Tuesday, 21 November 2017

Prevention of Diabetes

India is home to over 60 million adults with diabetes (7.8% of the population), of which more than 30 million are undiagnosed or untreated, thus increasing the risk of developing complications and premature mortality.

Given the challenges in early detection and management of diabetes, it is imperative to seek innovative ways that help to expand the reach of health literacy and services among the general population and high risk groups, while also improving management and quality of life in confirmed diabetics.

One of the most promising new opportunities is afforded by the high penetration of mobile communications in India: the country now has over a billion mobile subscriptions. The delivery of healthcare services through mobile phones has increased worldwide over the past two decades and there is increasing evidence of the efficiency of this harnessing this opportunity. Therefore, the Ministry of Health and Family Welfare (MoHFW) in collaboration with the WHO Country Office for India and other partners, has launched a mobile health initiative for the prevention and care of diabetes – mDiabetes.

mDiabetes will contribute to improving awareness about diabetes and promoting healthy diets and active lifestyle, which are vital to the prevention of diabetes. mDiabetes will also enhance health care seeking and early diagnosis, contribute to better adherence to drug or dietary control, self-care, as well as prevention of complications among patients with diabetes.

mDiabetes is based on proven algorithms for diabetes prevention and care, and builds on previous international experiences in using mobile technologies to deliver these interventions.


Frequently Asked Questions (FAQ)

Can diabetes be cured?

No. Diabetes cannot be cured. It can only be controlled. In certain cases of type 2 diabetics who are obese, weight reduction can achieve a normal state without use of drugs.

Why is diabetes becoming a problem in our country?
Indians have significantly high rates of diabetes when compared to other ethnic groups such as Europeans, Africans and the like. This is attributed to high genetic susceptibility and rapid change in life style. Recent studies have shown that the prevalence of diabetes in India is as high as 12 to 18% of the adult population especially in urban areas. The magnitude of the problem is likely to increase. Diabetes occurs at a younger age in India.

Can a person have diabetes without symptoms?
Yes. The common symptoms of diabetes are excessive thirst, excessive hunger and frequent urination. The person may also feel weak and exhausted. These symptoms are associated with severe diabetes. Very often many people do not have these characteristic symptoms even when the blood sugar levels are in the diabetic range. Many have vague symptoms and complain of body pain and lassitude, etc. Hence, it is difficult to detect diabetes by means of typical symptoms alone. A lot of personal variations are seen with respect to symptoms of diabetes.

Is diabetes more common among men or women?
In most population it is not very different. Women seem to have higher prevalence in certain population due to increased obesity. Today in India, diabetes is found almost equally in men and women.

Can I lead a normal life with diabetes?
Yes. This is a disorder either due to defective action or deficiency of insulin. It is life style disorder. When the blood sugar is kept under control, a diabetic can have a healthy, normal life.


Prevention of Diabetes

Healthy Diet

Calorie Requirements based on weight and usual activity for adults:



  •     Obese inactive, sedentary men/women - 20 kcal/kg of present weight
  •     Normal BMI, sedentary men/women - 22 – 25 kcal/kg
  •     Normal BMI, active men/women  - 30 kcal/kg
  •     Thin/Very active - 40 kcal/kg


The calorie requirements, in addition to the above mentioned criteria should be based on the patient’s usual food intake. One third of the total calories can be distributed for early morning and breakfast. Another one third for mid morning snack and lunch and the remaining one third for evening snack and dinner.

Carbohydrates:



  •     Carbohydrates should approximate 55 – 60% of total calories /day
  •     Minimum of 130gm/day
  •     25 -50gms of carbohydrates from fiber per day may be given


Proteins:



  •     Daily requirement is 15 – 20% of the total calories/day
  •     1gm/kg of present body weight/day
  •     1gm/kg of ideal body weight if obese
  •     0.6-0.8 mg/kg body weight in nephropathy
  •     50% of daily protein has to be from Class 1 sources


Fats:



  •     Daily requirement is 15 – 20% of the total calories/day
  •     Saturated fat < 7%
  •     Polyunsaturated fat – up to 10%
  •     Monounsaturated fat – up to 20%
  •     Intake of trans fat should be minimized (Bakery products)
  •     Limit dietary cholesterol to less than 200 mg/day
  •     Daily visible fat intake is 3 – 5 tsp/day
  •     Oil - 500 gm/month/person

Physical Activity


Routine exercises belong to three categories namely: 1) Aerobic exercise, 2) Flexibility Exercise and 3) Strength exercise.  
Aerobic Exercise:
This is a rhythmic, repeated and continuous movement of the large muscle groups. A total of about 30 – 45 minutes a day, at least 5 days a week is recommended.  Walking, bicycling, jogging, continuous swimming, water aerobics and sports activities should be performed at sufficient intensity and frequency.
Flexibility Exercise:
Stretching the body’s muscles provides freedom of movement to do the things you need to do and the things you like to do. Stretching can improve your flexibility, although it will not improve your endurance or strength.
Stretching exercise should be done after your regularly scheduled aerobic activities. You should do stretching every day. Do each stretching exercise at least 4 times each session. Slowly stretch into the desired position, as far as possible without pain, and hold the stretch for 15–60 seconds. Relax, then repeat, trying to stretch a little farther. Always remember to breathe while stretching. Counting out loud can help ensure that you are breathing.

Strengthening exercise:
Strength exercise increases one’s heart rate, works up muscles and raises the breathing rate. This uses large muscles that do not require oxygen for short period of exercise. It helps build strong bones and muscles, lower blood glucose, makes the action of insulin more effective. A common concern among health care providers is that higher intensity resistance exercise should not be performed by middle-aged or older people at risk for cardiovascular disease. The concern centre around the increase in blood pressure that might cause stoke, myocardial infarction or retinal bleeds.

Side Effects of Exercise

  • Excessive increments in blood pressure
  • Exercise induced orthostatic hypotension
  • Increased protein excreted in urine
  • Hypoglycaemia
  • Foot ulcers
  • Accelerated degeneration of joints
  • Higher intensity resistance exercise increase in blood pressure that might cause stoke, myocardial infarction or retinal bleeds in middle-aged or older people at risk for cardiovascular disease. 

Types of Physical Activity

Routine exercises belong to three categories namely: 1) Aerobic exercise, 2) Flexibility Exercise and 3) Strength exercise.  
Aerobic Exercise:
This is a rhythmic, repeated and continuous movement of the large muscle groups. A total of about 30 – 45 minutes a day, at least 5 days a week is recommended.  Walking, bicycling, jogging, continuous swimming, water aerobics and sports activities should be performed at sufficient intensity and frequency.
Flexibility Exercise:
Stretching the body’s muscles provides freedom of movement to do the things you need to do and the things you like to do. Stretching can improve your flexibility, although it will not improve your endurance or strength.
Stretching exercise should be done after your regularly scheduled aerobic activities. You should do stretching every day. Do each stretching exercise at least 4 times each session. Slowly stretch into the desired position, as far as possible without pain, and hold the stretch for 15–60 seconds. Relax, then repeat, trying to stretch a little farther. Always remember to breathe while stretching. Counting out loud can help ensure that you are breathing.

Strengthening exercise:
Strength exercise increases one’s heart rate, works up muscles and raises the breathing rate. This uses large muscles that do not require oxygen for short period of exercise. It helps build strong bones and muscles, lower blood glucose, makes the action of insulin more effective. A common concern among health care providers is that higher intensity resistance exercise should not be performed by middle-aged or older people at risk for cardiovascular disease. The concern centre around the increase in blood pressure that might cause stoke, myocardial infarction or retinal bleeds.


Preferred Exercise



  • The type and intensity of the exercise chosen should not be too difficult for the person to master.
  • The activity or activities chosen should be enjoyable for the person to perform.
  • 5 – 10 minutes of warm up exercise such as walking or bicycling at low intensity to prepare the muscles, heart and lungs.
  • 30 minutes of aerobic exercise include walking, bicycling, jogging, continuous swimming, water aerobics and sports activities performed and sufficient intensity and frequency.
  • 5 – 10 minutes of cool down exercise consists of the same activities as the warm up.
  • Plan to increase intensity or duration of activity over time.



Sarkari Niyukti

For more information visit http://mdiabetes.nhp.gov.in



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