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Title: Diabetes:


1
Diabetes
  • Type 1 Type 2
  • Part 1

2
Diabetes Mellitus Etymology
  • The word diabetes comes from a Greek derivative
    meaning to pass through a siphon.
  • The word mellitus comes from a Latin derivative
    meaning sweetened with honey.
  • Combining the words diabetes and mellitus
    literally means sugar passing through the body

3
Definition of Diabetes
  • Diabetes mellitus is a group of metabolic
    diseases characterized by high blood sugar
    (glucose) levels, which result from defects in
    insulin secretion, or action, or both. Elevated
    levels of blood glucose (hyperglycemia) lead to
    spillage of glucose into the urine, hence the
    term sweet urine. Normally, blood sugar levels
    are tightly controlled by insulin, a hormone
    produced by the pancreas. Insulin lowers the
    blood glucose level. When the blood glucose
    elevates (for example, after eating food),
    insulin is released from the pancreas to
    normalize the glucose level. In patients with
    diabetes, the absence or insufficient production
    of insulin causes hyperglycemia. Although
    diabetes is a chronic medical condition, it can
    be controlled.

4
Important Definitions
  • Chronic Disease a disease of long duration
  • Metabolic Disease any disorder that involves an
    alteration in the normal metabolism of
    carbohydrates, lipids, proteins, water, and
    nucleic acids.
  • Blood Sugar (Glucose) sugar in the form of
    glucose in the blood.
  • Insulin a polypeptide hormone secreted by the
    pancreas and assists in the regulation of the
    metabolism of carbohydrates, fats and the
    conversion of glucose and glycogen, which lower
    blood glucose levels.
  • Hyperglycemia the presence of abnormally high
    concentration of glucose in the blood.
  • Pancreas an irregularly shaped gland which lies
    behind the stomach that secretes pancreatic
    juices into the duodenum and insulin into the
    bloodstream.

5
Pathology
  • The increase of blood glucose in persons with
    diabetes causes a loss of sugar through the
    urine. Normally the kidney reabsorbs all glucose
    that filters from the blood into the kidney
    tubules. However, individual with diabetes, the
    kidney cannot reabsorb the excessive amount of
    glucose. When blood glucose levels rise about 160
    mg/dl, the excess spills over into the urine,
    which is called glycosuria. The excess of glucose
    in the urine causes another major problem that is
    high osmotic pressure that holds water in the
    kidney tubules preventing much of it from being
    reabsorbed. The person with diabetes excretes not
    only large amount glucose but also large amount
    of fluid. This obviously causes the body to
    dehydrate, which is partially compensated by
    person drinking large amount of water due to
    excessive thirst (polydipsia). If the person does
    not keep up with excessive fluid loss malfunction
    of certain cells in the brain can occur leading
    the weird behavior, coma and death. Diabetic
    patients have to concerns the supply of energy to
    the tissues. Despite the large quantities of
    glucose present in the blood, the cells cannot
    obtain the normal amount of glucose to supply
    energy. Therefore, they resort to fats and
    proteins for nourishment. As a result decreased
    protein synthesis and an increase use of protein
    as an energy source by glucose-starved cells,
    tissues waste away. Therefore, patient loses huge
    amount of weight and loses ability to grow or
    repair damaged tissues.

6
Pathology Continued
7
Type 1 Diabetes
  • Type 1(Insulin dependent or formerly known as
    juvenile onset) In type 1 diabetes, the pancreas
    undergoes an autoimmune attack by the body
    itself, and is rendered incapable of making
    insulin. Abnormal antibodies have been found in
    the majority of patients with type 1 diabetes.
    Antibodies are proteins in the blood that are
    part of the body's immune system. The patient
    with type 1 diabetes must rely on insulin
    medication for survival. In autoimmune diseases,
    such as type 1 diabetes, the immune system
    mistakenly manufactures antibodies and
    inflammatory cells that are directed against and
    cause damage to patients' own body tissues. In
    persons with type 1 diabetes, the beta cells of
    the pancreas, which are responsible for insulin
    production, are attacked by the misdirected
    immune system. It is believed that the tendency
    to develop abnormal antibodies in type 1 diabetes
    is, in part, genetically inherited, though the
    details are not fully understood. Exposure to
    certain viral infections (mumps and Coxsackie
    viruses) or other environmental toxins may serve
    to trigger abnormal antibody responses that cause
    damage to the pancreas cells where insulin is
    made. These antibodies can be measured in the
    majority of patients, and may help determine
    which individuals are at risk for developing type
    1 diabetes.

8
Type 2 Diabetes
  • Type 2 diabetes (non insulin dependent or
    formerly known as adult onset) the most common
    form. People can develop it at any age, even
    during childhood. This form of diabetes usually
    begins with insulin resistance, a condition in
    which muscle, liver, and fat cells do not use
    insulin properly. At first, the pancreas keeps up
    with the added demand by producing more insulin.
    In time, however, it loses the ability to secrete
    enough insulin in response to meals. While it is
    said that type 2 diabetes occurs mostly in
    individuals over 30 years old and the incidence
    increases with age, we are seeing an alarming
    number patients with type 2 diabetes who are
    barely in their teen years. In fact, for the
    first time in the history of humans, type 2
    diabetes is now more common than type 1 diabetes
    in childhood. Most of these cases are a direct
    result of poor eating habits, higher body weight,
    and lack of exercise.

9
Comparison of Type 1 Type 2 Diabetes
Characteristics Type 1 Type 2
Usual Age At Onset Under 20 years Over 40 years
Development Of Symptoms Rapid Slow
Percent Of Diabetic Population 10 90
Association With Obesity Rare Common
Beta Cells Of Islets Destroyed Usually not destroyed
Insulin Secretion Decreased Normal or Increased
Associated With Particular HLA Antigens Yes No
Usual Treatment Insulin Diet, Oral stimulators of insulin secretion
10
Signs Symptoms of Diabetes
  • High amounts of glucose in the urine can cause
    increased urine output and lead to dehydration.
    Dehydration causes increased thirst and water
    consumption.
  • The inability of insulin to perform normally has
    effects on protein, fat and carbohydrate
    metabolism. Insulin is an anabolic hormone, that
    is, one that encourages storage of fat and
    protein. A relative or absolute insulin
    deficiency eventually leads to weight loss
    despite an increase in appetite.
  • Some untreated diabetes patients also complain of
    fatigue, nausea and vomiting.
  • Patients with diabetes are prone to developing
    infections of the bladder, skin, and vaginal
    areas.
  • Fluctuations in blood glucose levels can lead to
    blurred vision.
  • Extremely elevated glucose levels can lead to
    lethargy and coma.

11
Complications Related to Diabetes
  • Acute Complications
  • Without insulin, patients with type 1 diabetes
    develop severely elevated blood sugar levels.
    This leads to increased urine glucose, which in
    turn leads to excessive loss of fluid and
    electrolytes in the urine. Lack of insulin also
    causes the inability to store fat and protein
    along with breakdown of existing fat and protein
    stores. This deregulation, results in the process
    of ketosis and the release of ketones into the
    blood. Ketones turn the blood acidic, a condition
    called diabetic ketoacidosis (DKA). Symptoms of
    diabetic ketoacidosis include nausea, vomiting,
    and abdominal pain. Without prompt medical
    treatment, patients with diabetic ketoacidosis
    can rapidly go into shock, coma, and even death.
  • In patients with type 2 diabetes, stress,
    infection, and medications (such as
    corticosteroids) can also lead to severely
    elevated blood sugar levels. Accompanied by
    dehydration, severe blood sugar elevation in
    patients with type 2 diabetes can lead to an
    increase in blood osmolality (hyperosmolar
    state). This condition can lead to coma
    (hyperosmolar coma). A hyperosmolar coma usually
    occurs in elderly patients with type 2 diabetes.

12
Complications Related to Diabetes Continued
  • Chronic Complications
  • The major eye complication of diabetes is called
    diabetic retinopathy.
  • Diabetes accelerates hardening of the arteries
    (atherosclerosis) of the larger blood vessels,
    leading to coronary heart disease (angina or
    heart attack), strokes, and pain in the lower
    extremities because of lack of blood supply. For
    more information, please read the following
    articles stroke, angina and heart attack.
  • Kidney damage from diabetes is called diabetic
    nephropathy.
  • Nerve damage in diabetes is called diabetic
    neuropathy and is caused by disease of small
    blood vessels. In essence, the blood flow to the
    nerves is limited, leaving the nerves without
    blood flow, and they get damaged or die as a
    result (a term known as ischemia).
  • Because of poor blood circulation, diabetic foot
    injuries may not heal. Sometimes, minor foot
    injuries can lead to serious infection, ulcers,
    and even gangrene, necessitating surgical
    amputation of toes, feet, and other infected
    parts.
  • Diabetic neuropathy can also affect nerves to the
    stomach and intestines, causing nausea, weight
    loss, diarrhea, and other symptoms of gastro
    paresis (delayed emptying of food contents from
    the stomach into the intestines, due to
    ineffective contraction of the stomach muscles).

13
Diagnosis of Diabetes
  • The following tests are used for diagnosis
  • A fasting plasma glucose test measures blood
    glucose after patient have gone at least 8 hours
    without eating. This test is used to detect
    diabetes.
  • An oral glucose tolerance test measures blood
    glucose after patient have gone at least 8 hours
    without eating and 2 hours after you drink a
    glucose-containing beverage. This test can be
    used to diagnose diabetes.
  • In a random plasma glucose test, doctor checks
    blood glucose without regard to when patient ate
    last meal. This test, along with an assessment of
    symptoms, is used to diagnose diabetes.
  • Positive test results should be confirmed by
    repeating the fasting plasma glucose test or the
    oral glucose tolerance test on a different day.

14
Fasting Plasma Glucose Test
Plasma Glucose Result (mg/dL) Diagnosis
99 Below Normal
100 to 125 Pre-diabetes (impaired fasting glucose
126 Above Diabetes
Results confirmed by repeating the test on another day Results confirmed by repeating the test on another day
15
Treatment of Diabetes
  • There is no cure for diabetes. The immediate
    goals are to stabilize your blood sugar and
    eliminate the symptoms of high blood sugar. The
    long-term goals of treatment are to prolong life,
    relieve symptoms, and prevent long-term
    complications such as heart disease and kidney
    failure.
  • LEARN THESE SKILLS
  • Basic diabetes management skills will help
    prevent the need for emergency care. These skills
    include
  • How to recognize and treat low blood sugar
    (hypoglycemia) and high blood sugar
    (hyperglycemia)
  • What to eat and when
  • How to take insulin or oral medication
  • How to test and record blood glucose
  • How to test urine for ketones (type 1 diabetes
    only)
  • How to adjust insulin and/or food intake when
    changing exercise and eating habits
  • How to handle sick days
  • Where to buy diabetes supplies and how to store
    them
  • After you learn the basics of diabetes care,
    learn how the disease can cause long-term health
    problems and the best ways to prevent these
    problems. People with diabetes need to review and
    update their knowledge, because new research and
    improved ways to treat diabetes are constantly
    being developed.

16
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18
Diabetes Physical ActivityPart 2
19
Diabetes Exercise
  • Exercise is considered to be one of the
    cornerstones of diabetes care
  • The effects of diabetes on a session of exercise
    is dependent upon several factors, including
  • use and type of medications to lower blood
    glucose
  • timing of medication administration
  • timing, amount, and type of previous food intake
  • blood glucose level before exercise
  • presence and severity of diabetic complications
  • use of other medications
  • intensity, duration, and type of exercise

20
Benefits for Diabetics from Exercise
  • Possible improvement in blood glucose control in
    those individuals with type II
  • Improved insulin sensitivity resulting in a lower
    medication requirement
  • Reduction in body fat, which can help to increase
    insulin sensitivity
  • Cardiovascular benefits a decreased risk for
    cardiovascular disease
  • Stress reduction stress can interrupt diabetes
    control by increasing counter regulatory
    hormones, ketones, free fatty acids and urine
    output
  • Prevention of type II diabetes

21
Prescribing Exercise to Individuals with Diabetes
  • Careful monitoring of blood glucose levels and
    attention to food intake and medication
    administration are necessary in order for
    individuals with diabetes to participate in
    physical activity
  • Exercise must be individualized according to
    medication schedule, presence and severity of
    complications, and expected benefits and goals of
    the program
  • Generally speaking, 1 hour of exercise requires
    an additional 15 grams of carbohydrate either
    before of after exercise
  • If exercise is vigorous or lasts longer than 1
    hour, and additional 15 to 30 grams of
    carbohydrate per hour may be necessary

22
Exercise Precautions with Individuals Who Have
Diabetes
  • Must have a readily available source of fast
    acting carbohydrates (ie. box of raisins, can of
    Pepsi Cola, fruit juice, cookies)
  • Participants must consume adequate amounts of
    fluid before, during, and after exercise
  • Participants must always carry medical
    identification

23
Exercise Prescription AdolescentsPart 3
24
Adolescence
  • Defined as the second stage of life, ages 10 to
    22, when young people experience significant
    biological, physiological, and social changes
    necessary to prepare for adulthood (Holmes 1995).
  • Divided into early adolescents (10 to 14) and
    late adolescents (15 to 22)
  • Many adolescents will experience a growth spurt
    of 2.5 to 3 years during which they will attain
    about 20 of their adult height (Payne and Isaacs
    1995).
  • Final growth often occurs by the age of 18 for
    females and by around 20 to 21 for males
  • Some studies suggest that some adolescents
    experience a period of clumsiness and awkwardness
    when in a phase of rapid growth
  • If this period of clumsiness is evident, teachers
    should reassure students that the awkward stage
    is only temporary and very natural
  • During the rapid growth many adolescents often
    feel self-conscious about their bodies and
    abilities

25
Physical Activity and Adolescents
  • Children in North America are fatter than they
    were in previous decades (U.S. Department of
    Health and Human Services 2000 Flegal, Dietz,
    Srinivasan, and Berenson 1988).
  • This circumstance is a major cause of concern for
    parents, health practitioners, politicians, and
    physical education teachers. The main reason for
    this concern is the fact that obesity is related
    to the two main categories of killers in the U.S.
    - heart disease and cancer (Centers for Disease
    Control and Prevention 2002).
  • Physical activity is a way of combating obesity,
    and lack of it is one of the reasons we have this
    problem today (Centers for Disease Control and
    Prevention 2002).

26
Exercise for Adolescents (Ages 14 to 16 Years
Old)
  • Exercise should provide both aerobic and
    anaerobic components
  • Adolescence is a period of dynamic change for
    most individuals which includes physical,
    emotional and social adjustments
  • Students physical capabilities may vary greatly
    due to the amount of individual change that is
    taking place
  • It is important to get everyone involved in
    activities which they are comfortable
    participating in
  • Boys and girls should be separated into theyre
    own groups to provide the most comfortable
    atmosphere for all participants
  • Attention span of adolescents is shorter than
    that of adults, therefore instructions should be
    to the point and provided during each rest period

27
Type of Exercise for Adolescents
  • Short term moderate to high intensity physical
    activity are age appropriate for adolescents ages
    14 to 16
  • High intensity activities should be followed up
    by a short rest period to allow students to
    recuperate
  • Games that involve running, kicking, ball
    control, and throwing are optimal for this age
    group
  • Activities could include soccer, dodge ball,
    floor hockey, hand ball etc.
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