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Diabetes

Diabetes. Leading cause of: 1 End-stage renal disease Adult blindness Amputations. Insulin Deficiency 1 Insulin Resistance 1. 3 Major Types: 1 Type I Type II Gestational. 8% of Americans currently have diabetes 2.

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Diabetes

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  1. Diabetes

  2. Leading cause of:1 • End-stage renal disease • Adult blindness • Amputations Insulin Deficiency1 Insulin Resistance1 • 3 Major Types:1 • Type I • Type II • Gestational 8% of Americans currently have diabetes2 Men and women have different Clinical Presentations3 and Responses to Treatment4 Introduction

  3. Pancreas Cell Biology Beta Cell Islets of Langerhans

  4. Liver 4 GI Tract Skeletal Muscle 1 Glucose 3 Glucose uptake Insulin 2 Pancreas Physiology Adipocytes

  5. Liver 4 GI Tract Skeletal Muscle 1 Glucose 3 No Glucose uptake Insulin 2 Pancreas Pathology Adipocytes

  6. Lean muscle metabolizes glucose independent of insulin1 Glucose • On average, men have more skeletal muscle than women2 • Diabetic men achieve glucose control faster than women Skeletal Muscle

  7. Liver Glucagon • Diabetic women produce stress hormones: • During ovulation4 • As a part of premenstrual syndrome5 • During pregnancy6 Pancreas Glucose Glucose Cortisol Glucagon and Cortisol

  8. Autoimmune Disease1 Insulin replacement • The immune system destroys the insulin-secreting cells • Patients require insulin replacement • No Insulin Production Type I Diabetes

  9. Metabolic Disorder1 GIucose • Insulin receptors do not bind insulin • No cellular signal produced • Insulin Resistance Insulin No Signal Type II Diabetes

  10. Sex-Exclusive Disease • Occurs only in Women • High risk for • Type 2 Diabetes1 • High risk for Cardiovascular Disease2 Gestational Diabetes

  11. Type II Diabetes in Children

  12. 25 Million Americans have diabetes • 8% of the population • 95% of diabetic population has Type 2 Diabetes By the year 2050… 1 in 3 Epidemiology Will have Type 2 Diabetes

  13. Frequent urination, polydipsea, polyphagia, fatigue, blurry vision, weight loss, numbness in hands and feet1 Men Erectile dysfunction (ED) is common among type 2 diabetics. Women Reoccurring yeast infections are commonly seen in both type 1 and type 2 females. Clinical Presentation

  14. BMI 25 plus 1 risk factor:1 Screening

  15. Classes of Medications1 • Insulin • Biguanide • Sulfonylurea • Thiazolidinedione • Dipeptidyl peptidase-4 inhibitor Treatment

  16. Type I Diabetes • Insulin Replacement is required1 Type II Diabetes Insulin Replacement may become necessary1 Women require more insulin2 Insulin Therapy

  17. Enhances insulin sensitivity in muscle and adipose tissue1 Inhibits hepatic glucose production1 • Increases cardiac glucose uptake in women2 • Negatively effects heart metabolism in men2 Biguanide Metformin (Glucophage; Glucophage XR)

  18. Pancreas Stimulate insulin secretion from the beta cells in the pancreas1 Side effects include hypoglycemia and weight gain1 Sulfonylureas Insulin Glyburide (Diabeta, Glynase, Micronase); Glipizide (Glucotrol, Glucotrol XL); Glimepiride (Amaryl) Beta Cell

  19. Reduces insulin resistance and redistributes fat1 Signal • Men and women are at higher risk for fractures2 • Women are at risk for osteoporosis2 • May induce ovulation in women with PCOS1 Thiazolidinediones Pioglitazone (Actos); Rosiglitazone (Avandia

  20. Pancreas Decreases glucagon secretion1 Stimulates insulin secretion1 Less glucagon means less glucose production from the liver1 Dipeptidyl Peptidase 4 Inhibitors Glucagon Alogliptin (Nesina); Linagliptin (Tradjenta); Saxagliptin (Onglyza); Sitagliptin (Januvia) Alpha Cell

  21. Men Men moderate their intake of unhealthy food (except in social environments)1 Women Restrict unhealthy food from their diets1 Nutrition

  22. Women • Higher incidence of depression and anxiety5 • Higher risk for blindness3 • Higher risk for myocardial infarction3 • Higher mortality after anMI3 • Men • Higher rates of amputation1,2 • Greater risk for peripheral vascular disease3 • Higher risk for erectile dysfunction4 Prognosis

  23. Women are more likely to… Men are more likely to… • Reveal their condition to friends and family • Assimilate diabetes management into their schedule • Keep their diabetes hidden from friends and family • Ignore their diabetes management in social situations Social Considerations

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