A presentation to the community on diabetes prevention.

1. Prevention of Type II Diabetes
● What is it?
● Prevalence and symptoms-29 m Americans
and 10 % of the world
● How is it diagnosed?
● How can we prevent it??

2. Emperor Shahjan-knew a thing or
two about diabetes??
● 1592-1666
● Builder of the Taj Mahal
● Imprisoned by his pious son
● Chose lentils as his only diet

3. Type II diabetes-resistance to
insulin and high blood sugar
● Insulin- liver, fat, and skeletal muscle cells
● Pancreas -hormones that help regulate blood
sugar
● Insulin/glucagon

4. How blood sugar increases?
● A

5. Insulin resistance-pre-fat cells not
shown here

6. Dawn phenomenon is a major
problem for many
● Liver releases sugar early morning
● Early in evolution, was a good thing
●

7. Prevalence of Type II diabetes
among ethnic populations in US

8. Type II diabetes age breakdown
● A

9. Symptoms in Type 2 diabetes
● Thirst, dry mouth, bigger appetite, peeing a lot
● Higher blood sugar-headaches, blurred vision,
and fatigue

10. Sometimes more serious problems
before diagnosis
● Cuts or sores that are slow to heal
● Frequent yeast infections or urinary tract
infections
● Itchy skin, especially in the groin area
●

11. Diabetic retinopathy-damage to the
blood vessels
● Retina=inner layer of eye
● New blood vessels can grow around retina
● aneurysm=a widening
● Edema(excess fluid)
● Hemmorhage(bleeding)

12. Microaneurysms: The earliest
clinical sign of Diabetic Retinopathy
● small, red dots in the superficial retinal layers

13. Diabetic Retinopathy
● Boat-shaped preretinal hemorrhage

14. Diabetic Neuropathy
● tingling, numbness, pain, and a pins and
needles sensation -- often in your fingers,
hands, toes, or feet.

15. Foot injuries can get serious
● Hard to feel your feet
● small injury can lead foot sores and gangrene.
● In severe cases-infections, possible
amputation.

16. Diabetic Nephropathy
● Sugar damages blood vessels and other cells in
your kidneys.
● Persistent albuminuria (>300 mg/d or >200
μg/min) confirmed on at least 2 occasions 3-6
months apart
● Decline in glomerular filtration rate (GFR)
● High blood pressure

17. Nephropathy
● Kidneys

18. Diagnosis-symptoms plus following
● a random venous plasma glucose >200 mg/dl
● Fasting plasma glucose concentration >126
mg/dl
● 2h ≥ 200mg/dl two hours after 75g anhydrous
glucose in an oral glucose tolerance test
● HbA1c test – 6.5 % (8-12 weeks average)

19. HbA1C diagnosis still controversial
● Cross-sectional studies-data collected at a
defined time
● Look at prevalence of acute or chronic
conditions; can't infer causality
● Need long term,multi-ethnic prospective cohort
studies
● Precisely establish predictive glucose and
HbA1c levels

20. More studies needed on HbA1c
● Long term prospective cohort(similar
individuals) studies across major ethnic groups
● Precisely establish glucose and HbA1c levels
predictive of microvascular and macrovascular
complications

21. Prevention
● Reduce the waistline
● Change sedentary lifestyle
● Quit smoking
● Avoid red meat, processed meat, high-fat dairy
products, and sweets
● Improve cholesterol and triglyceride levels

22. Prevention
● Portion control-learn when you are full
● Early to bed and early to rise
● Dinner by 6 p.m.
● At least 7 hours of sleep
● Reduce stress

23. Fasting as prevention
● Besides caloric restriction and intermittent
fasting
● 40 % less food is eaten
● Coincidentally, 35-40% of food is wasted in
affluent households these day
● Fasting synchronizes the body clock

24. Does fasting promote autophagy?
● Liver can recycle proteins, sugars, fats, and
nucleic acids in lysosomes
● Acid alpha glucosidase-in lysosomes
● Metabolism improves??
● More research needed

25. Regulation of liver metabolism by
different types of autophagy
● A

26. Conclusion
● Teach children about healthy food, portion
size, and exercise
● Reduce use of processed foods and fast food
● Avoid sweet drinks, sodas etc.
● Eat more vegetables and fruits
● Eat early, encourage Group Eating
● Stop force feeding children