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. Dr. David Pittman answers questions and addresses the truth and debunks the myth.

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Diabetes - Separating Fact from Fiction

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