Diabetes

And YOU.

Diabetes Diabetes is Greek for

“siphoning” or “go through”, coined around 250 B.C., because of the excessive urination.

People knew about the ailment – urination, crazed thirst, wasting flesh, as far back as 1500 BC.

– Hindus noted that black ants were attracted to the sufferer’s urine because of the sugar in it.

1869-German anatomist Paul Langerhans discovered unique structures in the pancreas – The Isles of Langerhans.

1920’s-Canadians Banting, Macleod, Best & Collip extracted & purified insulin from the pancreas.

1922-14 yr. old boy was injected with insulin. It extended his life 13 yrs.

DIABETES

What is diabetes?

Diabetes is a disease in which levels of blood glucose, also called blood sugar, are above normal.

– After a meal, the body breaks food down into glucose, which the blood carries to cells throughout the body.

– Cells use insulin to carry glucose into a cell and help metabolize the glucose into energy.

InsulinA hormone produced in the Isles of Langerhans of the Pancreas.

– Insulin works in conjunction with body cells to convert sugar, protein & other forms of food into energy.

– Insulin is required to carry glucose from blood

across cell membrane to be used as energy fuel.

for liver conversion of glycogen to glucose

for the formation of Fatty Acids from Adipose (Fat)

DIABETES

Types of Diabetes

Type 1 diabetes (formerly

called juvenile diabetes) is usually first diagnosed in children, teenagers, and young adults.

In this form of diabetes, the pancreas no longer makes insulin because the body’s immune system has attacked and destroyed the pancreatic beta cells that are specialized to make insulin.

Type 2 diabetes (formerly

called adult-onset diabetes) is the most common form. Type 2 diabetes can be developed at any age, even during childhood. Type 2 diabetes usually begins with insulin resistance, a condition in which muscle, liver, & fat cells do not use insulin properly.

– Thus, more insulin is needed to help glucose enter cells. The pancreas tries to produce more insulin, but over time, loses its ability to secrete enough in response to meals..

DIABETES

Types of Diabetes Gestational diabetes is

diabetes that first occurs during pregnancy.

– When women are pregnant, their need for insulin appears to increase, and many can develop gestational diabetes during the late stages of pregnancy.

– This form of diabetes usually goes away after the baby is born, a woman who has had it is more likely to develop type 2 diabetes later in life.

LADA In latent autoimmune diabetes in adults (also called type 1.5 diabetes or double diabetes)

people show signs of both type 1 & type 2 diabetes.

– Diagnosis: usually after age 30.– Most LADA diabetics still make

their own insulin when first diagnosed

– .The beta cells have been destroyed by the immune system, as in type 1.

DIABETES

Other Types of Diabetes

Genetic Defects of the Beta Cell – Such as maturity-onset

diabetes of the young (MODY) and neonatal diabetes mellitus

Genetic Defects in Insulin Action

– Resulting in the body’s inability to control blood glucose levels, SEE: Leprechaunism & Rabson-Mendenhall Syndrome

Diseases of the Pancreas – Conditions that damage

the pancreas– SEE: Pancreatitis & Cystic

Fibrosis Excess Hormone Amounts

– From medical conditions that work against the action of insulin

SEE: Cortisol in Cushing’s syndrome

DIABETES

Other Types of Diabetes Medications & Chemicals

– that reduce insulin action, i.e., gluco-corticoids, or chemicals that destroy beta cells

Infections– i.e., congenital rubella &cytomegalovirus

Rare Autoimmune Disorders– i.e., stiff-man syndrome, an autoimmune

disease of the central nervous system Genetic Syndromes (diabetes-associated)

– such as Down syndrome &Prader-Willi syndrome

What is prediabetes?

How is it different from diabetes?

CHECK YOUR TEST RESULTS!

DIABETES

What is prediabetes?– Prediabetes is the state that

occurs when a person's blood glucose levels are higher than normal but not high enough for a diagnosis of diabetes.

Prediabetes is sometimes referred to as Impaired Glucose Tolerance or Impaired Fasting Glucose (IGT/IFG.

Some studies show that many people with prediabetes develop type 2 diabetes in 10 years.

How is it different from diabetes?

CHECK YOUR Glucose TEST RESULTS!

DIABETES

There are three different tests that can determine whether you have Prediabetes/Diabetes: – The A1C test– The fasting plasma glucose

test (FPG) – The oral glucose tolerance

test (OGTT).

The blood glucose levels measured after these tests determine whether you have a normal metabolism, or whether you have prediabetes or diabetes.

DIABETES

The three tests – The A1C test

– The fasting plasma glucose test (FPG)(Preferred test: convenient & low cost.)

– The oral glucose tolerance test (OGTT).

Glycated hemoglobin (A1C) test. This blood test indicates your average blood sugar level for the past two to three months.

– The higher your blood sugar levels, the more hemoglobin you'll have with sugar attached. An A1C level between 5.7 and 6.4 percent is prediabetes.

If your blood glucose level is abnormal following the FPG, you have impaired fasting glucose (IFG).

If your blood glucose level is abnormal following the OGTT, you have impaired glucose tolerance (IGT). 

Both are also known as prediabetes.

DIABETES

Table 1. FPG test

Plasma Glucose Result (mg/dL) Diagnosis

99 or below

Normal

100 to 125Pre-diabetes(impaired fasting glucose)

126 or above Diabetes*

DIABETES

Table 2. OGTT

2-Hour Plasma Glucose Result (mg/dL) Diagnosis

139 and below

Normal

140 to 199Pre-diabetes(impaired glucose tolerance)

200 and above Diabetes*

DIABETES

Table 3. Gestational diabetes: Above-normal results for the

OGTT*

When Plasma Glucose Result (mg/dL)

Fasting95 or higher

At 1 hour 180 or higher

At 2 hours 155 or higher

At 3 hours 140 or higher

DIABETES

Who should be tested for diabetes and pre-diabetes?

– Adults without symptoms who are overweight or obese and have one or more additional risk factors for diabetes.

In those without these risk factors, testing should begin at age 45. The Body Mass Index Table can be used to find out whether someone is normal weight, overweight, obese, or extremely obese

People aged 45 or older should consider getting tested for pre-diabetes or diabetes.

People younger than 45 should consider testing if they are overweight, obese, or extremely obese and have one or more of the following risk factors:

DIABETES

Pre-diabetes/Diabetes

RISK FACTORS being physically inactive having a parent, brother, or

sister with diabetes having a family background that

is African American, Alaska Native, American Indian, Asian American, Hispanic/Latino, or Pacific Islander

giving birth to a baby weighing more than 9 pounds or being diagnosed with gestational diabetes

having high blood pressure—140/90 mmHg or above—or being treated for high blood pressure

having an HDL, or “good,” cholesterol level below 35 mg/dL or a triglyceride level above 250 mg/dL

having polycystic ovary syndrome, also called PCOS

having IFG or IGT on previous testing having a condition called acanthosis

nigricans, characterized by a dark, velvety rash around the neck or armpits

having a history of cardiovascular disease—disease affecting the heart and blood vessels

DIABETES

Glucose attaches permanently to proteins in retina, kidneys & small blood vessels, causing proteins to function abnormally.

80% of Diabetics die of a CVD! Kidney Disease is a common

accompany condition to Diabetes. Diabetes Degrades

– Vision/Eye– Circulation loss & Nerve

Damage = Amputation of Extremities

– Immune system Impotence in Type II Males

DIABETES

Type I Insulin-dependent

– Autoimmune Disease– Juvenile Onset (Onset

before 35 yrs.)– Body can not or does not

produce (enough) insulin (immune system destroys pancreas cells )

Type I Dietetic must:– Inject insulin – Or use a pump, transdermal

patch, nasal inhaler ( must accompany regular insulin injections)

– NEW: Continuous glucose monitor inserted into the skin, automatically measures glucose every few minutes.

DIABETES

Type II Diabetes Mellitus A Metabolic Disorder

– Non-insulin dependent– Adult Onset

Hyperglycemia Body can not use all

of glucose, e.g. excess glucose in blood stream

Not Enough Insulin Produced &/Or Available:

– Body Can Not Utilize available, adequate supply of insulin @ cellular level

Tissues become increasingly less sensitive to presence of insulin & blood levels of glucose build

OR, insulin defective, not useable

DIABETES

Gestational Diabetes– Pregnancy Onset

Temporary Usually disappears

with the birth of the fetus

Insulin Syndrome: A Metabolic or X syndrome that refers to people whose bodies do not manage insulin well.

– People with high blood pressure, high blood sugar, & abnormal blood fats & cholesterol —together with obesity

– IS is seen in children 7-10 yrs. old.

DIABETES RISK FACTORS 1

>10 Genes (believed to be

on 4 separate chromosomes) are responsible for producing Type II Diabetes

DIABETES RISK FACTORS 2

Hispanic, African-American, Native American, Asian/Pacific Is.

Mexican Americans & ethnic others have a genetic mutation

NIDDM-1 gene mutation plays a large role in some ethnic groups, & is absent in others.

– NIDDM-1 serves as the blueprint for a protein called calpain10 (a protease).

– People with mutated NIDDM-1 produce less calpain10.

Obesity/Over Wgt A hormone – Resistin – released by fat

cells interferes with the activity of insulin, producing Type II Diabetes.”

NOTE: The mutated NIDDM-1 gene is believed to have evolved as a “thrifty” gene to protect people during times of famine. It is associated with a frugal energy balance, e.g. decreased metabolic rate while sleeping, and a tendency to “hoard” rather than “burn” glucose.

DIABETES “Condition”

Diabetes (like HIV) Requires:– Schedule Meds (insulin such as Humalog and

Humalin)– Schedule food intake– Schedule exercise– Schedule sleep/rest– Control stress aggressively– No Cure

DIABETES

Pre-Diabetes is found to be REVERSABLE!

Cut Dietary Fat & Calories

MAGIC BULLET Exercise for 30 min/5 da./wk.

Rosiglitazone (Avandia) is a Type II Diabetes Prevention Drug given when the patient is unable to diet & exercise successfully to control glucose levels.

Byetta (Exenatide) mimics a hormone that slows emptying of stomach for Type IIs.

Actos lowers glucose, reducing risk of HA, stroke for Type IIs.

DIABETES

Controls ***Aerobic

Exercise has the greatest protective effect!

Aerobic Ex. + Anaerobic Wgt. Pgm. control diabetes (glucose uptake), decrease body fat, & build skeletal muscle.

DIABETES

Hypoglycemia – (Low Blood sugar = <80 mg/dL) – Caused by Too little food, too much insulin

or diabetes medicine, or extra exercise, interaction with other medications

– Onset may be sudden & progress quickly to insulin shock.

– WHAT TO DO!– Drink OJ, Milk, or East Hard Candy– Test Blood sugar, if low …– Call Your Doctor

– Within 30 min. symptom abatement, eat a snack of peanut butter or a meat sandwich & a glass of milk.

Symptoms– Sweating– Anxious– Shaking– Rapid HR– Dizziness– Hunger– Impaired Vision– Weakness,

fatigue– Headache– Irritable

DIABETES

Type I: Experimental Therapies (none of these cure diabetes, they are experimental and the long term effects are unknown)

– Transplants of Islet Cells in Pancreas.

– Re-engineer of other body cells to produce insulin

– Stem cell conversion to Isle Cells.

Infusion of monoclonal antibodies into Type I infants to block the destruction of the Islet Cells.

DiaPep277 injected into babies to halt Islet Cell destruction.

Administration of Vit. D (2000 IUs) has produced 80% less risk.

DIABETES

California Department of Health Services– Diabetes Control Program

601 North 7th Street-MS 675, P.O. Box 942732, Sacramento, CA 94234

www.dhs.ca.gov/diabetesPhone: 916-445-2547