1. Diabetes

2. Diabetes Prevalence in U.S., 1994-2004 (CDC)

3. Diabetes Prevalence in U.S., 1995

4. Diabetes Prevalence in U.S., 1996

5. Diabetes Prevalence in U.S., 1997

6. Diabetes Prevalence in U.S., 1998

7. Diabetes Prevalence in U.S., 1999

8. Diabetes Prevalence in U.S., 2000

9. Diabetes Prevalence in U.S., 2001

10. Diabetes Prevalence in U.S., 2002

11. Diabetes Prevalence in U.S., 2003

12. Diabetes Prevalence in U.S., 2004

13. Diabetes Prevalence in the U.S., 2004

14. Diabetes Prevalence, 2005

15. Diabetes Prevalence, 2006

16. Diabetes Prevalence, 2007

17. Diabetes Prevalence, 2008

18. Diabetes Prevalence, 2009

19. Prevalence (continued)  Another view: Millions living with diabetes 1980- 2010 (CDC)living with diabetes  Percentage of those living with diabetes, by age, 1980-2010 (CDC)by age  Ethnicity and sex - diabetes prevalence increased 1980-2010 (CDC) Ethnicity and sex  WA estimates of diagnosed diabetes: percentage of adults (CDC) WA

20. Diagnosis Changes  Diabetes knowledge has increased in last four decades  Criteria for diabetes have changed (Source: American Diabetes Association)diabetes  Criteria change may explain some of the increase seen in the 1990s

21. World Prevalence  Which country has the most diabetes?  Top 10 - International Diabetes Federation (Table 2.1) Top 10 - International Diabetes Federation  World Health Organization World Health Organization  International Diabetes Federation International Diabetes Federation

22. Diabetes  An excess of glucose (sugar) in the blood Inadequate insulin production Inefficient insulin use

23. Diabetes Symptoms  Frequent urination  Thirst  Hunger  Weight loss (despite thirst, hunger)  Fatigue  Irritability  Type 2 diabetes may often have no symptoms until later

24. Insulin  Hormone produced by pancreas beta cells (WebMD)pancreas  After a meal, blood glucose levels rise  Insulin moves glucose into body ’ s cells For use For storage Animation (WebMD; click “Anatomy/Function”) Animation

25. Insulin  Insulin released from pancreas Insulin binds to specific receptors on cells (WebMD; click “Anatomy/Function;” 2 nd animation)specific receptors Insulin-receptor triggers a transporter to move glucose into the cell Insulin-receptor triggers a transporter to move glucose into the cell Example:GLUT-4, found inside fat and muscle cells Insulin binding triggers transporter GLUT-4 to move from inside cell to cell membrane GLUT-4 opens up, allowing glucose to move inside

26. Types of Diabetes  Type I Juvenile-onset Diabetes Insulin-Dependent Diabetes  Type II Adult-onset Diabetes Non-Insulin-Dependent Diabetes

27. Type I Diabetes  5-10% of the population  Person with Type I has little or no insulin to move glucose into cells  Two classifications: Type Ia Type Ib

28. Type Ia Diabetes  The most common form of Type I diabetes  Insulin production is halted  Autoimmune response Antibodies destroy pancreas ’ beta cells (WebMD; click “Causes,” select 1 st animation) Antibodies YouTube animation (4 min)animation Genetics, infant diet may be related to susceptibility  Insulin injections required

29. Type Ib Diabetes  Insulin production is halted  Of unknown origin Not due to autoimmune response Chromosomal abnormality possibility Viral infection possibility Genetic predisposition triggered by environmental factor Those of Asian, African American and Hispanic descent more frequently diagnosed  Insulin therapy Oral medication may be used to control condition

30. Type II Diabetes  Most common Approximately 90% of diabetes cases  Up to one half unaware they have Type II  Stereotype: over age of 50 years  Type II increasing among youth  Treatments: diet, activity, medication

31. Type II Diabetes  Inadequate insulin production  Uncontrolled insulin release rate  Reduced insulin sensitivity  Insulin receptor problems Reduction in receptor number Antibodies attaching to receptors, blocking insulin Animation (WebMD) Animation

32. Type II Diabetes  Video: insulin resistance Video YouTube

33. Type II Diabetes Risk Factors  Poor diet (high fat, low fiber, simple carbohydrates)  Physical inactivity  Genetic predisposition & family history  History of gestational diabetes  Age

34. Type II Diabetes and Ethnicity  Some minority populations at increased risk Japanese Chinese South African blacks Native American Pimas, Navajos, Aleuts Native Hawaiian Latino Maskarinec G, et al. Diabetes prevalence and body mass index differ by ethnicity: the multiethnic cohort. Ethnicity & Disease 19(1), 2009. Kitagawa,T. Owada,M. Urakami,T. Yamauchi,K. Increased incidence of non-insulin dependent diabetes mellitus among Japanese schoolchildren correlates with an increased intake of animal protein and fat. Clin Pediatr (Phila).1998; 37(2): 111-115

35. Type II Diabetes and Ethnicity  Reasons for increased risk are many Lifestyle factors Diet Inactivity Obesity Genetic factors Thrifty gene controversy

36. Latent Autoimmune Diabetes of Adulthood  Per title, impacts adults  Also known as Type 1.5, Latent Type 1, Slow onset Type 1, Autoimmune diabetes in adults  May be misdiagnosed Person often normal weight, may lack family history Onset is slow, with similar blood sugar challenges seen in Type 2  Like Type 1, an autoimmune response results in destruction of pancreatic beta cells

37. Diabetes Complications  Blood vessel damage Increased CV disease risk Atherosclerosis More lipids in bloodstream Damage in kidneys affects filtration of waste Damage in vessels leading to retina  Nerve damage Numbness, paralysis Sores, amputation  Video (WebMD) Video

38. Hyperglycemia & Hypoglycemia  Hyperglycemia When glucose cannot enter cell, levels in bloodstream remain elevated If dysfunctional, pancreas cannot make enough insulin to move glucose out of blood and into cells If functional, pancreas releases more insulin “ hyperinsulinemia ”  Hypoglycemia Too much insulin production Can occur in those with diabetes (too much insulin, not enough food)

39. Diabetes Resources  Support Groups Little Kids with Insulin Dependent Diabetes - for parents, 10am Saturdays, every other month beginning January, Seattle Children ’ s Hospital; Zuraya Aziz: 425-985-9199 Parents of Kids Experiencing Diabetes - for family of those all-age children with Type I diabetes; email for newsletter: POKED.WA@gmail.com. POKED.WA@gmail.com

40. Diabetes Resources - Support Groups  Northwest Hospital Diabetes Support Group Second Tuesday of each month, 1-2:30pm Third Thursday of each month, 7-8:30pm Diabetes Education Classroom/TCU Dining Room, NW Hospital Register by phone, 206-368-1564, or online  Swedish Diabetes Education Center Group First Wednesday of each month, 7:30am First Hill, 206-215-2440

41. Diabetes Resources  American Diabetes Association: http://www.diabetes.org/ http://www.diabetes.org/  National Diabetes Education Program: http://www.ndep.nih.gov/ http://www.ndep.nih.gov/  Annual ADA Diabetes Expo Annual ADA Diabetes Expo April, Seattle Convention Center