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    An Introduction To Diabetes Mellitus: ("Sweet Flow")

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    Subramaniam Raman
    The document provides an overview of diabetes mellitus, including key statistics and facts. It describes the two main types of diabetes - type 1 is characterized by a lack of insulin production and accounts for 5% of cases, while type 2 is caused by insulin resistance and makes up 90% of cases. Complications of diabetes include both macrovascular issues like heart disease as well as microvascular damage to the eyes, kidneys, and nerves. Treatment involves blood glucose monitoring, oral medications or insulin, diet and lifestyle changes, and managing complications.

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    An Introduction To Diabetes Mellitus: ("Sweet Flow")

    Uploaded by

    Subramaniam Raman
    50 views31 pages
    The document provides an overview of diabetes mellitus, including key statistics and facts. It describes the two main types of diabetes - type 1 is characterized by a lack of insulin production and accounts for 5% of cases, while type 2 is caused by insulin resistance and makes up 90% of cases. Complications of diabetes include both macrovascular issues like heart disease as well as microvascular damage to the eyes, kidneys, and nerves. Treatment involves blood glucose monitoring, oral medications or insulin, diet and lifestyle changes, and managing complications.

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    Health information

    Original Title

    Diabetes

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    The document provides an overview of diabetes mellitus, including key statistics and facts. It describes the two main types of diabetes - type 1 is characterized by a lack of insulin production and accounts for 5% of cases, while type 2 is caused by insulin resistance and makes up 90% of cases. Complications of diabetes include both macrovascular issues like heart disease as well as microvascular damage to the eyes, kidneys, and nerves. Treatment involves blood glucose monitoring, oral medications or insulin, diet and lifestyle changes, and managing complications.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    50 views31 pages

    An Introduction To Diabetes Mellitus: ("Sweet Flow")

    Uploaded by

    Subramaniam Raman
    The document provides an overview of diabetes mellitus, including key statistics and facts. It describes the two main types of diabetes - type 1 is characterized by a lack of insulin production and accounts for 5% of cases, while type 2 is caused by insulin resistance and makes up 90% of cases. Complications of diabetes include both macrovascular issues like heart disease as well as microvascular damage to the eyes, kidneys, and nerves. Treatment involves blood glucose monitoring, oral medications or insulin, diet and lifestyle changes, and managing complications.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 31

    An Introduction to Diabetes Mellitus

    (sweet flow)

    What will we cover today?


    Statistics and facts A physiological description Distinctions between the different types Complications Treatment and management

    Statistics and Facts on Diabetes


    The CDC has declared an epidemic of diabetes 16 million, or 5.9% of Americans are affected 19% of the population over 65 has diabetes Ethnic minorities are at greater risk

    Statistics and Facts, continued


    Having diabetes greatly increases morbidity and mortality. Diabetes is the 6th leading cause of death in the United States. Each year a large percent of our health care dollar goes towards diabetes patients.

    What exactly is Diabetes?

    Diabetes is

    a chronic disease characterized by high blood glucose levels


    Can be diagnosed with an oral glucose tolerance test Fasting: greater than 126 mg/dL Non-fasting: greater than 200 mg/dL

    caused by defects in insulin secretion, insulin action, or both

    Hormonal Control of Glucose

    After a meal: Insulin (anabolism)


    Decreases blood glucose (GLUT4 transporter) Increases glycogen synthesis Decreases gluconeogenesis Lipoprotein lipase

    lipogenesis

    Stimulates protein synthesis

    Hormonal Control of Glucose

    Between meals: Glucagon (catabolism)


    Increases blood glucose Increases glycogen breakdown in liver and muscle Increases gluconeogenesis in liver Activates hormone sensitive lipase Mobilizes triglyceride stores-Lypolysis

    Metabolic acidosis

    Type 1 Diabetes

    Also known as juvenile diabetes, or Insulin-dependent diabetes mellitis (IDDM) Accounts for 5% of total diabetes cases Onset is between 8-14 yrs old usually presenting with ketosis

    Honey-moon phase Antibodies to islet cells and/or insulin

    Regarded as an auto-immune disease

    Type 1 Diabetes, contd


    Gradual loss of beta cell function until no longer able to synthesize adequate insulin to control blood sugar Presenting symptoms are polydipsea, polyurea, polyphagia, and weight loss Patients are most often lean Patients must rely on exogenous sources of insulin Has a genetic link

    Type 2 Diabetes

    Formerly known as adult-onset Non-insulin dependent diabetes mellitis (NIDDM) 90% of total cases Very strong genetic component 80% with Type 2 are obese

    Type 2 Diabetes

    Develops gradually so may go undiagnosed Begins with insulin resistance Caused by

    Initially by a defect in the mechanism of GLUT4 transporter (sensitivity of cells to insulin)

    hyperinsulinemia

    Eventually the pancreas may cease to produce insulin


    Hypoinsulinemia 40% end up on insulin

    Risk Factors for Type 2 Diabetes


    Genetic profile Age Race Obesity Physical inactivity

    Gestational Diabetes

    Lactogen can antagonize the action of insulin Increased need for insulin during the 2nd and 3rd trimester 7% of American pregnancies Screened for during the 24th and 28th week After delivery, 90% become normoglycemic Have up to 60% chance of developing Type II later

    Macrovascular Complications

    Coronary Heart Disease Peripheral vascular disease Cerebrovascular disease Hypertension Dyslipidemia

    Microvascular Complications

    Retinopathy

    #1 cause of new blindness among adults 80% of all patients have some form 15 years after diagnosis

    Microvascular Complications

    Nephropathy

    20% develop this after 15 years of diabetes Kidney function declines May progress to total renal failure and require dialysis or transplant

    Microvascular Complications

    Neuropathy

    Peripheral- hands and feet Autonomic- cardiovascular, GI tract: esophagus, stomach, small intestine, and colon Gastroparesis

    Irregular contractions of stomach Fullness, bloating, nausea, vomiting, diarrhea, constipation Detrimental effects on blood glucose control

    Management/ Treatment

    Type 1:

    Blood glucose monitoring Glycolated hemoglobin Insulin regimen


    Conventional Intensive

    Management/ Treatment

    Type 2

    Oral Hypoglycemic Agents


    Insulin

    secretagogues sensitizers

    sulfolnylureas Thiazolidinediones Avandia

    Insulin

    Glucose

    inhibitors

    Biguanides Glucophage

    Management/ Treatment, contd


    Insulin Combined Therapies


    Combination of OHAs OHAs and Insulin

    Management/ Treatment, contd

    Diet

    Weight loss Hypocaloric diet The exchange diet Carbohydrate counting Glycemic index and load

    Glycemic Index and Load


    The rate at which foods provide glucose to the blood, relative to a reference carbohydrate. Factors that influence: Type of fiber Presence of fat Form of sugar (fructose vs sucrose,) Starch structure (amylose, amylopectin-glycemic index)

    Glycemic Index and Load

    Fiber, glycemic index foods (beans, vegetables, whole fruit, and whole grains) are preferred for managing blood glucose. Glycemic Load= CHO(g) X GI White rice, baking potatoes, bagels, and jelly beans have high GI and GL

    Goals

    Maintain a blood glucose that is as normal as possible Achieve and maintain optimal lipid levels Prevent or delay complications Prolong life and the quality of it

    Questions and Comments?

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