYUSH
Chief Speakers: Dr K P Dash, MD, DFID
Dr Aurobindo Dhali, Ex Minister & MLA
Sri Sajjan Sharma
Sri Jagannath Chatterjee
Conclusion: Dr Pravas Tripathy, Associate Professor, AIIMS, Bhubaneswar

Sri Sajjan Sharma welcomed all participants on behalf of Maa Janaki Swathya Mission. He invited the dignitaries to the dias.

Sri Jagannath Chatterjee introduced Dr K P Dash and spoke on the aims and objectives of MJSM and the activities the Trust is going to take up in the future. He reiterated that MJSM intends to guide and counsel patients and bring together doctors from all treatment modalities so as to offer a system of integrated medicine to the public of Odisha. He then invited Dr K P Dash to take forward the discussion.

Dr M M Padhi pointed out that this session was only the first session on diabetes. Future sessions would take up nutrition, lifestyle, and treatment options with ayurveda, homeopathy, naturopathy and yoga.

Dr K P Dash began by stating that diabetes is the fastest growing disease today. There are 93 million diabetics in India with 67 lakhs in Odisha, the district of Khurda having the highest incidence. States like Punjab, Kerala, and Tamil Nadu are leading and Odisha is the 5th in the list.

What is diabetes?
Cells need glucose. But when they are unable to absorb it and the glucose remains in the blood it results in high blood sugar.

Diabetes needs a multi pronged approach. The pancreatic beta and alpha cells, liver, kidney, stomach hormones, brain and fat cells are involved with diabetes and play a role in glucose metabolism. Diabetes results in disruption in all of these sectors and more.

He said changing lifestyle, diet, exercise and stress reduction is key to control diabetes.

There are 8 types of diabetes that affect children, young people, pregnant women, and the elderly. Type 1 diabetes (insulin dependent) is being seen in children because of genetic and environmental factors. Type 2 diabetes is due to reduction of beta cell numbers and insulin is unable to push glucose into cells. This is caused due to genetics and being overweight.

Gestational diabetes affects pregnant women in the period 24 to 28 weeks. This can affect both mother and child. It can result in still birth and large size babies.

There is a Type 1 and 1/2 diabetes that affects young and old people and is called late autoimmune diabetes. People between 32 and 60 years are affected.

There is pancreatic diabetes that occurs due to calcium deposit in pancreas or due to cystic fibrosis in pancreas.

Hyperthyrodism can lead to diabetes. Many drugs used in treating epilepsy, psychiatric disorders, hypothyroidism etc can cause diabetes. Steroids can also cause diabetes.

Besides these mumps infection, rubella and cytomegalivirus infection can also cause diabetes.

Then he talked on diagnosis of diabetes. He said diabetes is like an iceberg. Only the tip is visible. Therefore many people do not realize they have diabetes.

The classical symptoms of diabetes are excessive urination, excessive hunger, weight loss despite eating well, chronic weakness and fatigue, eyesight problems and repeated urinary tract infections particularly in women. Diabetics also suffer from fungal infections particularly in folds of the body.

A measurement of more than 125, 8 to 10 hours after food, and more than 199 two hours after food is considered to be diabetes. Recently the WHO has revised the parameters but investigations have found that it is better to stick to the current parameters. After medication the measurement of 100 after fasting and 140 after food are considered normal. People in the range of 100 to 125 after fast and 140 to 199 after food are considered pre diabetic.

An apple shaped body with protruding stomach  indicates possibility of diabetes. Low HDL and high BP also may indicate presence of diabetes. People with metabolic syndrome must check themselves for diabetes.

Besides usual tests there are also other specialized tests that can check whether diabetes is well controlled or whether it is affecting other organs and the nervous system. People can also test themselves using glucometers at home.

Overweight people, people whose close relatives have diabetes or have suffered heart attacks in early age should also get themselves checked. Those suffering from polycystic ovary syndrome should also get themselves checked.

Insulin resistance features are usually black marks in the body, high lipid profile. Children with both low and high birth weight can be diabetic.

Pre diabetics should check their blood sugar every year. Women who have suffered diabetes during pregnancy should check themselves once every three years. Elderly need to be checked both for low and high blood sugar levels. Variations in levels of blood sugar is not a good sign.

People with diabetics must be careful about retinopathy, kidney function and foot ulcers. Foot care is very important as foot ulcers can lead to gangrene and amputation of foot. Doctors must check patients for retinopathy and nervous response, numbness, pain, burning sensations in every visit. The instruments to check are easily available and must be kept in the clinic. Creatinine and urea tests must be carried out in case of suspicion of kidney involvement.

Patients must never take over the counter medicine. There are many types of medication for many types of diabetes. Metformin is for overweight people while Sulphonylurea group is for underweight people.

Urine micro albumin test can point out kidney involvement very early before the damage has taken place. Cholesterol test, ultra sound of stomach, endoscopy tests can be suggested if required. Diabetics with gastric ulcer may develop cancers which need to be detected early. Triglyceride level should be less than 150. Swelling of the legs can point out anaemia, liver problems, kidney and heart problems.

Foot care is very important. Always use comfortable slippers one size more than required. Upper part of the footware must be soft. Never use tight shoes. Never move outside in bare foot. Check with a mirror for cracks in feet. In case of pain dip feet in warm salt water for relief. Use soft cream for cracks.

- Lifestyle modification
- Nutrition, diet control
- Exercise
- Stress control

Nutrition - no fasting. No feasting. Do not eat till full stomach. Don't go for morning walk in empty stomach. Eat a few biscuits at least.

Eat six times a day. 3 big meals, 3 small meals. 50% of your diet should be green vegetables. Eating raw vegetables is very good. Control use of oil. Never go in for cheap brands. Use healthy oils that are not refined. Women of the house must not use more than 1/2 liter of oil per person per month.

25% of the diet must be cereals. 15% should be protein. Eat fibrous food. Go for pulses with skin.

Avoid all kinds of sweets. No white sugar. If you want you can take little of good jaggery but quantity must be less. No artificial sweeteners.

You can take all types of fruits but in moderation. At one time you can take 80 to 100 grams of fruits.

Body weight.
Reduce your weight if you are overweight. If you are obese reduce obesity.

Walking is best. Walk for one hour in the morning after day break. If you can walk briskly you can walk for 30 to 40 minutes. Do not go out before sunrise. Do not go out alone. You can also do evening walk. Warm up 5 to 10 minutes, intense exercise 10 to 20 minutes, cool down 5 to 10 minutes. Increase your exercise gradually. Know your limits. Elderly must be careful not to increase heart beat rate. Exercise can be of three types; muscle strengthening, aerobic and stretching. Choose as you like. Walking is best.

- No to alchohol and smoking
- No to passive smoking
- No tobacco in any form

- Don't be afraid of insulin
- Don't think insulin cannot be stopped
- Take insulin around navel
- In a diameter around navel select 12 spots and maintain the routine
- Take in fat, not in skin or muscle
- Not in inner thighs because blood vessels are there
- Now there are various types of insulin
- You can take pen type or syringe
- Do not store insulin in deep fridge

- Peripheral neuropathy
- Nocturnal pains
- Numbness
- Burning
- Ulcers leading to gangrene
- Kidney damage
- Retinopathy, retinal detachment
- Proximal neuropathy

Other precautions:
- Keep BP within 130/80
- Lipid control
- Vitamins like ALA, Benpho thiamine
- Be careful about type of BP medicine being given to you. Check with your doctor
- For BP control there is DASH diet. Check in internet
- Be careful about NSAID drugs like Fenac and Brufen
- Diabetes can lead to TB, pneumonia and increased risk for infection, and also dental infections
- Always keep chocolate with you. Take if blood sugar suddenly drops. You can know if you are shivering and feel sudden loss of strength

He then informed about new innovations in diabetes treatment.

Dr Aurobindo Dhali.
Dr Dhali talked about how he controls diabetes. He has been suffering for 35 years but has not developed any complications because he is careful about diet, plays badminton regularly, and avoids stress. ( Dr Dhali is a follower of the Brahma Kumari Institution and he must be doing meditation regularly).

He said diabetics must always maintain a positive attitude and be jolly always.

He said diabetes can be a blessing because it forces us to regulate our lifestyle, habits, diet, and exercise.

He said he takes chapatis and plenty of green vegetables. He does not have any intoxicating habits.

Concluding remarks by Dr Pravas Tripathy.

He said there are three types of care; Doctor care, Nursing care, and Home care. But if the rate of the disease increases 10% and becomes and epidemic social awareness and campaigns become necessary.

He thanked all the participants for their patience.

Dr M M Padhi also thanked the participants and informed that instead of last Saturday, the monthly programmes would be held on 4th Saturdays. In the next programme nutrition and diet for diabetics would be discussed. He requested all to regularly attend the programmes.