Diabetes thebasics
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  • 5.9% of the US population has diabetes.
    Approximately 15.1 million people.
    Each day 2,200 people are diagnosed.
    798,000 will be diagnosed this year.
    It is the 7th leading cause of death.
    Currently, there is no cure for diabetes only methods to treat its symptoms.
  • Type 1 diabetesResults from the body's failure to produce insulin, the hormone that "unlocks" the cells of the body, allowing glucose to enter and fuel them. It is estimated that 5-10% of Americans who are diagnosed with diabetes have type 1 diabetes.
    Type 2 diabetes Results from insulin resistance (a condition in which the body fails to properly use insulin), combined with relative insulin deficiency. Most Americans who are diagnosed with diabetes have type 2 diabetes.
    Gestational diabetes Immediately after pregnancy, 5% to 10% of women with gestational diabetes are found to have diabetes, usually, type 2.
    Pre-diabetes Pre-diabetes is a condition that occurs when a person's blood glucose levels are higher than normal but not high enough for a diagnosis of type 2 diabetes. There are 57 million Americans who have pre-diabetes, in addition to the 23.6 million with diabetes.
  • Type 1 diabetes (formerly known as "juvenile diabetes") occurs when the pancreas stops making insulin all together. Type 1 diabetes is usually diagnosed in youth, although sometimes people develop type 1 well into their 30's.
    Type 2 diabetes occurs when the pancreas makes some insulin, but either it can't make enough or the insulin it does make doesn’t work very well. Type 2 diabetes is traditionally associated with older people but these days, more and more youth are being diagnosed with type 2 diabetes.
  • Type 1 diabetes is usually diagnosed in children and young adults, and was previously known as juvenile diabetes. In type 1 diabetes, the body does not produce insulin. Insulin is a hormone that is needed to convert sugar (glucose), starches and other food into energy needed for daily life.
  • Type 2 diabetes is the most common form of diabetes. In type 2 diabetes, either the body does not produce enough insulin or the cells ignore the insulin. Insulin is necessary for the body to be able to use glucose for energy.
    When you eat food, the body breaks down all of the sugars and starches into glucose, which is the basic fuel for the cells in the body. Insulin takes the sugar from the blood into the cells. When glucose builds up in the blood instead of going into cells, it can cause two problems:
    Right away, your cells may be starved for energy.
    Over time, high blood glucose levels may hurt your eyes, kidneys, nerves or heart.
    While diabetes occurs in people of all ages and races, some groups have a higher risk for developing type 2 diabetes than others. Type 2 diabetes is more common in African Americans, Latinos, Native Americans, and Asian Americans/Pacific Islanders, as well as the aged population.
  • Doctors diagnose on the basis of high levels of glucose in the blood.
    There are 2 types of blood tests used for screening and diagnostic.
    Screening is done on people with no symptoms of diabetes. You have probably seen these done at health fairs where blood is taken by pricking your finger.
    For a diagnostic tests, the physician draws blood from a vein. Two of the diagnostic tests are:
    Fasting Plasma Glucose Test – fasted for at least 8 hours.
    Oral Glucose Tolerance Test: Must fast overnight, then your fasting blood sugar is tested. You then receive 75 grams of glucose and blood samples are taken four times to measure blood glucose levels.
    Diabetes is actually diagnosed when two diagnostic test completed at different times/days show that your blood sugar is high.
  • Diabetes often goes undiagnosed because many of it’s symptoms seem so harmless. Early detection and treatment can lower the incidence of complications.
  • OGTT is a single 2-hour post challenge glucose level after drinking or ingesting a 75 gm glucose solution after an overnight fast of 8-12 hours.
    Impaired Fasting Glucose
    When a person has a fasting glucose equal to or greater than 110 and less than 126 mg/dl, they are said to have impaired fasting glucose. This is considered a risk factor for future diabetes, and will likely trigger another test in the future, but by itself, does not make the diagnosis of diabetes.
    Impaired Glucose Tolerance
    A person is said to have impaired glucose tolerance when the 2-hour glucose results from the oral glucose tolerance test are greater than or equal to 140 but less than 200 mg/dl.  This is also considered a risk factor for future diabetes. There has recently been discussion about lowering the upper value to 180 mg/dl to diagnose more mild diabetes to allow earlier intervention and hopefully prevention of diabetic complications.
    Diabetes
    A person has diabetes when oral glucose tolerance tests show that the blood glucose level at 2 hours is equal to or more than 200 mg/dl.  This must be confirmed by a second test (any of the three) on another day. There has recently been discussion about lowering the upper value to 180 mg/dl to diagnose more people with mild diabetes to allow earlier intervention and hopefully prevention of diabetic complications.
  • The Good News About Diabetes
    You might be wondering: What’s the “good” news about diabetes, the seventh leading cause of death that has reached epidemic proportions in the United States in the past 10 years? The good news is that we now have definitive proof that type 2 diabetes can be delayed or prevented in persons at risk for the disease.
    How— through moderate changes in lifestyle. The Diabetes Prevention Program (DPP) was a large, multi-site clinical trial that proved that type 2 diabetes can be prevented or delayed through modest weight loss (5 to 7 percent of initial body weight) and regular physical activity. In fact, these modest changes resulted in a 58 percent reduction in the development of diabetes in persons at increased risk for the disease. Moreover, these impressive results were obtained in all ethnic and age groups and especially in those over age 60.
    You’re probably saying to yourself … “Every time I try to get my overweight patients to lose weight, I fail.”We recognize how difficult it is to get patients to lose weight. Aggressive (and sometimes unrealistic) goals often lead to failure and frustration for both patient and health care provider. Again, the good news is that significant risk reduction can be achieved through modest weight loss. In the DPP, a man who weighed 290 pounds and lost 7 percent of his body weight would still weigh 270 pounds, but have the potential for significant risk reduction for developing diabetes.
  • Each year 190,000 people die as a result of diabetic complications.
    Diabetes complications are the seventh leading cause of death. They are all strongly related to high blood sugar.
    They include:
    Blindness- this is the leading cause of blindness in people 20 to 74 years of age.
    Kidney Disease – 10 –21% develop kidney disease, it is the most common cause of end-stage renal disease requiring the need of dialysis to live.
    Heart Disease and Stroke – diabetes are 2 –4 times more likely to have heart disease.
    Early testing is good.
  • Consistency
  • This is the only way to give feedback to your doctor. Especially if your goal is to eliminate meds.
  • What about insulin?
    Although it is a common practice to try pills before insulin, you may start on insulin based on several factors.
    These factors include:
    how long you have had diabetes
    how high your blood glucose level is
    what other medicines you take
    your overall health
    Because diabetes pills seem to help the body use insulin better, some people take them along with insulin shots. The idea behind this "combination" therapy is to try to help insulin work better.
    Inside the pancreas, beta cells make the hormone insulin. With each meal, beta cells release insulin to help the body use or store the blood glucose it gets from
    food. In people with type 1 diabetes, the pancreas no longer makes insulin. The beta cells have been destroyed and they need insulin shots to use glucose from meals. People with type 2 diabetes make insulin, but their bodies don't respond well to it. Some people with type 2 diabetes need diabetes pills or insulin shots
    to help their bodies use glucose for energy. Insulin cannot be taken as a pill. The insulin would be broken down during digestion just like the protein in food. Insulin must be injected into the fat under your skin for it to get into your blood.
    There are many different insulins for many different situations and lifestyles and there are more than 20 types of insulin sold in the United States. These insulins differ in how they are made, how they work in the body, and price. Insulin is made in labs to be identical to human insulin or it comes from animals (pigs). Future availability of animal insulin is uncertain.
  • Also known as low blood sugar.
    Part of living with diabetes is learning to cope with some of the problems that go along with having the disease. Hypoglycemia or low blood glucose (sugar) is one of those problems. Hypoglycemia happens from time to time to everyone who has diabetes.
    Hypoglycemia, sometimes called an insulin reaction, can happen even during those times when you're doing all you can to manage your diabetes. So, although many times you can't prevent it from happening, hypoglycemia (low blood glucose) can be treated before it gets worse. For this reason, it's important to know what hypoglycemia is, what symptoms of hypoglycemia are, and how to treat hypoglycemia.
    What are the symptoms of hypoglycemia?
    Shakiness
    Dizziness
    Sweating
    Hunger
    Headache
    Pale skin color
    Sudden moodiness or behavior changes, such as crying for no apparent reason
    Clumsy or jerky movements
    Seizure
    Difficulty paying attention, or confusion
    Tingling sensations around the mouth
    How do you know when your blood glucose is low?
    Part of managing diabetes is checking blood glucose often. Ask your doctor how often you should check and what your blood glucose levels should be. The results from checking your blood will tell you when your blood glucose is low and that you need to treat it.
    You should check your blood glucose level according to the schedule you work out with your doctor. More importantly though, you should check your blood whenever you feel low blood glucose coming on. After you check and see that your blood glucose level is low, you should treat hypoglycemia quickly.
    If you feel a reaction coming on but cannot check, it's best to treat the reaction rather than wait. Remember this simple rule: When in doubt, treat.
  • How do you treat hypoglycemia?
    The quickest way to raise your blood glucose and treat hypoglycemia is with some form of sugar, such as 3 glucose tablets (you can buy these at the drug store), 1/2 cup of fruit juice, or 5-6 pieces of hard candy.
    Ask your health care professional or dietitian to list foods that you can use to treat low blood glucose. And then, be sure you always have at least one type of sugar with you.
    Once you've checked your blood glucose and treated your hypoglycemia, wait 15 or 20 minutes and check your blood again.  If your blood glucose is still low and your symptoms of hypoglycemia don't go away, repeat the treatment.  After you feel better, be sure to eat your regular meals and snacks as planned to keep your blood glucose level up.
    It's important to treat hypoglycemia quickly because hypoglycemia can get worse and you could pass out.  If you pass out, you will need IMMEDIATE treatment, such as an injection of glucagon or emergency treatment in a hospital.
    Glucagon raises blood glucose. It is injected like insulin. Ask your doctor to prescribe it for you and tell you how to use it.  You need to tell people around you (such as family members and co-workers) how and when to inject glucagon should you ever need it.
    If glucagon is not available, you should be taken to the nearest emergency room for treatment for low blood glucose.  If you need immediate medical assistance or an ambulance, someone should call the emergency number in your area (such as 911) for help.  It's a good idea to post emergency numbers by the telephone.
    If you pass out from hypoglycemia, people should:
    NOT inject insulin.
    NOT give you food or fluids.
    NOT put their hands in your mouth.
    Inject glucagon.
    Call for emergency help.
    How do you prevent low blood glucose?
    Good diabetes control is the best way we know to prevent hypoglycemia.  The trick is to learn to recognize the symptoms of hypoglycemia.  This way, you can treat hypoglycemia before it gets worse.
  • Hyperglycemia happens from time to time to all people who have diabetes. It is the technical term for high blood sugar. Other stresses can also cause it.
    What are the symptoms of hyperglycemia?
    The signs and symptoms include: high blood glucose, high levels of sugar in the urine, frequent urination, and increased thirst.
    Part of managing your diabetes is checking your blood glucose often. Ask your doctor how often you should check and what your blood glucose levels should be. Checking your blood and then treating high blood glucose early will help you avoid the other symptoms of hyperglycemia.
    It's important to treat hyperglycemia as soon as you detect it. If you fail to treat hyperglycemia, a condition called ketoacidosis (diabetic coma) could occur. Ketoacidosis develops when your body doesn't have enough insulin. Without insulin, your body can't use glucose for fuel. So, your body breaks down fats to use for energy.
    When your body breaks down fats, waste products called ketones are produced. Your body cannot tolerate large amounts of ketones and will try to get rid of them through the urine. Unfortunately, the body cannot release all the ketones and they build up in your blood. This can lead to ketoacidosis.
    Ketoacidosis is life-threatening and needs immediate treatment. Symptoms include:
    shortness of breath
    breath that smells fruity
    nausea and vomiting
    a very dry mouth
  • Hemoglobin A1C is the blood test with a memory. Hemoglobin is the protein in red blood cells that carries oxygen. These blood cells stay in circulation for 2-3 months. It is not used to diagnose just to monitor blood sugar control. It is performed two times a year. A hemoglobin of 6% indicates good control and level>8% indicates action is needed.
    A1C  a test that measures a person's average blood glucose level over the past 2 to 3 months. Hemoglobin (HEE-mo-glo-bin) is the part of a red blood cell that carries oxygen to the cells and sometimes joins with the glucose in the bloodstream. Also called hemoglobin A1C or glycosylated (gly-KOH-sih-lay-ted) hemoglobin, the test shows the amount of glucose that sticks to the red blood cell, which is proportional to the amount of glucose in the blood.
  • Diabetics also must be pay close attention to their feet, this may be an issue with exercise. 1 in 5 people with diabetes enter the hospital due to foot problems. Usually due to poor wound healing which is caused by poor circulation.

Transcript

  • 1. Diabetes: The Basics Presented By: Shahid Nawaz Researcher King Saud University, Riyadh,KSU
  • 2. People have diabetes because…. (1)The insulin their body makes doesn’t work right or (2)Their body doesn’t make enough insulin.
  • 3. Insulin takes the glucose from blood into cells. Insulin takes the glucose from blood into cells. People have diabetes because….
  • 4. . . Insulin helps sugar move out of the blood and into the cells. Cells will not allow blood sugar in without insulin. - this can cause a problem. How Does Insulin Work?
  • 5. Energy for Our Bodies • Energy comes mostly from the glucose in the foods we eat. • Blood takes the glucose to our cells. • The pancreas makes insulin, which unlocks the cells so the glucose can get in. • Extra glucose is stored as fat or in the liver for use if needed later. • Energy comes mostly from the glucose in the foods we eat. • Blood takes the glucose to our cells. • The pancreas makes insulin, which unlocks the cells so the glucose can get in. • Extra glucose is stored as fat or in the liver for use if needed later.
  • 6. Types Of Diabetes  Type I - body does not produce any insulin.  Type II- body is not making enough or is losing sensitivity to insulin made.  Secondary - a consequence from another disease. For example, pancreatitis or cystic fibrosis.  Gestational Diabetes- diabetes during pregnancy.  Impaired Glucose Tolerance- an intermediate between normal and diabetes.
  • 7. Why Isn’t The Body Making Insulin?  In people with Type I, the immune system has made a big mistake.  It attacks the beta cells and destroys them.  In people with Type II, the pancreas is still making insulin, just not enough to keep up, or their bodies have become insulin resistant.
  • 8. Type I  Usually diagnosed in children and young adults.  Must take daily insulin shots to stay alive.  Type I accounts for 5-10% of the population with diabetes.
  • 9. Type II  The most common form of the disease.  Approximately 50% of men and 70% of women are obese when diagnosed.  Nearing epidemic proportions  increased number of older Peoples.  greater occurrence of obesity  sedentary lifestyles
  • 10. How You Diagnosed With Diabetes?  The ADA redefined it’s criteria for diagnosing diabetes.  <110 mg/dl is normal fasting blood glucose.  110 – 126 mg/dl is impaired fasting glucose.  >126 mg/dl (fasting blood glucose) is used to diagnose diabetes.
  • 11. What Are The Symptoms?  Polyphasia - excessive eating  Polyurea - excessive urination  Polydypsia - excessive fluid intake  Blurred vision  Poor wound healing  Irritability
  • 12. Short Term Complications • People who have diabetes can have life- threatening short-term complications. They must try to avoid complications, but also be prepared to treat them if they happen: – High blood sugar or hyperglycemia – Low blood sugar or hypoglycemia – High ketones or diabetic ketoacidosis
  • 13. Long Term Complications • Too much glucose in the blood damages the lining of the vessels that carry the blood. • Blood vessels all over the body get damaged. • The damage causes the body organs not to work well.
  • 14. What Problems Does Blood Vessel Damage Cause? • Heart and blood vessel damage can lead to high blood pressure, strokes and heart attacks. • Kidney damage can lead to kidney failure and the need for dialysis and kidney transplant. • Eye damage can lead to blindness. • Nerve damage can lead to tingling, numbness and pain in hands and feet. • Nerve damage can also cause problems with the digestive system.
  • 15. What Problems Does Blood Vessel Damage Cause? • Foot damage can lead to infections and need for amputation of toes, feet or legs. • Skin and mouth damage can lead to gum disease, infections and loss of teeth. • Bone damage can lead to osteoporosis and broken bones. • Brain damage can lead to dementia.
  • 16. In Order To Be Diagnosed With Diabetes:  Person must have symptoms of diabetes  Plasma glucose >200  Fasting blood glucose of >126 mg/dl 2-hour plasma glucose >200 mg/dl on oral glucose tolerance test
  • 17. Screening  All patients at age 45 and older  If the results are normal, repeat every 3 years  Screen at a younger age if patient meets following risk factors  Obesity  Inactive lifestyle  First degree relative with diabetes)  Was diagnosed with gestational diabetes or delivered a baby whose birth weight >9 lbs.  Hypertension  HDL level <40(men) <50(women) or triglycerides >250  Found to have impaired glucose tolerance or impaired fasting on a previous test.
  • 18. I’ve Got Diabetes, Now What?  After diagnosis, there is a great need for education.  A diabetic diet is no different from the basic healthy eating plan.  An activity goal is no different than a basic healthy activity plan.
  • 19. Diabetes Complications  Kidney  Heart  Nerve damage  Feet/skin  Eye/Vision  Teeth/Gums
  • 20. Treatment Goals For Type II  Achieve normal or near-normal blood glucose levels.  Prevent, delay or treat complications.  Improve health through optimal monitoring, nutrition and activity.
  • 21. Blood Glucose Monitoring  All diabetics must keep track of blood glucose levels.  This is the only way to know if the treatment is effective.  Gives the diabetic a good indication of what affects their blood sugar level.  Must check at least 2 times a day and four times a day for at least 3 days a week.
  • 22. Insulin  Type I and sometimes Type II patients need to be treated with insulin.  There are more than 20 types.  They differ in how they are made, how they work in the body and their cost.
  • 23. Hypoglycemia  Hypoglycemia- low blood sugar  Happens to everyone with diabetes  Symptoms include shakiness, dizziness, sweating, hunger, headache, pale skin, sudden moodiness, clumsy or jerky movements, difficulty paying attention, and tingling sensations around mouth.
  • 24. How To Treat Hypoglycemia  Quickest way to raise blood glucose is with some form of sugar.  3 glucose tablets, 1/2 cup of fruit juice, 5-6 pieces of candy.  Wait 15-20 minutes and test blood sugar again.  If hypoglycemia goes untreated, patient could get worse and pass out.
  • 25. Hyperglycemia  High blood sugar  Not enough insulin  Too much food  Too little exercise
  • 26. Hemoglobin A1c  A good indicator of blood glucose control.  Gives a % that indicates control over the preceding 2-3 months.  Performed 2 times a year.  A hemoglobin of 6% indicates good control and level >8% indicates action is needed.
  • 27. Treatment Goals  The main goal is to normalize blood sugar. Realistic goals for diabetics are 70-140 mg/dl before meals, <180 mg/dl after and a glycosolated hemoglobin (HgA1C) within 1% of normal.  Need good blood glucose control to avoid complications.
  • 28. Physical Activity And Diabetes  Especially beneficial in type II diabetes.  Possible improvement in blood glucose control.  Improved insulin sensitivity/lower medication requirement.  Reduction in body fat.  Cardiovascular benefits.  Stress reduction.  Prevention of Type II diabetes (IGT).
  • 29. Things To Consider  Medication timing.  Food intake timing.  Recent illness or infection.  Postpone exercise if glucose reading is below 100 mg/dl or above 250 mg/dl  Consume 15g of carbs. per 60 min. of exercise.  Keep a snack handy.  Practice proper foot care.  Carry medical identification.
  • 30. How To Avoid Complications  Control weight  Eat a healthy well-balanced diet.  Get regular exercise  Have regular checkups  Check feet everyday for cuts and blisters  Do not smoke!  Keep blood sugars normal  Avoid the 2 common diabetic problems, hypoglycemia and hyperglycemia
  • 31. What Is A Healthy Diet? • Make healthy food choices. – More fruits and vegetables of many colors. – More whole grains. – Fish 2-3 times a week. – Only lean meat or chicken without skin. – Low-fat or non-fat dairy products. – Drink water instead of sugary or carbonated drinks. – Decrease snack foods that are high calorie and fat. – Watch portion sizes. – Cook with liquid oils and decrease fats in your diet.
  • 32. How to Eat A Healthy Diet – Practice portion control so you don’t eat too much. (examples of portion sizes) – Avoid eating fast food, prepared foods and unhealthy snacks.
  • 33. Exercise • Physical activity: – Gets you moving!! – Decreases insulin resistance of the cells! • Being physically fit has three parts: – Strength – Endurance – Flexibility
  • 34. Exercise • Especially beneficial in type II diabetes. • Promotes weight loss • Increases insulin sensitivity. • Must also be aware of medication and intake to prevent hypoglycemia.
  • 35. Benefits of Exercise • Strengthens heart, muscles, bones. • Helps insulin work better (decreases insulin resistance). • Improves blood circulation. • Keeps joints flexible.
  • 36. Benefits of Exercise • Decreases: – Blood glucose-less damage to vessels – Blood pressure-less risk of stroke – Cholesterol-less risk of heart attack and stroke – Stress- less risk of depression.
  • 37. Methods of Carbohydrate Control There are many new methods of controlling diabetes, these are still the two most common. • Exchange Lists • Carbohydrate counting- Very basic, allows a little more freedom and variety.
  • 38. Grains and More Diabetics should have 6 or more servings of grains, beans and starchy vegetables per day. Choose whole-grain foods that are nutritious and high in fiber, such as whole grain bread or crackers, bran cereal and brown rice. Beans can be another good source of fiber. Don't use white flour when cooking, instead look for whole wheat or whole grain alternatives. Eating right is just one of the ways to manage your diabetes. Exercise and regular diabetic testing are other elements to live a healthy lifestyle
  • 39. Sources  American Diabetes Association  Diabetes.org