1. Dr Hassan Makki DO FACC Phoenix Heart Center

2.  Diabetes mellitus (DM) is a group of diseases characterized by high levels of blood glucose resulting from defects in insulin production, insulin action, or both.  The term diabetes mellitus describes a metabolic disorder of multiple causes characterized by chronic hyperglycemia with disturbances of carbohydrate, fat and protein metabolism resulting from defects in insulin secretion, insulin action, or both.

8.  At least 10.3 million Americans have been diagnosed with diabetes mellitus, and another 5.4 million are estimated to have undiagnosed diabetes. Onset often precedes diagnosis.  90% of diabetic patients have Type II diabetes  Hispanics 11 %, African Americans 10%, Native Americans, and Asians  Diabetes in women essentially cancels out any hormonal protection (up to 13%).

9.  Makes cholesterol particles smaller, stickier and more plaque forming  Sugar molecules actually directly (and indirectly) damages artery walls  Sets up a Pro- Inflammatory and Pro- Clotting environment  Hormone activation of immune cells

10.  ~80% of all diabetic mortality  75% from coronary atherosclerosis  25% from cerebral or peripheral vascular disease  >75% of all hospitalizations for diabetic complications  >50% of patients with newly diagnosed type 2 diabetes have heart or vascular dz

13.  #1 Cause of amputation  Every 30 sec someone looses a limb to DM  1/5 require amputation  1/4 diabetics will develop an ulcer

14.  With DM  Often no symptoms  Neck, back, shoulder, stomach pains  The longer someone is diabetic, the more subtle the symptoms

15.  Activity LEVEL  Weight (BMI >30), waist size (40/36 m/f)  BP  Family history  Sugars….Fasting (>100), Post meal (>200)  CHOL screening  STOP SMOKING  If known DM, more testing may be required; stress test, ABI, Ultrasound, Calcium score.  Consult Cardiologist!

17.  Impaired Fasting sugar (>100) or Post meal (>200), HGAIC less than 5.7  HGAIC >6.0  Full blown DM  Diet exercise, follow up  Start DM Meds  Start HEART MEDS!

18.  ASA  STATINS  BP meds  ACE inhibitors  17% reduction in cardiac/vascular events  52% reduction vs 32% in non DM  51% reduction when diastolic less than 80-85

19.  Diabetics are a delicate population with serious medical problems.  Problem is an epidemic!  Early detection and appreciation is key  High index of suspicion is required when diabetics have any symptoms….or not having symptoms.  Aggressive risk modification upstream prevents problems downstream  Very preventable disease!

20.  Thank you  Questions!?

21.  www.Phoenixheartcenter.com www.Phoenixheartcenter.com  DM DM  www.Yourdiabetesinfo.org www.Yourdiabetesinfo.org  http://diabetes.niddk.nih.gov/  For Diabetes screening:  http://ndep.nih.gov/am-i-at- risk/DiabetesRiskFactors.aspx  http://ndep.nih.gov/am-i-at-risk/diabetes- risk-test.aspx