DIABETES

1
DIABETES
2
Gross Anatomy

• Endocrine
• Gland
• Hormone
• Blood
• Target tissues

3
Anatomy of Pancreas
4
Microscopic Pancreas
5
Islet of Langerhans
6
Protein Hormone
7
Control of Hormone Secretion
8
What is Diabetes?

• Diabetes is a disease in which the body doesn't
  produce or properly use insulin, a hormone that
  allows sugar, starches and other food to be
  converted into energy.
• Type 2 diabetes is closely linked to obesity and
  places people who have the disease at greater
  risk of cardiovascular disease.
• Type 1 diabetes is an autoimmune disorder where
  B-cells are destroyed by antibodies.

9
Symptoms

• Symptoms such as thirst and frequent urination,
  complications like heart trouble or signs of
  excess glucose or sugar in blood and urine tests.
  From there the doctor can decide, based on these
  tests and a physical exam, whether someone has
  diabetes. If a blood test is borderline abnormal,
  the doctor may want to monitor the person's blood
  glucose regularly. If a person is overweight, he
  or she probably will be advised to lose weight.
• In type 2 diabetes, the disease can be present
  while the person feels completely asymptomatic.

10
How Common is Diabetes?

• About 18.2 million people in the United States --
  6.3 of the population -- have diabetes.
• Incidence is increasing due to obesity. Its
  type 2 that is a major health issue in America.
• 1.3 million new cases diagnosed annually. The
  disease kills more than 200,000 Americans every
  year, making it the sixth leading cause of death
  in the United States.
• Since 1990, obesity has increased by more than 60
  percent in the United States.

11
Who Gets It

• Family medical history is a strong indicator for
  many chronic diseases, including diabetes,
  stroke, obesity, cancer and heart disease.
• Lack of exercise, excess weight often lead to
  Type 2 diabetes.

12
Trend for Acquiring Diabetes in US
13
Trend by State
14
Diabetic Retinopathy

• Damage to blood

vessels in the retina.
15
Foot Amputations

• 1995 doctors perform some 54,000 amputations on
  diabetics each year because of diabetic ulcers.

16
Diabetic Kidney Disease

• Symptoms occur after extensive damage.
• swelling -- usually around the eyes in the
  mornings later, general body swelling may result
  
• foamy appearance or excessive frothing of the
  urine
• unintentional weight gain (from fluid
  accumulation)
• swelling of the legs
• poor appetite
• nausea and vomiting
• general ill feeling
• fatigue
• headache
• frequent hiccups
• generalized itching

17
Type 2 Diabetes

• Type 2 diabetes, formally known as adult onset
  diabetes, often develops when people are
  overweight and inactive.
• In the past, the cause of high blood sugar levels
  in children was type 1 diabetes, which was then
  known as juvenile diabetes. But today, more and
  more children and teenagers are being diagnosed
  with type 2 diabetes.

18
Insulin and Type 2 Diabetes

• There are at least two problems with insulin in
  type 2 diabetes.
• Insulin resistance, when your cells do not
  respond properly to the insulin signal and blood
  sugar is not stored or used
• Poor insulin secretion, where the cells of the
  pancreas cannot make enough insulin to overcome
  the insulin resistance. In type 1 diabetes, there
  is an autoimmune process that destroys the cells
  that make insulin, so it's purely a problem with
  insulin production and secretion.

19
Diabetes Type 2 in Children

• At least part of the rise is due to the presence
  of insulin resistance in some kids today,
  probably from obesity and being less active. Some
  youth don't have the ability to make more insulin
  to compensate for this resistance, and therefore
  they develop diabetes. According to a nationwide
  survey, 15 percent of kids are obese. And there's
  an even larger population that's at risk of
  becoming obese or overweight. Where exercise is
  not always a part of daily life puts a child at
  risk.

20
Which Children Should Be Screened?

• The American Diabetes Association recommends
  screening for kids who have a body mass index
  (BMI) greater than the 85th percentile for their
  age and sex and who have at least two other risk
  factors. For these children, testing should be
  done every two years in children starting at age
  10 or earlier if puberty begins sooner. Youth
  with multiple risk factors (obesity,
  hypertension, family history, inactive, high LDL,
  low HDL) and those who have symptoms should be
  screened.

21
How to Manage Type 2 Diabetes

• In kids who come in very critically ill and with
  very high blood sugars, you begin with insulin
  therapy. Once you get the blood sugar under
  control with insulin, you then begin lifestyle
  changes and oral medication and try to wean them
  off the insulin.
• With the kids in whom diabetes is found
  incidentally on a routine physical, or who have a
  few mild symptoms, we start with just exercise
  and nutrition if it's safe. Then we continue with
  lifestyle management and add oral medication as
  needed. And then, as the disease progresses, we
  may need to start insulin therapy.

22
Symptoms in Children

• If they notice that the child is drinking more or
  going to the bathroom more, they should contact
  their pediatrician. Some kids will complain of
  blurry vision or vague abdominal pain and females
  may have yeast infections. In severe cases,
  nausea, vomiting, abdominal pain, and extreme
  fatigue or confusion can develop.
• Many children don't have these symptoms, so the
  parents of children with excessive weight gain or
  something called acanthosis nigricans (a
  darkening or thickening of the skin in the back
  of the neck or under the arms, thought to be due
  to high insulin levels), should contact their
  pediatrician to see if they should be screened
  for diabetes.

23
Pre-diabetes

• Pre-diabetes, the period when people at high risk
  of full-blown diabetes exhibit elevated
  blood-sugar levels. But they're still capable of
  processing that glucose -- the energy that fuels
  the body's cells.
• But if those people don't take the necessary
  steps to bring their blood sugar levels under
  control, they could eventually succumb to such
  devastating diabetes-induced complications as
  heart disease, blindness, kidney failure and
  amputations.
• Some 41 million Americans are estimated to have
  pre-diabetes.

24
Diagnosing Pre-diabetes

• Pre-diabetes is diagnosed for sugar levels
  between 100 and 125 mg/dl after 8-hr fast.
• Those elevated levels are doing harm to the body
  even though the person isn't suffering from
  diabetes. If you look at people whose blood
  sugars are at that level, you can already find
  evidence of the damage caused by diabetes.
• People with pre-diabetes 50 percent greater
  risk of heart attack and stroke. Once they
  actually have diabetes, their risk of heart
  disease increases to two to four times that of
  someone without diabetes.
• Blood sugar between 100 and 110 have a 20 percent
  higher chance of developing diabetes than those
  whose blood sugar is healthier. Those with blood
  sugar between 110 and 125 are at 40 percent
  greater risk. Levels of 126 or above are
  considered diabetes.
• The American Diabetes Association believes the
  rampant spread of diabetes and its precursors are
  caused by factors that can be managed by the
  individual.

25
Preventing DiabetesType 2

• Lose weight by eating less and choosing more
  nutritious food.
• Exercise.
• Its as simple as that!
• Read Diabetes Are You at Risk? Time Dec. 8,
  2003