All About Diabetes > Diabetes Management > Education And Counselling


 

The following slide kit would assist a physician in discussing Diabetes with their patients, and also try and simplify certain concepts and advice that may be beneficial to them

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The first question in a person's mind is what is Diabetes. Physicians assume that patients know exactly what Diabetes is and speak with medical jargon that further confuses the patient. Thus the talk with this slides must be kept simple.

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Some people think that Diabetes is a contagious disease, it is not. It is a metabolic disorder that comes due to many factors. Your genetic make up, lifestyle and stress are some of the most common reasons why a person can get diabetes

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Every person requires glucose for energy in their body. Glucose comes from the food we feat, specially carbohydrates eg rice. Food gets digested, gets converted to glucose and then comes into the body.

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Insulin is a protein hormone, a chemical messenger that helps to metabolize the glucose in our bodies. It is made from a gland situated in our abdomen called the Pancreas. The Pancreas makes and releases insulin that helps convert glucose to the much needed energy that the body requires.

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In simple terms diabetes is a condition that occurs due to high levels of glucose in the blood. This high blood glucose is called Hyperglycemia medically. Is occurs due to the lack of Insulin.

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Diabetes occurs due to the improper functioning of the insulin factory, the Pancreas. In type 1 DM there is little or no insulin made, but in type 2 which is the most common form of Diabetes, insulin is made but not enough to satisfy the body's needs.

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There are three main types of Diabetes and some rare forms. Type 1 affects young children is results in an absolute deficiency of Insulin. Type 2 DM is the most common form of Diabetes. 95% of all Diabetics are this type. In type 2 DM insulin is made but not enough, as the body is also resistant to the insulin that it makes. Thus there is a relative deficiency of Insulin in type 2 DM. Gestational DM is Diabetes that gets diagnosed for the first time during pregnancy. The diabetes condition reverts back to normal after delivery but the woman is at high risk for future DM. Babies are at high risk of complications in a diabetic mother.

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What are the chief symptoms of Diabetes?

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Excessive thirst, urination and weight loss are the most common symptoms that a patient may have. There are cases where patients have lost upto 40 kgs. Getting up at night for frequent urination is a typical symptom too. Dryness of mouth of altered sensation of the mouth are also common.

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Others include irritability, weakness, tiredness and fatigue.

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Its important to note that Type 2 DM is a silent disease. One may have it for a long time and infact have no symptoms. They may either all the symptoms or none at all or a few from the list described before. Thus after the age of 45 and maybe earlier if you are at high risk form DM, like your parents are Diabetic etc, one needs to do regular check ups.

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There are many ways to diagnose Diabetes. Usually its through a simple blood test. Urine testing is now not a preferred method to diagnose DM. New test like the Hba1c% test makes testing easier as it can e done at any time of the day, with no relationship to meals.

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FPG- is one the most common tests to diagnose Diabetes. Fast for 8 hrs overnight, then give your blood and if your levels are >=126 mg% then maybe you are a diabetic. Repeat testing at another day is ideal before one is labeled a diabetic.

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The OGTT is another test used for diagnosis of Diabetes. This is usually done after meals or having taken a glucose load of 100 gms. Levels greater than 200 mg% is considered to be diabetic. Again, we must repeat this test again to prove definitely.

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The Hba1c% test is a new test that can also be used to detect Diabetes. It also gives values that can let you know if you are in control or not. It is easy to use and does not have any relation to any meal. Ideally it must be done every 3 months if you are a diabetic to check control.

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This slide shows the various cut off levels for Diagnosis of Diabetes. In todays practical world, FPG is the most preferred test as it can be done simply and easily. If the laboratory does Hba1c% testing then even this test is easy to perform. One can randomly check their sugars and if more than 200 and with symptoms then also we can diagnose Diabetes.

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Levels regarding diagnosing diabetes and control of Diabetes are different. Patients must try and get their sugars as close to normal as possible. Better control means a lesser chance of developing Diabetes complications in the future.

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Many patients are confused about this Myth. A patient must never stop their medicines if their Diabetes is under control. Diabetes is a lifelong disorder, currently there is not permanent cure, but control is the only option. With very fat people and diabetes, Bariatric surgery can cause a cure of their Diabetes, but then this surgery is reserved for very fat people only and is not meant for every diabetic.

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If one neglects their diabetes control then serious complications can arise that can impair the quality of life that one leads.

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Complications occur to the duration of the high level of glucose in the body. More the poor control greater the chances to get complications. Besides glucose other factors like smoking, cholesterol etc can contribute to the complications.

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Diabetes and uncontrolled sugar in the body can cause damage to many organs. Heart disease, brain stroke, eye problems, leg ulcers, risk of amputation, etc are some the common problems that arise.

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Diabetes cannot be cured currently but only controlled. Diabetes can be brought under good control by changing one lifestyle. Proper diet, exercise and regular intake of medicines can make one control their diabetes rather than diabetes control them.

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Another very common myth, which is wrong. Sugar and glucose is very essential to the body. One must not stop eating carbohydrates or sugar based food totally, but one must learn what to eat and how much to eat. Sugary drinks like Coca-cola, are to be avoided but sugar in the form of whole grains are allowed.

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Unfortunately, due to our current lifestyles, we are becoming more obese and lazy. We hardly ever exercise and we eat all the high calories and fast foods as we don't have time to do proper cooking. We eat at restaurants, eat fried and high oil foods. We use the lift instead of walking up stairs and we would buy another car rather than cycling to work. Obesity is a very high risk factor for Diabetes and thus the more fat one is the higher the risk for type 2 DM.

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Exercise is very important to control Diabetes. Besides having a glucose lowering effect, exercise helps in body weight reductions, and thus helps in overall body conditioning. It has other benefits other than pure glucose reduction as discussed on this slide.

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If diet and exercise are not enough to control ones diabetes then oral medications are started. There are many classes of oral medicines and the doctor may choose any one which depends on the patients condition and tolerability. These medicines can be given as a combination in one tablet or singly. They can also be taken with insulin.

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A very common fear in Diabetics is that once the doctor starts Insulin, it means the end stage of the disease and that death is imminent. This is not true, in fact insulin is a natural hormone made by the body. As this natural hormone is not enough to control sugar we need to give it by injections. As Insulin is a protein hormone, it gets digested in the stomach and thus can be taken by mouth. It is the best drug to control ones sugars.

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Insulin is either given as a replacement for type 1 DM, or in type 2 DM as an additional supplement to control sugars. As time passes many diabetics cannot produce their own insulin and thus need a complete replacement of Insulin to survive.

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Insulin is a wonderful drug, but one must know more about it before using it. It cannot be taken by mouth. There are various types of insulins in the market today and the doctor must educate patients about its types and uses.

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Diabetes does not mean the end to life. One can lead a very normal life with Diabetes. One must know about Diabetes and must learn to control it.

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Control your Diabetes well. Keep your Hba1c% under 7 and life will be better.

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