Diabetes

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Diabetes
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Diabetes Prevalence in U.S., 1994 (CDC)
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Diabetes Prevalence in U.S., 1995 (CDC)
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Diabetes Prevalence in U.S., 1996 (CDC)
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Diabetes Prevalence in U.S., 1997 (CDC)
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Diabetes Prevalence in U.S., 1998 (CDC)
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Diabetes Prevalence in U.S., 1999 (CDC)
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Diabetes Prevalence in U.S., 2000 (CDC)
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Diabetes Prevalence in U.S., 2001 (CDC)
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Diabetes Prevalence in U.S., 2002 (CDC)
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Diabetes Prevalence in U.S., 2003 (CDC)
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Diabetes Prevalence in U.S., 2004 (CDC)
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Diabetes Prevalence in U.S., 2004, county-wide
(CDC)
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Diabetes Prevalence in U.S., 2005 (CDC)
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Diabetes Prevalence in U.S., 2006 (CDC)
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Diabetes Prevalence in U.S., 2007 (CDC)
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Diabetes Prevalence in U.S., 2008 (CDC)
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Diabetes Prevalence in U.S., 2009 (CDC)
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Diabetes Prevalence in U.S., 2010 (CDC)
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Prevalence (continued)

• Another view Millions living with diabetes
  1980-2011 (CDC)
• Percentage of those living with diabetes, by age,
  1980-2011 (CDC)
• Ethnicity and sex - diabetes prevalence increased
  1980-2011 (CDC)
• State estimates of diagnosed diabetes percentage
  of adults (CDC)

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World Prevalence

• Which country has the most diabetes?
• Top 10 - International Diabetes Federation
• International Diabetes Federation

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Diabetes

• An excess of glucose (sugar) in the blood
• Inadequate insulin production
• Inefficient insulin use

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Diagnosis Criteria Changes

• Criteria change may explain some of the increase
  seen in the 1990s

Year of Reports Year of Reports Year of Reports
Criteria 1979 80 1997 99 2003
Fasting Diabetes Impaired fasting glucose 140 mg/dl N/A 126 mg/dl 110-125 mg/dl 126 mg/dl 100-125 mg/dl
2-hour Test Diabetes Impaired fasting glucose 200 mg/dl 140-199 mg/dl 200 mg/dl 140-199 mg/dl 200 mg/dl 140-199 mg/dl
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Diabetes Symptoms

• Frequent urination
• Thirst
• Hunger
• Weight loss (despite thirst, hunger)
• Fatigue
• Irritability
• Type 2 diabetes may often have no symptoms until
  later

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Insulin

• Hormone produced by pancreas beta cells
• After a meal, blood glucose levels rise
• Insulin moves glucose into bodys cells
• For use
• For storage
• Animation (whfreeman.com click animation,
  insulin)

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Insulin

• Insulin released from pancreas
• Insulin binds to specific receptors on cells
• Insulin-receptor triggers a transporter to move
  glucose into the cell
• ExampleGLUT-4, found inside fat and muscle cells
• Insulin binding triggers transporter GLUT-4 to
  move from inside cell to cell membrane
• GLUT-4 opens up, allowing glucose to move inside

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Types of Diabetes

• Type 1
• Type 2
• Latent Autoimmune Diabetes of Adulthood
• Others prediabetes, gestational diabetes
• Diabetes video (YouTube)

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Type 1 Diabetes

• 5-10 of the population
• Person with Type 1 has little or no insulin to
  move glucose into cells
• There may be different causes
• Autoimmune most common
• Non-autoimmune unknown, or idiopathic, causes
  (genetic, viral, other) (Krishnamurthy
  Balasubramanian, et.al., Diabetes Care)

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Type 1 Diabetes

• Cause Autoimmune response
• Antibodies destroy pancreas beta cells
• YouTube animation (4 min)
• ClearlyHealth provides an additional video
  (YouTube)
• Genetics, infant diet may be related to
  susceptibility
• The most common form of Type 1 diabetes
• Insulin production is halted
• Insulin injections required

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Type 1 Diabetes

• Cause Of unknown origin
• Idiopathic diabetes
• Not due to autoimmune response
• Chromosomal abnormality possibility
• Viral infection possibility
• Genetic predisposition may be triggered by
  environmental factor
• Those of Asian, African American and Hispanic
  descent more frequently diagnosed
• Insulin production is halted
• Insulin therapy
• Oral medication may be used to control condition

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Type 2 Diabetes

• Most common
• Approximately 90 of diabetes cases
• Up to one half unaware they have Type 2
• Stereotype over age of 50 years
• Type 2 increasing among youth
• Treatments diet, activity, medication

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Type 2 Diabetes

• Inadequate insulin production
• Uncontrolled insulin release rate
• Reduced insulin sensitivity
• Insulin receptor problems
• Reduction in receptor number
• Antibodies attaching to receptors, blocking
  insulin

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Type 2 Diabetes

• Video insulin resistance
• YouTube

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Type 2 Diabetes Risk Factors

• Poor diet (high fat, low fiber, simple
  carbohydrates)
• Physical inactivity
• Genetic predisposition family history
• History of gestational diabetes
• Age
• Obesity

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Type 2 Diabetes and Ethnicity

• Some minority populations at increased risk
• Japanese
• Chinese
• South African blacks
• Native American
• Pimas, Navajos, Aleuts
• Native Hawaiian
• Latino
• . 9 Maskarinec G, et al. Diabetes prevalence and
  body mass index differ by ethnicity the
  multiethnic cohort. Ethnicity Disease 19(1),
  200 link to
• Kitagawa,T. Owada,M. Urakami,T. Yamauchi,K.
  Increased incidence of non-insulin dependent
  diabetes mellitus among Japanese schoolchildren
  correlates with an increased intake of animal
  protein and fat. Clin Pediatr (Phila).1998
  37(2) 111-115
• Peer N, Steyn K, Lombard C, Lambert EV,
  Vythilingum B, et al. (2012) Rising Diabetes
  Prevalence among Urban-Dwelling Black South
  Africans. PLoS ONE 7(9)e43336.
  doi10.1371/journal.pone.0043336.

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Type 2 Diabetes and Ethnicity

• Reasons for increased risk are many
• Lifestyle factors
• Diet
• Inactivity
• Obesity
• Genetic factors
• Thrifty gene controversy
• Specific to ethnicity
• SHAIKH-LESKO, RINA. "Diabetes' genetic
  underpinnings can vary based on ethnic
  background, studies say - Office of
  Communications Public Affairs - Stanford
  University School of Medicine." Stanford
  University School of Medicine. N.p., n.d. Web. 16
  Oct. 2013. lthttp//med.stanford.edu/ism/2013/may/d
  iabetes_butte.htmlsthash.ZbNZFsJ

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Latent Autoimmune Diabetes of Adulthood

• Per title, impacts adults
• Also known as Type 1.5, Latent Type 1, Slow onset
  Type 1, Autoimmune diabetes in adults
• May be misdiagnosed
• Person often normal weight, may lack family
  history
• Onset is slow, with similar blood sugar
  challenges seen in Type 2
• Like Type 1, an autoimmune response results in
  destruction of pancreatic beta cells
• Approximately 10 of diabetes population
• Gebel, Erika, and PhD. "The Other Diabetes LADA,
  or Type 1.5 Diabetes Forecast Magazine."
  Diabetes Forecast Magazine. N.p., n.d. Web. 16
  Oct. 2013. lthttp//forecast.diabetes.org/magazine/
  features/other-diabetes-lada-or-type-15gt.
• Wroblewski M, Gottsäter A, Lindgärde F, Fernlund
  P, Sundkvist G Gender, autoantibodies, and
  obesity in newly diagnosed diabetic patients aged
  4075 years. Diabetes Care21 250 255,1998

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Diabetes Complications

• Blood vessel damage
• Increased CV disease risk
• Atherosclerosis
• More lipids in bloodstream
• Damage in kidneys affects filtration of waste
• Damage in vessels leading to retina
• Nerve damage
• Numbness, paralysis
• Sores, amputation
• Video (WebMD)

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Hyperglycemia Hypoglycemia

• Hyperglycemia
• When glucose cannot enter cell, levels in
  bloodstream remain elevated
• If dysfunctional, pancreas cannot make enough
  insulin to move glucose out of blood and into
  cells
• If functional, pancreas releases more insulin
• hyperinsulinemia
• Hypoglycemia
• Too much insulin production
• Can occur in those with diabetes (too much
  insulin, not enough food)

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Diabetes Resources

• Support Groups
• Little Kids with Insulin Dependent Diabetes - for
  parents, 10am Saturdays, every other month
  beginning January, Seattle Childrens Hospital
  Zuraya Aziz 425-985-9199
• Parents of Kids Experiencing Diabetes - for
  family of those all-age children with Type I
  diabetes email for newsletter
  POKED.WA_at_gmail.com.
• Pacific Medical Centers (PACMed) adult support
  groups on various days
• Swedish Hospital Medical Center adult diabetes
  education classes

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Diabetes Resources - Support Groups

• Northwest Hospital Diabetes Support Group
• Second Tuesday of each month, 1-230pm
• Third Thursday of each month, 7-830pm
• Diabetes Education Classroom/TCU Dining Room, NW
  Hospital
• Register by phone, 206-368-1564, or online
• Swedish Diabetes Education Center Group
• First Wednesday of each month, 730am
• First Hill, 206-215-2440

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Diabetes Resources

• American Diabetes Association http//www.diabetes
  .org/
• National Diabetes Education Program
  http//www.ndep.nih.gov/
• Annual ADA Diabetes Expo
• April, Seattle Convention Center