3.  Collection of glands that secrete hormones directly into the bloodstream. › Adrenal glands, parathyroid glands, pancreas, pineal gland, pituitary gland, ovaries, testes, thymus gland, thyroid gland

4. (Hormone.org, 2012)

5. (Zelman, Tompary, Raymond, Holdaway, Mulvhill, 2010)

6.  TSH  T3  T4  Disruption of hormones › Hyperthyroidism › Hypothyroidism (NIDDK, 2006)

7.  Exophthalmos  Profuse perspiration  Hand tremors  Goiter  Weight loss  Nervousness/excitability  Rapid pulse  Polydipsia  Diarrhea  Insomnia  Most common type: Grave’s Disease

8.  Most common type of hypothyroidism › Hashimoto’s Disease › The thyroid doesn’t make enough thyroid hormone › Symptoms:  Fatigue, mental depression, feeling cold, weight gain, dry skin and hair, constipation, menstrual irregularities

9.  Most people have no symptoms  4 types: › Papillary – slow growing – easily treated – rarely fatal › Follicular – again slow growing – rarely fatal › Medullary – less common – more aggressive › Anaplastic – least common – most aggressive

10.  Adrenal Insufficiency › Adrenal glands cannot produce enough cortisol  OR › Pituitary gland fails to produce enough adrenocorticotropin (ACTH)  Symptoms: › Chronic, worsening fatigue › Muscle weakness › Loss of appetite › Weight loss › Nausea/vomiting › Diarrhea › Craving for salty foods › Low blood glucose › Headache

11.  Caused by prolonged exposure of the body’s tissues to high levels of the hormone cortisol.  Relatively rare but risk factors: › Obesity › Type 2 diabetes › High blood pressure

12.  Signs & Symptoms: › Rounded face › Upper body obesity › Increased neck fat › Bruise easily / poor healing › Weakened bones › Fatigue › Increased thirst/urination › Irritability / anxiety / depression (NIDDK, 2006)

13.  Medication  Radioactive Iodine  Surgery  Prevention??

15. In diabetes, blood glucose builds up for several possible reasons… High Blood Glucose (Hyperglycemia) Too little insulin is made Liver releases too much glucose Cells can’t use insulin well American Diabetes Association

16.  Type 1 › Pancreas makes too little or no insulin  Pre-diabetes  Gestational Diabetes  Type 2 › Cells do not use insulin well (insulin resistant) › Ability for pancreas to make insulin decreases over time

17. Number of Americans with Diagnosed Diabetes, 1980-2009 www.cdc.gov

18.  Currently affects about 29.1 million Americans of all ages. › About 9.3% of the population (U.S.) › Estimated 8 million undiagnosed › Hispanics/Latinos – about 13% diagnosed › African Americans – about 13% diagnosed › Asian Americans – about 9% diagnosed (CDC, 2014)

19. (Oregon.gov, 2006)

20.  Increased thirst  Increased urination  Blurry vision  Fatigue  Weight loss  Nausea and vomiting  More frequent infections

21.  A leading cause of blindness  Leading cause of non-accident amputations  Kidney disease  Nerve damage (peripheral neuropathy)  Heart attack / stroke

22. Oral medication only 58% No medication 16% Insulin only 12% Insulin and oral medicatio n 14% Treatment of Diabetes National Diabetes Information Clearinghouse. National Diabetes Statistics, 2011. Available at: http://diabetes.niddk.nih.gov/dm/pubs/statistics/

24.  “The best time to plant a tree is 20 years ago. The second best time is now.”  Chinese Proverb  Good news with diabetes prevention › Small steps matter

25.  Active interventions (vs placebo) would: Cost-Effectiveness of Lifestyle Modification or Metformin: DPP Herman WH, et al for the Diabetes Prevention Program Research Group. Ann Intern Med. 2005:142:323-332. Intensive Lifestyle Metformin Delay onset of type 2 diabetes by 11.1 years3.4 years Reduce incidence of type 2 diabetes by 20%8% Increase life expectancy by 0.5 years0.2 years Cost per QALY$1,124$31,286 QALY = Quality Adjusted Life Years