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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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what is 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
    • Stores glucose as glycogen in liver and muscle
what is diabetes1
What is diabetes?
  • Type 1
    • Lack of insulin production
    • Commonly found in children and adults of normal weight
    • Treatment
      • Daily insulin necessary
what is diabetes2
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
what is diabetes3
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
what is diabetes4
What is diabetes?
  • Type 2
    • Etiology
      • Lifestyle Factors
        • Obesity (55%)
        • Hypertension
        • Cholesterol
        • Age
        • Sedimentary Lifestyle
      • Genetics
presentation
Presentation
  • Hyperglycemia
    • Extreme thirst
    • Frequent urination
    • Dry skin
    • Hunger
    • Blurred vision
    • Drowsiness
    • Decreased healing
presentation1
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
presentation2
Presentation
  • Hyperglycemia
    • Extreme thirst
    • Frequent urination
    • Dry skin
    • Hunger
    • Blurred vision
    • Drowsiness
    • Decreased healing
diagnosis
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]

treatment
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
treatment1
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
treatment oral
Treatment- Oral
  • Metformin (Glucophage)
    • Prevents release of stored sugars
    • First option oral treatment
    • Can cause weight loss
    • Side Effects:
      • Upset stomach
      • Diarrhea
treatment oral1
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
treatment oral2
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
treatment oral3
Treatment- Oral
  • Meglitinides (Prandin, Starlix)
    • Increase insulin production
      • Short acting
    • Used if reaction to sulfonylureas
    • Take with meals
    • Side Effects:
      • Hypoglycemia
    • High Cost
hypoglycemia
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:
long term effects
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
long term effects1
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
long term effects2
Long Term Effects

Neovascularization

Macular Edema

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long term complications
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
long term complications1
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

long term complications2
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.
diabetes in north carolina
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
references
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
references1
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