1. Alam na ng langgam, Alam mo ba? Recognizing the Signs and Symptoms of Diabetes

2. Diabetes Mellitus : Increasing Prevalence of Diagnosed Cases Persons With Diagnosed Diabetes (millions) Diabetes Overview. October 1995 (updated 1996). NIDDK publication NIH 96-1468. Kenny SJ et al. In: Diabetes in America. 2nd ed. 1995:47-67. Year 8 7 6 5 4 3 2 0 1 19581963196819791984198919948,000,000 5X increase

3. Diabetes Mellitus: Health Impact of the Disease *Diabetes is the no. 1 cause of renal failure, new cases of blindness, and nontraumatic amputations Diabetes Blindnes s* Renal failure* Amputation* Life expectancy 5  to 10 yr Cardiovascular disease  2X to 4X Nerve damage in 60% to 70% of patients 6th leading cause of death  Diabetes Statistics. October 1995 (updated 1997). NIDDK publication NIH 96-3926. Harris MI. In: Diabetes in America. 2nd ed. 1995:1-13.

4. What is diabetes? Diabetes is a disease wherein: The body is unable to properly use and store glucose (a form of sugar). Glucose backs up into the bloodstream — causing your blood glucose or "sugar" to rise too high

5. NORMAL KUMPLETO ANG MANGGAGAWA AT LAHAT AY NAGTATRABAHO LAHAT AY GUMAGAWA NG INSULIN

6. There are two major types of diabetes Type 1 (also called juvenile-onset or insulin-dependent) diabetes The body completely stops producing any insulin The patient must take daily insulin injections to survive It usually develops in children or young adults

7. Causes of Diabetes Saltiel AR, Olefsky JM. Diabetes. 1996;45:1661-1669. Peripheral Tissues (Muscle) Glucose Liver Impaired insulin secretion Increased glucose production Receptor + postreceptor defects Insulinresistance Pancreas

8. DIABETES TYPE 1 KULANG ANG MANGGAGAWA (ng insulin) KULANG SA PRODUKSYON NG INSULIN

9. There are two major types of diabetes Type 2 (also called adult-onset or non insulin-dependent) diabetes –The body produces insulin but not enough to properly convert food into energy –usually occurs in people who: Are over 40 years old Are overweight Have a family history of diabetes.

10. Causes of Diabetes Saltiel AR, Olefsky JM. Diabetes. 1996;45:1661-1669. Peripheral Tissues (Muscle)Glucose Liver Impaired insulin secretion Increased glucose production Receptor + postreceptor defects Insulinresistance Pancreas

11. DIABETES TYPE 2 KUMPLETO ANG MANGGAGAWA PERO HINDI LAHAT MAY GINAGAWA (na insulin) AYAW GUMAWA NG INSULIN AYAW I-PROCESO ANG INSULIN

12. Who May Get Diabetes?

13. Diabetes can happen to anyone but the following are more likely to develop diabetes: Those who have close relatives with diabetes Those who are over 40 years old Overweight people Those with an Asian heritage Women who develop diabetes while pregnant (gestational diabetes)

14. How will we know if we have diabetes?

15. People with diabetes may experience the following symptoms: Being very thirsty Having to go to the bathroom very frequently to urinate Unexplained weight loss Increased hunger

16. People with diabetes may experience the following symptoms Blurry vision Irritability Tingling or numbness in the hands or feet Frequent skin, bladder or gum infections Wounds that don't heal Extreme unexplained fatigue / tiredness

17. In some cases, there are no symptoms!

18. How is Diabetes Diagnosed? All individuals aged 45 years and above should be tested for diabetes –If normal, they should be re-tested every three years.

19. Testing should be conducted earlier and more frequently in the following: Overweight people Those with a first degree relative who has diabetes Members of a high-risk ethnic population (African American, Hispanic, Native American, Asian) Women who delivered a baby weighing more than 9 pounds

20. Testing should be conducted earlier and more frequently in the following: Women who had gestational diabetes Those who have HDL cholesterol levels equal to or less than 35 mg/dl or triglyceride levels equal to or greater than 250 mg/dl Those who have high blood pressure Those who had impaired glucose tolerance or impaired fasting glucose

21. How is Diabetes Diagnosed? Fasting plasma glucose is above 126 mg/dl Diabetes symptoms exist and casual plasma glucose is equal to or above 200 mg/dl; or Plasma glucose is equal to or above 200 mg/dl during an oral glucose tolerance test. Testing should be repeated on a different day to confirm the diagnosis. If a casual plasma glucose equal to 200 mg/dl or above is detected, the confirming test used should be a fasting plasma glucose or an oral glucose tolerance test.

22. Criteria for the Diagnosis of Diabetes: 1997 ADA Guidelines Plasma Glucose Level (mg/dL) *Third criterion:  200 mg/dL casual plasma glucose (regardless of time since last meal) plus symptoms of diabetes (polyuria, polydipsia, unexplained weight loss) Stage of Glycemic Control Fasting Plasma Glucose OGTT (2-hr Postload Glucose) <110 <110 110 – 125  126  126 <140 <140 140 – 199  200  200 ADA. Diabetes Care.1997;20:1183-1197. Normal IFG or IGT Diabetes*

23. What is Borderline Diabetes? Impaired fasting glucose. Fasting plasma blood glucose in the 110-125 mg/dl range If your blood glucose two hours after the oral glucose tolerance test is between 140-199 mg/dl

24. What Should I Eat? It's not so much "what" you should eat but “how much”  If overweight, lose weight.  Eating more foods that are broiled and fewer foods that are fried.  Cutting back on butter or oil in cooking.  Eating fish and chicken more often and only lean cuts of beef and pork  Eating more meatless meals Begin an exercise program, exercise will help you use the insulin you produce to convert the food you eat into energy this will help keep your blood sugars lower

25. Can diabetes be prevented? Research suggests that type 2 diabetes risk can be lowered by as much as 58% through a program of moderate sustained weight loss and moderate daily exercise. Metformin, a medication used to treat type 2 diabetes, has been shown to lower diabetes risk by 31%.

26. What other problems can diabetes cause? Poorly managed diabetes can lead to long-term complications Heart attacks Strokes (brain attack) Blindness Kidney failure Blood vessel disease that may require amputation of a limb Nerve damage Impotence in men

27. If people keep their blood sugars as close to normal as possible, they can reduce their risk of developing some of these complications by 50 percent or more.

29. Davies MJ. Circulation. 1996;94:2013-2020.

33. ADA Targets for Glycemic Control and Recommended Action Levels Biochemical Index Goal Action Suggested FPG (preprandial), mg/dL Bedtime glucose, mg/dL HbA 1c, % Values are for nonpregnant individuals ADA. Diabetes Care. 1997;20(suppl 1):S5-S13. 80   120 80   120 100   140 <7 >140>160>8

34. The Philippine College of Physicians wishes to acknowledge the following for their invaluable contribution in the preparation of this module Institute for the Study of Diabetes Foundation (ISDF) American Diabetes Association (ADA) James Wee, MD, FPCP