Diabetes mellitusDiabetes mellitus

DefinitionDefinition

Diabetes is a metabolic disorder resulting in Diabetes is a metabolic disorder resulting in abnormally high blood sugar levels (hyperglycemia)abnormally high blood sugar levels (hyperglycemia)

Blood sugar is normally Blood sugar is normally controlled by a hormone controlled by a hormone called insulin that is called insulin that is secreted by the pancreassecreted by the pancreas

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History of DiabetesHistory of Diabetes

First known reference comes from First known reference comes from an Egyptian papyrus dating back to an Egyptian papyrus dating back to 1550 BC1550 BC

Diabetes was named by the Diabetes was named by the Greek physician Aretaeus Greek physician Aretaeus between 30 and 90 ADbetween 30 and 90 AD

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History of the DiseaseHistory of the Disease

Avicenna, a famous Arab physician, Avicenna, a famous Arab physician, described the complications of the described the complications of the disease and how it progresseddisease and how it progressed

French physician Bouchardat French physician Bouchardat recognized the importance of calorie recognized the importance of calorie intake in the 1870sintake in the 1870s

http://www.pre-renaissance.com/images/http://www.pre-renaissance.com/images/avicenna2.jpgavicenna2.jpg

History of the DiseaseHistory of the Disease

Paul Langerhans identified the importance of the Paul Langerhans identified the importance of the pancreas in the early 19pancreas in the early 19thth century and discovered century and discovered the islets of Langerhans, a group of cells that would the islets of Langerhans, a group of cells that would later be known to produce insulinlater be known to produce insulin

History of the DiseaseHistory of the Disease

Frederick Banting discovered the hormone insulin Frederick Banting discovered the hormone insulin and won the Nobel Prize for his efforts in the 1920sand won the Nobel Prize for his efforts in the 1920s

Mental Break 1

• Who is this?

Mental Break 1

• How about this?

Mental Break 1

• And finally, who is this?

StatisticsStatistics

8% of the population has some form of 8% of the population has some form of diabetesdiabetes

The number of cases increased by 13.5% The number of cases increased by 13.5% between 2005 and 2007between 2005 and 2007

Total economic cost of diabetes in the United Total economic cost of diabetes in the United States in 2007 was estimated at $174 billionStates in 2007 was estimated at $174 billion

Healthy MetabolismHealthy Metabolism

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Diabetic MetabolismDiabetic Metabolism

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How might this cause problems?How might this cause problems?

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How it causes problemsHow it causes problems Too much glucose inhibits the reabsorption of water by the kidneyToo much glucose inhibits the reabsorption of water by the kidney

Causes excessive thirst and urinationCauses excessive thirst and urination

It gets absorbed by parts of the body in which excess glucose is not toleratedIt gets absorbed by parts of the body in which excess glucose is not tolerated Eyes, kidneys, nerves, heartEyes, kidneys, nerves, heart

Can you guess what kind of Can you guess what kind of major complications excess major complications excess

glucose in these organs glucose in these organs would cause?would cause?

Why diabetes is badWhy diabetes is bad If left uncontrolled, diabetes can lead to:If left uncontrolled, diabetes can lead to:

Heart attack/Stroke – the risk of each is 2 Heart attack/Stroke – the risk of each is 2 to 4 times higher in people with diabetesto 4 times higher in people with diabetes

High Blood Pressure – 73% of diabetics High Blood Pressure – 73% of diabetics have high blood pressurehave high blood pressure

Blindness – diabetes is the leading cause Blindness – diabetes is the leading cause of blindness in adults 20-74 years of ageof blindness in adults 20-74 years of age

Why diabetes is badWhy diabetes is bad

Why diabetes is badWhy diabetes is bad Kidney failure – diabetes is also the leading Kidney failure – diabetes is also the leading

cause of kidney failurecause of kidney failure

Ketoacidosis - diabetic comas due to Ketoacidosis - diabetic comas due to biochemical imbalances that can even lead biochemical imbalances that can even lead to deathto death

Diabetes can also lead to nervous system Diabetes can also lead to nervous system disease, gum disease, and pregnancy disease, gum disease, and pregnancy complications complications

Why diabetes is badWhy diabetes is bad

Signs and SymptomsSigns and Symptoms

Excessive urine productionExcessive urine production Results in increased thirst and fluid intakeResults in increased thirst and fluid intake

Blurred visionBlurred vision Weight loss (Type 1)Weight loss (Type 1) LethargyLethargy Changes in metabolismChanges in metabolism

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DiagnosisDiagnosis

Doctors use either a Fasting Plasma Glucose Doctors use either a Fasting Plasma Glucose Test (FPG) or an Oral Glucose Tolerance Test Test (FPG) or an Oral Glucose Tolerance Test (OGTT) to confirm that a patient has diabetes(OGTT) to confirm that a patient has diabetes

The FPG is recommended because it is easier, The FPG is recommended because it is easier, faster, and less expensive to performfaster, and less expensive to perform

Mental Break 2

• A Public Service Announcement from Michael Phelps…

• Breakfast: Three fried-egg sandwiches loaded with cheese, lettuce, tomatoes, fried onions and mayonnaise. Two cups of coffee. One five-egg omelet. One bowl of grits. Three slices of French toast topped with powdered sugar. Three chocolate-chip pancakes.

• Lunch: One pound of enriched pasta. Two large ham and cheese sandwiches with mayo on white bread. Energy drinks packing 1,000 calories.

• Dinner: One pound of pasta. An entire pizza. More energy drinks.

Mental Break 2

• So, eating 12,000 calories a day is ok if

you are Michael Phelps

TypesTypesType 1Type 1Type 2Type 2Gestational Gestational

Risk factors and treatment for diabetes differ Risk factors and treatment for diabetes differ slightly between the typesslightly between the types

However, genetics impact both type 1 and type 2: However, genetics impact both type 1 and type 2: having relatives with diabetes increases ones having relatives with diabetes increases ones chances of getting the disease.chances of getting the disease.

Type 1Type 1

5-10% of diagnosed diabetes cases in humans5-10% of diagnosed diabetes cases in humans

Immune system destroys beta cells in the Immune system destroys beta cells in the pancreas, the only cells in the body capable of pancreas, the only cells in the body capable of making insulin. making insulin.

Previously known as juvenile diabetes because it Previously known as juvenile diabetes because it most often diagnosed in children and young adultsmost often diagnosed in children and young adults

Unlike Type 2, diet and exercise cannot prevent the Unlike Type 2, diet and exercise cannot prevent the disease. disease.

Treatment of Type 1Treatment of Type 1

Insulin replacement therapy – insulin is Insulin replacement therapy – insulin is supplemented to the body either by injection or supplemented to the body either by injection or an insulin pumpan insulin pump

Strict dietary management is required - Strict dietary management is required - carbohydrate tracking and monitoring glucose carbohydrate tracking and monitoring glucose levelslevels

Both of these have to be kept up for the life of Both of these have to be kept up for the life of the patientthe patient

Treatment of Type 1Treatment of Type 1

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Type 2Type 2

90-95% of diagnosed diabetes cases in 90-95% of diagnosed diabetes cases in humanshumans

Pancreas produces insulin, but the body’s Pancreas produces insulin, but the body’s response to insulin is diminishedresponse to insulin is diminished

Unlike type 1, it is usually a late-onset Unlike type 1, it is usually a late-onset disease, meaning that it develops later in lifedisease, meaning that it develops later in life

Type 2Type 2

Prevalence is rapidly increasing and it is also Prevalence is rapidly increasing and it is also being found more often in younger peoplebeing found more often in younger people

Both of these observations are being linked to Both of these observations are being linked to the obesity epidemic that has taken over the the obesity epidemic that has taken over the globe.globe.

Obesity has been found to cause increased Obesity has been found to cause increased insulin resistance which can result in diabetesinsulin resistance which can result in diabetes

Type 2Type 2

Over 85% of diabetics have a Body Mass Over 85% of diabetics have a Body Mass Index of over 25, which is classified as Index of over 25, which is classified as overweightoverweight

Over 55% have a BMI of over 30, which is Over 55% have a BMI of over 30, which is obeseobese

Treatment and Prevention of Treatment and Prevention of Type 2Type 2

A proper diet and good exercise habits can A proper diet and good exercise habits can support weight loss and effectively limit the support weight loss and effectively limit the effects of the disease.effects of the disease.

Management of glucose levels Management of glucose levels

is still required and often is still required and often

insulin replacement therapyinsulin replacement therapy

is also needed.is also needed.

GestationalGestational

Characterized by high glucose levels in Characterized by high glucose levels in pregnant women who never showed signs of pregnant women who never showed signs of diabetes before their pregnancydiabetes before their pregnancy

Affects about 3-10% of pregnanciesAffects about 3-10% of pregnancies

It is believed that hormones released during It is believed that hormones released during pregnancy increase insulin resistancepregnancy increase insulin resistance

Gestational Cont…Gestational Cont…

Babies are at increased risk of complicationsBabies are at increased risk of complications

Mothers are at increased risk of developing Mothers are at increased risk of developing type 2 diabetes after pregnancytype 2 diabetes after pregnancy

It is a treatable condition by controlling diet, It is a treatable condition by controlling diet, monitoring glucose, and giving insulin when monitoring glucose, and giving insulin when necessarynecessary

Mental Break 3

• Who can name the hormone that regulates glucose?

• Which diabetes is treatable with diet and exercise?

• What is the largest planet in the solar system?

Presentation in AnimalsPresentation in Animals

Diabetes is a growing problem in both dogs Diabetes is a growing problem in both dogs and catsand cats

Dogs are most often Dogs are most often

found to have type 1found to have type 1

diabetes, while cats diabetes, while cats

have a combinationhave a combination

SymptomsSymptoms

Symptoms are similar to those in humansSymptoms are similar to those in humans Sudden weight loss or gainSudden weight loss or gain Excessive drinking or urinationExcessive drinking or urination Appetite is either excessive or absentAppetite is either excessive or absent Dogs are highly sensitive to eye problems such as Dogs are highly sensitive to eye problems such as

blurred vision and cataractsblurred vision and cataracts In cats, the back legs become weak and their gait In cats, the back legs become weak and their gait

may become wobbly or stiltedmay become wobbly or stilted Thinning of the skin can also occurThinning of the skin can also occur Dehydration can finally lead to deathDehydration can finally lead to death

TreatmentTreatment

If left untreated, diabetes is life-threatening If left untreated, diabetes is life-threatening in pets.in pets.

However, diagnosis and treatment by a However, diagnosis and treatment by a veterinarian can control the disease, veterinarian can control the disease, prolonging life, and can even lead to prolonging life, and can even lead to remission in cats.remission in cats.

DietDiet

A simple change of diet can go a long ways A simple change of diet can go a long ways in helping to reduce the effects of diabetes.in helping to reduce the effects of diabetes.

A low-carbohydrate diet reduces the amount A low-carbohydrate diet reduces the amount of insulin needed and stabilizes blood sugar of insulin needed and stabilizes blood sugar levels in cats. levels in cats.

A high-fiber, moderate-carb diet has been A high-fiber, moderate-carb diet has been recommended for dogs.recommended for dogs.

MedicationsMedications

The most common form of treatment in pets The most common form of treatment in pets is insulin injections similar to those used in is insulin injections similar to those used in humans. humans.

Oral medications in the form of pills are Oral medications in the form of pills are available, but are not often recommended available, but are not often recommended because they are much less effective.because they are much less effective.

Ongoing ResearchOngoing Research Type 1 TreatmentType 1 Treatment

Islet Cell Encapsulation – transplant of insulin-producing Islet Islet Cell Encapsulation – transplant of insulin-producing Islet cells encapsulated in permeable membrane to get around cells encapsulated in permeable membrane to get around the immune systemthe immune system

Islet Cell Regeneration – Involves a protein that is Islet Cell Regeneration – Involves a protein that is responsible for the regeneration of Islet cells and other responsible for the regeneration of Islet cells and other important hormones in the pancreas – in clinical trialsimportant hormones in the pancreas – in clinical trials

Islet cell development from stem cellsIslet cell development from stem cells

Ongoing ResearchOngoing Research Type 1 Treatment Type 1 Treatment

Gene Therapy – an oral medication consisting of viral Gene Therapy – an oral medication consisting of viral vectors containing the insulin gene is digested and vectors containing the insulin gene is digested and delivered to the upper intestines where it is reproduceddelivered to the upper intestines where it is reproduced

Type 1 PreventionType 1 Prevention

Immunization – a biochemical mechanism is being Immunization – a biochemical mechanism is being researched that prevents the immune system from researched that prevents the immune system from attacking beta cellsattacking beta cells

Ongoing ResearchOngoing ResearchIslet CellIslet Cell

NanotechnologyNanotechnology

Any Questions?Any Questions?

ReferencesReferences

http://www.diabetes.org/home.jsphttp://www.diabetes.org/home.jsp

http://en.wikipedia.org/wiki/Diabeteshttp://en.wikipedia.org/wiki/Diabetes

http://www.idb.hr/diabetologia/05no4-1.pdfhttp://www.idb.hr/diabetologia/05no4-1.pdf

http://chinese-school.netfirms.com/diabetes-history.htmlhttp://chinese-school.netfirms.com/diabetes-history.html

http://blogs.wsj.com/health/2008/08/13/the-michael-phelps-http://blogs.wsj.com/health/2008/08/13/the-michael-phelps-diet-dont-try-it-at-home/diet-dont-try-it-at-home/