1. What is Diabetes?
Diabetes 101
 Diabetes mellitus is a group of diseases
characterized by high levels of blood
Ginny Burns RN MEd CDE glucose resulting from defects in insulin
production, insulin action or both.
Why do we care? What Does This Mean?
Diabetes is now recognized as
20.8 million people one of the largest epidemics
humanity has ever faced and
 Diagnosed 14.6 million a leading cause of death!!!!
 Undiagnosed 6.2 million
 7% of the total population
Estimated Costs of Diabetes?
 Total cost: $132 billion
 70% of people with  Direct Medical costs: $92 billion
diabetes will die of
cardiovascular disease.  Indirect costs: $40 billion
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2. What about people? Ethnic Groups over 20 years
Every 24 hours:  8.7% White
New cases: 4,100  9.5% Hispanic
Deaths: 810  13.3% Black
Amputations: 230  27% SW Native Americans
Kidney Failure: 120
Blindness: 55  21% of all Americans over age 60
What about Utah?
 61% of all
Hispanic/Latino  154,000 people in Utah have been
diagnosed
Americans born in  1 out of every 25 people in Utah have
diabetes
2000 AD will have  Sixth leading cause of death in Utah and
US
Diabetes
Types of Abnormal Glucose? Types of Abnormal Glucose?
 1. Type 1 diabetes---previously called  3. Gestational diabetes---a form of
insulin-dependent diabetes (IDDM) or glucose intolerance that is diagnosed in
juvenile-onset diabetes. some women during pregnancy.
 2. Type 2 diabetes---previously called  4. Prediabetes---term used to
non-insulin-dependent diabetes distinguish people who are at in
(NIDDM) or adult-onset diabetes. increased risk for developing diabetes.
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3. How Food is Digested
Diagnosing diabetes
1. Food enters
stomach
 Fasting plasma
4. Pancreas
releases insulin 5. Insulin unlocks glucose test (see
receptors figure to the right)
6. Glucose
enters cell  If fasting glucose test is
positive, confirm results
3. Glucose enters
bloodstream by repeating on a
2. Food is converted different day.
into glucose
Symptoms Type 1
 Extreme thirst  5-10% of all diagnosed cases
 Frequent urination  May be autoimmune, genetic or
 Extreme hunger environmental
 Blurry vision  Beta-cell destruction usually leading to
 Unexplained weight loss absolute insulin deficiency
 Tingling or numbness in the hands or feet
 Onset usually abrupt in young but can
Constant fatigue

be slow in older patients
 Dry / irritated skin (above and beyond Utah standards)
 Usually normal weight or slender
 Wounds that are slow to heal
What happens in Type 1 diabetes?
Type 1
1. Food enters
stomach
4. Pancreas
cells produce
no insulin
Insulin is the medication that is used!!!!! 5. Glucose rises in blood
Symlin, insulin pumps, glucose sensors
3. Glucose enters
bloodstream
2. Food is converted
into glucose
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4. Type 2 Type 2
 90-95% of all diabetes cases
 Onset is usually very slow
 Older age? Children? And Obesity
 Family history, history of gestational DM
 Depression?
 Complications are often present at
diagnosis: retinopathy, neuropathy
nephropathy
What Happens in Type 2 diabetes?
Type 2
 Hypertension is most often present 1. Food enters
stomach
 Cholesterol levels often abnormal 4. Pancreas
releases too little 5. Insulin is less
 Medications: insulin effective
oral diabetes medications, lipid 6. Less glucose
enters cell
lowering agents, hypertensive
medications, pain medications for
3. Glucose enters
bloodstream
2. Food is converted
neuropathy, insulin, Byetta, Symlin into glucose
7. Glucose rises in blood
Diabetes Complications Diabetes Complications
 Cardiovascular Disease (CVD):  Eyes
 2 to 4 times the risk of heart disease and Glaucoma, cataracts, retinopathy
stroke compared with people without
diabetes
 Kidneys
 Diabetes appears to particularly increase Nephropathy, renal failure
the risk of CVD in women  Nerves
 Major cause of death in all patients with Neuropathy, amputations
DM
 Gums and teeth
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5. Preventing Complications Preventing Complications
 Glycemic Control
 Developing self-management skills is at  Control the amount of sugars and carbohydrates
the foundation of diabetes consumed
management:  Aggressive Lipid Lowering
 Lower the amount of “bad fats” in your diet
 Self-monitoring of blood glucose  Management of Hypertension
 Meal planning  Decrease blood pressure and find ways to manage
 Exercise stress
 Medication compliance
Gestational Diabetes? Gestational?
 Diabetes diagnosed in pregnancy  No known cause of gestational
 2-5% of all pregnancies diabetes, but there are some ideas
 More common in obese women  Hormones from the placenta may block the
action of the mother's insulin in her body
 More common if family hx of DM causing insulin resistance
 More frequent in African Americans,  The stress of the pregnancy may also
Hispanic/Latino Americans and cause insulin resistance
American Indians  Usually disappears after pregnancy
 Risk for Type 2 diabetes later in life
Gestational? Gestational?
Screening 24-26 wks.  Women have 20-50% chance of
50gram glucose drink with blood draw 1 developing diabetes in the next 5-10
hour after drink. yrs.
Positive if results are equal or greater It appears that the largest risk comes
from weight!!
than 140mg/dL
Encourage normal body weight!!!
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6. Pre-diabetes—do we care? Pre-diabetes and Obesity?
 Estimated 61 million people
 Estimated 70% progress to DM Are they connected?
 Lifestyle changes may prevent or delay
the onset to DM
YES!!!
 Complications begin when glucose
levels are elevated!!!!
Obesity 1990 Obesity in 2001
Diabetes in 1990 Diabetes in 2001
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7. What can we do? What about exercise?
 We need to move, move,
move, move, move, move,
Make Lifestyle move and move some
more!!
changes!!!  About 1 hr every day should be the
minimum. 10,000 steps is great!!!
What about food? Diets? Or Just Healthy Eating?
Mike Huckabee, Governor from Arkansas,  Eat Less
said he lost several hundred pounds by  Decrease highly processed foods
following the advice of his MD:
 Increase fruits and vegetables
Do not drink your carbohydrates
“If is wasn’t a food 100

years ago, don’t eat
it”!!!!!
Questions?
 Twitter:@AskGinny
 Blog:http://askginnyaboutdiabetes.
blogspot.com
or
askginny@utah.gov
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