Sample Text: Today I am excited to talk to you about a really important area of medicine and health and that is Diabetes.
Engage the audience with the questions….you are trying to position the topic as being important, having value….as well as getting the audience members engaged….. Sample Text: Okay, let’s start with a show of hands. How many of you know someone with Diabetes? ………yes looks like all of you……and that is not unusual. Now how about that next question….how many of you struggle with your weight? Well you are not alone……..and today……we are going to talk about just how closely linked these two problems are and what you can do to make a plan to live healthily and reduce your risk of Diabetes or improve your diabetes control if you have it.
Sample text: So my goal for us is to learn what “diabetes” really I, how a person develops diabetes and how food affects weight and how weight affects diabetes risk. I also want you to walk away today empowered, recognizing what you can do to help improve and maximize your health
Sample text: Let’s start in mini-medschool and then visit the market, and finally pull it all together with a health assessement and take home plan
Sample text: According to the ADA……….and according to the NIH…….. http://www.diabetes.org/diabetes-basics/?loc=GlobalNavDB http://ndep.nih.gov/diabetes-facts/index.aspx#whatisdiabetes
Sample text: There are 2 basic types of diabetes we talk about. Type one and type 2………(then explain both)……finish by stressing that the rest of this talk will be primarily focused on Type 2 Diabetes since that is overwhelmingly what most people have. If you have any specific questions about Type 1 I am happy to address them as well.
Sample text: Diabetes is an extremely common disease and it is growing more common every day. Perhaps 50 years ago it was quite rare, but for a number of reasons we will talk about it is now a leading causes of death and illness in America diabetes.niddk.nih.gov/ DM/PUBS/statistics/ http://www.cdc.gov/diabetes/pubs/pdf/ndfs_2011.pdf http://www.diabetes.org/about-diabetes.jsp http://www.uptodate.com/patients/content/topic.do?topicKey=~X0jjLnBn4._ko http://diabetes.niddk.nih.gov/DM/PUBS/statistics/ http://www.cdc.gov/diabetes/pubs/estimates07.htm Diabetes is a group of diseases marked by high levels of blood glucose, also called blood sugar, resulting from defects in insulin production, insulin action, or both
Sample text: The leading risk factors for Diabetes are……..the Non-Modifiable are good to know about but since we can do very little to affect them, we prefer to focus on the modifiable risk factors, the R-hand column where you can see quite a few factors which you can I have influence over with our “ fingers, feet and forks” as they like to say. http://www.diabetes.niddk.nih.gov/dm/pubs/riskfortype2/index.aspx http://www.cdc.gov/diabetes/consumer/prevent.htm
Sample text: One of the modifiable risk factors stands out above the others however as the most clearly related and most powerfully predictive of diabetes risk. You can see the numbers here where the risk of ……………
Sample text: I always like pictures and in this graphic you see the changing colors of the states of the country. Well that change in color represents a drastic change in obesity and overweight in America. In fact now more than 2 in 3 Americans are either overweight or obese. When you look at similar charts of diabetes rates you see almost mirror images as compared to the rates of overweight/obese. --http://www.cdc.gov/nccdphp/publications/factsheets/Prevention/pdf/obesity.pdf --http://www.cdc.gov/nccdphp/publications/factsheets/Prevention/obesity.htm
Sample text: Here is just one more way to look at the data. You can see how closely the 2 curves resemble one another. As we have increased in weight, our rates of diabetes have tripled in the last 30 years. http://www.cdc.gov/diabetes/statistics/prev/national/figpersons.htm
Sample text: Unfortunately unless we change something we are projected to have even higher rates of diabetes every year for the predictable future
Sample text: Increased cases of diabetes, translates to increased costs. In fact…………………the reason for all this spending is in large part due to the complications associated with Diabetes --http://www.ncbi.nlm.nih.gov/pubmed/12679416-- --http://www.chrp.org/pdf/HSR10_08_04.pdf --http://www.nchc.org/facts/cost.shtml --Catlin, A, C. Cowan, S. Heffler, et al, &quot;National Health Spending in 2005.&quot; Health Affairs 26:1 (2006): 142-153. --Borger, C., et al., &quot;Health Spending Projections Through 2015: Changes on the Horizon,&quot; Health Affairs Web Exclusive W61: 22 February 2006. -- http://www.mathematica-mpr.com/health/ --http://aspe.hhs.gov/health/NDAP/NDAP04.pdf
Sample text: Diabetes……..and increases……etc…. Now that we know http://diabetes.niddk.nih.gov/DM/PUBS/statistics/
Sample text: So in review……. Now let’s move on to the 2 nd and 3 rd year of mini-medical school and learn more about how the body works and what happens when diabetes sets in
Sample text: Perhaps the most important organ involved in blood sugar control is the pancreas. The pancreas sits in your abdomen, wrapped up close to the stomach ad the small intestines
Sample text: There the pancreas produces all kinds of hormones and digestive enzymes to help you digest, absorb and metabolize your food
Sample text: IN medical school we learned the pancreas is a unique organ because it both puts enzymes into the small intestines and also produces hormones that are released into the blood. The most important hormone I want you to remember after today’s talk is insulin…..Insulin is crucially important for blood sugar control and the next slide is going to help explain that for you……
Sample text: IN this slide I want to help demonstrate a really complex system of molecules and hormones in a way that makes sense to both of us. So first imagine a bunch of houses (click thru). Each house has a gate (click thru). And in front of the houses is a road (Click). That road represents the blood vessels in your body and the houses represent the cells of your body. Now the cells need energy to work and that energy is sugar or “glucose” (click) Glucose or sugar travels to the house /cell via the road/blood vessel. Now when sugar gets to the house it can’t get in unless the gate keeper :insulin” is there. So insulin, the hormone produced by your pancreas acts like a gate keeper and opens up the gates leading into the house and allowing sugar out of the blood stream and into the cell so the cell can do it’s job. Now how does 95% of Type 2 Diabetes happen? Like this. As we develop belly fat, the fat cells release hormones with fancy names like interleukin 6 and Tumor necrosis factor alpha and C reactive protein. There names don’t really matter though so we will call them X,Y,Z. Well these hormones actually go up to the gate insulin is trying to open and block the gate, kind of like a “bouncer “ at a bar who says…no you can’t come in here. Well these molecules (inflammatory cytokines) block insulin from doing it’s job and then sugar can’t get out the blood stream so it builds up. Of course the body is smart so it figures, “I just need more insulin.” It produces more insulin and the increased insulin can overcome the gate blockers. So this continues on for years…on average about 10 years. All this time the pancreas has been producing extra insulin, working overtime, triple shifts…..and then one day the pancreas just says, I can’t do it anymore, I am done. And on that day a person gets diagnosed with “Type 2 Diabetes.” Of course their insulin had been high for years before that…let’s look….
Sample text: So Insulin climbs and climbs, but finally the pancreas just gives up and can no longer do it’s job. Not because it was a bad pancreas, just because we overworked it for too many years without a break …….All those years of high amounts of insulin also cause other problems…..
Sample text: You can see how increased fat pushes a person into a bad cycle like we talked about…..
Sample text: So let’s review…we know that…
Sample text: So all that sounds pretty bad. What can we do? The good news is there is a lot we can do. Remember the risk factors for Diabetes we described earlier? Well studies have shown that making personal choices about what and how much you eat and how much exercise you get every day can powerfully influence your risk of diabetes. Let’s look at a few
Sample Text In this landmark study people either were given health counseling and coached to make particular healthy life choices. These included the following goals………. The good news for us is that if we are overweight or obese and we choose to make such goals our own then we reduce the risk of diabetes dramatically as well…….there have been many other studies that show similar benefit…….but let’s start looking at our own risks and whether there are things we need to do to improve our health (Presenter…feel free to add other studies here and spend more time ….if you feel it is needed) http://www.epi2008.com.br/apresentacoes/PAINEIS_22_09_PDF/Jaakko%20Tuomilehto.pdf
Sample Text So what do we know….we know………now it’s time to look at whether we have maximized our own health and where there is room to improve…..and make ourselves as “Diabetes proof” as possible
Sample Text Hand out the risk assessment tools and the BMI. Help them walk through each piece
Sample Text After completing the risk assessment tool then take a few minutes to go through and help them develop a personalized health plan. Answer questions………have fun…smile
Your food your weight cec2012
Powerpoints designed for andgiven as part of a Community- Education Collaborative Boston, MA 2012 Stephan Esser MD www.esserhealth.com
Disclaimer Does not constitute Medical Advice Check with your primary health care provider prior to making any changes in diet, exercise or medication The information provided today is intended for educational purposes only. It does not replace consultation with your medical provider, does not constitute medical care and does not necessarily represent the opinions of the various supporting institutions.
Show of Hands How many of you know someone with Diabetes? How many of you struggle with your Weight?
Goals Educate: What is “Diabetes” How do you develop Diabetes How your food and your weight affect your risk Empower: Give you a few tools to take home Develop a personalized Health Plan to improve your weight and help prevent or improve control of your diabetes
Outline Go to “Mini-Med School” Learn just how much of a problem Diabetes is Review some basic anatomy and physiology Find out what really causes “Type 2 Diabetes” Visit the Market Learn how food can affect your Diabetes risk Put it all together Tips to take home
What is Diabetes? ADA 2011: “a group of diseases characterized by high blood glucose levels that result from defects in the bodys ability to produce and/or use insulin.” NIH 2011: “Diabetes is a group of diseases marked by high levels of blood glucose, also called blood sugar, resulting from defects in insulin production, insulin action, or both.”
Types of Diabetes Type 1: Insufficient or non-existent Insulin production Pancreatic destruction (autoimmune, cancer etc..) 5-10% of all cases Type 2: Insulin is unable to work Insulin insensitivity/resistance 90-95% of all cases
Statistics 2011 8.3% of the population 25.8 million US citizens 18.8 mill. diagn. 7.0 mil. undia. 26.9% age > 60 have DM2 7th Leading Cause of Death
Risk Factors for T2D Non-Modifiable Modifiable Age >45 Overweight/Obese Family History Physical Activity Race High Blood Pressure Prior hx of Gest. DM High Cholesterol Nutrition
Overweight ↑ risk of T2D by 300% Obesity ↑ risk by 900%
Cost to the Nation Healthcare is 2-3 times that of those without DM(WHO) 2007: Total costs exceeded $174 billion dollars Projected costs by 2020 of $192 billion “Without preventive action, 1 in 3 children born in 2000 will develop diabetes in their lifetime.” (HHS) Perspective Cost of DM2 care in 2005 > budget of the D. of Ed. Diabetes care is 12 percent of the total health care spending nationwide—roughly one of every eight dollars.
What we know Diabetes rates have tripled in the last 30 years Rates of Diabetes continue to climb each year Rates of overweight/obesity mirror Diabetes rates Diabetes is extremely dangerous and very expensive to treat
Pancreas Secretes digestive enzymes into the intestine Amylase, lipase, trypsin, chymotrypsin, bicarbonate, water digestion, neutralize acid Secretes hormones into the blood Insulin, glucagon, somatostatin Blood sugar control, neuro-hormonal control
In Review Increased Belly (Visceral) fat increases the risk of Diabetes Diabetes results in high blood sugars High blood sugars cause damage to the body As rates of Obesity rates of Diabetes Rates of Diabetes have tripled in the last 25 years The cost of treating Diabetes is extremely expensive