Stress and Diabetes Mellitus By: Manuela Belda SISD 24534

Statistics: Prevalence of total diabetes in the United States, all ages -- United States, 2002 Total: 18.2 million people--6.3 percent of the population--have diabetes. Undiagnosed: 5.2 million people Diabetes was the sixth leading cause of death listed on U.S. death certificates in 2000. diabetes contributed to 213,062 deaths. Cost of diabetes in the United States, 2002 Total (direct and indirect): $132 billion

What is diabetes?? Diabetes mellitus – commonly referred to as diabetes – is a chronic illness that affects the metabolism Diabetes – “sweat urine” Characterized by too much glucose (a type of sugar) in the blood. = Hyperglycemia Results from defects in insulin production, action or both. There are two main types: One and Two

??Glucose & Insulin?? Glucose – simple sugar Function: Provides fuel for cells to function Insulin –hormone produced by beta cells in the pancreas works as a key that opens the cells for glucose to enter. Regulates glucose levels in the blood

Type 1 5%-10% of all diagnosed cases of diabetes Also known as juvenile diabetes mellitus or insulin dependent diabetes mellitus [IDDM] Autoimmune disease: Risk factors Genetics Exposure to viral infections and other environmental toxins Who is at risk: Lean, young individuals however there are adults that present the same disease – latent autoimmune diabetes in adults [LADA] Treatment - insulin

1) Food enters the system and is digested in to simpler units, [one being glucose] 2) Glucose enters the blood stream 3) Insulin is produced by the pancreas and is released into the blood stream. 4) Insulin binds to the cell allowing glucose to enter

1) Food enters the system and is digested in to simpler units, [one being glucose] 2) Glucose enters the blood stream 3) Insulin is produced by the pancreas and is released into the blood stream. 4) Insulin binds to the cell allowing glucose to enter Cell

1) Food enters the system and is digested in to simpler units, [one being glucose] 2) Glucose enters the blood stream 3) Little or no insulin is produced by the pancreas and is released into the blood stream. 4) Glucose accumulates in the bloodstream. Cell

Type 2 90%-95% of all diagnosed cases Commonly known as adult onset diabetes mellitus or non-insulin dependent diabetes mellitus [NIDDM] The cells of the body lack sensitivity to insulin

Treatment Type 2 diabetes mellitus is first treated with weight reduction, a diabetic diet, and exercise. When these measures fail to control the elevated blood sugars, oral medications are used.. Increase the insulin output by the pancreas Decrease the amount of glucose released from the liver Increase the sensitivity (response) of cells to insulin Decrease the absorption of carbohydrates from the intestine

Risk Factors

SES and Diabetes South Carolina Prevalence Data Income Prevalence % Less than $15,000 15.7 $15,000-24,999 10.7 $25,000-34,999 9.0 $35,000-49,000 6.9 $50,000+ 4.5

Other problems that may occur: Heart disease and stroke High blood pressure Nervous system disease Dental disease Complication in pregnancy Atherosclerotic trouble Kidney failure Blindness Chronic pain Proteins may be knocked out Too much/too little insulin Some symptoms: Frequent urination Increased fatigue Excessive thirst Irritability Extreme hunger Blurry vision Unusual weight loss

How does stress affect this disease?

During acute stress: Epinephrine released Liver Increased lypolysis of triglycerides Pancreas Decreased Glycogen synthesis IncreasedGlycogenolysis Increased Gluconeogenesis Increased circulating free fatty acids Increased Blood glucose Decreased insulin Increased glucagon Decreased glucose uptake in skeletal muscle and peripheral tissues

During chronic stress: Cortisol Liver Promotes lipolysis in extremities Increased gluconeogenesis Increased blood glucose

Chronic stress and Type I More glucose and fatty acids in the blood stream They gum up in the wrong places glucocorticoids promote insulin resistance in fat cells Fat cells release another hormone that promote insulin resistance in other tissues [muscle and liver]

What factors are stressful for individuals with diabetes??

Social and familial factors In children: Family conflict and dysfunction Predictive of adherence difficulty Family support, cohesion and organization Better adherence and metabolic control Patient-physician relationship Those who discontinue tend to be in poorer health

Patient characteristics: Depression and anxiety is associated with poor management of the disease Alienated, opportunistic, and explosive temperaments were in poorer glucose control Beliefs: [about symptoms, severity of disease, vulnerability to negative consequences treatment benefits and costs, perceived ability to successfully perform self-care tasks] – self efficacy

Environmental factors and Behavioral Contigencies Daily treatment demand Following a prescribed diet and set mealtimes Monitoring blood glucose levels Making sure to eat and exercise Taking medications [1 to 4 insulin shots daily] Pricking one’s finger for testing glucose levels time consuming and irritating Having to stop smoking and consuming alcohol

Psychosocial Impact The diagnosis usually comes as a shock and is a stressor in and of itself Psychosocial impact: Depression / anxiety / social withdrawal Fear of hypoglycemia (low blood sugars) Feeling of guilt and shame when hyperglycemia occurs Fears of future medical complications Feeling of being different Feeling of dependence and vulnerability

Coping with diabetes Role of perception Control and self efficacy Relationship between coping styles and health outcomes in youths with type I diabetes Avoidance coping – “tell yourself that the problem is not important” – try to stay away from home as much as possible Ventilation coping – “blame others” – get angry about it

Tara W. Strine: -study People with diabetes that suffer from any sort of depression or emotional problems are more likely to smoke to ease off their tensions Have high cholesterol High blood pressure Avoid exercise – running, calisthenics, golf, gardening or walking – leading to obesity They tend to experience 4 or more of 5 major risk factors for heart disease http://www.hindustantimes.com/news/181_986616,00500020.htm