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
Introduction:
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.
Treatment.
- 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.
Exercise:
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.
Habits.
- No to alchohol and smoking
- No to passive smoking
- No tobacco in any form
Insulin:
- 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
Complications:
- 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.
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