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Diabetes

Diabetes. Lecture 6a Chapter 19 Dudek. Glucose circulating in the blood is a source of ready fuel for body cells.

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Diabetes

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  1. Diabetes Lecture 6a Chapter 19 Dudek

  2. Glucose circulating in the blood is a source of ready fuel for body cells. • The amount of carbohydrate consumed and, to a lesser extent, the type of carbohydrate eaten are the primary determinants of how quickly and how high blood glucose levels rise after eating. • A rise in postprandial blood glucose levels stimulates the pancreas to secrete insulin. • Canadian Clinical Practice Guidelines algorithm for diagnosing diabetes- next slide.

  3. Diabetes-direct and indirect costs

  4. Diabetes • Diabetes is one of the most costly and burdensome chronic diseases of our time. • Increasing in epidemic proportions • The estimated direct and indirect cost associated with diabetes was $ $13.5 billion in 2014 rising to $17 billion by 2024 in Canada. • Number of diabetes cases are continuing to rise but we could reduce new cases by 50-90 % if the population would eat and exercise properly.

  5. Diabetes—(cont.) • Type 1 diabetes • Formerly known as insulin-dependent diabetes mellitus • Characterized by the absence of insulin • Risk factors for type 1 diabetes may be: • Autoimmune • Genetic • Environmental-e.g. toxins • Infections-certain viruses • Dietary components or bodily derivatives thereof-controversial

  6. Diabetes—(cont.) • Type 1 diabetes—(cont.) • No known way to prevent type 1 diabetes • All people with type 1 diabetes require exogenous insulin to control blood glucose levels. • Most often detected in children, adolescents, and young adults • Classic symptoms of polyuria, polydipsia, and polyphagia

  7. Diabetes—(cont.) • Type 2 diabetes • Occurs most often after the age of 45 years • Accounts for 90% to 95% of diagnosed cases of diabetes • A slowly progressive disease that usually begins as a problem of insulin resistance • Type 2 diabetes is often asymptomatic.

  8. Diabetes—(cont.) • Type 2 diabetes—(cont.) • Insulin resistance is strongly linked to obesity. • Risk factors for type 2 diabetes • Age 45 years or older • Overweight (BMI ≥25 kg/m2) and obese (BMI ≥30 kg/m2) • Even better than BMI are waist circumferences (≥ 94/80 or 90/80 M/F depending on ethnicity as per Nutr 2108 lab) • First-degree relative with diabetes • Physically inactive or exercises fewer than three times per week

  9. Diabetes—(cont.) • Type 2 diabetes—(cont.) • Risk factors for type 2 diabetes—(cont.) • Member of high-risk ethnic group: African Canadian, Latino, Aboriginal, Asian Canadian • Previously identified with prediabetes such as impaired fasting glucose or impaired glucose tolerance • History of gestational diabetes or giving birth to a baby weighing more than 9 pounds • Hypertensive • HDL-c < 0.9 mmol/L and/or triglyceride level ≥ 2.8 mmol/L

  10. Diabetes—(cont.) • Gestational diabetes • Hyperglycemia that develops during pregnancy • Risk factors • A family history of gestational diabetes • Obesity, being a member of a certain ethnic population (Aboriginals, African Canadians, Asian Canadians) • A history of giving birth to an infant weighing more than 9 pounds

  11. Diabetes—(cont.) • Gestational diabetes—(cont.) • All women are routinely screened between 24 and 28 weeks of gestation. • women with gestational diabetes are at greater risk of type 2. • Offspring exposed to gestational diabetes are more likely to get type 2 diabetes compared to those without such exposure

  12. Acute Diabetes Complications • Untreated or poorly controlled diabetes can lead to acute life-threatening complications. • Conversely, hypoglycemia caused by overuse of medication, too little food, or too much exercise, can also be life threatening.

  13. Acute Diabetes Complications—(cont.) • Diabetic ketoacidosis (DKA) • People with type 1 diabetes are susceptible to diabetic ketoacidosis (DKA). • Characterized by hyperglycemia (glucose levels > 13.8 mmol/L) and ketonemia • Caused by a severe deficiency of insulin or from physiologic stress, such as illness or infection

  14. Acute Diabetes Complications—(cont.) • Diabetic ketoacidosis (DKA)—(cont.) • Polyuria may lead to dehydration, electrolyte depletion, and hypotension. • Hyperventilation occurs in an attempt to correct acidosis by increasing expiration of carbon dioxide. • Fatigue, nausea, vomiting, and confusion develop. • Diabetic coma and death are possible.

  15. Acute Diabetes Complications—(cont.) • Diabetic ketoacidosis (DKA)—(cont.) • DKA is sometimes the presenting symptom when type 1 diabetes is diagnosed. • DKA rarely develops in people with type 2 diabetes. • DKA is treated with electrolytes, fluid, and insulin.

  16. Acute Diabetes Complications—(cont.) • Hyperosmolar hyperglycemic nonketotic syndrome (HHNS) • Characterized by hyperglycemia (>33.3 mmol/L) without significant ketonemia • Occurs most commonly in people with type 2 diabetes • Dehydration and heat exposure increase the risk. • Illness or infection is usually the precipitating factor.

  17. Acute Diabetes Complications—(cont.) • Hyperosmolar hyperglycemic nonketotic syndrome (HHNS)—(cont.) • Older people may be particularly vulnerable. • Develops relatively slowly • Symptoms-dehydration, hypotension, decreased mental acuity, confusion, seizures and coma • Best protection against HHNS is regular glucose monitoring. • Treatment includes insulin and fluid and electrolyte replacement.

  18. Acute Diabetes Complications—(cont.) • Hypoglycemia • Blood glucose level less than 4 mmol/L • Commonly referred to as “insulin reaction” • Occurs from taking too much insulin, inadequate food intake, delayed or skipped meals, extra physical activity, or consumption of alcohol without food • Symptoms

  19. Acute Diabetes Complications—(cont.) • Hypoglycemia symptoms • Early signs and symptoms of diabetic hypoglycemia include: • Shakiness • Dizziness • Sweating • Hunger • Irritability or moodiness • Anxiety or nervousness • Headache • Nighttime symptoms • Diabetic hypoglycemia can also occur while you sleep. Signs and symptoms, which can awaken you, include: • Damp sheets or bedclothes due to perspiration • Nightmares • Tiredness, irritability or confusion upon waking

  20. Acute Diabetes Complications—(cont.) • Hypoglycemia symptoms • Severe symptoms • If diabetic hypoglycemia goes untreated, signs and symptoms of severe hypoglycemia can occur. These include: • Clumsiness or jerky movements • Muscle weakness • Difficulty speaking or slurred speech • Blurry or double vision • Drowsiness • Confusion • Convulsions or seizures • Unconsciousness • Death

  21. Acute Diabetes Complications—(cont.) • Hypoglycemia—(cont.) • Mild hypoglycemia is treated with 15 to 20 g of glucose. • Symptoms normally improve in 10 to 20 minutes. • Hypoglycemic unawareness • Consistent monitoring of blood glucose is especially important.

  22. Long-Term Complications • Retinopathy • Nephropathy • Neuropathy • Myocardial infarction • Stroke • Peripheral vascular disease

  23. Long-Term Complications—(cont.) • Mild to severe forms of nervous system damage • Impaired wound healing • Periodontal disease • Pregnancy complications • Increased susceptibility to other illnesses

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