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Diabetes 101 An emerging epidemic in our community

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Title: Diabetes 101 An emerging epidemic in our community


1
Diabetes 101 An emerging epidemic in our
community
  • Pamela Fonju, FNP, MSN
  • Dept. of Emergency Medicine Ambulatory Surgery
  • Jacobi Medical Center
  • Bronx, New York

2
Diabetes As defined by ADA
  • According to the American Diabetic Assocition,
    diabetes can be defined as
  • A disease in which the body does not produce or
    properly use insulin. Insulin is a hormone that
    is needed to convert sugar, starches and other
    food into energy needed for daily life. The cause
    of diabetes continues to be a mystery, although
    both genetics and environmental factors such as
    obesity and lack of exercise appear to play
    roles.Approximately 17 million people in the
    United States, or 6.2 of the population, have
    diabetes. While an estimated 11.1 million have
    been diagnosed, unfortunately, 5.9 million people
    (or one-third) are unaware that they have the
    disease.

3
Diabetes As defined by WHO
  • According to the World Health Organization
  • The term diabetes mellitus describes a metabolic
    disorder of multiple aetiology characterized by
    chronic hyperglycaemia with disturbances of
    carbohydrate, fat and protein metabolism
    resulting from defects in insulin secretion,
    insulin action, or both.

4
Types of Diabetes
  • Type 1 diabetes (previously known as
    insulin-dependent diabetes) Type 1 diabetes is
    an auto-immune disease where the body's immune
    system destroys the insulin-producing beta cells
    in the pancreas. This type of diabetes, accounts
    for 10-15 of all people with the disease. It can
    appear at any age, mainly in people under under
    40, and is triggered by environmental factors
    such as viruses, diets, and people with genetic
    pre-disposition.
  • People with type 1 diabetes must inject
    themselves with insulin several times a day and
    follow a careful diet and exercise plan.

5
Types of Diabetes continues
  • Type 2 diabetes (previously known as non-insulin
    dependent diabetes)Type 2 diabetes is the most
    common form of diabetes, affecting 85-90 of all
    people with the disease. This type of diabetes,
    also known as late-onset diabetes, is
    characterised by insulin resistance and relative
    insulin deficiency. The disease is strongly
    genetic in origin but lifestyle factors such as
    excess weight, inactivity, high blood pressure
    and poor diet are major risk factors for its
    development. Symptoms may not show for many years
    and, by the time they appear, significant
    problems may have developed. People with type 2
    diabetes are twice as likely to suffer
    cardiovascular disease.

6
Types of Diabetes contines...
  • Gestational diabetes mellitus (GDM)GDM, or
    carbohydrate intolerance, is first diagnosed
    during pregnancy through an oral glucose
    tolerance test. Between 5.5 and 8.8 of pregnant
    women develop this form of diabetes.
  • Risk factors for GDM include a family history of
    diabetes, increasing maternal age, obesity and
    ethnic group with a high risk factor. While the
    carbohydrate intolerance usually returns to
    normal after the birth, the mother has a
    significant risk of developing permanent
    diabetes.

7
Who is at risk for diabetes???
  • Diabetes can occur in anyone, however, the
    following people have an increased tendency to
    develop Type 2, or adult-onset diabetes
  • People who have close relatives with the disease
  • People who are over 40 and overweight
  • Women who developed diabetes while pregnant
    (gestational diabetes)
  • In general, the risk of developing diabetes
    increases with aging.

8
Signs and symptoms of diabetes
  • Regardless of the type, people with diabetes
    presents with similar signs and symptoms.
  • Most common is the three Ps
  • Polyuria (frequent urination)
  • Polydipsia (frequent thirst)
  • Polyphagia (frequent hunger)
  • Weight loss may also be seen in some individuals
  • Increased and/or unexplained sense of fatigue
  • Wounds which does not heal easily (this account
    for the majority of amputations in the United
    States.

9
Diagnosis of diabetes
  • The diagnosis of diabetes mellitus is easily
    established when a patient presents with classic
    symptoms of hyperglycemia (thirst, polyuria,
    weight loss, visual blurring), and
  • has a fasting blood glucose concentration of 126
    mg/dL (7.0 mmol/L) or higher,
  • or a random value of 200 mg/dL (11.1 mmol/L) or
    higher, and confirmed on another occasion.

10
Treatment
  • The goal of treatment is to
  • Reduce morbidity and mortality from complications
    of diabetes and
  • Preservation of quality of life
  • Some treatment option includes
  • Diet a consistent, well-balanced diet that is
    high in fiber, low in saturated fat, and low in
    concentrated sweets.
  • Exercise as little as 20 minutes of walking 3
    times a week has a proven beneficial effect.
    However some exercise is better than no exercise.

11
Treatment continues..
  • In addition to life style changes, medications
    may be necessary for those who are not able to
    control their blood glucose with diet and
    excecise. Class of medications include
  • Biguanide (such as metformin), works primarily by
    reducing liver release of blood glucose from
    glycogen stores and increases the uptake of
    glucose by the bodys tissue.
  • Thiazolidinediones (such as rosiglitazone),
    increases bodys sensitivity to insulin.
  • Sulfonylureas (glyburide, Micronase, glucotrol)
    stimulates the pancreas to produce more insulin.
  • Biguanides decrease the amount of glucose
    produced by the liver.
  • Alpha-glucosidase inhibitors slows absorption of
    starches.
  • Meglitinides stimulates the pancreas to produce
    more insulin.

12
Treatment options continues..
  • Insulins Human insulin is the only type of
    insulin available in the United States it is
    less likely to cause allergic reactions than
    animal-derived varieties of insulin.
  • The type of insulin chosen to customize treatment
    for an individual is based on the goal of
    providing optimal blood sugar control.
  • Different types of insulin are available and
    categorized according to their times of action
    onset and duration.

13
Types of insulins
  • Rapid-acting insulins includes
  • Regular insulin (Humulin R, Novolin R)Insulin
    lispro (Humalog)Insulin aspart (Novolog)Insulin
    glulisine (Apidra)Prompt insulin zinc
    (Semilente, slightly slower acting)Inhaled
    insulin (Exubera

14
Types of insulins continues..
  • Intermediate-acting insulins
  • Isophane insulin, neutral protamine Hagedorn
    (NPH) (Humulin N, Novolin N)Insulin zinc (Lente)
  • Long-acting insulins
  • Extended insulin zinc insulin (Ultralente)Insulin
    glargine (Lantus)Insulin detemir (Levemir)

15
CONCLUSION
  • Prevention, prevention, prevention!!!!!!!!
  • Keep your blood glucose within normal limits
  • Follow up with your Doctor or health care
    pratitioner.
  • For people with hypertension and heart disease,
    take your medications as prescribed and follow up
    with your cardiologist on a regular basis.
  • If you are on insulin, keep your doctors
    appointment every 3months or whenever your blood
    glucose in not undercontrol.
  • Drink adequate amount of fluids and avoid too
    much salt.
  • Exercise, exercise, and exercise.
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