Studies have shown over 50% reduction in diabetes with exercise therapy-Prof.Tasnim Ahsan


World Diabetes Day at JPMC

Studies have shown over 50% reduction in diabetes
with exercise therapy - Prof.Tasnim Ahsan

Weight control, use of healthy balanced diet, regular exercise
and avoiding smoking will help in diabetes control

KARACHI: Exercise is the best intervention for diabetes management and studies have shown that almost over 50% reduction in diabetes with exercise therapy. This was stated by Prof. Tasnim Ahsan an eminent endocrinologist and Director of JPMC. She was speaking at the public awareness session organized at JPMC to celebrate the World Diabetes Day on November 11, 2013. The programme consisted of educational informative talks in Urdu and easy to understand English language as it was attended by a number of patients in addition to healthcare professionals and nurses. Responding to various questions Prof.Tasnim Ahsan said that weight gain with the use of insulin and certain anti-diabetic drugs like sulfonylurea’s is a problem but with diet control and regular exercise the weight gain can be reduced.
Responding to a question regarding bariatric surgery to reduce weight, she said that it was only being performed at private healthcare facilities and was not available at public hospitals. It has certain clear-cut guidelines and selection of patients for this surgical procedure is extremely important. Not only that it had certain complications as well. These patients need prior counseling and long term management after surgery is not so easy. People with BMI of over forty can opt for bariatric surgery wherein the size f the stomach is reduced with the result that one starts eating little but it can also lead to deficiency of certain micronutrients and it was not an option for many patients. Lipo suction, she clarified, was different than bariatric surgery. Pre operative assessment of patients opting for bariatric surgery is important and there is no cure for diabetes which can only be controlled with diet, medications and exercise, she added. As regards exercises, one has to be careful and consult the doctor so that exercise does not increase the problems for the patients. There are many exercises which can be performed which are suitable for patients suffering from various other co-morbid conditions like Rheumatoid arthritis and osteoarthritis, low back pain etc. Patient education plays an important role in diabetes management, she added.
Earlier Dr. Fatima Zehra in her presentation on leading a healthy life said that diabetes is endemic in ten developing countries including Pakistan and if not treated it has serious complications like stroke, kidney failure and myocardial infarction. Failure to control diabetes can lead to patients going on dialysis much early. Foot ulcers can lead to amputation. There is increased morbidity and mortality in patients with diabetes. It is estimated that by 2030 Pakistan will be at NO.4 place as regards prevalence of diabetes in the world. Some of the factors contributing to increased prevalence of diabetes include weight gain and sedentary life style. Almost 50% of patients with diabetes die before sixty years of age and most of these deaths are from cardiovascular diseases. If HBA1c is between 5.7 to 6.4, one should start preventive measures. Use balanced healthy diet, more use of vegetables and fruits reduce intake of fats, weight control, exercise and avoiding smoking will be extremely beneficial.
Dr. Urooj Lal Rehman cautioned against the use of junk food, cold drinks. We have no playgrounds in most of the schools hence the children do not get opportunity for exercise. Diabetes lead to 22% IHD, 11% stroke. Use of stairs, regular walk will burn enough calories. Complications of diabetes can also lead to birth injuries at the time of delivery; hence it is advisable that women with Gestational Diabetes should get themselves registered at some healthcare facility for delivery.
Dr. Samar Abbas discussed management of hypoglycemia at home and pointed out that most of the patients on insulin therapy or those taking drugs like Daonil may suffer from hypoglycemia episodes. They may have increased appetite, feel darkness and have increased palpitation and sweating. They should immediately take some sweet like juice or any other sweet liquid before going to consult a doctor or visiting the healthcare facility for further management. Prof. Tasnim Ahsan opined that people with diabetes should always carry with them some juice or toffees when they travel so that they use it in case of a hypoglycemic episode. It usually occurs when the blood sugar level is less than 70. If the patient is unconscious, they will be managed by the healthcare team. Prevalence of Type- 1 diabetes is less than 5% and hypo episodes are seen more in Type-2 diabetes. Patients must know what the symptoms are so that they can recognize these hypo episodes and manage them immediately. Target HBA1c Prof. Tasnim Ahsan said should be less than 7. People whose diabetes is under control should get their HbA1c test done twice a year but those on high risk must get it done after every three to four months. When diabetes is not controlled even with the use of maximum dosage of three drugs, then the patients should be put on insulin therapy and reduce some of the oral anti diabetics.
Yet another important highlight of the meeting was two Skits written and performed by the House Officers wherein signs and symptoms of diabetes, managing known diabetic with pregnancy were highlighted. These not only provided some amusement to the participants but also carried lot of important health messages regarding diabetes and how to manage it.
The programme was preceded with a three days short course for the postgraduates and house officers. The topics which were scheduled to be discussed during the course included Glucose homeostasis / Classification and Diagnosis of DM by Dr.Fatema Zehra, Management of Type I & II DM, Pharmacological Treatment of DM and Peri-operative control of Diabetes by Prof.Tasnim Ahsan, Medical Nutrition Therapy & Exercise in DM by Dr.Urooj Lal Rehman, Management of Hypertension, Dyslipidemia & Hyperuricemia in Diabetes Mellitus by Dr. Ali Asghar, Diabetic Neuropathy by Prof. Shaukat Ali, Diabetic Foot by Dr. Musarrat Riaz, Hypoglycemia In DM by Dr. Rukhshanda Jabeen, Diabetic Retinopathy by Dr. Javed Niazi, Macrovascular Complications of DM by Dr. Zahid Jamal, Diabetic Nephropathy by Dr. Manohar Lal, Pregnancy & Diabetes / Gestational Diabetes by Dr. Ayesha Sheikh and Care of Neonates Infant/Child/Adolescent with Diabetes by Prof. Jamal Raza.

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