An Introduction to Diabetes Mellitus

(sweet flow)

What will we cover today?

Statistics and facts A physiological description Distinctions between the different types Complications Treatment and management

Statistics and Facts on Diabetes

The CDC has declared an epidemic of diabetes 16 million, or 5.9% of Americans are affected 19% of the population over 65 has diabetes Ethnic minorities are at greater risk

Statistics and Facts, continued

Having diabetes greatly increases morbidity and mortality. Diabetes is the 6th leading cause of death in the United States. Each year a large percent of our health care dollar goes towards diabetes patients.

What exactly is Diabetes?

Diabetes is

a chronic disease characterized by high blood glucose levels

Can be diagnosed with an oral glucose tolerance test Fasting: greater than 126 mg/dL Non-fasting: greater than 200 mg/dL

caused by defects in insulin secretion, insulin action, or both

Hormonal Control of Glucose

After a meal: Insulin (anabolism)

Decreases blood glucose (GLUT4 transporter) Increases glycogen synthesis Decreases gluconeogenesis Lipoprotein lipase

lipogenesis

Stimulates protein synthesis

Hormonal Control of Glucose

Between meals: Glucagon (catabolism)

Increases blood glucose Increases glycogen breakdown in liver and muscle Increases gluconeogenesis in liver Activates hormone sensitive lipase Mobilizes triglyceride stores-Lypolysis

Metabolic acidosis

Type 1 Diabetes

Also known as juvenile diabetes, or Insulin-dependent diabetes mellitis (IDDM) Accounts for 5% of total diabetes cases Onset is between 8-14 yrs old usually presenting with ketosis

Honey-moon phase Antibodies to islet cells and/or insulin

Regarded as an auto-immune disease

Type 1 Diabetes, contd

Gradual loss of beta cell function until no longer able to synthesize adequate insulin to control blood sugar Presenting symptoms are polydipsea, polyurea, polyphagia, and weight loss Patients are most often lean Patients must rely on exogenous sources of insulin Has a genetic link

Type 2 Diabetes

Formerly known as adult-onset Non-insulin dependent diabetes mellitis (NIDDM) 90% of total cases Very strong genetic component 80% with Type 2 are obese

Type 2 Diabetes

Develops gradually so may go undiagnosed Begins with insulin resistance Caused by

Initially by a defect in the mechanism of GLUT4 transporter (sensitivity of cells to insulin)

hyperinsulinemia

Eventually the pancreas may cease to produce insulin

Hypoinsulinemia 40% end up on insulin

Risk Factors for Type 2 Diabetes

Genetic profile Age Race Obesity Physical inactivity

Gestational Diabetes

Lactogen can antagonize the action of insulin Increased need for insulin during the 2nd and 3rd trimester 7% of American pregnancies Screened for during the 24th and 28th week After delivery, 90% become normoglycemic Have up to 60% chance of developing Type II later

Macrovascular Complications

Coronary Heart Disease Peripheral vascular disease Cerebrovascular disease Hypertension Dyslipidemia

Microvascular Complications

Retinopathy

#1 cause of new blindness among adults 80% of all patients have some form 15 years after diagnosis

Microvascular Complications

Nephropathy

20% develop this after 15 years of diabetes Kidney function declines May progress to total renal failure and require dialysis or transplant

Microvascular Complications

Neuropathy

Peripheral- hands and feet Autonomic- cardiovascular, GI tract: esophagus, stomach, small intestine, and colon Gastroparesis

Irregular contractions of stomach Fullness, bloating, nausea, vomiting, diarrhea, constipation Detrimental effects on blood glucose control

Management/ Treatment

Type 1:

Blood glucose monitoring Glycolated hemoglobin Insulin regimen

Conventional Intensive

Management/ Treatment

Type 2

Oral Hypoglycemic Agents

Insulin

secretagogues sensitizers

sulfolnylureas Thiazolidinediones Avandia

Insulin

Glucose

inhibitors

Biguanides Glucophage

Management/ Treatment, contd

Insulin Combined Therapies

Combination of OHAs OHAs and Insulin

Management/ Treatment, contd

Diet

Weight loss Hypocaloric diet The exchange diet Carbohydrate counting Glycemic index and load

Glycemic Index and Load

The rate at which foods provide glucose to the blood, relative to a reference carbohydrate. Factors that influence: Type of fiber Presence of fat Form of sugar (fructose vs sucrose,) Starch structure (amylose, amylopectin-glycemic index)

Glycemic Index and Load

Fiber, glycemic index foods (beans, vegetables, whole fruit, and whole grains) are preferred for managing blood glucose. Glycemic Load= CHO(g) X GI White rice, baking potatoes, bagels, and jelly beans have high GI and GL

Goals

Maintain a blood glucose that is as normal as possible Achieve and maintain optimal lipid levels Prevent or delay complications Prolong life and the quality of it

Questions and Comments?