How to Manage DM Dr Hiren Patt D

How to Manage DM ? Dr Hiren Patt D. M. (Endocrinology)

Mr Patel • 24 years/male Height Weight 160 68 • Mother & Father: DM • Glucometer (RBS) – 186

Am I Diabetic ? • Dr Hiren: Need to do proper tests. FBS PPBS Hb. A 1 c

Am I Diabetic ? • Dr Hiren: Need to do proper tests. FBS PPBS Hb. A 1 c Mr Patel 138 214 6. 6 %

Am I Diabetic ? • Dr Hiren: Need to do proper tests. FBS PPBS Hb. A 1 c Mr Patel 138 214 6. 6 % You have DM DM ≥ 126 ≥ 200 ≥ 6. 5 %

Pre-DM FBS PPBS Hb. A 1 c 100 -125 140 -199 5. 7 -6. 4 %

Types of DM • Type 1 DM • Type 2 DM • DM in pregnancy • Other types

Reason for DM at 24 years? • Family h/o DM • Mr Patel: But, They got DM at 50 years of age • Dr Hiren: You are overweight • Mr Patel: My weight is only 68 kg

Ideal Weight Height 155 160 165 170 Ideal Weight 53 56 59 63 Overweight: 12 kg

Can I Cure DM ? • You can’t cure DM, but you can control DM • Mr Patel: Can I cure my DM with Karela juice? • Dr Hiren: No

Mr Patel • Started walking: 20 min/day • Karela juice: 1 glass/day FBS PPBS 138 214 After 3 month 156 244

Mr Patel Comes Back • Mr Patel: What should I do ? • Dr Hiren: You have to take Rx • Mr Patel: I am worried that it will damage my kidney/liver • Dr Hiren: This is not a pain killer. In fact by controlling your DM, it protects your kidney/liver from getting damaged by DM.

• Mr Patel: What are the side effects of medicines ? • Dr Hiren: Not much. 1) stomach upset 2) low sugar

• Mr Patel: I want to take minimum medicines. • Dr Hiren: Ok. That’s possible. I need weight loss of 8 kg. • Mr Patel: How do I lose weight ? • Dr Hiren: Tell me your diet & activity.

Daily diet Breakfast: • 2 bhakhri + 1 cup tea (buffalo milk) Lunch: • 3 Roti + 1 bowl sabji + 1 bowl rice + 1 bowl dal + butter milk Evening snack: • samosa/vada pao/sandwich + 1 cup tea Dinner: • 1 bhakhri + 1 bowl sabji + 1 bowl khichdi + 1 glass milk

Activity • 8 am – wakes up • 9 am – breakfast • 10 am to 6 pm - M. B. A. Executive (sitting job) • 7 pm – dinner • 8 pm to 8. 30 pm – walking (3 -4 days/week) • 8. 30 to 10. 30 pm - T. V. /laptop

Weight = Savings • Savings = Earning – expense If you want to lose weight • Reduce your earning (diet) • Increase your expense (exercise)

Reduce your Earning Carbohydrate • • • Potato Sweet potato Sweets Maida Bhakhri Thepla Paratha Naan Kulcha Soft drinks Juice Fat • • Oil Butter Ghee Fastfood Junkfood Packaged food Fried food

Preferred diet • Fruits: Apple, orange, mosambi, papaiya, watermelon • Salads • Veg soup/Tomato soup • Green vegetables • Sprouts/dal • Buttermilk/low fat milk • Egg white

Mr Patel’s New Diet • 9 am: 1 cup tea/milk (low fat) + sprouts • 11 am: 1 fruit + 4 almonds • 1 pm: 1 salad + 1 green veg + 1 dal + butter milk + 1 roti • 4 pm: 1 fruit + sukha bhel/veg soup/tomato soup • 7 pm: 1 salad + 1 green veg + 1 roti/half khichdi + butter milk + 1 dal • 10 pm: 1 cup milk + 2 walnuts

What About Expense ? • 8 to 9 am: table tennis • 9 to 10 pm: walking

Glucose Monitoring • Mr Patel: How frequently I should check sugar levels ? • Dr Hiren: FBS/PPBS (monthly), Hb. A 1 c (3 monthly)

Glucometer • Mr Patel: Is Glucometer readings accurate? • Dr Hiren: No. But, still you can use it as per the doctor’s advise.

Mr Patel – After 3 months • Lost 10 kg weight • Weight: 68 -> 58 kg • FBS – 105 • PPBS – 132 • Hb. A 1 c – 5. 6 %

• Mr Patel: Is DM under control? FBS PPBS Hb. A 1 c Mr Patel 105 132 5. 6 % DM - Control < 130 < 180 <7%

• Mr Patel: What will happen if DM is not controlled ? • • Dr Hiren: Retina (Eyes) damage Heart attack Kidney failure Brain stroke Foot problems Infections

Monitoring for Complications of DM Once in a Year Kidney Creatinine Urine Alb/Creat ratio Eye Liver Heart Cholesterol Foot Fundus SGPT, SGOT BP, ECG Lipid profile Examination

Conclusion • Experience (not weight) should increase with age • Weight management (Diet & Exercise) are more important then medicines • Periodic sugar monitoring & consultation with doctor is must

Thanks