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diabetes

diabetes. What is diabetes?. Metabolic disease resulting from inability of body to use or produce insulin High blood glucose Low cellular glucose/glycogen stores Insulin Produced by Islet of Langerhans in the pancreas Increases uptake of glucose in liver, muscle and fat

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diabetes

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  1. diabetes

  2. What is diabetes? • Metabolic disease resulting from inability of body to use or produce insulin • High blood glucose • Low cellular glucose/glycogen stores • Insulin • Produced by Islet of Langerhans in the pancreas • Increases uptake of glucose in liver, muscle and fat • Stores glucose as glycogen in liver and muscle

  3. What is diabetes? • Type 1 • Lack of insulin production • Commonly found in children and adults of normal weight • Treatment • Daily insulin necessary

  4. What is diabetes? • Type 1 • Etiology • Previously no known etiology but recent research suggests viral infection may cause autoimmune destruction of insulin producing beta cells • Genetics

  5. What is diabetes? • Type 2 • Insulin not recognized by receptors throughout body • Can have decreased insulin production • Commonly seen in overweight adults • Disease is encroaching on younger populations • Treatment • Lifestyle modification • Pills • Insulin

  6. What is diabetes? • Type 2 • Etiology • Lifestyle Factors • Obesity (55%) • Hypertension • Cholesterol • Age • Sedimentary Lifestyle • Genetics

  7. Presentation • Hyperglycemia • Extreme thirst • Frequent urination • Dry skin • Hunger • Blurred vision • Drowsiness • Decreased healing

  8. Presentation • Hyperglycemia • Causes: • Excess food intake • Insufficient medication • Illness/Stress • Sedintary Lifestyle • Very high levels of sugar may lead to diabetic coma • Chronic hyperglycemia can lead to eye, kidney, nerve and vasculature damage

  9. Presentation • Hyperglycemia • Extreme thirst • Frequent urination • Dry skin • Hunger • Blurred vision • Drowsiness • Decreased healing

  10. Diagnosis Both the fasting glucose and 75 g glucose tolerance test are suitable for diagnosing diabetes Recommended to screen asymptomatic adults with BP greater than 135/80 mm Hg (treated or untreated) Both the fasting glucose and 75 g glucose tolerance test were suitable for diagnosing diabetes [2]

  11. Treatment • Lifestyle Changes • Increase physical activity • Cholesterol • BP • Heart Function • Weight Loss • Insulin Sensitivity • Diet • 45-60 grams of carbohydrates/meal • <15 grams of carbohydrates/snack

  12. Treatment • Insulin • Treats Type 1 and Type 2 • Types • “Meal” Insulin • Long-Acting Insulin • Insulin Mixes • Vials or pins • Insulin Care • Must be refrigerated • Never freeze • Discard vial 4 weeks after first use • Pen expirations vary widely

  13. Treatment- Oral • Metformin (Glucophage) • Prevents release of stored sugars • First option oral treatment • Can cause weight loss • Side Effects: • Upset stomach • Diarrhea

  14. Treatment- Oral • Sulfonylureas • Increase insulin production in Type 2 patients • Low blood sugar risk dependant on dose • Use if patient not eligible for or intolerable of Metformin

  15. Treatment- Oral • Glitazones (Avandia, Actos) • Increase efficacy of insulin • Side Effects: • Weight gain • Swelling • 6-12 before full benefit • High Cost • Alpha-glucosidaseInhibtors • Slow absorption of carbohydrates from gut

  16. Treatment- Oral • Meglitinides (Prandin, Starlix) • Increase insulin production • Short acting • Used if reaction to sulfonylureas • Take with meals • Side Effects: • Hypoglycemia • High Cost

  17. Hypoglycemia • Shaking • Tachycardia • Diaphoresis • Dizziness • Anxiety • Hunger • Impaired Vision • Fatigue • Headache • Irritability • Frequent side effect of excess insulin, meglitinides, and sulfonylureas • Also caused by increased exercise or inadequate food inatke • Can result in insulin shock • Symptoms:

  18. Long Term Effects • Heart disease and stroke • 2-4x increased risk • 65% die from MI or stroke • 33% have peripherial artery disease • Retinopathy • Leading cause of new cases of blindness in patients ages 20-74

  19. Long Term Effects • Retinopathy • Commonly latent until late stages of disease requiring laser treatment • Regular fundus exams needed • Pathophysiology • Abnormal blood vessel permeability • Ischemic vascular occlusion • Neovascularization

  20. Long Term Effects Neovascularization Macular Edema http://www.google.com/imgres?imgurl=http://www.vrmny.com/images/crp_pdr.jpg&imgrefurl=http://www.vrmny.com/pe/p_dr.html&usg=__SWMTClpHmgZkMj2cMGjSNwXESLs=&h=242&w=250&sz=8&hl=en&start=0&zoom=1&tbnid=bFqQltu4Ds4ouM:&tbnh=166&tbnw=175&prev=/images%3Fq%3Ddiabetic%2Bneovascularization%26hl%3Den%26client%3Dfirefox-a%26hs%3Dqbu%26rls%3Dorg.mozilla:en-US:official%26biw%3D1280%26bih%3D617%26tbs%3Disch:1&itbs=1&iact=hc&vpx=296&vpy=93&dur=2841&hovh=193&hovw=200&tx=115&ty=123&ei=mXm2TIT7IIP-8AaPrvnVAQ&oei=mXm2TIT7IIP-8AaPrvnVAQ&esq=1&page=1&ndsp=18&ved=1t:429,r:1,s:0

  21. Long Term Complications • Nephropathy • Leading cause of kidney failure (44% in 2005) • First sign is proteinuria • Albumin excretion 30-300mg/day is diagnostic • Increased likelihood of hypoglycemia from medication • Amputation • >60% of non-traumatic lower-limb amputations are due to diabetes

  22. Long Term Complications • Neuropathy • 60-70% have mild forms of nerve damage • Can lead to foot complications like ulcers and infection • Inspection • Erythema, warmth, callus formation • Bony deformities, join mobility, gait • Pulse • Loss of sensation =Refer to podiatrist

  23. Long Term Complications • Neuropathy • Prophylaxis • - Avoid going barefoot, even in the home • - Test water temperature before stepping into a bath • - Trim toenails to shape of the toe; remove sharp edges with a nail file. Do not cut cuticles. • - Wash and check feet daily • - Shoes should be snug but not tight and customized if feet are misshapen or have ulcers • - Socks should fit and be changed daily • McCullogh, David. Foot Care in diabetes mellitus. Up to Date. May 2010.

  24. Diabetes in North Carolina • In 2008 NC ranked 17th highest in the US for adult diabetes prevalence with 9.3% of the population diagnosed (643,000) • An estimated 1.25 million adults in NC have some type of hyperglycemia • The estimated cost of diabetes in NC was 5.3 billion in 2006 • 7th leading cause of death (2,150) and contributed to 6,226 deaths in 2007

  25. References • 2009 Diabetes Fact Sheet. NC Diabetes Prevention and Control Branch. http://www.ncdiabetes.org/factsFigures/index.asp • Diabetes Basics and Living with Diabetes. American Diabetes Association. http://www.diabetes.org/ • US Preventive Services Task Force. Screening for Type 2 Diabetes Mellitus in Adults: U.S. Preventive Services Task Force Recommendation Statement. Annals of Internal Medicine 2008;148:855-68. http://www.annals.org/cgi/reprint/148/11/846.pdf

  26. References • Olivia Linthavong. What is Diabetes? Diabetes Maintenance and Prevention Program at the Open Door Clinic. 2009. • Olivia Linthavong. Carbohydrate Counting Handout. Diabetes Maintenance and Prevention Program at the Open Door Clinic. 2009. • Genuth, S, Alberti, KG, Bennett, P, et al. Follow-up report on the diagnosis of diabetes mellitus. Diabetes Care 2003; 26:3160. • Drugs for Type 2 Diabetes. Treatment Guidelines from the Medical Letter 2008; 6(71). http://medlet-best.securesites.com.libproxy.lib.unc.edu/restrictedtg/t71.pdf

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