DIABETES MELLITUS

is a multifactorial systemic disease characterized by hyperglycemia and frequently hyperlipedemia. The hyperlipedemia. symptoms are caused by a decrease in the secretion of insulin or a decrease in the effectiveness of insulin

CLASSIFICATION :
 

Type I : Insulin dependent diabetes mellitus (IDDM) Type II : Non Insulin dependent diabetes mellitus (NIDDM) Diabetes mellitus associated with other conditions or syndromes. Gestational diabetes mellitus (GDM)

CAUSES
Genitic

IDDM
Associated with Human leucocyte antigen Unknown Strong autoimmune bares

NIDDM
Not associated with HLA

Heridity Autoimmune Environmental faoctors

Familial aggregates are common Possible auto antibodies seen in 20% of patients

Ferquent Poor eating habit coincidence Inactivity provides between IDDM and stimulus for those who viral infections are geneticaly predisposed. Risk factors are age ( es with age) obesity, family history

PATHOPHYSIOLOGY


Pancreatic bets cells destroyed by auto immune process

          

Insulin deficiency Glucose not stored in liver Hyperglycemia Kidneys do not absorb excess glucose Glycosuria Loss of fluid and electrolytes Polyuria and polydipsia Decreased storage of calories Polyphegia Fat break down Increased production of ketone bodies Diabetic ketoacidosis

COMPONENT OF DIET RECOMMENDED AMOUNT

Carbohydrate Proteins Fat poly unsaturated Saturated Monosaturated Cholesterol Fiber

60% 0.8g/kg 6-8% < 10% 30% < 300mg 40gms

GLYCAEMIC INDEX
Glycaemic index is defined as the area under the blood glucose response curve for each food expressed as a percentage of the area, after taking the same amounts of carbohydrates as glucose. glucose.

For example: High glycaemic food is glucose and example: low glycaemic glucose soyabeans and peanuts

EXERCISE AND THE DIABETIC



Exercise increases the rate at which glucose leaves the blood. Before exercise begins control should be there, control means blood glucose concentration is close to normal. The controlled diabetic has sufficient insulin such that glucose can be taken up into muscle during exercise and can counter the normal increase in glucose release from the liver due to the action of catecholamines and glucagan. In contract diabetic with inadequate insulin experiences only a small increase in glucose utilitation by muscle. But has the muscle. normal increase in glucose release from the lever. This causes an lever. elevation of the plasma glucose resulting in hyperglycemia. hyperglycemia. If an IDDM starts exercise with toomuch insulin the rate at which plasma glucose is used by muscle is accelerated while glucose release from the lever is decreesed. This causes hypoglycemia. decreesed. hypoglycemia.

For these reasons exercise plan is different for type-1 typeand type-2 diabetic. type- diabetic. Type 1 diabetic Rick factor checked before exercise CAD Micro vascular or neurological complications

DANGERS May Worsen retina, kidney or peripheral nerve

BEFORE EXERCISE


Blood glucose consumed

80 to 100mg/dl, CHO should be 100mg/dl,

If above 250mg/dl, exercise should be delayed 250mg/dl, untill it is below 250mg/dl. 250mg/dl. Should not exercise at time of peak insulin action. action. Glucose should be monitered frequently during exercise. exercise. Additional CHO should be recovery from the exercise. exercise. consumed during

EXERCISE


Performing a submaximal exercise test and setting the exercise intensity in terms of heart rate and RPE responses Use non-weight bearing, low impact activities nonAvoiding heavy weight lifting maneouver to minimice the BP Drinking more fluid available form of CHO and and valsalva

 

carrying

readily

FINALLY


A sedentary type-1 diabetic typebetween diet and insulin

has

to

shuffle

Exercise is not viewed as a primary means of acheiving control. But encouraged to participate control. in a regular exercise benefits. benefits.

TYPETYPE-2 DIABETIC


Exercise is a primary recommendation for type-2 typediabetic for To help deal with obesity which is usually present To help to control the blood glucose

The combination of diet and exercise may be sufficient to elinmate the need for insulin and the oral medication used to stimulate insulin secretion. secretion.

TYPES OF EXERCISE


Low intensity and long duration activity that is done almost everday to maximize the benefits related to insulin sensitivity and weight loss. loss. Exercise Benefits for NIDDM : Glycolic control can be achieved with regular exercise by revising insulin resistance that is exercise increases insulin sensitivity Risk factors for CHD stroke and PVD is avoided by delaying atheroscelerotic changes Weight loss and the accompanying reduction in body fat and its distribution enhance glucose tolerance and insulin sensitivity

 

The combination of diet and regular exercise is more effective in reducing body fat in diabetics than either treatment alone. alone. Exercise decrease anxiety, improves mood and self esteem and increases sense of well being and psychological control and enhance the quality of life. life. In conclusion regular exercise delays or even prevents the onset of insulin resistance and NIDDM in men and women at high risk for developing these problems