Diabetes mellitus

Definition Diabetes is a metabolic disorder resulting in abnormally high blood sugar levels (hyperglycemia) Blood sugar is normally controlled by a hormone called insulin that is secreted by the pancreas http://graphics8.nytimes.com/images/2007/08/01/health/adam/19200.jpg

History of Diabetes First known reference comes from an Egyptian papyrus dating back to 1550 BC “Diabetes” alluded to the Greek word for “flowing through”, referring to the excessive production of urine Diabetes was named by the Greek physician Aretaeus between 30 and 90 AD http://clendening.kumc.edu/dc/pc/Aretaeus.jpg

History of the Disease Avicenna, a famous Arab physician, described the complications of the disease and how it progressed http://www.pre-renaissance.com/images/avicenna2.jpg French physician Bouchardat recognized the importance of calorie intake in the 1870s

History of the Disease Paul Langerhans identified the importance of the pancreas in the early 19th century and discovered the islets of Langerhans, a group of cells that would later be known to produce insulin How about drawing an arrow (yellow?) to show the islets?

History of the Disease Frederick Banting discovered the hormone insulin and won the Nobel Prize for his efforts in the 1920s He used an extract of the pancreas of dogs that prolonged the life of diabetic dogs.

Mental Break 1 Who is this?

Mental Break 1 How about this?

Mental Break 1 And finally, who is this? So, what do they all have in common?

Statistics 8% of the population has some form of diabetes The number of cases increased by 13.5% between 2005 and 2007 Total economic cost of diabetes in the United States in 2007 was estimated at $174 billion

Healthy Metabolism The lettering needs to be larger. How about reading into Photoshop, erasing current lettering and put in larger font. Within the pancreas are islets of Langerhans The islets contain special cells called beta cells Beta cells produce insulin Insulin allows glucose to be absorbed into muscles and tissues http://www.daviddarling.info/images/insulin_secretion.jpg

Diabetic Metabolism http://www.citisletstudy.org/images/edt.jpg As in previous slide, lettering is too small. Also, did you get permission to use these illustrations? We need that (and also a reference for where they came from) Type 1 – Pancreas produces little or no insulin Glucose unable to enter body effectively Type 2 – Pancreas produces sufficient insulin, but it doesn’t work effectively http://www.citisletstudy.org/images/edt.jpg http://www.soylabs.com/img/diabetes_type2.jpg

How might this cause problems? http://assets.aarp.org/external_sites/adam/graphics/images/en/19825.jpg

How it causes problems Too much glucose inhibits the reabsorption of water by the kidney Causes excessive thirst and urination It gets absorbed by parts of the body in which excess glucose is not tolerated Eyes, kidneys, nerves, heart This is true, but does not follow logically from the previous slide. Parts of the body don’t “want” anything. You need to explain why surplus glucose in these organs is a problem.

Can you guess what kind of major complications excess glucose in these organs would cause? Blood vessel damage

Why diabetes is bad If left uncontrolled, diabetes can lead to: Heart attack/Stroke – the risk of each is 2 to 4 times higher in people with diabetes High Blood Pressure – 73% of diabetics have high blood pressure Blindness – diabetes is the leading cause of blindness in adults 20-74 years of age But none of this explain why extra glucose causes such problems. High blood pressure/heart attack/stroke caused by the thickening and weakening of blood vessels due to absorption of glucose Blindness is caused by both the absorption of glucose by the lenses of the eyes, distorting them and the damage to blood vessels in the retina

Why diabetes is bad High blood pressure/heart attack/stroke caused by the thickening and weakening of blood vessels due to absorption of glucose Blindness is caused by both the absorption of glucose by the lenses of the eyes, distorting them and the damage to blood vessels in the retina

Why diabetes is bad Kidney failure – diabetes is also the leading cause of kidney failure Ketoacidosis - diabetic comas due to biochemical imbalances that can even lead to death Diabetes can also lead to nervous system disease, gum disease, and pregnancy complications Kidney failure also due to damage to the organ’s blood vessels Ketoacidosis is caused by excessive ketone levels due to the break down of fats and proteins, and lack of glucose absorbed. It is also made worse by the dehydration caused by diabetes

Why diabetes is bad Kidney failure also due to damage to the organ’s blood vessels Ketoacidosis is caused by excessive ketone levels due to the break down of fats and proteins, and lack of glucose absorbed. It is also made worse by the dehydration caused by diabetes Why is there more breakdown of fats and proteins? Also, you need to remind presenter to explain ketoacidosis in 8th grade language.

Signs and Symptoms Excessive urine production Results in increased thirst and fluid intake Blurred vision Weight loss (Type 1) Lethargy Changes in metabolism Type 1 has not been explained. By the way, I have seen sudden weight loss in adults with Type 2 (isn’t Type 1 childhood diabetes)? Need to credit the source of the slide. http://www.lighthouse.org/images/sim-dia.jpg

Diagnosis Doctors use either a Fasting Plasma Glucose Test (FPG) or an Oral Glucose Tolerance Test (OGTT) to confirm that a patient has diabetes The FPG is recommended because it is easier, faster, and less expensive to perform

A Public Service Announcement from Michael Phelps… Mental Break 2 A Public Service Announcement from Michael Phelps… Breakfast: Three fried-egg sandwiches loaded with cheese, lettuce, tomatoes, fried onions and mayonnaise. Two cups of coffee. One five-egg omelet. One bowl of grits. Three slices of French toast topped with powdered sugar. Three chocolate-chip pancakes. Lunch: One pound of enriched pasta. Two large ham and cheese sandwiches with mayo on white bread. Energy drinks packing 1,000 calories. Dinner: One pound of pasta. An entire pizza. More energy drinks.

So, eating 12,000 calories a day is ok if you are Michael Phelps Mental Break 2 So, eating 12,000 calories a day is ok if you are Michael Phelps http://blogs.wsj.com/health/2008/08/13/the-michael-phelps-diet-dont-try-it-at-home/

Types Type 1 Type 2 Gestational Risk factors and treatment for diabetes differ slightly between the types However, genetics impact both type 1 and type 2: having relatives with diabetes increases ones chances of getting the disease.

Type 1 5-10% of diagnosed diabetes cases in humans Immune system destroys beta cells in the pancreas, the only cells in the body capable of making insulin. Previously known as juvenile diabetes because it most often diagnosed in children and young adults Unlike Type 2, diet and exercise cannot prevent the disease.

Treatment of Type 1 Insulin replacement therapy – insulin is supplemented to the body either by injection or an insulin pump Strict dietary management is required - carbohydrate tracking and monitoring glucose levels Both of these have to be kept up for the life of the patient

Treatment of Type 1 Credit source of photos http://i.ehow.com/images/GlobalPhoto/Articles/2138538/insulin-in-treating-diabetes-ga-2-main_Full.jpg http://www.diabetescaregroup.info/images/pump1.jpg

Type 2 90-95% of diagnosed diabetes cases in humans Pancreas produces insulin, but the body’s response to insulin is diminished Unlike type 1, it is usually a late-onset disease, meaning that it develops later in life

Type 2 Prevalence is rapidly increasing and it is also being found more often in younger people Both of these observations are being linked to the obesity epidemic that has taken over the globe. Obesity has been found to cause increased insulin resistance which can result in diabetes

Type 2 Over 85% of diabetics have a Body Mass Index of over 25, which is classified as overweight Over 55% have a BMI of over 30, which is obese

Treatment and Prevention of Type 2 A proper diet and good exercise habits can support weight loss and effectively limit the effects of the disease. Management of glucose levels is still required and often insulin replacement therapy is also needed.

Gestational Characterized by high glucose levels in pregnant women who never showed signs of diabetes before their pregnancy Affects about 3-10% of pregnancies It is believed that hormones released during pregnancy increase insulin resistance

Gestational Cont… Babies are at increased risk of complications Mothers are at increased risk of developing type 2 diabetes after pregnancy It is a treatable condition by controlling diet, monitoring glucose, and giving insulin when necessary

Mental Break 3 Who can name the hormone that regulates glucose? Which diabetes is treatable with diet and exercise? What is the largest planet in the solar system?

Presentation in Animals Diabetes is a growing problem in both dogs and cats Dogs are most often found to have type 1 diabetes, while cats have a combination Prevalence is increasing

Symptoms Symptoms are similar to those in humans Sudden weight loss or gain Excessive drinking or urination Appetite is either excessive or absent Dogs are highly sensitive to eye problems such as blurred vision and cataracts In cats, the back legs become weak and their gait may become wobbly or stilted Thinning of the skin can also occur Dehydration can finally lead to death

Treatment If left untreated, diabetes is life-threatening in pets. However, diagnosis and treatment by a veterinarian can control the disease, prolonging life, and can even lead to remission in cats.

Diet A simple change of diet can go a long ways in helping to reduce the effects of diabetes. A low-carbohydrate diet reduces the amount of insulin needed and stabilizes blood sugar levels in cats. A high-fiber, moderate-carb diet has been recommended for dogs. Talk about diet needs specific to animals

Medications The most common form of treatment in pets is insulin injections similar to those used in humans. Oral medications in the form of pills are available, but are not often recommended because they are much less effective. Specific oral medications

Ongoing Research Type 1 Treatment Islet Cell Encapsulation – transplant of insulin-producing Islet cells encapsulated in permeable membrane to get around the immune system Islet Cell Regeneration – Involves a protein that is responsible for the regeneration of Islet cells and other important hormones in the pancreas – in clinical trials Islet cell development from stem cells

Ongoing Research Type 1 Treatment Type 1 Prevention Gene Therapy – an oral medication consisting of viral vectors containing the insulin gene is digested and delivered to the upper intestines where it is reproduced Type 1 Prevention Immunization – a biochemical mechanism is being researched that prevents the immune system from attacking beta cells

Ongoing Research Islet Cell Nanotechnology Need elaboration in notes section.

Any Questions?

References http://www.diabetes.org/home.jsp http://en.wikipedia.org/wiki/Diabetes http://www.idb.hr/diabetologia/05no4-1.pdf http://chinese-school.netfirms.com/diabetes-history.html http://blogs.wsj.com/health/2008/08/13/the-michael-phelps-diet-dont-try-it-at-home/