The ABCDE of Diabetes: 360-degree approach for Diabetes management.

14 the October is the world’s Diabetes day! Best wishes for all Diabetics. Daily treatment, healthy lifestyle, regular monitoring, and self-managing strategies and education can help you manage your diabetes. Less and less sugar means more and more happiness. May all those with diabetes have a happy and a healthy Diabetes Day! May all those with pre diabetes manage your A1Cs- sugar levels and prevent progression to type 2 diabetes!

The centenary year of insulin discovery offers an exclusive opportunity to change the lives of millions suffering from diabetes.

Well what is Diabetes?

Diabetes, is a group of metabolic disorders characterized by a high blood sugars over a prolonged period of time. It is a metabolic syndrome! If left untreated, diabetes can cause many health complications- diabetic ketoacidosis, cardiovascular disease, stroke, kidney disease, foot ulcers, loss of vision and cognitive impairment.

· Pre-diabetes is a condition where blood glucose levels are high but not high enough to be diagnosed as type 2 Diabetes. With weight correction, life style changes one can control their blood glucose levels and prevent type 2 diagnosis. Oral hypoglycemic drugs may not be required.

· Type 1 diabetes results from failure of the pancreas to produce enough insulin due to loss of beta cells in the pancreas is called insulin-dependent diabetes or Juvenile diabetes. The cause is due an autoimmune response

· Type 2 diabetes begins with insulin resistance, a condition in which cells fail to respond to insulin properly. As the disease progresses even production of insulin may be hindered. Genetic and environmental factors, Obesity and lack of physical exercise cause type-2 Diabetes.

· Gestational diabetes is a form of diabetes that develops during pregnancy. 90% of Gestational Diabetes cases will return to normal health once the baby is born.

Insulin is the principal hormone that regulates the uptake of glucose from the blood into most cells of the body. Therefore, Either the deficiency of insulin or increased resistance to insulin play a central role in all forms of diabetes mellitus.

Even 100 years after the discovery of insulin, millions of people with diabetes around the world cannot access the care they need.

The question is Access to Diabetes care — if not now, when?

One in two patients do not get adequate care. 70% pay for the medicines out of their own pocket- The cost of treatment drives 40% of patients below the poverty line.

The Indian population lacks a general awareness about diabetes and its complications. The delay in presentation and diagnosis, increases the burden of diabetes. Type 2 diabetes remains undetected for a long time and may be diagnosed only with the onset of complications like infections, heart attack, stroke, loss of vision, ulcers etc.

Hello friends

I am

Dr prabhu dev

Former Director Jayadeva institute of cardiology-

Former VC Bangalore University-

Former chairman Karnataka state health commission-

I want to share some of my thoughts on ABCDE of Diabetic Management! It is 360-degree approach for Diabetes management. If this helps some of you in managing diabetes, helps in preventing a heart attacks or prevent a stroke or avoid an amputation, I feel it is worth the effort.

India may not be the diabetes capital of the world, but we are getting there. Diabetes is the new epidemic in India. India stands second in the world with 77 million diabetics and 37 million pre-diabetics! It is estimated to reach 135 million by 2045. Here in India type 1 diabetes is rare than it is in western countries.

Diabetes is a major cause of heart attack, blindness, stroke and lower limb amputation and kidney failure. There is no cure for diabetes but with adequate treatment and self-management strategies, a person can live long and lead a healthy life- Regular exercise, Controlled carbohydrate intake, normal BP, normal body weight, Controlling stress are some ways to control and prevent diabetes.

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The causes of diabetes in India are multifactorial and includes genetic factors and environmental influences, obesity and sedentary life style with rising living standards and a steady urban migration.

I must warn you that Diabetes may occur even in lean individuals at a much lower body mass index in Indians. Even lean individuals may get diabetes.

The hyper cholesterol levels and dyslipidemias make Indians more prone to development of the complications of diabetes at an early age 20–40 years.

-25% per cent — Neuropathy

- 24 per cent -Cardiovascular complications like heart attacks and strokes

21 per cent — Renal issues or kidney problems

17 per cent Retinopathy and loss of vision

5.5 per cent Foot ulcers leading to amputations

Now what is this 360-degree approach for Diabetes management Or ABCDE of diabetes management

A for A1C (HbA1c) levels or glycosylated Hemoglobin levels

B for BP readings

C for cholesterol levels

D for drugs and medication

E for Exercise

Let us take up one by one

Let us look at HbA1C results and its interpretation

Red blood cells live an average life of three months, the glycosylated hemoglobin reflects the sugar exposure to the cells over that time. A1C is an average of all your blood sugars- fasting, Postprandial, random and before bedtime sugar level.

HbA1C of

· 6.5% Or higher indicates Diabetes- with average sugar levels of 140 mg/ dl and above

· 5.7 % to 6.4% indicates Pre-diabetes with average sugar levels of 120mg and 140mg/dl

· Below 5.7% — Normal- with average sugars of 97mg/dl

· A combination of diet, exercise, and medication can bring levels of HbA1c down.

· People with diabetes should have an A1C test every 3 months to make sure their blood sugar is in their target range. People with low Hemoglobin or Anemia, may get misleading results.

Blood pressure and diabetes

Normal BP is 119/79 mm of Hg or lower. Diabetes and high blood pressure often go together, and are referred to as the ‘Vicious Twins’.

An ambulatory blood pressure monitor is a device that you wear. It measures your BP while you are on the go day and night. The recorded BP’s helps to decide your treatment.

Normal BP-119/79

Hypertension stage- 1: BP- 120 to 129 of systolic and 80 of diastolic

Hypertension stage 2: 130 to 139 of systolic and 80 to 89 of diastolic

Hypertension stage — 3

140 or higher of systolic and 90 or higher of diastolic

Hypertensive crisis

Systolic of 180 and above or a Diastolic of 120 and above! Needs emergency treatment!

Non drug management: Sodium restriction, Normalization of weight, moderately intense physical activity, management of stress.

Drug therapy of hypertension: ACE inhibitors, β-blockers and diuretics. Usually a combination of drugs is necessary to normalize the BP quickly.

Cholesterol and diabetes

The management of diabetic dyslipidemia is a key element to prevent Cardiovascular events in individuals with type 2 diabetes. High cholesterol levels may be a sign that you are at higher risk of heart disease and stroke.

What is cholesterol?

Cholesterol is a type of blood fat or blood lipid

High Density Lipoprotein– is a bad cholesterol’, because it is this form of cholesterol that can build up in blood vessels and block it over time

Low Density Lipoprotein — ‘is a good cholesterol’, because it helps to clear buildup of bad cholesterol of the blood.

Triglycerides — another form of blood lipid also a bad cholesterol

Total cholesterol is all these put together. These are appropriately treated with statin group of drugs!

Body Mass Index (BMI) targets

Healthy: 18.5 to 24.9

Overweight: 25 to 29.9

Obese: 30 to 39.9

Morbidly obese: equal to or greater than 40

Watch your waist and weight: Get into the habit of measuring your waist and weighing yourself regularly

Less than 80cm for women

Less than 94cm for men

Screening for complications

Cardiac:

ECG every three months to detect Silent heart attacks.

Foot — if there is a chronic non healing ulcer in the foot get a limb Plethesmography done which measures the blood flow in different regions of the limb!

Retinopathy: have yearly dilated retinal exam

Smoking cessation

Since 2002 with all the public education there have been more former smokers than current smokers. Tobacco use is the leading preventable cause of death. Life expectancy for smokers is at least 10 years shorter than for nonsmokers. Every year More than 480,000 quit smoking by death!

What is Self-monitoring in the management of Diabetes?

Patients can measure their blood glucose at home. Patients using insulin can check their glucose levels before and after meals, at bedtime, and before exercising. People with diabetes who are not taking insulin should also check their blood sugar levels post- prandial and fasting. They can record their BP.

The diabetes plate meal!

25% of your meal should be vegetables, 25% should be fruits, 25% proteins and 25% should be grains.

Get good nutrition- Eat with heart in Mind!

Exercise to achieve 70 % of your maximal Heart rate!

Max heart rate is 220- your age

Take medication regularly!

Message is manage your diabetes well and live a normal life, live a long life and live good quality of life.

Former director of Sri Jayadeva Institute of Cardiology, Former VC of Bangalore University and former chairman of the Karnataka State Health Commission