1. Diabetes Lecture 6a Chapter 19 Dudek

2. Glucose circulating in the blood is a source of ready fuel for body cells. The amount of carbohydrate consumed and, to a lesser extent, the type of carbohydrate eaten are the primary determinants of how quickly and how high blood glucose levels rise after eating. A rise in postprandial blood glucose levels stimulates the pancreas to secrete insulin. Canadian Clinical Practice Guidelines algorithm for diagnosing diabetes- next slide.

4. Diabetes-direct and indirect costs

5. Diabetes Diabetes is one of the most costly and burdensome chronic diseases of our time. Increasing in epidemic proportions The estimated direct and indirect cost associated with diabetes was $ $13.5 billion in 2014 rising to $17 billion by 2024 in Canada. Number of diabetes cases are continuing to rise but we could reduce new cases by 50-90 % if the population would eat and exercise properly.

6. Diabetes—(cont.) Type 1 diabetes –Formerly known as insulin-dependent diabetes mellitus –Characterized by the absence of insulin –Risk factors for type 1 diabetes may be: oAutoimmune oGenetic oEnvironmental-e.g. toxins oInfections-certain viruses oDietary components or bodily derivatives thereof-controversial

7. Diabetes—(cont.) Type 1 diabetes—(cont.) –No known way to prevent type 1 diabetes –All people with type 1 diabetes require exogenous insulin to control blood glucose levels. –Most often detected in children, adolescents, and young adults –Classic symptoms of polyuria, polydipsia, and polyphagia

8. Diabetes—(cont.) Type 2 diabetes –Occurs most often after the age of 45 years –Accounts for 90% to 95% of diagnosed cases of diabetes –A slowly progressive disease that usually begins as a problem of insulin resistance –Type 2 diabetes is often asymptomatic.

9. Diabetes—(cont.) Type 2 diabetes—(cont.) –Insulin resistance is strongly linked to obesity. –Risk factors for type 2 diabetes oAge 45 years or older oOverweight (BMI ≥25 kg/m 2 ) and obese (BMI ≥30 kg/m 2 ) oEven better than BMI are waist circumferences (≥ 94/80 or 90/80 M/F depending on ethnicity as per Nutr 2108 lab) oFirst-degree relative with diabetes oPhysically inactive or exercises fewer than three times per week

10. Diabetes—(cont.) Type 2 diabetes—(cont.) –Risk factors for type 2 diabetes—(cont.) oMember of high-risk ethnic group: African Canadian, Latino, Aboriginal, Asian Canadian oPreviously identified with prediabetes such as impaired fasting glucose or impaired glucose tolerance oHistory of gestational diabetes or giving birth to a baby weighing more than 9 pounds oHypertensive oHDL-c < 0.9 mmol/L and/or triglyceride level ≥ 2.8 mmol/L

11. Diabetes—(cont.) Gestational diabetes –Hyperglycemia that develops during pregnancy –Risk factors oA family history of gestational diabetes oObesity, being a member of a certain ethnic population (Aboriginals, African Canadians, Asian Canadians) oA history of giving birth to an infant weighing more than 9 pounds

12. Diabetes—(cont.) Gestational diabetes—(cont.) –All women are routinely screened between 24 and 28 weeks of gestation. –women with gestational diabetes are at greater risk of type 2. –Offspring exposed to gestational diabetes are more likely to get type 2 diabetes compared to those without such exposure

13. Acute Diabetes Complications Untreated or poorly controlled diabetes can lead to acute life-threatening complications. Conversely, hypoglycemia caused by overuse of medication, too little food, or too much exercise, can also be life threatening.

14. Acute Diabetes Complications—(cont.) Diabetic ketoacidosis (DKA) –People with type 1 diabetes are susceptible to diabetic ketoacidosis (DKA). –Characterized by hyperglycemia (glucose levels > 13.8 mmol/L) and ketonemia –Caused by a severe deficiency of insulin or from physiologic stress, such as illness or infection

15. Acute Diabetes Complications—(cont.) Diabetic ketoacidosis (DKA)—(cont.) –Polyuria may lead to dehydration, electrolyte depletion, and hypotension. –Hyperventilation occurs in an attempt to correct acidosis by increasing expiration of carbon dioxide. –Fatigue, nausea, vomiting, and confusion develop. –Diabetic coma and death are possible.

16. Acute Diabetes Complications—(cont.) Diabetic ketoacidosis (DKA)—(cont.) –DKA is sometimes the presenting symptom when type 1 diabetes is diagnosed. –DKA rarely develops in people with type 2 diabetes. –DKA is treated with electrolytes, fluid, and insulin.

17. Acute Diabetes Complications—(cont.) Hyperosmolar hyperglycemic nonketotic syndrome (HHNS) –Characterized by hyperglycemia (>33.3 mmol/L) without significant ketonemia –Occurs most commonly in people with type 2 diabetes –Dehydration and heat exposure increase the risk. –Illness or infection is usually the precipitating factor.

18. Acute Diabetes Complications—(cont.) Hyperosmolar hyperglycemic nonketotic syndrome (HHNS)—(cont.) –Older people may be particularly vulnerable. –Develops relatively slowly –Symptoms-dehydration, hypotension, decreased mental acuity, confusion, seizures and coma –Best protection against HHNS is regular glucose monitoring. –Treatment includes insulin and fluid and electrolyte replacement.

19. Acute Diabetes Complications—(cont.) Hypoglycemia –Blood glucose level less than 4 mmol/L –Commonly referred to as “insulin reaction” –Occurs from taking too much insulin, inadequate food intake, delayed or skipped meals, extra physical activity, or consumption of alcohol without food –Symptoms

20. Acute Diabetes Complications—(cont.) Hypoglycemia symptoms Early signs and symptoms of diabetic hypoglycemia include: Shakiness Dizziness Sweating Hunger Irritability or moodiness Anxiety or nervousness Headache Nighttime symptoms Diabetic hypoglycemia can also occur while you sleep. Signs and symptoms, which can awaken you, include: Damp sheets or bedclothes due to perspiration Nightmares Tiredness, irritability or confusion upon waking

21. Acute Diabetes Complications—(cont.) Hypoglycemia symptoms Severe symptoms If diabetic hypoglycemia goes untreated, signs and symptoms of severe hypoglycemia can occur. These include: Clumsiness or jerky movements Muscle weakness Difficulty speaking or slurred speech Blurry or double vision Drowsiness Confusion Convulsions or seizures Unconsciousness Death

22. Acute Diabetes Complications—(cont.) Hypoglycemia—(cont.) –Mild hypoglycemia is treated with 15 to 20 g of glucose. oSymptoms normally improve in 10 to 20 minutes. –Hypoglycemic unawareness oConsistent monitoring of blood glucose is especially important.

23. Long-Term Complications Retinopathy Nephropathy Neuropathy Myocardial infarction Stroke Peripheral vascular disease

24. Long-Term Complications—(cont.) Mild to severe forms of nervous system damage Impaired wound healing Periodontal disease Pregnancy complications Increased susceptibility to other illnesses