|
 |
 |
|
What is a Diabetes Mellitus?
What is a Diabetes Mellitus?
Diabetes is an illness which occurs as a result of problems with the production and supply of insulin in the body. Most of the food we eat is turned into glucose, a form of sugar. We use glucose as a source of energy to provide power for our muscles and other tissues. Our bodies transport glucose in our blood. In order for our muscles and other tissues to absorb glucose from our blood, we need a hormone called insulin. Without insulin, our bodies cannot obtain the necessary energy from our food.
Insulin is made in a large gland behind the stomach called the pancreas. It is released by cells called beta cells. When a person has diabetes, either their pancreas does not produce insulin they need or their body cannot use its own insulin effectively.
As a result, people diabetes cannot use enough of the glucose in the food they eat. This leads to increase in the amount of glucose in the blood. This high level of glucose or "high blood sugar" is called hyperglycemia. High levels of glucose in the blood can lead to serious complications.
The word Diabetes in Greek means “to pass through or to flow through” and Mellitus means “sweet”. This is an exact description of what is happening in the body: i.e. a fluid (urine) containing sugar passes through the kidneys (glycosuria).
OR
Diabetes is a disorder of carbohydrates, proteins and fat metabolism. There is an excess of glucose in the blood due to ineffective utilization by the body.
The hormone “Insulin” (secreted by the Beta-Cells of the islets of Langerhans in the pancreas) helps in the entry of glucose in most of the body’s cells, especially those of the muscles, liver and fat. Insulin acts like a “Key” that unlocks the “Doors” to the cells and allows glucose (the body fuel) to enter these cells. Insulin also helps in the regulation of fat metabolism and the stimulation of amino acid uptake by the cells. Insulin promotes the storage of excess glucose as glycogen in the liver and muscles tissue, which is used as a source of energy in emergencies.
OR
When there is too little insulin formed or the insulin formed is unable to act properly, there results an inadequate utilization of glucose leading to elevated blood glucose levels. This elevated blood glucose is the primary effect and the spilling of glucose into the urine is a secondary effect. Furthermore, it is also responsible for a number of complications if untreated, like heart and kidney diseases, increased risk of stroke and may also result in blindness, besides others.
|
Who gets diabetes?
Who gets diabetes?
Anyone, anywhere, at any age can develop diabetes.
Many adults have had diabetes for several years before their symptoms are recognised. By the time they are diagnosed, a great many have already started to develop the complications of diabetes - visual impairment, kidney failure, heart disease, stroke and nerve damage. In many parts of the world, people with diabetes are not diagnosed at all.
Spotting diabetes early means that it can be treated and the risk of serious complications can be greatly reduced. A number of factors contribute to the likelihood of someone developing diabetes.
Risk factors for Type 1 diabetes: |
 |
Age - 90-95% of people with diabetes have type 2 diabetes. This type usually occurs in people over the age of 40, but is now also affecting children and adolescents to a greater extent. The older you are, the greater your risk of diabetes.
|
Risk factors for Type 2 diabetes:
|
|
Obesity - Over 80 per cent of people with type 2 diabetes are overweight. The more overweight you are, the greater is your risk of getting diabetes.
|
|
Family history of diabetes - Research has shown that people are more at risk if there is a history of diabetes in close family members. The closer the relative, the greater is your risk of diabetes.
|
|
Physical inactivity - Research has shown that people who do not lead an active life are more at risk of developing type 2 diabetes. The less exercise you do, the greater your chances of developing diabetes.
|
|
Race/ethnicity - As far as we know, race and ethnicity are important in determining the possibility of a person developing diabetes. Little research, however, has been undertaken outside of the United States. Within that population, African-Americans, Hispanic Americans, Native Americans, Asian-Americans and Pacific Islanders are more likely to have diabetes.
|
|
Diabetes during pregnancy - Some women develop a temporary type of diabetes called 'gestational diabetes' when they are pregnant. Gestational diabetes develops in 2-5% of all pregnancies, but usually disappears when the pregnancy is over. However, women who have had gestational diabetes or who have given birth to a large baby (4kg or greater) are at a greater risk of developing type 2 diabetes, at a later stage in their lives.
|
|
Impaired
Glucose Tolerance
(IGT)A
healthy person’s
blood sugar
is usually
between
70 and 110
mg/dL (milligrams
of
glucose in
100 millilitres
of
blood) or,
in millimols,
between
3.9 and 6.0
mmol/L. Impaired
glucose
tolerance is
a level of
blood glucose
which
is higher than
normal, but
not high enough
to
be in the range
where doctors
classify this
as diabetes. |
What
are the different types of diabetes?
What are the different types of diabetes?
There
are different types
of diabetes:
|
|
Type
1 Diabetes
|
|
Type
2 Diabetes
|
|
Gestational
Diabetes (GDM)
|
Type
2 (commonest form
of diabetes)
|
Type
2 diabetes is sometimes
called non-insulin
dependent diabetes
or adult-onset
diabetes. People
with type 2 diabetes
do not usually
require injections
of insulin. Usually
they can control
the glucose in
their blood by
watching their
diet, taking regular
exercise, oral
medication, and
possibly insulin.
Type 2 diabetes is
most common in people
older than 45, who
are overweight. However,
as a consequence
of increased obesity
among the young,
it is becoming more
common in children
and young adults.
Type 2 diabetes is
the most common type
of diabetes and accounts
for 90-95% of all
diabetes.
If people
with type 2
diabetes are
not diagnosed
and treated,
they can develop
serious complications,
which can result
in an early
death. Worldwide,
millions of
people have
type 2 diabetes
without even
knowing it.
Others do not
have access
to adequate
medical care.
The onset of
type 2 diabetes
is also linked
to genetic
factors but
obesity, physical
inactivity
and unhealthy
diet increase
the risks.
Type 2 diabetes
develops when
the body can
still make
some insulin,
but not enough,
or when the
insulin that
is produced
does not work
properly (known
as insulin
resistant).
In most cases,
this is linked
with being
overweight.
|
It
generally occurs
in adults:
|
|
Specially
common in overweight
people |
|
Your
cells cannot use
the insulin your
body makes |
|
Insulin
produced is insufficient |
|
Can
be controlled with
diet and exercise |
|
Sometimes
insulin is necessary |
What
should we do to know if we have type 2 diabetes?
What should we do to know if we have type 2
diabetes?
Type 2 diabetes is the
most common form of diabetes. If you have just been diagnosed
with type 2 diabetes, don't panic. Although the disease is serious
and at present incurable, with access to the proper medicines,
quality care and accurate information, a person with diabetes
can live a long, healthy and happy life.
Learn as much as you can about your diabetes. The more you
learn, the less fear
you will have. You might have a hard time believing and accepting
that you or a family member has type
2 diabetes. Feeling
scared, shocked, angry or overwhelmed are normal and most people
feel these emotions when they first
find out they have
diabetes.
Sometimes,
healthy habits like eating well, losing weight and exercising
are not enough. In that case, you may need to take diabetes
pills or insulin shots.
Diabetes pills: There are several types of diabetes pills.
Your healthcare professional will tell you what kind of
pills to take and how often. Taking pills, however, does
not replace the need to live a healthy lifestyle.
Insulin shots: Insulin
helps your cells take in blood glucose and thus reduce the
amount of glucose in your blood.
How
do you monitor your blood glucose?
How do you monitor your blood glucose?
If you can, you should
obtain a glucometer so that you can check your glucose levels
regularly. A glucometer is a machine that checks the level of
glucose in a small drop of blood from your finger. The drop is
placed on a blood glucose strip. Talk to a healthcare professional
about the various machines available and which one is right for
you. When you decide, make sure you receive the proper training.
| Ask
your healthcare provider
about: |
|
The
type of blood glucose
strips to use
|
|
How
to clean your glucometer
|
|
How
to check whether
your meter is accurate |
Write
down each result,
along with the time
and date. This way,
you will soon learn
how well your treatment
plan is working,
and you will learn
how exercise and
food affect you. |
If you would
like to use your
computer rather
than write everything
down in a notebook,
there are a number
of good software
packages in the
market. Remember,
the more you
know about your
body and your
illness the more
you’ll
know about how
to take care
of yourself.
|
|
Blood
testing is a quick
measurement of
your blood glucose
level
at any point in time |
|
Blood
testing shows how
your blood glucose
levels are affected
by your food intake,
insulin, stress
levels, illness
and physical
activity |
|
Blood
testing is a quick
method to identify
high and low blood
glucose levels |
|
Blood
testing will help
you, your doctor
and diabetes healthcare
team to make the
necessary changes
in insulin, meal
planning or exercise
to achieve good
blood glucose control |
High blood glucose
High blood glucose (hyperglycaemia)
can result when food, activity and insulin are not balanced. It
can also occur when you are sick, pregnant or under stress.
What is Type 1 Diabetes?
What is Type 1 Diabetes?
Type 1 diabetes is sometimes
called insulin-dependent,
immune-mediated or juvenile-onset diabetes. It is caused by an
auto-immune reaction where the body’s
defence system attacks
the insulin-producing cells. The reason why this occurs is not
fully understood. People with type 1 diabetes
produce very little
or no insulin. The disease can affect people of any age, but
usually occurs in children or young adults. People
with this form of
diabetes need injections of insulin every day in order to control
the levels of glucose in their blood. If
people with type
1 diabetes do not have access to insulin, they die.
| This
type of diabetes
generally occurs
in children and
young adults: |
|
Here,
pancreas is
not able to
produce enough
insulin
|
|
Insulin
is the only
treatment for
them
|
|
Tablets
don’t work
here!! |
What should we know if we have type 1 diabetes?
What should we know if we have type 1 diabetes?
If you have just been diagnosed with
type 1 diabetes, don't panic. At present, although the disease
is serious and incurable, access to the proper medicines, quality
care and accurate information can help you live a long, healthy
and happy life.
People usually find out they have this type of diabetes before
the age of 30, most often in childhood or during their teens.
If you have it, it is time for you to take your disease seriously
and find out as much information as possible so that you can
make informed decisions about your life.
You might have a hard time believing and accepting that you
or a family member has type 1 diabetes. Feeling scared, shocked,
angry or overwhelmed are normal and most people feel these
emotions when they first find out they have diabetes.
What
can you do to feel better?
What
can you do to feel better?
|
Share
your feelings
with your family
and friends.
Tell them what
you need from
them to help
you manage your
diabetes well. |
|
Don’t
worry, just
because you
have diabetes
does not necessarily
mean that you
have to stop
doing things
you and your
family enjoy. |
How
do you take care of your
diabetes?
How
do you take care of your
diabetes?
The problem in diabetes is too much
glucose in the blood. Therefore, the goal of treatment is to
lower glucose levels through medication in the form of insulin,
a healthy diet and exercise.
Monitoring your blood sugar
Blood testing is
a quick measurement of your blood glucose level at any point
in time. It shows how your blood glucose levels are affected
by your food intake, insulin, stress levels, illness and
physical activity. Blood testing is a quick method to identify
high and low blood glucose levels.
If you can, you should obtain a glucometer so that you can
check your glucose levels regularly. A glucometer is a machine
that checks the level of glucose in a small drop of blood from
your finger. The drop is placed on a blood glucose strip. Talk
to a healthcare professional about the various machines available,
and which one is right for you. When you decide, make sure
you receive the proper training.
| Ask
your healthcare
provider about: |
|
The
type of blood
glucose strips
to use |
|
How
to clean your
glucometer |
|
How
to check whether
your meter is
accurate |
Most people with type 1 diabetes do
best by measuring the sugar
in their blood at least four times a day. Write down each result,
along with the time and date. This
way, you will soon learn
how well your treatment plan is working, and you will learn
how exercise and food affect you. If you would
like to use your computer
rather than write everything down in a notebook, there are a
number of good software packages in the
market. Remember, the more
you know about your body and your illness, the more you’ll
know about how to take care of yourself. Blood testing will
help you, your doctor and diabetes healthcare
team to make the necessary
changes in insulin treatment, meal planning or exercise to achieve
good blood glucose control.
High blood glucose:
High blood glucose (hyperglycaemia)
can result when food,
activity and insulin are not balanced. It can also occur when
you are sick, pregnant or under stress.
| The
signs of high blood
glucose are: |
|
Feeling
thirsty |
|
Urinating
often |
|
Feeling
tired |
|
Sweating |
If you think your blood glucose is high, check your blood glucose
levels. If you have type 1 diabetes, test your urine for ketones.
Seek medical advice immediately if ketones are present.
Low blood glucose:
A low blood glucose level
(hypoglycaemia) can occur when your blood glucose drops below
the normal range (usually less than 70 mg/dL or 4 mmol/L).
Hypoglycaemia occurs in
type 1 diabetes or insulin-treated type 2 diabetes when blood
sugar levels drop below the normal range. It can be caused by:
|
Taking
too much insulin |
|
Not
eating enough food |
|
Missing
or delaying a meal |
|
Changing
the amount of exercise
you do |
|
Drinking
alcohol without eating |
Low blood glucose can happen quickly, it is important to identify
the symptoms. Make a mental
note of the symptoms you are feeling. This will help you to
identify low blood glucose in the future.
Common feelings are the following:
|
Feeling
hungry |
|
Feeling
shaky or light-headed |
|
Feeling
nervous, irritable or
confused |
|
Feeling
weak |
|
Feeling
your heart beating at
a faster rate |
|
Feeling
a numbness or tingling
in your tongue or lips |
|
Feeling
unusually sleepy |
|
Being
sweaty |
|
Having
a headache |
But remember - some people do not have early warning signs
of hypoglycaemia. These individuals must check their blood glucose
levels more often to avoid this condition.
It is especially important
for all people with diabetes to check their blood glucose levels
before driving a car.
When you think your blood
sugar is low, check it if you can.
| In
short, symptoms of Type
1 diabetes include: |
|
Increased
hunger and thirst |
|
Increased
urination |
|
Sudden
weight loss |
|
Feeling
tired |
|
Frequent
infections |
|
Slow
healing of cuts or sores |
|
Numbness
or tingling in hands
or feet |
|
Blurred
vision |
|
Dry,
itchy skin |
In both types of diabetes, sugar stays in your blood, resulting
in high blood sugar levels.
In both types of diabetes,
the symptoms are quickly
relieved once the diabetes is treated.
What
is Gestational Diabetes
Mellitus (GDM)?
What
is Gestational Diabetes Mellitus
(GDM)?
What
are the causes and risk
factors for diabetic disease?
What
are the causes and risk factors
for diabetic disease?
| The
risk factors |
|
You
being Indian (South
Asian) is itself a
risk factor |
|
A
close member of your
family has diabetes
(parent or brother
or sister) |
|
Body
mass index more than
23 |
|
You
are overweight or if
your waist is 80 inches
or over for women |
|
Habitual
physical inactivity |
|
You’ve
been told you have
impaired glucose tolerance |
|
If
you’re a woman
and you’ve had
gestational diabetes |
|
If
you’re over 30 |
What
are the complications from diabetes?
What are the complications from diabetes?
Diabetes is a chronic, life-long
condition that requires careful control. Without proper management
it can lead to various complications
such as cardiovascular disease,
kidney failure, blindness and nerve damage.
|
|
What
are the short-term complications
of diabetes?
What are the
short-term complications of
diabetes?
| Cost
of Ignorance! |
|
Low
blood sugar (hypoglycaemia): A person who takes
insulin is going to
face the
problem of their blood
sugar falling too low
at some point (because
they have overestimated
the insulin they need,
have exercised more
than anticipated or
have not
eaten enough). Hypoglycaemia
can be corrected rapidly
by eating some sugar.
If it is not corrected
it can lead to the
person losing consciousness.
It is important that
the person with diabetes
recognises the signs
of hypoglycaemia. |
|
Ketoacidosis: When the body breaks
down fats, acidic waste
products called ketones
are produced. The body
cannot tolerate large
amounts of ketones
and will try to get
rid of
them through the urine.
However, the body cannot
release all the ketones
and they build up in
your blood, causing
ketoacidosis. Ketoacidosis
is a severe
condition caused by
lack of insulin. It
mainly
affects people with
type 1 diabetes. |
|
Lactic
acidosis: Lactic acidosis
is the build up of
lactic acid in the
body. Cells
make lactic acid when
they use glucose for
energy. If too much
lactic acid stays in
the body,
the balance tips and
the person begins to
feel ill. Lactic acidosis
is rare and mainly
affects people with
type 2 diabetes. |
|
Bacterial/fungal
infections: People with
diabetes are more prone
to bacterial and fungal
infections. Bacterial
infections include sties
and boils. Fungal infections
include athlete’s
foot, ringworm and vaginal
infections. |
|
|
What
are the long-term complications
of diabetes?
What are
the long-term complications of
diabetes?
Eye
Disease (Retinopathy)
Eye disease or retinopathy,
is the leading cause of blindness
and visual impairment in adults
in developed societies. About
2% of people who have had diabetes
for 15 years become blind,
while about 10% develop a severe
visual impairment.
In diabetes, eyes are
often damaged before even
the symptoms are felt.
It is therefore important
for every individual to
visit an eye specialist.
Diabetes can affect the
eyes in many ways:
|
Retinopathy
|
|
Cataract
|
|
Glaucoma
|
Early intervention reduces
risk of blindness. You can
protect your eyes by,
|
Having an eye exam
once a year
|
|
Controlling
blood sugar and blood
pressure
|
|
Not
smoking
|
|
Telling
your doctor about any
eye trouble |
Heart
Problems (Diseases of the
circulatory system)
Disease of the circulatory
system, or cardiovascular
disease, accounts for 75%
of all deaths among people
with diabetes of European
origin. In USA, coronary
heart disease is present
in between 8-20% of people
with diabetes over 45 years
of age. Their risk of heart
disease is 2-4 times higher
than those who do not have
diabetes. It is the main
cause of disability and
death for people with type
2 diabetes in industrialized
countries.
People with diabetes are
considered to be at high
risk for heart disease.
At times, large vessels
become blocked and this
process is termed as atherosclerosis.
In such a condition, the
heart has to work much
harder to pump the blood
through these clogged vessels
which leads to heart attack,
stroke, high blood pressure
and poor circulation to
the arms, legs and brain.
How
to protect your heart:
|
|
Control your blood
pressure and cholesterol
to minimize damage
to various organs
|
|
Exercise,
follow a healthy
diet and stop smoking
(if you are smoker)
|
|
Taking
Statins, aspirin and
certain group of BP
medication lowers the
risk of heart diseases
besides controlling
sugar |
|
Check
these levels frequently,
as per your doctor’s
advice |
TARGETS
|
Your
Goal
|
Systolic
Blood Pressure |
less
than 130 or lower
|
Diastolic
Blood Pressure |
less
than 80 |
LDL
cholesterol |
less
than 100 mg/dl or lower |
HDL
cholesterol (men) |
more
than 40 mg/dl |
HDL
cholesterol (women) |
more
than 50 mg/dl |
Triglycerides |
less
than 150 mg/dl or lower |
Kidney Disease
(Nephropathy)
Diabetes is the leading
cause of kidney disease
(nephropathy). About one
third of all people with
diabetes develop kidney
disease and approximately
20% of people with type
1 diabetes develop kidney
failure.
People with diabetes are
considered to be at high
risk of kidney problems
also. This is due to the
damage of the small blood
vessels (microangiopathy)
and the filtering units
(nephrons). At the time
of diagnosis of diabetes
(particularly type 2),
the renal functions like
blood urea, serum creatinine
and micro albuminuria should
be evaluated.
How to protect your kidney:
|
Have
strict control on
blood pressure and
sugar
|
|
Screen
for protein in urine
|
|
Screen
for (protein in urine)
Microalbuminuria on
annual basis |
|
Certain
medication like ACE
inhibitors and Angiotensin
receptor blocker are
groups of medication
that prevent and delay
the progression of
disease even if BP
is normal |
Nerve
Disease (Neuropathy)
Diabetic nerve disease
or neuropathy affects at
least half of all people
with diabetes. There are
different types of nerve
diseases which can result
in a loss of sensation
in the feet or in some
cases the hands, pain in
the foot and problems with
the functioning of different
parts of the body including
the heart, the eye, the
stomach, the bladder and
the penis. A lack of sensation
in the feet can lead to
people with diabetes injuring
their feet without realizing
it. These injuries can
lead to ulcers and possibly
amputation.
It is the most common problem
seen with long duration
or poor control of diabetes.
Diabetes can lead to foot
ulcers and amputation.
Your chances of having
it are high if you have:
|
|
What
is the treatment for diabetes?
What is the
treatment for diabetes?
Today,
there is no cure for diabetes,
but effective treatment exists.
If you have access to the appropriate
medication, quality of care
and good medical advice, you
should be able to lead an active
and healthy life and reduce
the risk of developing complications.
Good diabetes control means
keeping your blood sugar
levels as close to normal
as possible. This can be
achieved by a combination
of the following:
Controlled diet
Food raises blood sugar levels.
People with diabetes have the
same nutritional needs as anyone
else, that is to say, a well-balanced
diet.
Physical exercise
Exercise lowers blood sugar.
Like insulin, it also helps
your body use its blood sugar
efficiently. It may also help
insulin work more effectively.
Exercise will also help you
to lose weight.
Medication
Insulin lowers blood sugar
levels. People with type 1
diabetes require multiple daily
insulin injections for survival.
People with type 2 diabetes
may require oral hypoglycaemic
drugs to lower their blood
sugar and some may need insulin
injections at some point.
It is important to achieve
the right balance of the
above elements. Too much
or too little of either can
impact how you feel. Achieving
this balance is a life-long
commitment on the part of
the person with diabetes.
Take care of the following:
Only diet therapy gives
control in the early stages
of the disease but diet is
always the first step for
diabetes management.
Although diabetes cannot
be cured, it can be treated
very successfully.
The main aim of treatment
of both types of diabetes
is to achieve blood glucose,
blood pressure and cholesterol
levels as near to normal
as possible. This, together
with a healthy lifestyle,
will help improve well-being
and protect against long-term
damage to the eyes, kidneys,
nerves, heart and major arteries.
You are sure to have lots
of questions about your diet.
A regular review will help
you for better and more choices.
Myth
- People with diabetes
should eat special
diabetic foods
|
|
Diabetic
versions of foods offer
no special benefit. |
|
They
still raise blood glucose
levels, contain just
as much fat and calories,
are usually more expensive
and can also have a laxative
effect. |
|
Healthy
diet for people with
diabetes is the same
as that recommended
for everyone – low
in fat, salt and sugar,
with meals including
starchy foods like
bread and pasta and
plenty
of fruit and vegetables. |
Diabetes Management Tool
2: Exercise
Being active is good for
all of us but is especially
important for people with
diabetes. It helps you to
achieve ideal body weight.
It revives our metabolic
system.
Physical activity combined
with healthy eating and medication
that you may be taking will
help you to manage your diabetes
and prevent long term complications.
Exercise is good for everyone
and is an important tool
in managing your diabetes.
It can be just as useful
as diabetes medicine or planning
your diet. Most people with
diabetes who exercise regularly
require less medication.
Exercise and Type 2 Diabetes
Type 2 Diabetes can be treated
with diet and exercise
alone, or with medicine
or insulin. People with
Type 2 Diabetes may be
overweight. Weight loss
and regular exercise may
reduce the blood sugar,
need for medicine and enable
your body to use insulin
better.
|
|
Why
is regular exercise good for
a person with diabetes?
Why is regular
exercise good for a person with
diabetes?
|
Improves
blood sugar level |
|
Improves
weight control |
|
Increases
a sense of well being |
|
Increases
your body’s sensitivity
to insulin |
| Note:
Exercise is only a therapy
which gives some control
in the early stage of
the disease and we would
still require medicine
for optimal control. |
Exercise:
Do’s & Don’ts
Do’s |
|
Always
consult your doctor before
starting your exercise
routine |
|
Start
gradually but regularly |
|
Exercise
at the same time everyday |
|
Participate
in active sports like
jogging, swimming, etc. |
|
Keep
sugar or something sweet
handy to avoid low blood
sugar levels |
|
Always
have someone around who
can detect symptoms of
hypoglycemia |
| Don’ts |
|
Do
not exercise on an empty
stomach |
|
Avoid
exercise soon after injecting
insulin |
|
Consult
doctor if your blood
sugar values are very
high |
Monitoring Your Health
Monitoring your health when
you have Diabetes is crucial
to preventing some of the
complications associated
with Diabetes. This involves
your regular blood checks.
Structured Education
Living with diabetes becomes
a lifelong process. Regular
sessions will make life
easy and colourful without
many hassles. We do have
regular sessions by experts
to manage your diabetes
better by providing you
with a good and reliable
system.
Your doctor knows the best
treatment as it depends on
the type of diabetes, your
condition and associated
problems.
Diabetes Management Tool
3: Tablets
50 % of beta cells have already
failed at diagnosis!
|
For
tablets to act, the pancreas
must be capable of secreting
insulin |
| Different
type of tablets available
in India Include: |
|
Sulphonylureas
like glipmerdide and
Gliclazide |
|
Biguanides - Metformin |
|
Sensitizers Pioglitazone |
|
Repaglinide |
|
Alpha-glucosidase inhibitors |
|
Some
work at cell level to
help insulin enter the
cell |
|
Few
slow the absorption of
glucose in the body |
| Tablets
become ineffective when
the pancreas cannot produce
insulin any more. |
| Oral
Agents: Where not to
use |
|
Type
I Diabetes |
|
Pregnancy
and lactation |
|
Concurrent
diseases - hepatic, renal
or infections |
|
Primary
OAD failure |
|
Secondary
OAD failure |
Diabetes Management Tool
4: Insulin
“
The Life Enhancer”
What is Insulin?
Insulin is vital for life.
It is a hormone produced
by the pancreas and helps
the glucose enter the cells
where it is used as fuel
for energy so we can work,
play and generally live
our lives. Without this
energy, we die. Most of
the people who need insulin
for their survival cannot
obtain it.
|
Polypeptide
hormone (poly=many; peptide=chain
of amino acids) |
|
Produced
by ß-cells in the
islets of Langerhans
of pancreas |
|
Exerts
profound effects on: |
|
carbohydrate,
fat and protein metabolism |
|
to some extent on water
and electrolyte balance |
‘Insulin is rarely,
if ever, given at the right
time, in the right way or
in the right amount. It is
therefore amazing that anyone
with diabetes has any semblance
of good blood glucose control.’
- Professor Edwin Gale, Bristo.
If you need insulin,
it doesn’t mean you failed.
Tablets cannot control blood
glucose forever, because
they don’t stop the
problem of your own declining
insulin production getting
worse. Islet b-cell dysfunction
worsens over time, regardless
of therapy.
How does insulin work?
Put simply, insulin unlocks
the ‘doors’ of
cells to let the glucose
in and it also suppresses
liver glucose production.
|
|
Why
do people have to inject insulin?
Why do people
have to inject insulin?
For
people who do not have diabetes,
the production of insulin by
the pancreas varies according
to the level of sugar in the
blood. Each time we eat, our
blood glucose or sugar rises,
an appropriate amount of insulin
is produced so that the blood
sugar returns to normal within
a couple of hours. For the
person with diabetes whose
body is not making insulin,
insulin injections are necessary
to maintain the proper balance
of sugar in the blood and in
the cells.
Insulin cannot yet be given
by mouth because the acids
in the stomach destroy it before
it can begin to do its work.
Insulin must be given by injection.
|
|
How
much insulin does a person need?
How much
insulin does a person need?
Each
person with diabetes is different.
Developing a schedule of
insulin therapy depends upon
how much
insulin each person’s
pancreas is still making;
how sensitive they are to
the insulin;
their lifestyle; and their
eating patterns.
Capillary blood sugar monitoring,
through a finger prick, provides
the person and his or her
management team with very
concrete information in determining
the type, amount and timing
of insulin injections. The
various insulin programmes
can range from one or two
injections of insulin per
day to three, four or more
injections.
|
|
How
is insulin packaged?
How is insulin
packaged?
Insulin
is dissolved in a liquid and
packaged in a vial. The most
common solution is U-100 insulin,
which has 100 units of insulin
per 1ml of fluid. There is
also a U-40 solution (400 units
of insulin per 10ml of fluid)
available in some areas of
the world; however standardization
of insulin to the U-100 insulin
is being investigated.
|
|
Are
there different kinds of insulin?
Are there
different kinds of insulin?
There
are many different kinds of
insulin, which are broken down
into four main categories.
The categories are based on:
|
The
onset of the insulin
(when it starts working) |
|
The
peak (when it works the
hardest) |
|
The
duration (how long it
lasts) |
|
Rapid-acting
insulin has an onset
of 15 minutes after injection,
a peak that occurs 30-90
minutes after the onset,
and duration of up to
5 hours. |
|
Short-acting
insulin has
an onset of 30 minutes,
a peak
that occurs 2-4 hours
after the onset, and
duration of 4-8 hours. |
|
Intermediate-acting
insulin has an onset
of 2-6 hours, a peak
that occurs 4-14 hours
after the onset, and
duration of 14-20 hours. |
|
Long-acting
insulin has an onset
of 6-14 hours, a very
weak peak that occurs
10-16 hours after injection,
and duration of 20-24
hours. |
Following an initiative
by IDF, a universal colour
code for all insulin preparations
has been agreed upon and
has the support of the world's
major insulin manufacturers
and health organisations.
A worldwide colour-coding
standard means that the different
preparations of insulin will
have the same colour of label
regardless of the manufacturer
as well as reducing the confusion
and uncertainty for persons
with diabetes who have to
buy insulin abroad. The following
types of insulin preparations
will be covered in the new
colour code:
Type 2 Diabetes
and Insulin
Most people with Type 2 Diabetes
eventually need insulin because
their own production of insulin
falls off with time and they
therefore inevitably become
insulin deficient.
|
|
When
should insulin treatment be started?
When should
insulin treatment be started?
Insulin
will not make your diabetes
worse. In fact, it will help
control your glucose, so you’ll
have fewer complications and
you’ll feel better. Strict
glycemic control reduces the
risks of both micro vascular
and macro vascular complications.
All patients with type 1 diabetes
need insulin lifelong for survival.
Individuals with type 2 diabetes,
whose diabetes is not controlled
with oral drugs, also become
insulin dependent to achieve
normoglycemia. In special situations
like severe infections, surgery,
pregnancy, kidney failure or
liver disease, insulin is introduced
temporarily and may be continued
for long term.
|
|
Why
some people don’t want
insulin therapy?
Why some
people don’t want insulin
therapy?
|
|
Is
there a problem with access to
insulin?
Is there
a problem with access to insulin?
There
is a critical problem, particularly
in those countries where the
full, unsubsidized price of
insulin is high and must constantly
be paid for by the user or
the family over many years
or decades.
In many developing countries,
insulin can cost more than
50% of the average annual income.
Despite being far more affordable,
some developing countries no
longer have access to animal-sourced
insulins, which have been saving
lives for decades. In such
countries, the only insulin
available can cost over 600%
more than in neighbouring countries
(e.g. 30 USD compared to 5
USD each month). Consequently,
even in middle-income families
of such countries, the inability
to afford insulin is resulting
in the earlier development
of complications and premature
deaths of persons with diabetes.
There is enormous financial
strain on very limited incomes.
In stark contrast, the
price of insulin in developed
economies is usually heavily
subsidized by governments
or insurance arrangements.
As a result, the yearly
cost of insulin is usually
well below 0.3% of average
annual income (less than
3 USD each month). If persons
in developed economies
had to pay the same relative
price for insulin, it would
cost them approximately
1,000 USD each month (12,000
USD each year).
Diabetes is now a world
wide epidemic and insulin-treated
diabetes continues to increase
alarmingly. This is a serious
and urgent problem.
|
|
What
is the difference between animal
and human insulin?
What is the
difference between animal and
human insulin?
The
insulin we inject comes from
two sources, either animals
(pig or cow pancreas) or from
genetically engineered bacterium,
which produces insulin very
similar to that of humans,
hence the name human insulin.
Unfortunately, some people
cannot control their diabetes
using human insulin, which
is why some organizations
are campaigning to ensure
that animal insulin is available
to those who need it. Insulin
therapy started with the
insulin from the animal species
(cow and pig).
Soon replaced by human
insulin, which:
|
is
less antigenic |
|
works
continuously |
|
has
much lesser side effects |
| Today,
human Insulin is the
most widely used insulin
in the world. |
|
|
Where
does insulin act?
Where does
insulin act?
|
|
How
to administer insulin?
How to administer
insulin?
Delivery
of insulin by the insulin injection
has to be done by the correct
technique to ensure accuracy.
Preparing
the injection (one type
of insulin):
|
|
Wash
your hands and gently
mix the insulin. |
|
Remove
the flat, coloured cap
from the bottle; do not
remove the rubber stopper
or the metal band under
the cap. |
|
Clean
the rubber stopper of
the bottle with an alcohol
swab. |
|
Remove
the needle cover and
pull back the plunger
until the tip is at the
line for the prescribed
number of units. This
will pull air into the
syringe. |
|
Insert
the needle through the
rubber stopper of the
bottle, making sure that
the tip of the needle
is not in the insulin. |
|
Depress
the plunger to push air
into the bottle. |
|
Turn
the bottle and syringe
upside down, so that
needle is in the insulin. |
|
Pull
back on the plunger of
the syringe. This will
draw insulin into the
syringe. |
|
Stop
pulling when the plunger
reaches the line for
your prescribed dose. |
|
Turn
the bottle and syringe
upside down, so that
needle is in the insulin. |
|
Pull
back on the plunger of
the syringe. This will
draw insulin into the
syringe. |
|
Stop
pulling when the plunger
reaches the line for
your prescribed dose. |
|
If
bubbles are present,
push the insulin back
into the vial and start
again with the previous
steps. Repeat the process
until there are no bubbles. |
|
Pull
the needle out of the
rubber stopper. If you
need to lay the syringe
down, put the cover back
on the needle. |
Preparing
the injection (two types
of insulin):
|
|
Mix
the insulin, remove the
flat plastic cover and
clean the stopper. |
|
Inject
air into the vial of
NPH in the number of
N units prescribed by
your doctor. Do not draw
insulin into the syringe.
Remove the syringe from
the vial. |
|
Inject
air into the vial of
R in the number of R
units prescribed by your
doctor. Then turn the
vial and the syringe
upside down. Pull back
on the plunger until
you have drawn your prescribed
dose of R into the syringe. |
|
Remove
any air bubbles then,
remove the needle from
the vial of R. |
|
Insert
the needle into the vial
of NPH. Then turn the
vial and the syringe
upside down. Pull back
on the plunger until
the syringe contains
your prescribed total
dose of R and NPH. Be
careful not to push any
R into the vial of NPH. |
|
R
should be drawn into
the syringe first. This
prevents cloudiness in
the R vial due to inadvertent
contamination that may
occur if the NPH is already
in the syringe. |
Caution: Do not push the extra
insulin (more than the
dose) that you draw from
the NPH vial back into
the vial. This will cause
insulin in the vial to
be contaminated. Discard
the insulin in the syringe
and start over again. |
| How
to take the injection |
|
Choose
an injection site. |
|
Pinch up
a large area of skin. |
|
Insert
the needle into the skin
at a 90º angle. |
|
Push
the plunger all the way
down. Release the pinched
skin and count to five
slowly. |
|
Pull
the needle straight out. |
|
Do
not rub the injection
site. |
| Needles
and syringes |
|
Use
U-40 syringe with 40
IU insulin and U-100
syringe with 100 IU insulin. |
|
Recap
needle after use. |
|
Inspect
injection sites for redness
or swelling. If found
consult your doctor. |
|
Store
syringe at room temperature. |
|
Do
not clean needle with
alcohol. Wipe it with
clean cloth or shake
it dry. |
| How
to make injections less
painful |
|
Inject
insulin at room temperature. |
|
Make
sure no air bubbles remain
in the syringe before
injection. Hold the syringe
upright and tap it. |
|
Inject
into the skin at 90 degree
angle. |
|
Do
not change the direction
of the needle during
insertion or withdrawal. |
|
Make
sure skin is dry before
injection. |
| The
shortcomings of human
insulin |
|
Fear
of hypoglycemia |
| Convenience
issues |
|
Inconvenient timing of
injection |
|
Complicated regimen |
|
To be taken 30 minutes
before meal |
|
Lifestyle to fit therapy |
|
Hyperglycemia immediately
after meal |
|
Hypoglycemia before next
meal |
| Fear
of injection |
| Available
insulin therapies |
| Human
insulin |
|
Human Actrapid (Short
Acting Human Insulin) |
|
Human Insulatard (Intermediate
Acting Human Insulin) |
|
Human Mixtard 30 and
50 (Premix Human Insulin) |
| Modern
insulin |
|
Insulin Aspart (Novorapid,
Rapid Acting Analogue) |
|
Biphasic Insulin Analogue
(Novomix 30, Premixed
Analogue) |
| Problems
with syringes/vials |
| Need
to overcome fear of injection |
|
major barrier to insulin
initiation |
|
self injection |
|
needs confidence and
ease of use |
|
needs to suit patient
lifestyle (active) |
| It’s
a cumbersome procedure |
| 1Difficult
to transport and carry
around |
| Inaccuracy
in withdrawing the correct
amount of insulin |
| Difficulty
in mixing insulin |
| Insulin
wastage |
| Stigma
of injections and hence
suggestion of ill-health |
| Needle
passes a rubber membrane
and loses sharpness causing
more pain |
| |
| Advantages
with devices (1) |
|
Simplicity
- Simple to operate and
inject |
|
Accuracy
- A new superior standard
in dose accuracy |
|
Reliability
- High quality materials
and finish |
|
Discreetness
- Non-medical, non-syringe
design |
|
All-in-one – Pen
+ insulin cartridge +
needles |
|
Portability
- Small and compact,
robust carrying case
- with space for extra
needles and cartridge |
| How
to make injections less
painful |
|
Inject
insulin at room temperature. |
|
Make
sure no air bubbles remain
in the syringe before
injection. Hold the syringe
upright and tap it. |
|
Inject
into the skin at 90 degree
angle. |
|
Do
not change the direction
of the needle during
insertion or withdrawal. |
|
Make
sure skin is dry before
injection. |
| Insulin
storage |
| In-use
insulin must be kept
out of refrigerator at
room temperature |
|
Vials,
penfills and pens not
in use stored between
2° and 8°C |
|
Storage
in/near freezing compartment
is to be avoided (more
important - suspensions) |
|
Too
high temperature causes
gradual decrease in biological
potency |
|
In-use
insulin stored at room
temperature (25°C)
up to 4 weeks (vials)
and up to 4-6 weeks (penfills
and devices) |
|
Pens/Penfills
in-use should not be
kept in refrigerator |
|
|
How
to store insulin?
How to store insulin?
How
is the glycemic index (GI) of
a food determined?
How is the glycemic
index (GI) of a food determined?
The
glycemic effect of food depends
on a number of factors such as,
|
The
type
of starch
(amylose
vs. amylopectin)
|
|
The
presence
of fat
or soluble
dietary
fibre
can slow
the gastric
emptying
rate
thus
lowering
the GI
|
|
Unrefined
breads
with
higher
amounts
of fibre
generally
have
a lower
GI value
than
white
breads
|
|
Many
brown
breads,
however,
are treated
with
enzymes
to soften
the crust,
which
makes
the starch
more
accessible.
This
raises
the GI,
with
some
brown
breads
even
having
GI values
over
100.
|
What
are the benefits of the glycemic
index?
What are the benefits
of the glycemic index?
Glycemic index of foods:
GI values can be interpreted intuitively as percentages on an absolute
scale and are commonly interpreted as follows:
| Classification |
GI
range
|
Examples |
| Low
GI |
55
or less |
most
fruit and vegetables
(except potatoes,
watermelon),
grainy breads,
pasta, legumes/pulses,
milk, products
extremely low
in carbohydrates
(fish, eggs,
meat, nuts,
oils) |
| Medium
GI |
56
- 69 |
wheat
bread, whole
wheat products
in general,
brown rice,
basmati rice,
orange sweet
potato, table
sugar |
| High
GI |
70
- 99 |
corn
flakes, boiled
potato, some
white rice
(eg. jasmine),
white bread
(ALL maida
based products)
|
| |
100 |
straight
glucose |
High
GI
(70 and above)
|
|
High
GI is not very
good for diabetes
as sugar may
shoot up |
Medium
GI
(50- 69)
|
|
Medium
is good for
you
|
Low
GI
(55 and under)
|
|
Low
GI is very
good for your
diabetes |
Detection
of diabetes
Most common method is Blood Sugar Test:
You are a diabetic if:
Fasting
blood sugar is more than 126 mg/dl
OR
2
hours after having
food, your blood
sugar is more
than 200 mg/dl
Blood Glucose Goals
Your goal:
Do your level best
| |
Normal
(mg/dl)
|
Diabetic (mg/dl) |
| Before meal |
less than 100 |
More than 126 |
| 2 hours after food |
less than 140 |
More than 200 |
| HbA1C (%) |
less than 7 |
More than 7
|
What
is obesity and severe (morbid)
obesity?
What is obesity
and severe (morbid) obesity?
OBESITY
AND BARIATRIC SURGERY
At the Max Hospitals we want you to feel confident that weight loss surgery
is right for you. This Q & A is designed to give you answers to common
questions people have about weight loss surgery.
Obesity
results from
the excessive
accumulation
of fat that exceeds
the body's skeletal
and physical
standards. Morbid
obesity is a
serious disease
process in which
the accumulation
of fatty tissue
on the body interferes
with or injures
the other body
organs. This
can cause serious
and life-threatening
health problems,
which are known
as co-morbidities.
What
is the cause of obesity?
What is the cause
of obesity?
Obesity
can be caused due to endocrine
disturbances, such as thyroid
insufficiency and steroid excess,
and if present should be treated.
Usually obesity is due to mismatch
between calorie intake and
calorie used, especially in
those with a genetic predisposition.
Is
obesity a health hazard?
Is obesity a health
hazard?
Obesity
is not just a cosmetic issue;
it is a major health problem
with difficulty in walking
and breathing, decreased life
expectancy and quality, and
a high risk of:
What
is Thyroid?
What is Thyroid?
THYROID DISORDERS
The thyroid is a small gland, shaped like a butterfly, located in the
lower part of your neck.
The function of a gland
is to secrete hormones. The
main hormones released by
the thyroid are tri-iodothyronine,
abbreviated as T3, and thyroxin,
abbreviated as T4. These
thyroid hormones deliver
energy to cells of the body
and are one of the main hormones
to control the body’s
metabolism.
What
diseases and conditions affect
the Thyroid?
What diseases
and conditions affect the Thyroid?
| The
most common problems
that develop in
the thyroid include: |
|
Hypothyroidism
- An underactive
thyroid. |
|
Hyperthyroidism
- An overactive thyroid. |
|
Goitre
- An enlarged thyroid. |
|
Thyroid
nodules - Lumps in
the thyroid gland. |
|
Thyroid
cancer - Malignant
thyroid nodules or
tissue. |
|
Thyroiditis
- Inflammation of
the thyroid. |
|
|
Thyroid gland is regulated by control centres in the brain - hypothalamus
and pituitary gland. Hypothalamus in the brain releases Thyrotropin
- Releasing Hormone (TRH). The release of TRH tells the pituitary gland
to release Thyroid Stimulating Hormone (TSH). This TSH, circulating
in your bloodstream, is what tells the thyroid gland to make thyroid
hormones and release them into your bloodstream.
In case your
gland is not releasing enough
thyroid hormones then TSH goes
up (Hypothyroidism). In case
too many thyroid hormones are
being released or too much
medication is being taken,
then TSH goes down (hyperthyroidism).
Hypothyroidism
This occurs when the thyroid gland is under-active, improperly formed
at birth, surgically removed completely or in part. One of the most
common causes of hypothyroidism is the autoimmune disease called Hashimoto's
disease, in which antibodies gradually target the thyroid and destroy
its ability to produce thyroid hormone. Symptoms of hypothyroidism
usually go along with a slowdown in metabolism and can include fatigue,
weight gain, depression etc.
Hypothyroidism is a treatable condition but in most patients cannot be
cured i.e. they would need treatment life long. Once treated almost all
symptoms gradually disappear.
| Signs
and symptoms of hypothyroidism |
|
Sleepiness,
fatigue, lethargy |
|
Loss
of memory, trouble concentrating |
|
Unusually
dry, coarse skin |
|
Goitre
(enlarged thyroid) |
|
Gradual
personality change, depression |
|
Increase
in weight, bloating or
puffiness (oedema) |
|
Sensitivity
to cold |
|
Hair
loss, sparseness of hair |
| Diagnostic
Testing |
|
Thyroid-stimulating
hormone (TSH) |
|
Free
triiodothyronine (f T3)
(Some labs do Total T4
only) |
|
Free
levothyroxine (f T4) (Some
labs do Total T4 only) |
| Additionally,
the following measurements
may be needed: |
|
Anti-thyroid
antibodies (TPO antibodies
and Thyroglobulin antibodies)
for evidence of autoimmune
diseases that may be damaging
the thyroid gland |
|
Serum
Lipid Profile — As
cholesterol may be elevated
in hypothyroidism |
|
CBC-testing
for anaemia, including
ferritin |
|
Ultrasound
of thyroid |
|
Fine
needle biopsies in case
of nodule |
|
Thyroid
uptake scan in cases of
nodule |
Hyperthyroidism
When the thyroid gland becomes overactive and produces too much thyroid
hormone, a person is said to be suffering from hyperthyroidism.
The most common cause of hyperthyroidism is the autoimmune condition
known as Graves' disease, where antibodies target the gland and
cause it to speed up hormone production.
Most people with hyperthyroidism have symptoms, including one
or more of the following:
|
|
Anxiety
and irritability |
|
Weakness
(in particular of the upper
arms and thighs, making
it difficult to lift heavy
items or climb stairs) |
|
Tremors
(of the hands) |
|
Perspiring
more than normal |
|
Rapid
or irregular heartbeats |
|
Fatigue,
weight loss |
|
Normal
or increased appetite and
frequent bowel movements |
|
Irregular
menstrual periods or stop
having their periods altogether |
|
Possible
infertility |
Autoimmune
Thyroid Disease (Graves’ Disease)
Most thyroid dysfunctions such as hypothyroidism or hyperthyroidism are
due to autoimmune thyroid diseases. Autoimmune disease refers to a condition
where the body's natural ability to differentiate between its tissues,
organs and glands vs. outside bacteria, viruses or pathogens, becomes
disrupted. This causes the immune system to wrongly mount an attack on
the affected area by producing antibodies.
Hyperthyroidism can be treated using medicine, radiation or surgery.
Many factors, such as age and the severity and type of hyperthyroidism,
are important in determining which treatment is best.
Medications
The two main types of medicines used to treat hyperthyroidism are anti-thyroid
drugs and beta-blockers. Anti-thyroid drugs, such as methimazole and
propylthiouracil (PTU), work by decreasing the production of the thyroid
hormone.
o Radioactive iodine: Destroying the thyroid with radiation, called radioiodine
ablation, is a permanent way to resolve hyperthyroidism. The amount of
radiation used is small and does not cause cancer.
o Surgery: Although it is a permanent cure for hyperthyroidism, surgery
to remove the thyroid gland is used far less often than anti-thyroid
drugs or radioactive iodine because of the risks (and expense) associated
with thyroid surgery.
Goitre/Thyroid Nodules
Sometimes the thyroid becomes enlarged - due to Hashimoto's disease,
Graves’ disease, nutritional deficiencies or other thyroid imbalances.
When the thyroid becomes enlarged, this is known as a goitre.
Some people develop solid
or liquid filled cysts, lumps,
bumps and tumours - both benign
and cancerous - in the thyroid
gland. These are known as thyroid
nodules. These patients require
an ultrasound, thyroid nuclear
scan and biopsy of the gland,
in most cases.
Thyroid Cancer
A small percentage of thyroid nodules are cancerous. While thyroid cancer
is a rare cancer, it's on the rise. Certain features include the thyroid
being hard, solid and symptoms like hoarseness.
Swallowing or breathing difficulties of thyroid nodules increases the
likelihood that a nodule is cancerous. Most nodules would require further
investigation which may include ultrasound, thyroid scan and biopsy,
besides thyroid hormones test.
Thyroid Diet and Lifestyle
Thyroid disorder is not a lifestyle related disease. We recommend normal
health diet and special thyroid supplements should be avoided. We in
India have iodized salt in most of the states in country which should
be taken. The medical world is not aware of any particular yoga or
exercise or any health supplements that can help you to prevent thyroid
diseases.
Diet and Exercise
Medical treatment (Orlistat and Sibutarmine) in combination with diet
and exercise is necessary. Medical treatment can help you to reduce
more than 10% bodyweight.
| Orlistat: |
|
Average
weight loss 10% over 3
months. |
|
Significant
reduction in waist circumference,
blood pressure, total and
LDL cholesterol, no effect
on HDL cholesterol and
triglycerides. |
|
Significant
reduction in the incidence
of diabetes in subjects
with impaired glucose tolerance. |
|
Adverse
effects: mainly gastrointestinal
(fatty and oily stool,
faecal urgency, oily spotting,
faecal incontinence). |
|
Only
drug approved for treatment
of obesity in children. |
| Sibutramine |
|
Average
weight loss up to 10% over
3 months. |
|
Significant
reduction in triglycerides
and glycosylated haemoglobin,
rise in HDL cholesterol. |
|
Side
effects may include dry
mouth and palpitation.
This is not recommended
in patients with uncontrolled
hypertension or history
of psychiatry disorder. |
Obesity
We look at overweight and obesity from a different perspective as health
professionals and the solution which you will get will differ from what
you get on your daily newspaper and leaflet. Obesity is when a person
is carrying too much body fat for their height and sex. A person is considered
obese if they have a Body Mass Index (BMI) (weight in kilograms divided
by their height in metres squared) of 28 amongst Asian and 30 for Caucasians
or greater.
In India (Asians), people with a BMI between 23 (25 for Caucasians) and
28 (30 for Caucasians) are categorized as overweight, and those with
an index above 28 are categorised as obese. People with a BMI of 40 or
more are described as morbidly obese.
Your waist circumference may
help us to assess your risk
of developing obesity-related
health problems, such as heart
disease. Adult obesity rates
have almost quadrupled (become
four times greater) over the
last 25 years, and two thirds
of urban Indian adults are
now considered overweight or
obese. Of these, 30% of men
and 23% of women are in Delhi
and Punjab.
Obesity can take up to nine
years off your lifespan. It
also makes you far more likely
to develop a range of health-related
problems than just cosmetic
issues, including:
|
Diabetes |
|
Heart
disease |
|
Stroke |
|
Osteoarthritis |
|
High
blood pressure |
|
Gallstones |
|
Infertility |
|
Depression |
|
Cancers
of the colon, breast, kidney
and stomach |
| Many
people may also experience
psychological problems,
such as: |
|
Having
low self-esteem (self-worth)
- or poor self image |
|
Having
low confidence levels |
|
Feeling
isolated in society or |
|
Having
reduced mobility leading
to a poor quality of life |
Causes
Obesity does not just happen overnight - it develops gradually from
poor diet and lifestyle choices and, to some extent, from your
genes.
|
|
Lifestyle
choices - Eating
more calories than you
need may be down to poor
food choices - for example,
eating high fat, processed
or fast foods - rather
than filling up on fruit,
vegetables and unrefined
carbohydrates, such as,
wholemeal bread and brown
rice. Alcohol also contains
a lot of calories, and
heavy drinkers are often
overweight.
Bad eating
habits
also tend
to run
in families
- rather
than inheriting
a slow
metabolism,
the habits
learnt
from your
parents
can be
an important
factor.
Childhood
obesity
is a strong
indicator
of weight-related
health
problems
in later
life, showing
that learned
unhealthy
lifestyle
choices
continue
into adulthood.
|
|
Lack
of physical activity -
Lack of physical activity
is another important
factor that is related
to obesity. |
|
Genes
and family -
Some people tend to stay
the same weight for years
without much effort,
whereas others find that
they gain weight quickly
if they are not careful.
This could be due, in
part, to your genes.
Scientists have discovered
certain genes that make
you feel hungrier or
make it take longer for
you to feel full. |
|
Medical
reasons - In
less than one out of
every 100 cases, there
is a medical reason for
obesity. Conditions such
as Cushing's syndrome
(over-production of steroid
hormones in the body)
and an under-active thyroid
gland are rare causes
of weight gain. |
|
Certain
medicines, including
some steroids
and antidepressants,
can contribute to weight
gain. Also, taking the
contraceptive pill and
quitting smoking may
increase your appetite. |
Diagnosis
Body Mass Index (BMI) is currently used as the most accurate and reliable
way of measuring how overweight you are.
You can work out your own
BMI using this calculation:
1. Measure your height in metres and multiply the number by itself -
this is the squared figure.
2. Measure your weight in kilograms.
3. Divide your weight by the answer you got in step 1 (squared height).
4. The number you are left with is your BMI.
For example, if you are:
|
1.65
metres tall (165cm - 65
inches), your squared figure
is 2.72 |
|
58
kg in weight |
|
58
kg divided by 2.72 |
|
21.3
BMI figure |
| For
most people, an ideal BMI
is between 18 and 23.
Tackling Obesity
The best way of tackling obesity is to reduce the amount of calories
that you eat and exercise more. Most people you know either regain
weight or fail to achieve significant weight loss. We have designed
the combination of diet and exercise along with pharmacological
treatment. Bariatric surgery can be an excellent choice for some
patients and can reduce significant weight.
Medication
The part of the brain that controls how hungry we are is called
the hypothalamus. It controls the hormones and chemical signals
circulating in our blood that influence appetite.
|
|
Sibutramine
(obego) and Rimonabant
(oberim), recommended internationally
can cause weight reduction
of up to 10% in 3 months,
in majority of cases, but
this needs to be discussed
with us before it can be
started. There are some
side effects but the benefits
may outweigh, in most patients. |
|
Orlistat
(obelit) works by blocking
the action of body chemicals
called enzymes which digest
fat. The undigested fat
is not absorbed into your
body and is passed out
with your faeces (stools).
This can cause diarrhoea.
You have to have made significant
effort to lose weight through
diet, exercise or changing
your lifestyle before taking
it. |
Surgery
People with a BMI of 35 or more are described as morbidly obese.
At this stage, the problem can be very hard to treat. Surgery may
be considered to restrict the amount of food eaten or to interrupt
the digestive process.
Surgery may also be an option for people with a BMI of 35 or more,
who have life-threatening cardiopulmonary problems - for example,
severe sleep apnoea (a sleep disorder where a person experiences
irregular breathing at night), obesity-related heart disease or diabetes.
It can be recommended to those who have a BMI of more than 38 and
failed to loose weight with diet for a long time.
There are three types of weight-loss surgery. The best type of surgery
depends upon how much weight needs to be lost. All of them are done
via laparoscopy (key hole surgery).
|
|
Sleeve
gastrectomy involves the
removal of the majority
of the stomach to create
a smaller, tubular (sleeve-shaped)
stomach that can hold less
food and is resistant to
stretching. |
|
Lap
banding, can be adjusted
or removed. This procedure
places a band around the
top of the stomach. This
causes the person to feel
full after eating a small
amount of food. |
|
In
gastric bypass, we create
a small pouch in the
stomach. The pouch is
connected to the small
intestine. These changes
cause the person to feel
full after eating a small
amount of food. It also
causes the body to absorb
fewer calories from food.
Weight loss surgery
can have complications,
such as pain, infection,
need for a second surgery,
or nutrition problems.
The specific complication
depends upon which
surgery is done and
if the person has other
medical problems. There
is a smaller risk of
complications when
weight loss surgery
is done in centres
with a great deal of
experience. Less than
1 in 100 people die
because of weight loss
surgery.
|
| After
surgery |
|
People
lose about 60 percent of
their extra weight. The
amount of weight lost depends
upon which surgery is done.
Other health problems (e.g.
diabetes or arthritis)
often improve after weight
loss surgery. It is important
to eat the right foods
and exercise to stay healthy.
Help with diet and exercise
planning is available. |
Bariatric
Surgery
Bariatric surgery is considered for those people who:
|
|
Are
over 18 years of age |
|
Have
a BMI greater than 40 or
greater than 35 and have
co-morbidities like hypertension,
diabetes etc. (WHO Recommendations) |
|
Have
a BMI greater than 37.5
or greater than 32.5 and
have co-morbidities like
hypertension, diabetes
etc. (Asia Pacific Guideline
Recommendations) |
|
Have
tried all other methods
of losing weight (diets,
exercise, medication etc.) |
|
Are
fit enough to undergo anaesthesia
and surgery
In addition, patients
should have documented
a high probability
of failure of non-surgical
weight-loss treatments
and be well informed,
motivated and compliant.
|
What
are the treatment options for
the morbidly obese?
What are the treatment
options for the morbidly obese?
The primary goal in managing
and treating obesity is to
decrease a patient's medical
risk and improve quality
of life. An appropriate weight
management programme combines
physical activity, diet,
behavioural modification,
psychological counselling
and sometimes drug therapy
to help patients achieve
weight loss or prevent further
weight gain. Surgery is reserved
for patients who have repeatedly
failed to lose weight by
all other means (diet, exercise,
behavioural and drug therapy)
and this is the last resort.
Surgical treatment is medically
necessary because it is the
only proven method of achieving
long term weight control
for the morbidly obese.
We will expect that you
will be compliant with all
steps of our programme. That
means keeping all appointments
that are made, pre-operative
testing, pre/post-operative
diet, band adjustments as
needed and any required medical
appointments.
What
are some of the risks involved
in weight loss surgery?
What are some
of the risks involved in weight
loss surgery?
Some of the specific
risks related to weight loss
surgery include:
|
Anastomotic
leak, which
is leaking
from the staple
line around
the newly formed
pouch or at
any new connections
that have been
made, including
to the small
intestine |
|
Gastric
Fistula, which
may occur when
there is abnormal
connection
with the stomach,
usually to
other organs
in the body |
|
Pulmonary
Embolism, which
is one of the
most common
risks or complications
of any surgery
- usually a
blood clot
that is causing
blockage of
an artery in
the lungs that
has normally
formed in the
legs and moved
its way up.
It is very
important to
get patients
out of bed
quickly after
surgery and
move around.
In addition,
anti-clotting
medications
are given. |
|
Wound
Infection – This
is when there
is a penetration
of bacteria
to the site
of surgical
incision. |
|
Wound
Seroma – The
swelling
at the site
of surgical
incision
caused by
fluid within
the tissue. |
Precautions
before surgery
to reduce
the risks
of complications
To try to reduce some risk, you can do the following at least a
month before surgery - increase physical activity, dietary advice,
lose 10% of body weight, quit smoking and quit drinking alcohol.
Doing these things can not only help reduce your risk but also
help optimize your recovery.
Pre-operative diet for weight loss surgery:
Dieting before surgery can significantly shrink liver size and
make operations shorter and safer. For two weeks before your operation,
you should follow this diet to prepare your body for surgery.
The
recommended
preoperative
diet will
consist
of a prescribed
amount
of a high
protein
drink plus
1-2 regular
meals.
|
First
week: 1 high
protein drink
with 2 regular
meals
I000 kcal reducing diet chart
| Bed
tea: |
Tea
|
1
cup |
| Breakfast: |
Milk
Cereal
Protein |
125ml
(1 cup)
20gms (1 chap/1 slice/Dahlia)
30gms paneer/1 egg/1kat sprouts |
| Mid-morning: |
Fruit/
Salad |
200
gms
150 gms |
| Lunch: |
Optifast |
1
glass
|
| Tea: |
Tea
Snack |
1
Cup
20 gms (Roasted Chana/Dhokla/Popcorn/Bhelpuri/Chana chat/
digestive biscuit)
|
| Dinner: |
Soup
Cereal
Dal
Vegetables
Oil
Curd |
1
bowl
20 gms (1 chap)
30 gms (1 kat)
150 gms (1 kat)
5 gms (1 tsp)
100 gms (1 kat) |
|
| Foods
allowed liberally: |
|
Raw
and boiled
vegetables |
|
Juices
like fresh
lemon, coconut
water, soda |
|
Vegetable
juices like
tomato juices,
clear soups,
cucumber juice |
|
Skimmed
or toned milk
and milk products |
|
Refined
vegetable oil
for cooking |
|
Egg
white, lean
meat, chicken,
fish |
| |
|
| Foods
to be avoided: |
|
Excess
of cream, butter,
oil, cheese,
mayonnaise,
ghee |
|
Excess
of fried foods
- potato chips,
puri, paratha,
pakora, cutlet |
|
Excess
of dried nuts |
|
Sugar,
sweets, desserts |
|
Whole
milk and its
products | | | |
