Diabetes: The Basics

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Diabetes The Basics

• Cornell Wellness Program

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Diabetes- What Is It?

• Body is not producing or has lost sensitivity to
  insulin.
• Insulin is a hormone that allows sugars (glucose)
  to enter into each cell in your body.
• Insulin is produced in the body by the pancreas.

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Quick Review-Anatomy Of The Pancreas

• A gland that lies behind the stomach
• Produces three
• hormones.
• Its on the left side!

Image National Science Foundation
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Insulin And The Other Hormones

• Insulin- Hormone that lowers blood glucose.
• Glucagon - Hormone that increases the amount of
  glucose in the blood when it is needed.
• Somatostatin - Hormone that can suppress both
  glucagon and insulin when needed.

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How Does Insulin Work?

• A person normally secretes insulin in response to
  an elevated blood sugar level.
• Insulin helps sugar move out of the blood and
  into the cells.
• Cells will not allow blood sugar in without
  insulin. - this can cause a problem.

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Types Of Diabetes

• Type I - body does not produce any insulin.
• Type II- body is not making enough or is losing
  sensitivity to insulin made.
• Secondary - a consequence from another disease.
  For example, pancreatitis or cystic fibrosis.
• Gestational Diabetes- diabetes during pregnancy.
• Impaired Glucose Tolerance- an intermediate
  between normal and diabetes.

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Why Isnt The Body Making Insulin?

• In people with Type I, the immune system has made
  a big mistake.
• It attacks the beta cells and destroys them.
• In people with Type II, the pancreas is still
  making insulin, just not enough to keep up, or
  their bodies have become insulin resistant.

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Type I

• Usually diagnosed in children and young adults.
• Must take daily insulin shots to stay alive.
• Type I accounts for 5-10 of the population with
  diabetes.

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Type II

• The most common form of the disease.
• Approximately 50 of men and 70 of women are
  obese when diagnosed.
• Nearing epidemic proportions
• increased number of older Americans
• greater occurrence of obesity
• sedentary lifestyles

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What Are The Symptoms?

• Polyphasia - excessive eating
• Polyurea - excessive urination
• Polydypsia - excessive fluid intake
• Blurred vision
• Poor wound healing
• Irritability

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How Are You Diagnosed With Diabetes?

• In June 1997, the ADA redefined its criteria for
  diagnosing diabetes.
• lt110 mg/dl is normal fasting blood glucose.
• 110 126 mg/dl is impaired fasting glucose.
• gt126 mg/dl (fasting blood glucose) is used to
  diagnose diabetes.

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In Order To Be Diagnosed With Diabetes

• Person must have symptoms of diabetes
• Plasma glucose gt200
• Fasting blood glucose of gt126 mg/dl
• FBS, FBG, FPG, FG, FS
• 2-hour plasma glucose gt200 mg/dl on oral glucose
  tolerance test
• OGTT, GTT

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Screening

• All patients at age 45 and older
• If the results are normal, repeat every 3 years
• Screen at a younger age if patient meets
  following risk factors
• Obesity
• Inactive lifestyle
• First degree relative with diabetes
• High-risk ethnic group (African Americans, Native
  Americans, Asian Americans, Hispanics/Latinos and
  Pacific Islander heritage)
• Was diagnosed with gestational diabetes or
  delivered a baby whose birth weight gt9 lbs.
• Hypertension
• HDL level lt40(men) lt50(women) or triglycerides
  gt250
• Found to have impaired glucose tolerance or
  impaired fasting on a previous test.

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Ive Got Diabetes, Now What?

• After diagnosis, there is a great need for
  education.
• A diabetic diet is no different from the basic
  healthy eating plan.
• An activity goal is no different than a basic
  healthy activity plan.
• So why bother?

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Diabetes Complications

• Kidney
• Heart
• Nerve damage
• Feet/skin
• Eye/Vision
• Teeth/Gums

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Treatment Goals For Type II

• Achieve normal or near-normal blood glucose
  levels.
• Prevent, delay or treat complications.
• Improve health through optimal monitoring,
  nutrition and activity.

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Blood Glucose Monitoring

• All diabetics must keep track of blood glucose
  levels.
• This is the only way to know if the treatment is
  effective.
• Gives the diabetic a good indication of what
  affects their blood sugar level.
• Must check at least 2 times a day and four times
  a day for at least 3 days a week.

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Oral Medications 4 Types

• Sulfonylurea-stimulates the body to make more
  insulin.
• Metformin-lowers blood sugar by helping the
  insulin work better
• Thiazolidinediones- increases muscle sensitivity
  to insulin.
• Alpha-glucosidase inhibitors- slow the process of
  carbohydrate digestion.

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Insulin

• Type I and sometimes Type II patients need to be
  treated with insulin.
• There are more than 20 types.
• They differ in how they are made, how they work
  in the body and their cost.

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Hypoglycemia

• Hypoglycemia- low blood sugar
• Happens to everyone with diabetes
• Symptoms include shakiness, dizziness, sweating,
  hunger, headache, pale skin, sudden moodiness,
  clumsy or jerky movements, difficulty paying
  attention, and tingling sensations around mouth.

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How To Treat Hypoglycemia

• Quickest way to raise blood glucose is with some
  form of sugar.
• 3 glucose tablets, 1/2 cup of fruit juice, 5-6
  pieces of candy.
• Wait 15-20 minutes and test blood sugar again.
• If hypoglycemia goes untreated, patient could get
  worse and pass out.

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Hyperglycemia

• High blood sugar
• Not enough insulin
• Too much food
• Too little exercise

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Hemoglobin A1c

• A good indicator of blood glucose control.
• Gives a that indicates control over the
  preceding 2-3 months.
• Performed 2 times a year.
• A hemoglobin of 6 indicates good control and
  level gt8 indicates action is needed.

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Treatment Goals

• The main goal is to normalize blood sugar.
  Realistic goals for diabetics are 70-140 mg/dl
  before meals, lt180 mg/dl after and a glycosolated
  hemoglobin (HgA1C) within 1 of normal.
• Need good blood glucose control to avoid
  complications.

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Physical Activity And Diabetes

• Especially beneficial in type II diabetes.
• Possible improvement in blood glucose control.
• Improved insulin sensitivity/lower medication
  requirement.
• Reduction in body fat.
• Cardiovascular benefits.
• Stress reduction.
• Prevention of Type II diabetes (IGT).

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Things To Consider

• Medication timing.
• Food intake timing.
• Recent illness or infection.
• Postpone exercise if glucose reading is below 100
  mg/dl or above 250 mg/dl
• Consume 15g of carbs. per 60 min. of exercise.
• Keep a snack handy.
• Practice proper foot care.
• Carry medical identification.

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How To Avoid Complications

• Control weight
• Eat a healthy well-balanced diet.
• Get regular exercise
• Have regular checkups
• Check feet everyday for cuts and blisters
• Do not smoke!
• Keep blood sugars normal
• Avoid the 2 common diabetic problems,
• hypoglycemia and hyperglycemia

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Conclusion

• For more informationwww.diabetes.org

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Questions?

• Contact the Wellness Program
• 255-3886
• wellness_at_cornell.edu
• 303 Helen Newman Hall

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Sources

• American Diabetes Association
• Diabetes.org