A Cowboy

1
A Cowboys Worst Enemy Run Away Glucose

• Helen Nichols, RD LN CDE

2
(No Transcript)
3
Classification

• Type 1 diabetes -results from B-cell destruction
  usually leading to absolute deficiency
• Type 2 diabetes -results from progressive insulin
  decline on the background of insulin resistance

4
Other Types

• Genetic defects in B-cell function
• Defects in insulin action
• Diseases of the exocrine pancreas (such as cystic
  fibrosis) and drug or chemical induced (such as
  the treatment of AIDS or after transplantation)
• Gestational Diabetes

5
Diabetes

• Pre-Diabetes or IGT or IFG
• Type 2 Diabetes
• Type 1 Diabetes
• Gestational Diabetes

6
Diagnosing Criteria

• Pre-Diabetes or Impaired Fasting Glucose
• Blood glucose ranging between
• 100 125 mg/dl
• Or
• Glucose Intolerance during OGTT 2 hours blood
  glucose reading between 140-199 mg/dl
• Pre-Diabetes often is in combination with
  metabolic syndrome or Syndrome X

7
Diagnosing Criteria

• Type 2 Diabetes
• Random blood glucose gt 200
• Two fasting blood glucose measures 126 or greater
  on two separate occasions
• A blood glucose of 200 or greater at the 2 hour
  mark of an oral glucose tolerance test

8
Metabolic Syndrome

• High Cholesterol gt200
• High Blood Pressure gt130/80
• Low HDL lt35
• LDL gt100
• Elevated Triglycerides gt150
• Central Obesity with BMI gt25

9
Screening for Diabetes

• gt45 years of age
• BMI gt 25 kg /height meters squared
• - every 3 years

10
Screening for Diabetes

• Individuals may be screened at a younger age if
• Are habitually inactive
• Have a first degree relative with diabetes
• Are a member of a high risk ethnic population
• Have had a baby gt 9 lbs. or previous diagnosis of
  GDM
• Have had previous elevated IGT or IFG test
• Are hypertensive
• Have a diagnosis of PCO syndrome
• Have a history of cardiovascular disease

11
Type 1 Diabetes

• Generally present with acute symptoms of diabetes
• -markedly elevated blood glucose
• - ketones
• - extreme thirst
• - frequent urination
• - weight loss
• - fatigue
• -blurry vision

12
Gestational Diabetes

• Diabetes that occurs during pregnancy
• A risk assessment is completed at the first visit
• High risk women found to be within target at the
  first screening should be re-screened at 24-28
  weeks
• All pregnant women are screened at 6-12 weeks
  post-partum

13
Diagnosing Gestational Diabetes

• One Step 100 gm OGTT
• gt95 mg/dl fasting,
• gt180 1 hour,
• gt155 2 hours,
• gt 140 3 hours
• Two Step 50 gm OGTT
• gt140 1 hour after

14
Number of Millions diagnosed in the US 1980
2004
15
2006 Data

• It is estimated that in 2006 18.2 million people
  have diabetes.

16
Diagnosed with Diabetes per 100 people
17
CDC Data TrendsRisk Factors for Complications
.                                              
                                                  
                                                  
   
18
Leading Causes of Death in SD
19
Incidences of Diabetes in SD 7.1
20
Wyoming Leading Causes of Death
21
Incidence of Diabetes in Wyoming5.8
22
Leading Causes of Death in North Dakota
23
Incidence of Diabetes in ND 6.2
24
Leading Causes of Death in Iowa
25
Incidence of Diabetes in Iowa 6.7
26
Diabetes Related Complications

• Related to management
• Diabetes out of control can lead to
• impaired circulation, wounds that dont heal and
  amputation
• kidney failure
• blindness
• early death from cardiovascular disease
• neuropathy

27
Diabetic Retinopathy

• Estimated to be the most frequent cause of new
  cases of blindness among adults aged 20-74

28
Diabetic Retinopathy

• Optimal glycemic control can substantially reduce
  the risk and progression of diabetic retinopathy
• Optimal blood pressure control can reduce the
  risk and progression of diabetic retinopathy
• The risk is strongly related to the duration of
  diabetes

29
Screening for Diabetic Retinopathy
30
(No Transcript)
31
Laser Photocoagulation Surgery

• Beneficial in reducing the risk of further visual
  loss
• Not beneficial in reversing already lost acuity
• There is strong support for a screening program
  to detect diabetic retinopathy

32
Screening

• Early detection leads to prevention!

33
Screening Leads to Delay in Diagnosis
34
(No Transcript)