Download Understanding DiabeteS

Understanding Diabetes
Prevention better than cure
By:
Dr. Riyaz
Consultant Endocrinologist
Medical Director
EDSC
Top 10 Countries/ territories of number
of people with diabetes (20-79 years),
2013
Almost half of all
people with diabetes
live in just three
countries
China
India
USA
IDF Diabetes Atlas, 6th Edition. Diabetes,prevelance,mortality and health expendiature for 2013 to 2035
Why the need for improved global
awareness ?
7 million new cases of diabetes each year
At least 50%
of people with diabetes
do not know they are affected
Healthy diet and exercise could prevent
up to 80% of type 2 diabetes
Every 10 seconds, a person dies
from diabetes-related causes
International Diabetes Federation. Did You Know?
http://www.idf.org/home/index.cfm?unode=3B96906B-C026-2FD3-87B73F80BC22682A
Some misconceptions about diabetes
“I don’t need to take my tablets
– I don’t feel ill”
“Only old people get
diabetes”
“Complications only occur
in patients who take insulin”
International Diabetes Federation. Did You Know?
http://www.idf.org/home/index.cfm?unode=3B96906B-C026-2FD3-87B73F80BC22682A
What is Human body ?
• Human body is like a complex
machine
• Glucose is the fuel of the
human body
How does body use glucose ?
• Glucose is used by our body
with the help of insulin
• Glucose can be used for
– Either immediate requirement
– Or stored for future use
Action of Insulin
What is Diabetes ?
Diabetes is a
disease in which
glucose levels in
the blood remains
higher than normal
Diabetes has serious implications
Stroke
2 to 4 fold increase in
cardiovascular
mortality and stroke3
Blindness
Leading cause
of blindness
in working age
adults1
Heart Disease
8/10 diabetic patients
die from cardiovascular
events4
Kidney failure
Amputations
Leading cause of
end-stage kidney disease2
Leading cause of
non-traumatic lower
extremity amputations5
1 Fong
DS et al. Diabetes Care 2003; 26 (Suppl. 1):S99–S102. 2Molitch ME et al. Diabetes Care 2003; 26 (Suppl. 1):S94–S98.
3 Kannel WB et al. Am Heart J 1990; 120:672–676. 4Gray RP & Yudkin JS. In Textbook of Diabetes 1997 Chapter 57.
5Mayfield JA et al. Diabetes Care 2003; 26 (Suppl. 1):S78–S79.
Am I At Risk?
• I have a parent, brother or sister with diabetes.
• I had diabetes when I was pregnant.
• I gave birth to a baby who weighed over 4
kilograms (9 pounds) at birth.
• I have been diagnosed with any of the following
conditions:
− Polycystic ovary syndrome
− Acanthosis nigricans (darkened patches of skin)
− Schizophrenia.
Am I At Risk?
•
•
•
•
I have high blood pressure.
I am overweight, especially around the waist.
I have high cholesterol in my blood.
I have health problems that are linked to
diabetes such as diabetes eye, nerve or kidney
problems.
How Do I Know If I Have
Diabetes?
• Review the list of risk factors
• Talk to your health care provider about your risk for
developing diabetes
• Ask your health care provider to check your blood
glucose, blood pressure and blood cholesterol
What you can do to prevent
type 2 DIABETES ?
Diabetes can be prevented or delayed
Small steps, Big rewards
Diabetes can be prevented
through small steps:
 Lose a modest amount of
weight (5–7%)
• by building up to 30 mins of
physical activity/day
• following a low-calorie,
low-fat eating plan
National Diabetes Education Program. Small steps. Big Rewards. Prevent Type 2 Diabetes.
http://ndep.nih.gov/campaigns/SmallSteps/SmallSteps_index.htm.
Exercise
The Exercise Prescription
Exercise Choices
Choose an exercise that
you enjoy and that fits
your personality
www.cdph.ca.gov/.../MO-CDAPP-DiabetesPreventionForYouAndYourF...
Getting Started with Exercise
• Make it as enjoyable as you
can
• Doing a little is better than
doing nothing
• Consider lessons or joining a
group
• Exercise daily to get used to it
• Start slowly
www.cdph.ca.gov/.../MO-CDAPP-DiabetesPreventionForYouAndYourF...
Healthy Diet
Make Simple Changes
• Reduce Fat,
Salt and
Sugar
• Eat more of
vegetables;
whole grains;
low fat dairy
products and
high fibre
foods
faculty.ksu.edu.sa/2902/.../Diabetes%20Education%20magic%20capsule
Fill Your Plate for Healthy Eating
• 1/2 is non-starchy vegetables
such as salad or cooked
vegetables.
• 1/4 is starchy foods such as
breads, grains or starchy
vegetables.
• 1/4 is meat, fish or poultry or
meat substitute.
• Milk and fruit completes the
meal.
faculty.ksu.edu.sa/2902/.../Diabetes%20Education%20magic%20capsule
Type of Diabetes
Types of Diabetes
Type I
 Absolute deficiency
of Insulin
 It is diagnosed in
childhood
Type II
 Deficiency of Insulin
production
 Loss in efficiency of
Insulin
Gestational
• Recognized, during
pregnancy.
• It is often temporary.
Signs and Symptoms of Diabetes
 Frequent urination
 Unusual thirst
 Extreme hunger
 Extreme fatigue (tiredness)
 Frequent infections
 Cuts slow to heal
 Tingling/ numbness in hands & feet
 Blurred vision
27
| Presentation Title | Presenter Name | Date | Subject | Business Use Only
Diet in Diabetes
• The proper diet is essential for diabetic treatment. It
helps magically in patients suffering from diabetes. It
provides relief from symptoms and various
complications in diabetics.
• Following are the food which are good for Diabetes :
faculty.ksu.edu.sa/2902/.../Diabetes%20Education%20magic%20capsule
Food good for Diabetes
Protein should take in moderation, high protein meal should be avoided
Onion
Broccoli
Bittergourd
Bengal gram
Beans
Peas
Curd
Soyabean
Soya protein
Apple
Groundnut
Fish
Banana
faculty.ksu.edu.sa/2902/.../Diabetes%20Education%20magic%20capsule
Garlic
Orange
Do’s for diabetes diet
•
•
•
•
•
•
•
DO drink plenty of water each day.
DO eat at least 3 servings of fresh vegetables daily.
DO eat at the same times everyday.
DO switch to low fat milk.
DO eat 20 - 25 grams of raw onion everyday.
DO eat a daily allotment of fresh fruit.
DO try to switch to herbal tea rather
than caffeinated tea
faculty.ksu.edu.sa/2902/.../Diabetes%20Education%20magic%20capsule
Don’ts for diabetes diet
•
•
•
•
DON'T overeat at any time.
DON'T eat or drink anything containing a lot of sugar.
DON'T eat fried or fatty foods.
DON'T have more than 2 cups of regular coffee or
tea daily.
• DON'T drink whole milk.
• DON'T eat cheese high in fat.
• DON'T eat lots of rice, potatoes, bananas or carrots.
These can raise your blood sugar.
faculty.ksu.edu.sa/2902/.../Diabetes%20Education%20magic%20capsule
Don’ts for a diabetic patients
Smoking
Mental
stress
Avoid
gaining
weight
Avoid of getting
hypoglycemia
faculty.ksu.edu.sa/2902/.../Diabetes%20Education%20magic%20capsule
Monitoring Your Diabetes:
Testing Your Sugars at Home
www.med.unc.edu/.../Diabetes%20Self%20Management%20Education%
Testing Sugars- How often?
• Depends what kinds of medicine you take:
• Test more often if:
– You have had low blood sugars (BG<70)
– Sugars have been unusually high (over 200)
– You are sick
– You are starting a new exercise program
www.med.unc.edu/.../Diabetes%20Self%20Management%20Education%
Hypoglycemia or Low Sugar:
Step 1- 10 to 15 Grams of Carbs
Pick One of these
5 to 8 Life
Savers®
1/4 to 1/3 cup
raisins
4 oz. orange juice
8 oz. milk
2 to 3
Glucose
Tablets
3 to 5 peppermint candies
½ can of
regular soda
www.med.unc.edu/.../Diabetes%20Self%20Management%20Education%
Hypoglycemia or Low Sugar:
Step 2- Recheck Blood Sugar
www.med.unc.edu/.../Diabetes%20Self%20Management%20Education%
Hypoglycemia or Low Sugar:
Step 3- Eat a protein snack
Pick One
peanut butter
sandwich or
crackers
½ meat sandwich
crackers & cheese
www.med.unc.edu/.../Diabetes%20Self%20Management%20Education%
Personal Habits You Can Do
•
•
•
•
•
•
•
•
Check your blood sugar
Maintain a healthy weight
Stop smoking
Exercise
Eat a healthy diet
Take medicines regularly
Check your feet every day
Brush and Floss your teeth every day
www.med.unc.edu/.../Diabetes%20Self%20Management%20Education%
Basic Succinct Statement - GALVUS®
Presentation: Tablets containing 50 mg of Vildagliptin.
Indications: ♦Galvus is indicated as an adjunct to diet and exercise to improve glycemic control in patients with type 2 diabetes mellitus (T2DM). It is
indicated: as monotherapy, IN COMBINATION: with metformin, when diet, exercise and metformin alone do not result in adequate glycemic control. with
a sulphonylurea (SU), when diet, exercise and a SU alone do not result in adequate glycemic control. with a thiazolidinedione (TZD), when diet, exercise
and a TZD alone do not result in adequate glycemic control. IN TRIPLE COMBINATION: with a sulphonylurea and metformin when diet and exercise
plus dual therapy with these agents do not provide adequate glycemic control.
♦Galvus is also indicated in combination with insulin (with or without metformin) when diet, exercise and a stable dose of insulin do not result in adequate
glycemic control. ♦Galvus is also indicated as initial combination therapy with metformin in patients with T2DM whose diabetes is not adequately
controlled by diet and exercise alone.
Dosage and administration: ♦Adults: The recommended dose is 50 mg or 100 mg daily for monotherapy, and for combination with metformin, with a TZD or
with insulin (with or without metformin); 50 mg daily in combination with a SU; 100 mg daily for triple combination with metformin and a SU. Maximum
dose is 100 mg/day (in two divided doses of 50 mg).♦Children (under 18 years of age): Not recommended. ♦Special population: In patients with
moderate to severe renal impairment or End Stage Renal Disease (ESRD), the recommended dose is 50 mg once daily.
Contraindications: Hypersensitivity to vildagliptin or to any of the excipients.
Warnings and precautions: ♦Galvus should not be used in patients with type 1 diabetes or for the treatment of diabetic ketoacidosis. ♦Not recommended in
patients with hepatic impairment including patients with a pre-treatment ALT or AST>2.5X the upper limit of normal. Liver function tests (LFT) to be
performed prior to treatment initiation, at three-month intervals during the first year and periodically thereafter. Withdrawal of therapy with Galvus
recommended if an increase in AST or ALT of 3X upper limit normal or greater persist. Following withdrawal of treatment with Galvus and LFT
normalisation, treatment with Galvus should not be reinitiated. ♦Clinical experience in patients with NYHA functional class III treated with vildagliptin is
still limited and results are inconclusive. ♦Not recommended in patients with NYHA Class IV.
Women of child-bearing potential, pregnancy: Should not be used during pregnancy unless the potential benefit justifies the potential risk to the fetus.
Breast-feeding: Should not be used.
Special excipients: Contains lactose
Adverse reactions: Rare cases of angioedema. Rare cases of hepatic dysfunction (including hepatitis) ♦Monotherapy - Common: dizziness - Uncommon:
headache, constipation, oedema peripheral. ♦Combination with metformin - Common: tremor, dizziness, headache. ♦Combination with a sulphonylurea
- Common: tremor, headache, dizziness, asthenia. ♦Combination with a thiazolidinedione - Common: weight increase, oedema peripheral. ♦Combination
with insulin - Common: headache, nausea, gastrooesophageal reflux disease, chills, decreased blood glucose – Uncommon: Diarrhoea, flatulence.
♦Combination with metformin and a sulphonylurea - Common: dizziness, tremor, asthesia, hypoglycaemia, hyperhidrosis. ♦Post-marketing experience Rare: hepatitis (reversible with drug discontinuation) – Unknown: urticaria, pancreatitis, localized exfoliation or blisters.
Interactions: ♦Vildagliptin has a low potential for drug interactions. ♦No clinically relevant interactions with other oral antidiabetics (glibenclamide,
pioglitazone, metformin), amlodipine, digoxin, ramipril, simvastatin, valsartan or warfarin were observed after co-administration with vildagliptin.
Packs: Box of 2 strips of 14 tablets each
Note: Before prescribing, please consult full prescribing information available from Novartis Healthcare Private limited, Sandoz House, Dr. Annie Besant
Road, Worli, Mumbai- 400 018, Tel: 022 2495 8888
For the use only of a registered medical practitioner or a hospital or a laboratory.
India BSS dtd 27 Jan 2014 based on international BSS dtd 18 Dec 2013
Basic Succinct Statement – GalvusMet®
Presentation: Tablets containing Vildagliptin/Metformin hydrochloride fixed dose combination: 50 mg/500 mg, 50 mg/850 mg, 50 mg/1,000mg.
Indications: ♦Galvus Met is indicated as an adjunct to diet and exercise to improve glycemic control in patients with type 2 diabetes mellitus
(T2DM) whose diabetes is not adequately controlled on metformin hydrochloride or vildagliptin alone or who are already treated with
the combination of vildagliptin and metformin hydrochloride, as separate tablets. ♦Galvus Met is indicated in combination with a
sulphonylurea (i.e., triple combination therapy) as an adjunct to diet and exercise in patients inadequately controlled with metformin
and a sulphonylurea. ♦Galvus Met is indicated in combination with insulin (i.e., triple combination therapy) as an adjunct to diet and
exercise to improve glycemic control in patients when stable dose of insulin and metformin alone do not provide adequate glycemic
control. ♦ Galvus Met is also indicated for the treatment of Type 2 Diabetes mellitus having HbA1c > 8% where diabetes is not
adequately controlled by diet and exercise alone.
Dosage and administration: ♦Do not exceed the maximum recommended daily dose of vildagliptin (100 mg). ♦Should be given with meals.
♦Adults: Starting dose for patients inadequately controlled on vildagliptin or metformin hydrochloride monotherapy: 50 mg/500mg twice
daily and gradually titrated after assessing adequacy of therapeutic response. ♦Starting dose for patients switching from combination
therapy of vildagliptin plus metformin hydrochloride as separate tablets: 50 mg/500 mg, 50 mg/850 mg or 50 mg/1,000 mg based on the
dose of vildagliptin or metformin already being taken. ♦Starting dose for treatment naïve patients: may be initiated at 50 mg/500 mg qd
and gradually titrated to a maximum dose of 50 mg/1,000 mg bid after assessing adequacy of therapeutic response. ♦Use in
combination with a sulphonylurea or with insulin: the dose of Galvus Met should provide vildagliptin dosed as 50 mg twice daily (100
mg total daily dose) and a dose of metformin similar to the dose already being taken. ♦Children (under 18 years of age): Not
recommended.
Contraindications: Known hypersensitivity to vildagliptin or metformin hydrochloride or to any of the excipients ♦renal disease or renal
dysfunction ♦congestive heart failure ♦acute or chronic metabolic acidosis including diabetic ketacidosis with or without coma ♦should
be temporarily discontinued in patients undergoing radiologic studies involving intravascular administration of iodinated contrast
materials.
Warnings and precautions: ♦Risk of lactic acidosis. ♦Monitoring of renal function. ♦Caution with concomitant use of medications that may
affect renal function or metformin hydrochloride disposition. ♦Should be temporarily discontinued in patients undergoing radiologic
studies involving intravascular administration of iodinated contrast materials. ♦Discontinue treatment in case of hypoxemia.
♦Temporary discontinuation in patients undergoing surgical procedure. ♦Excessive alcohol intake to be avoided. ♦Not recommended in
patients with hepatic impairment including patients with a pre-treatment ALT or AST >2.5X the upper limit of normal. Liver function
tests (LFT) to be performed prior to treatment initiation, at three-month intervals during the first year and periodically thereafter.
Withdrawal of therapy with Galvus Met recommended if an increase in AST or ALT of 3X upper limit normal or greater persist. Following
withdrawal of treatment with Galvus Met and LFT normalisation, treatment with Galvus Met should not be reinitiated. ♦Risk of decreased
vitamin B12 serum levels. ♦Should not be used in patients with type 1 diabetes or for the treatment of diabetic ketoacidosis. ♦Risk of
hypoglycemia. ♦May be temporarily withheld in case of loss of glycemic control. ♦Should only be used in elderly patients with normal
renal function. ♦Not recommended in pediatric patients.
2/2
Basic Succinct Statement – GalvusMet®
Women of child-bearing potential, pregnancy: Should not be used in pregnancy unless the potential benefit justifies the potential risk to
the foetus.
Breast-feeding: Should not be used during breast-feeding.
Adverse reactions:
♦Vildagliptin: Rare cases of angioedema. Rare cases of hepatic dysfunction (including hepatitis). ♦Vildagliptin monotherapy - Common:
dizziness – Uncommon: headache, constipation, oedema peripheral. ♦Metformin monotherapy – Very common: loss of appetite,
nausea, vomiting, diarrhoea, abdominal pain. Common: dysgeusia. Very rare: lactic acidosis, hepatitis, skin reactions such as
erythema, pruritus and urticarial, decrease of vitamin B12 absorption, liver function test abnormalities. ♦Other effects with
combination of Vildagliptin and Metformin - Common: tremor, dizziness, headache. ♦Other effects with combination of Vildagliptin
and Metformin with insulin – Common: headache, nausea, gastrooesophageal reflux disease, chills, blood glucose decreased–
Uncommon: diarrhoea, flatulence. ♦Other effects with combination of Vildagliptin and Metformin with a sulphonylurea – Common:
dizziness, tremor, asthenia, hypoglycemia, hyperhidrosis. ♦Post-marketing experience: - Rare: hepatitis (reversible with drug
discontinuation) - Unknown: urticaria, pancreatitis, localized exfoliation or blisters.
Interactions: ♦Interactions with Vildagliptin: low potential for drug interactions, no clinically relevant interactions with other oral
antidiabetics (glibenclamide, pioglitazone, metformin), amlodipine, digoxin, ramipril, simvastatin, valsartan or warfarin were
observed after co-administration with vildagliptin. ♦Interactions with metformin hydrochloride: furosemide, nifedipine, cationic
drugs, drugs tending to produce hyperglycemia, alcohol.
Packs: Box containing 6 strips of 10 tablets each
Note: Before prescribing, consult full prescribing information available from Novartis Healthcare Private Limited, Sandoz House, Dr.
Annie Besant Road, Worli, Mumbai- 400 018, Tel: 022 2495 8888
For the use only of a registered medical practitioner or a hospital or a laboratory.
India BSS dtd 31 Jan 2014 based on international BSS dtd 18 Dec 2013, effective from 1 Apr 14.
Disclaimer
“The views, opinions, ideas etc expressed therein are solely those of the author. Novartis does
not certify the accuracy, completeness, currency of any information and shall not be responsible
or in anyway liable for any errors, omissions or inaccuracies in such information. Novartis is not
liable to you in any manner whatsoever for any decision made or action or non-action taken by
you in reliance upon the information provided. Novartis does not recommend the use of its
products in unapproved indications and recommends to refer to complete prescribing
information prior to using any of the Novartis products.”
“Issued in scientific service to medical professionals”
For full product information please write to :
Novartis Healthcare Private Limited,
Sandoz House, 7th floor,
Shivsagar Estate, Dr. Annie Besant Road,
Worli, Mumbai, 400 018, INDIA
Item Code_ Scientific Presentation/Galvus/CVM/ 306082 / 10 / 2014
Approved to be used till Oct’2015 only
44