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Diabetes - Separating Fact from Fiction


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Diabetes is one of the most prevalent diseases in this country, and also one of the most misunderstood. As the illness becomes more and more widespread, the need for knowledge is growing by the day. …

Diabetes is one of the most prevalent diseases in this country, and also one of the most misunderstood. As the illness becomes more and more widespread, the need for knowledge is growing by the day. Dr. David Pittman answers questions and addresses the truth and debunks the myth.

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  • 1. Diabetes:  Separating Fact From Fiction
    David D. Pittman, MD
    Internal Medicine
  • 2. Question #1
    True/False:The incidence of diabetes mellitus is on the decline.
  • 3. Question #2
    Diabetes can affect individuals of which age group:
    a.  children
    b.  teenagers
    c.  adults
    d.  seniors
    e.  all of the above
  • 4. Question #3
    Once an individual is diagnosed with diabetes, he or she will need to begin taking insulin. 
  • 5. Visit our Health Library section for more information
  • 6. Diabetes:  What's the Big Deal?
    Nearly 24 million Americans are affected
    Of those, almost 6 million are unaware that they have diabetes
    These numbers are expected to rise
  • 7. What is Diabetes?
    Diabetes is a metabolic disorder characterized by an imbalance of circulating glucose and the body's supply or action of insulin.
  • 8. Who cares?
    Diabetes is the 7th leading cause of death in the U.S.
    Serious complications include:  heart disease, stroke, blindness, nerve damage, kidney disease, impotence, and amputations.
  • 9. Possible Symptoms of Diabetes - or Not
    Frequent Urination
    Blurred vision
    Weight Loss
  • 10. Diagnosis of Diabetes
    Fasting Plasma GlucoseLevel > 126mg/dL
    Oral GlucoseTolerance Test
    Random Plasma Glucose > 200
    Hemoglobin A1C > 6.5%
  • 11. WhatisHemoglobin A1C?
    Glycosylated hemoglobin is a rough estimate of the amount of "sugar" that "sticks" to a red blood cell (which contains hemoglobin) during it's 90 day lifespan.
    It is expressed as a percentage.
    Normally < 6%
  • 12. Whatdoes HgBA1c Mean?
    HgBA1c            Mean Glucose
        6                          135    7                          170
        8                          205
        9                          240
       10                         275
       11                         310
       12                         345
  • 13. My Doctor Said that I am "Pre-Diabetic"
    Fasting Plasma Glucoselevel 100 - 126
    2 hr post-meal glucose 140 - 199
    High likelihood of progressing to diabetes if no action taken.
  • 14. Type 1 Diabetes
    Children, teenagers, young adults
    Insulin deficiency resulting from auto-immune destruction of insulin-secreting pancreatic beta cells
    Typically present with classic features or emergent hyperglycemia (Diabetic Ketoacidosis -- DKA)
  • 15. Type 2 Diabetes
    90 - 95% diabetics worldwide
    Typically patients 40yr and older
    Family history
    Overweight or obese
    Insulin resistance and relative insulin deficiency
  • 16. Type 2 Diabetes
    Plasma glucose levels remain normal for many years prior to onset of frank Diabetes.
    As insulin resistance builds, pancreatic insulin secretion increases.
    Over time, pancreatic function declines and glucose subsequently increases.
  • 17. Type 2 Diabetes
    Most patients have co-existing clinical and biochemical features:
               Abdominal obesity            Hypertension            Dyslipidemia            = Metabolic Syndrome            
  • 18. Other Types of Diabetes
    Gestational diabetes (7% of US pregnancies)
    Drug induced
    Chronic pancreatitis
  • 19. Now What?
    Patient EDUCATION and self-management
    Diabetic educators/RN/dieticians
    Multi-Disciplinary team approach
  • 20. Treatment
    Foundation of treatment begins with :
                Diet            Weight loss            ExerciseThese reduce insulin resistance, glucose levels and improve cardiovascular risk factors.             
  • 21. Treatment
    Dramatic changes
    Nine separate classes
    Older therapies continue to be effective
  • 22.
  • 23.
  • 24. Treatment
    Lower blood pressure < 130/80
    Use Ace inhibitors (ACEi) or Angiotensin Receptor Blockers (ARB's)
    Lower cholesterol to goal (LDL < 100mg/dL)
  • 25. Long term Complications
    Coronary Arteries
    Carotid Arteries
    Cerebral Vascular Supply
    Peripheral Arteries
  • 26. Long term Complications
    Kidneys:  Diabetic nephropathy
    Eyes:  Diabetic retinopathy
    Peripheral nerves:  Diabetic neuropathy
    These disorders tend to correlate with degree of hyperglycemia
  • 27. Diabetic neuropathy and peripheral arterial disease
  • 28. d
    Long-term management of Diabetes depends largely upon individual action and attitudes.
  • 29. Questions?