1. Diabetes

2. Objectives: Diabetes Mellitus (DM) Discuss the prevalence of diabetes in the U.S. Contrast the main types of diabetes. Describe the classic symptoms of diabetes. Describe the function of insulin and glucagon. Describe the complications of diabetes. Describe the risk factors for diabetes. Identify the major risk groups for diabetes. Discuss the diagnostic criteria for diabetes. Identify fasting and random levels of blood glucose that would indicate diabetes.

3. Diabetes Mellitis  What is Diabetes?  Chronic hyperglycemia due to deficiency in the action or secretion of insulin.

4. Prevalence of Diabetes 1  29.1 million children and adults have diabetes 21 million diagnosed 8.1 million undiagnosed 86 million with prediabetes CDC.gov, 2014 National Diabetes Statistics Report

5. www.cdc.gov/diabetes County-level Estimates of Diagnosed Diabetes among Adults aged ≥ 20 years: United States 2004 Percent

6. www.cdc.gov/diabetes Percent County-level Estimates of Diagnosed Diabetes among Adults aged ≥ 20 years: United States 2005

7. www.cdc.gov/diabetes Percent County-level Estimates of Diagnosed Diabetes among Adults aged ≥ 20 years: United States 2006

8. www.cdc.gov/diabetes County-level Estimates of Diagnosed Diabetes among Adults aged ≥ 20 years: United States 2007 Percent

9. www.cdc.gov/diabetes County-level Estimates of Diagnosed Diabetes among Adults aged ≥ 20 years: United States 2008 Percent

10. Age-adjusted percent www.cdc.gov/diabetes County-level Estimates of Diagnosed Diabetes among Adults aged ≥ 20 years: United States 2009

11. County-level Estimates of Diagnosed Diabetes among Adults aged ≥ 20 years: United States 2010

12. County-level Estimates of Diagnosed Diabetes among Adults aged ≥ 20 years: United States 2011

13. Diabetes Physiology www.nlm.nih.gov Pancreas (Islets of Langerhans) –What is difference between alpha cells and beta cells? –Alpha cells –Produce glucagon –Increase blood glucose –Beta cells –Produce insulin –Decrease blood glucose

14. Islets of Langerhans http://www.britannica.com/EBchecked/topic-art/186893/101913 Alpha cells = 30% Beta cells = 60%

15. Insulin’s Function  What is insulin’s function?  Secreted when blood glucose is increasing  Promotes cell uptake of glucose, fat, and amino acids  Decreases blood glucose

16. Glucagon’s Function  What is glucagon’s function?  Starvation hormone  Secreted when blood glucose is low  Increases blood glucose

17. Type 1 Diabetes Mellitus  What is Type 1 Diabetes Mellitus?  5-10% of all diabetics  An autoimmune condition  Causes absolute insulin deficiency  Ketoacidosis prone  Genetic  Mortality rates

18. Ketoacidosis in Type 1 DM  What is ketoacidosis? Lack of insulin means cells cannot use glucose Without glucose, fats are metabolized to ketones Ketones are acidic (lowers blood pH)

19. Symptoms of Ketoacidosis  Excess thirst, dehydration  Weight loss  Nausea, vomiting  Fatigue  Dry skin  Rapid breathing  Confusion  Fruity (acetone) breath smell  A medical emergency

20. Type 2 Diabetes Mellitus  What is Type 2 Diabetes Mellitus?  90-95% of diabetics  Caused by insulin resistance and inadequate production of insulin  Beta-cell dysfunction is the major defect

21. Development and Progression Type 2 Diabetes Mellitus  Development Obesity  Progression Gradual decline in  -cell function

22. What are the Signs and Symptoms of DM?  Polyuria  Polydipsia  Polyphagia  Glucosuria  Weight loss

23. Pre-Diabetes  What is Pre-diabetes?  Blood glucose levels higher than normal but not high enough to be classified as diabetes

24. Gestational Diabetes  Any glucose intolerance during pregnancy  Pregnancy increases insulin resistance  About 7% of all pregnancies  Prone in 3 rd trimester (screen in week 24-28)

25. Hypoglycemia  Dx: Blood glucose < 50 mg/dL with symptoms  May occur within 4 hrs of eating (postprandial)  Symptoms:  Headache, slurred speech, confusion  Hunger, nervous, sweating, shakiness

26. Diabetes Complications  Microvascular  Neuropathy  Nephropathy  Retinopathy  Macrovascular  Large vessel disease  Hypertension  Dyslipidemia  Peripheral Artery Disease

27. What are the Risk Factors for Diabetes?  Family History of DM in 1 ° relative  Ethnic  Age  Overweight (BMI > 25 kg/m 2 )  Metabolic syndrome  History of GDM or baby > 9 lbs  Hypertension (>140/90)  Habitually physically inactive  History of Impaired Glucose Tolerance (IGT)

28. Criteria for Diagnosis of Diabetes  Hemoglobin A1C > 6.5%  Fasting plasma glucose (FPG) > 126 mg/dL (no food 8 hrs)  (normal FPG < 100)  2 hr plasma glucose > 200 mg/dL  Known as Oral Glucose Tolerance Test (OGTT)  75-g glucose in water solution  Symptoms of diabetes  and casual PG > 200mg/dL Diabetes Care Jan 2010 33:S11-61

29. Current Definition of Pre-diabetes  A1C: 5.7 – 6.4%  Impaired Fasting Glucose (IFG)  After 8 hr fast  100 mg/dL - < 126 mg/dL  Impaired Glucose Tolerance (IGT)  Oral Glucose Tolerance Test  Fasting and 2 hr test (after 75g glucose)  Fasting - < 100 and 2 hr = 140 - < 200 mg/dL  Combined IFG & IGT (CIFGT)  Fasting 100 - < 126 and 2 hr 140 - < 200 mg/dL

30. Who to screen for diabetes?  At age > 45 (if normal repeat every 3 yrs)  BMI > 25 (kg/m 2 )  Have a first-degree relative with diabetes  Are habitually physically inactive  Are members of a high-risk ethnic population  Have delivered a baby weighing 9 lb or been Dx with GDM  Are hypertensive (140/90)  Have an HDL cholesterol level 250 mg/dl  Had previous IGT  Have a history of vascular disease  Have symptoms of DM  Overweight children  (BMI >85 th percentile for age)

31. Metabolic Syndrome What is the Metabolic Syndrome? Synonyms:  Insulin resistance syndrome  Syndrome X  Dysmetabolic syndrome

32. Diagnostic Criteria for Metabolic Syndrome  (3 or more of the following:)  Abdominal obesity  waist circumference of > 40 in for men > 35 in for women  Hypertriglyceridemia (> 150 mg/dL)  Low HDL  < 40 mg/dL in men  < 50 mg/dL in women  High blood pressure (> 130/85 mm Hg)  High fasting glucose (> 110 and < 126 mg/dL) Executive Summary of the Third Report of the national cholesterol Education Program Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) JAMA. 2001; 285: 2486-2497

33. Lifestyle Intervention  Regular physical activity  Moderate diet  Modest weight loss

34. Questions?