Diabetes + Obesity = Diabesity lecture by Dr. S Grivas

2. What is Diabetes?

4. Source: Adapted from American Diabetes Association. Standards of medical care in diabetes—2012.
Diabetes Care. 2012;35 (Supp 1):S12, table 2.

6. 2013

8. Cost of Diabetes In the
US 2013

11. Types of Diabetes
Type 1

12. Type I
• Usually diagnosed in children and young
adults
Previously known as juvenile-onset
diabetes
The immune system attacks the insulin-
producing cells of the pancreas
Insulin is a hormone that is needed to
convert sugar, starches, and other food into
energy needed for daily life
•
•
•

13. Associated Conditions With Type I
•
•
•
Hypoglycemia
Ketoacidosis
Other auto-immune disorders
• 1.
• 2.
Thyroid disorders
Celiac disease

15. Type II
Formerly known as adult-onset or noninsulin-
dependent diabetes
A chronic condition that affects the body’s ability
to use glucose as the body’s main fuel source
More than 90% of diabetes in the U.S. is Type II
•
•
•
• Over
have
11%
25 million people (8.3%) are estimated to
diabetes in the U.S.
of all men aged 20 years or older have•
diabetes

16. Metabolic Derangements Associated
with Type II
• Increased secretion of insulin at the outset,
followed later by diminished secretion
A loss of sensitivity in the cells of the body
to the action of insulin (resulting from
obesity in a genetically predisposed
individual)
•

17. Type 1.5
Source: Am Fam Physician. 2010 Apr 1;81(7):843-847.

18. Latent Diabetes of
Adulthood
(LADA)
• Latent autoimmune diabetes in adults
(LADA) is a slow progressing form of
autoimmune diabetes. Like type 1 diabetes,
LADA occurs because your pancreas stops
producing adequate insulin, most likely
from some "insult" that slowly damages the
insulin-producing cells in the pancreas. But
unlike type 1 diabetes, with LADA, you
often won't need insulin for several months
up to years after you've been diagnosed.

19. LADA
• Many researchers believe
sometimes called type 1.5
LADA,
diabetes, is
a subtype of type 1 diabetes. Other
researchers believe diabetes occurs
on a continuum, with LADA falling
between type 1 and type 2 diabetes.

20. Maturity Onset Diabetes
Young (MODY)
of the
• MODY is a rare form of diabetes which is
different from both Type 1 and Type 2
diabetes, and runs strongly in families.
MODY is caused by a mutation (or change)
in a single gene. If a parent has this gene
mutation, any child they have, has a 50%
chance of inheriting it from them.

21. MODY
• If a child does inherit the mutation
they will generally go
MODY before they’re
their weight, lifestyle,
on to develop
25, whatever
ethnic group etc.

22. MODY
•
•
The key features of MODY are:
Being diagnosed with diabetes under
the age of 25.
Having a parent with diabetes, with
diabetes in two or more generations.
Not necessarily needing insulin.
•
•

23. Gestational Diabetes
Source: Mayo Clinic. Health: Gestational Diabetes

24. Type 3 ?

26. Type 2 Diabetes

27. Risk Factors

28. Obesity and
excess fat

29. Inactivity

30. Too many
calories and
too little
exercise

31. Additional Risk Factors – Type 2
•
•
•
•
•
Metabolic syndrome
Genetics
PCOS
Gestational diabetes
Ethnic background – Hispanic/Latino Americans,
African Americans, Native Americans, Asian-
Americans, Pacific islanders, and Alaska Natives
• Medicines: diuretics, steroids

32. Obesity

33. “Diabesity”
• Obesity is the
most powerful
risk factor for
type 2 diabetes.
Diabetologia. 2003 Nov;46(11):1586-7

34. Diabetes Care. 2007 Jun;30(6):1562-6.
How Big Is The Risk?

35. Diabetes and Obesity
there is too much fat• When
in the diet & on the body
the cells lose their ability
respond to insulin.
The fatigued pancreas
to
•
eventually loses its capacity
to produce insulin and the
blood sugar soars even
higher.

36. Complications
Heart Disease and Stroke
High Blood Pressure
Kidney Failure
Blindness
Nervous System Damage
Amputations
Mood and Memory Changes
Compromised Immune System
Premature Death &
Shortened Life Expectancy
of Diabetes

37. How?

40. Lifestyle Modifications

43. "
"
Dietary Excess and Imbalances
Diet has a vital influence on health.
At least 6 of the ten leading causes of illness and
death are associated with diet: coronary artery
disease, hypertension, cancer,
diabetes, and obesity.
stroke, and

44. Dietary Excess and Imbalances
~ Neil Nedley, M.D.
“It is now clear that diet
i n
the
c o n t r i b u t e s
tosubstantial ways
development of these
t h a td i s e a s e s a n d
modification of diet can
c o n t r ib u t e t o t h e ir
prevention and control.”
~ Neil Nedley, M.D.

45. Current Dietary
Recommendations
• A calorie restricted, low fat, high fiber diet

46. Benefits of High Fiber Foods
Fiber protects
against…
•
•
•
•
•
•
•
Constipation.
High cholesterol.
Heart disease.
High blood sugar.
Diabetes.
Certain cancers.
Obesity.
J Am Coll Nutr. 2004 Feb;23(1):5-17.

47. Grains

48. Whole
Health
Grains, Whole
Replacing refined grains with whole
grains can reduce the risk of
diabetes by 70%.
Am J Clin Nutr 2003 77: 622-629. Am J Public Health. 2000 Sep;90(9):1409-15.

49. WebMD – Best Grain
For Diabetics
Baked sweet or white potato
Whole-grain flour or corn tortillas
Whole-grain wheat pastas, cereals, &
breads
Brown rice, and other whole- grain
pastas, cereals, and breads

50. Vegetables

51. WebMD – BestVegetable Choices
for Diabetics
Fresh vegetables, eaten raw or lightly
roasted, or grilled.
steamed,
Plain frozen vegetables, lightly steamed.
Low sodium or unsalted canned vegetables.
Lettuces, greens, kale, spinach, arugula.

52. Fruits

53. WebMD – Best Fruit
Choices for Diabetics
fruit (no added sugar)•
•
•
•
Plain frozen or canned
Fresh fruit
Sugar-free or low-sugar jam or preserves
No sugar-added applesauce

54. What About Juices?

55. Use At Your Own Risk

56. Time
Orange Juice
Whole Orange
Am J Clin Nutr. 1981 Feb;34(2):211-7.
BloodSugar

57. Proteins

58. Best Protein Choices for
Diabetics
Tofu lightly sauteed, steamed, or cooked
Beans
Nuts
All vegetables and grains

59. Fats

60. Best Fat Choices for
Diabetics
•
•
•
•
•
•
Olives, or olive oil (in moderation)
Avocadoes
Flax or Chia Seeds
Soy-based margarines
Flax oil (in
Nuts and seeds
moderation)

61. Other Lifestyle
Interventions

62. Exercise
regularly

63. Achieve a
healthy weight

64. Medications

65. Metformin
• Metformin (Glucophage, Glumetza,
others). Generally, metformin is the first
medication prescribed for type 2 diabetes. It
works by improving the sensitivity of your
body tissues to insulin so that your body uses
insulin more effectively.

66. Sulfonylureas
• Sulfonylureas. These medications help
your body secrete more insulin. Examples of
medications in this class include glyburide
(DiaBeta, Glynase), glipizide (Glucotrol) and
glimepiride (Amaryl). Possible side effects
include low blood sugar and weight gain.

67. Medications
•
•
•
•
•
•
Prandin
Starlix
Januvia
Onglyza
Byetta
SGLT2 inhibitors
lnvokana
-

68. Insulins
glulisine (Apidra)•
•
•
•
•
•
Insulin
Insulin lispro (Humalog)
Insulin aspart (Novolog)
Insulin glargine (Lantus)
Insulin detemir (Levemir)
Insulin isophane (Humulin
N, Novolin N)

69. Botanical
Garlic
Gymnema sylvestre
Cinnamon
Berberine
Bitter melon
Chromium
Vanadium
Medicines
•
•
•
•
•
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•

70. Renal Insufficiency

71. Natural Therapies

72. Hydrotherapy and
Charcoal
Russian Steam Bath - to induce sweating
Sauna - same
Revulsive Fomentations over the kidney
areas (mid back) -increase blood flow to
the kidneys
Charcoal baths
Internal charcoal
•
•
•
•
•

73. Dietary Modifications
• If you do not have a problem eating
carbohydrates, these foods are a good
source of energy. If your health care provider
has recommended a low-protein diet, you
may replace the calories from protein with:
Fruits, breads, grains, and vegetables•

74. • Fats can be a good source of calories. Make
sure to use monounsaturated and
polyunsaturated fats (olive oil, canola oil,
safflower oil) to protect your heart health.

75. • Low-protein diets may be helpful before you
start dialysis.Your doctor or dietitian may
recommend a moderate-protein diet (1 gram
of protein per kilogram of body weight per
day).
Once you start dialysis, you will need to eat
more protein.
•

76. Protein Sources in a
Vegetarian
Grains
Vegetables
Nuts
Legumes
Diet
•
•
•
•
•
•
Soy protein powders
**** Doctors may recommend limiting some of the
legumes and nuts because of phosphorus and iron
content

77. • You may need to take calcium supplements
to prevent bone disease, and vitamin D to
control the balance of calcium and
phosphorous in your body.
Your doctor may recommend medicines
called "phosphorous binders" if diet changes
alone do not work to control the balance of
this mineral in your body.
•

78. Botanical Medicine
• Kidney disease -- Preliminary research
suggests astragalus may help protect the
kidneys and may help treat kidney disease.
More studies are needed.
University of Maryland Medical Center

80. Diabetes Reduction Summary
• Regular exercise in the open air and sunshine.
• Eat an unrefined plant based diet, low in fat, high in fiber.
• Make weight control a habit.
• Drink plenty of water.
• Get adequate sleep.
• Avoid stimulants such as coffee, alcohol and tobacco.
• Turn your stress over to God Who only can handle it.