Diabetes 101 An emerging epidemic in our community

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Diabetes 101 An emerging epidemic in our
community

• Pamela Fonju, FNP, MSN
• Dept. of Emergency Medicine Ambulatory Surgery
• Jacobi Medical Center
• Bronx, New York

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Diabetes As defined by ADA

• According to the American Diabetic Assocition,
  diabetes can be defined as
• A disease in which the body does not produce or
  properly use insulin. Insulin is a hormone that
  is needed to convert sugar, starches and other
  food into energy needed for daily life. The cause
  of diabetes continues to be a mystery, although
  both genetics and environmental factors such as
  obesity and lack of exercise appear to play
  roles.Approximately 17 million people in the
  United States, or 6.2 of the population, have
  diabetes. While an estimated 11.1 million have
  been diagnosed, unfortunately, 5.9 million people
  (or one-third) are unaware that they have the
  disease.

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Diabetes As defined by WHO

• According to the World Health Organization
• The term diabetes mellitus describes a metabolic
  disorder of multiple aetiology characterized by
  chronic hyperglycaemia with disturbances of
  carbohydrate, fat and protein metabolism
  resulting from defects in insulin secretion,
  insulin action, or both.

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Types of Diabetes

• Type 1 diabetes (previously known as
  insulin-dependent diabetes) Type 1 diabetes is
  an auto-immune disease where the body's immune
  system destroys the insulin-producing beta cells
  in the pancreas. This type of diabetes, accounts
  for 10-15 of all people with the disease. It can
  appear at any age, mainly in people under under
  40, and is triggered by environmental factors
  such as viruses, diets, and people with genetic
  pre-disposition.
• People with type 1 diabetes must inject
  themselves with insulin several times a day and
  follow a careful diet and exercise plan.

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Types of Diabetes continues

• Type 2 diabetes (previously known as non-insulin
  dependent diabetes)Type 2 diabetes is the most
  common form of diabetes, affecting 85-90 of all
  people with the disease. This type of diabetes,
  also known as late-onset diabetes, is
  characterised by insulin resistance and relative
  insulin deficiency. The disease is strongly
  genetic in origin but lifestyle factors such as
  excess weight, inactivity, high blood pressure
  and poor diet are major risk factors for its
  development. Symptoms may not show for many years
  and, by the time they appear, significant
  problems may have developed. People with type 2
  diabetes are twice as likely to suffer
  cardiovascular disease.

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Types of Diabetes contines...

• Gestational diabetes mellitus (GDM)GDM, or
  carbohydrate intolerance, is first diagnosed
  during pregnancy through an oral glucose
  tolerance test. Between 5.5 and 8.8 of pregnant
  women develop this form of diabetes.
• Risk factors for GDM include a family history of
  diabetes, increasing maternal age, obesity and
  ethnic group with a high risk factor. While the
  carbohydrate intolerance usually returns to
  normal after the birth, the mother has a
  significant risk of developing permanent
  diabetes.

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Who is at risk for diabetes???

• Diabetes can occur in anyone, however, the
  following people have an increased tendency to
  develop Type 2, or adult-onset diabetes
• People who have close relatives with the disease
• People who are over 40 and overweight
• Women who developed diabetes while pregnant
  (gestational diabetes)
• In general, the risk of developing diabetes
  increases with aging.

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Signs and symptoms of diabetes

• Regardless of the type, people with diabetes
  presents with similar signs and symptoms.
• Most common is the three Ps
• Polyuria (frequent urination)
• Polydipsia (frequent thirst)
• Polyphagia (frequent hunger)
• Weight loss may also be seen in some individuals
• Increased and/or unexplained sense of fatigue
• Wounds which does not heal easily (this account
  for the majority of amputations in the United
  States.

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Diagnosis of diabetes

• The diagnosis of diabetes mellitus is easily
  established when a patient presents with classic
  symptoms of hyperglycemia (thirst, polyuria,
  weight loss, visual blurring), and
• has a fasting blood glucose concentration of 126
  mg/dL (7.0 mmol/L) or higher,
• or a random value of 200 mg/dL (11.1 mmol/L) or
  higher, and confirmed on another occasion.

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Treatment

• The goal of treatment is to
• Reduce morbidity and mortality from complications
  of diabetes and
• Preservation of quality of life
• Some treatment option includes
• Diet a consistent, well-balanced diet that is
  high in fiber, low in saturated fat, and low in
  concentrated sweets.
• Exercise as little as 20 minutes of walking 3
  times a week has a proven beneficial effect.
  However some exercise is better than no exercise.

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Treatment continues..

• In addition to life style changes, medications
  may be necessary for those who are not able to
  control their blood glucose with diet and
  excecise. Class of medications include
• Biguanide (such as metformin), works primarily by
  reducing liver release of blood glucose from
  glycogen stores and increases the uptake of
  glucose by the bodys tissue.
• Thiazolidinediones (such as rosiglitazone),
  increases bodys sensitivity to insulin.
• Sulfonylureas (glyburide, Micronase, glucotrol)
  stimulates the pancreas to produce more insulin.
• Biguanides decrease the amount of glucose
  produced by the liver.
• Alpha-glucosidase inhibitors slows absorption of
  starches.
• Meglitinides stimulates the pancreas to produce
  more insulin.

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Treatment options continues..

• Insulins Human insulin is the only type of
  insulin available in the United States it is
  less likely to cause allergic reactions than
  animal-derived varieties of insulin.
• The type of insulin chosen to customize treatment
  for an individual is based on the goal of
  providing optimal blood sugar control.
• Different types of insulin are available and
  categorized according to their times of action
  onset and duration.

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Types of insulins

• Rapid-acting insulins includes
• Regular insulin (Humulin R, Novolin R)Insulin
  lispro (Humalog)Insulin aspart (Novolog)Insulin
  glulisine (Apidra)Prompt insulin zinc
  (Semilente, slightly slower acting)Inhaled
  insulin (Exubera

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Types of insulins continues..

• Intermediate-acting insulins
• Isophane insulin, neutral protamine Hagedorn
  (NPH) (Humulin N, Novolin N)Insulin zinc (Lente)
  
• Long-acting insulins
• Extended insulin zinc insulin (Ultralente)Insulin
  glargine (Lantus)Insulin detemir (Levemir)

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CONCLUSION

• Prevention, prevention, prevention!!!!!!!!
• Keep your blood glucose within normal limits
• Follow up with your Doctor or health care
  pratitioner.
• For people with hypertension and heart disease,
  take your medications as prescribed and follow up
  with your cardiologist on a regular basis.
• If you are on insulin, keep your doctors
  appointment every 3months or whenever your blood
  glucose in not undercontrol.
• Drink adequate amount of fluids and avoid too
  much salt.
• Exercise, exercise, and exercise.