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Aug 18, 2022 106 likes •676 views

Saima M. Ahmad, MD M. Ahmad, MD Saima Physicians Clinic of Spokane Physicians Clinic of Spokane Clinical Faculty, University of Washington. Clinical Faculty, University of Washington. Diabetes Statistics Diabetes Statistics 8.3% of the

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Saima Saima M. Ahmad, MD

  • M. Ahmad, MD

Physicians Clinic of Spokane Physicians Clinic of Spokane Clinical Faculty, University of Washington. Clinical Faculty, University of Washington.

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Diabetes Statistics Diabetes Statistics

  • 8.3% of the population, or 25.8 million

8.3% of the population, or 25.8 million children and adults in the US children and adults in the US

  • Diagnosed: 18.8 million people

Diagnosed: 18.8 million people

  • Undiagnosed: 7.0 million people

Undiagnosed: 7.0 million people

  • Prediabetes

Prediabetes: 79 million people : 79 million people

  • 1.9 million new cases of diabetes

1.9 million new cases of diabetes were were diagnosed in people over 20 years old in diagnosed in people over 20 years old in 2010. 2010.

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Diabetes Statistics Diabetes Statistics

  • Diabetes is the leading cause of blindness

Diabetes is the leading cause of blindness among adults aged 20 among adults aged 20– –74 years. 74 years.

  • Diabetes is the leading cause of kidney

Diabetes is the leading cause of kidney failure, accounting for 44% of new cases failure, accounting for 44% of new cases yearly. yearly.

  • A total of

A total of 202,290 people with end 202,290 people with end-

  • stage

stage kidney disease due to diabetes are living kidney disease due to diabetes are living

  • n chronic dialysis.
  • n chronic dialysis.
  • 60%

60% -

  • 70% of people with diabetes have

70% of people with diabetes have some nervous system damage some nervous system damage.

.

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People with Diabetes 2010 and People with Diabetes 2010 and 2030 2030

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Cost of Diabetes Cost of Diabetes

  • $174 billion: Total cost of diagnosed

$174 billion: Total cost of diagnosed diabetes in the United States in 2007 diabetes in the United States in 2007

  • $116 billion for direct medical costs

$116 billion for direct medical costs

  • $58 billion for indirect costs

$58 billion for indirect costs (disability, (disability, work loss, premature mortality work loss, premature mortality

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Prevention of Diabetes Prevention of Diabetes

  • Diet

Diet – – Whole grain and high fiber foods Whole grain and high fiber foods

  • Exercise

Exercise

  • Try to lose 5

Try to lose 5-

  • 7% body weight

7% body weight

  • Goal BMI under 25.

Goal BMI under 25.

  • Screening every 3 years

Screening every 3 years

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Basic Diabetes Information Basic Diabetes Information

  • Diabetes is a disease in which body does

Diabetes is a disease in which body does NOT produce or properly use Insulin. NOT produce or properly use Insulin.

  • Insulin is a hormone produced by

Insulin is a hormone produced by Pancreas that is needed to convert sugar Pancreas that is needed to convert sugar into energy needed for daily life. into energy needed for daily life.

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Glucose control in body Glucose control in body

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Types of Diabetes Types of Diabetes

  • Type 1 Diabetes:

Type 1 Diabetes:

  • Failure to produce Insulin

Failure to produce Insulin

  • Usually childhood, early teenage

Usually childhood, early teenage

  • Always need Insulin.

Always need Insulin.

  • Type 2 Diabetes:

Type 2 Diabetes:

  • Insulin resistance, or inability to use Insulin

Insulin resistance, or inability to use Insulin

  • Obesity related

Obesity related

  • May or may not need Insulin.

May or may not need Insulin.

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Types of Diabetes Types of Diabetes

  • Gestational Diabetes

Gestational Diabetes – – Pregnancy related Pregnancy related – – 4% of Pregnant women. 4% of Pregnant women.

  • Rare causes of Diabetes

Rare causes of Diabetes – – Trauma, Trauma, infection, medications, genetic defects etc infection, medications, genetic defects etc

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SLIDE 11

Risk factors for Diabetes Risk factors for Diabetes

  • Obesity

Obesity

  • Ethnicity

Ethnicity – – African African Americans, Native Americans, Native Americans Americans

  • Age

Age

  • Family history

Family history -

  • Genetics

Genetics

  • Sedentary Lifestyle

Sedentary Lifestyle

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Obesity Obesity

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Criteria for Diagnosis of Diabetes Criteria for Diagnosis of Diabetes

  • Normal Fasting Blood Glucose:100 mg/dl

Normal Fasting Blood Glucose:100 mg/dl

  • r less
  • r less
  • Pre

Pre-

  • Diabetes: or Impaired fasting Glucose:

Diabetes: or Impaired fasting Glucose: 110 110-

  • 126

126

  • Diabetes: >126 Fasting or

Diabetes: >126 Fasting or >200 Non Fasting >200 Non Fasting

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Pre Pre -

  • Diabetes

Diabetes

  • Glucose levels that are higher than normal

Glucose levels that are higher than normal but not yet high enough to be diagnosed but not yet high enough to be diagnosed as diabetes. as diabetes.

  • 57 million people in the US living with

57 million people in the US living with prediabetes prediabetes. .

  • You may need 2 hour fasting test called

You may need 2 hour fasting test called Glucose tolerance test. Glucose tolerance test.

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Symptoms of Diabetes Symptoms of Diabetes

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Symptoms of Type 1 Diabetes Symptoms of Type 1 Diabetes

  • Frequent urination (

Frequent urination (polyuria polyuria) )

  • Unusual thirst (

Unusual thirst (polydipsia polydipsia) )

  • Extreme hunger

Extreme hunger

  • Unusual weight loss

Unusual weight loss

  • Extreme fatigue and Irritability

Extreme fatigue and Irritability

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Symptoms of Type 2 Diabetes Symptoms of Type 2 Diabetes

  • Any of the type 1 symptoms

Any of the type 1 symptoms

  • Frequent infections

Frequent infections

  • Blurred vision

Blurred vision

  • Cuts/bruises that are slow to heal

Cuts/bruises that are slow to heal

  • Tingling/numbness in the hands/feet

Tingling/numbness in the hands/feet

  • Recurring skin, gum, or bladder infections

Recurring skin, gum, or bladder infections

  • Often people with type 2 diabetes have no

Often people with type 2 diabetes have no symptoms symptoms

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Gestational Diabetes Gestational Diabetes

  • Develops only during pregnancy

Develops only during pregnancy

  • Occurs in 4% of Pregnancies

Occurs in 4% of Pregnancies

  • Screening done in 24

Screening done in 24th

th -

  • 28

28th

th week of

week of pregnancy pregnancy

  • Diet and Insulin are the only treatments.

Diet and Insulin are the only treatments.

  • Can adversely affect baby.

Can adversely affect baby.

  • 25

25-

  • 40% greater risk of developing Type 2

40% greater risk of developing Type 2 Diabetes within 5 years, based on their Diabetes within 5 years, based on their ethnicity. ethnicity.

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Metabolic syndrome Metabolic syndrome

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Metabolic syndrome Metabolic syndrome

  • Central obesity, or abdominal

Central obesity, or abdominal fat, or BMI >30 fat, or BMI >30 kg/m² Waist kg/m² Waist

  • ver 40 inches in men
  • ver 40 inches in men

Waist over 35 inches in Waist over 35 inches in women. women.

  • AND any two of the following:

AND any two of the following:

  • Triglycerides: > 150

Triglycerides: > 150 mg/ mg/dL dL

  • Low HDL (or good)

Low HDL (or good) cholesterol: cholesterol: < 40 < 40 mg/ mg/dL dL in males, in males, < 50 < 50 mg/ mg/dL dL in females, in females,

  • High blood pressure:

High blood pressure: systolic BP > 130 or diastolic systolic BP > 130 or diastolic BP >85 BP >85 mm Hg mm Hg

  • Fasting Blood glucose

Fasting Blood glucose >100 >100 mg/ mg/dL dL

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Complications of Diabetes Complications of Diabetes

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Complications of Diabetes Complications of Diabetes

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Complications of Diabetes Complications of Diabetes

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Complications of Diabetes Complications of Diabetes

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Complications of Diabetes Complications of Diabetes

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Complications of Diabetes Complications of Diabetes

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Complications of Diabetes Complications of Diabetes

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SLIDE 28

ABCs of Diabetes ABCs of Diabetes

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Goals Goals

Glycemic control:

– A1C or 3 month average test<7.0% – Fasting Glucose 80-110mg/dl – Non-fasting <180mg/dl

Blood Pressure <130/80 Lipids:

– LDL Cholesterol <100mg/dl – Triglycerides <150mg/dl – HDL Cholesterol >40mg/dl

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Diabetic monitoring Diabetic monitoring

  • Home Blood glucose monitoring

Home Blood glucose monitoring

  • Daily foot checks (ulcers, nerve damage)

Daily foot checks (ulcers, nerve damage)

  • Ketone

Ketone monitoring at home for Type 1 monitoring at home for Type 1 diabetics. diabetics.

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Diabetic monitoring Diabetic monitoring

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Low blood glucose/ Hypoglycemia Low blood glucose/ Hypoglycemia

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Low Blood Glucose Low Blood Glucose

  • Usually blood glucose is <70

Usually blood glucose is <70

  • Can cause loss of consciousness or Coma

Can cause loss of consciousness or Coma

  • hunger

hunger

  • shakiness

shakiness

  • Nervousness, anxiety

Nervousness, anxiety

  • sweating

sweating

  • Sleepiness, confusion

Sleepiness, confusion

  • dizziness or light

dizziness or light-

  • headedness

headedness

  • difficulty speaking

difficulty speaking

  • weakness

weakness

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SLIDE 34

Treat Low Blood Glucose Treat Low Blood Glucose

  • Treat immediately with 1 Tbsp sugar/

Treat immediately with 1 Tbsp sugar/ honey honey

  • Hard candy

Hard candy

  • 4 oz Juice

4 oz Juice

  • Recheck Blood glucose in 15 minutes

Recheck Blood glucose in 15 minutes

  • Eat a snack or meal

Eat a snack or meal

  • Never drive if blood glucose is less than

Never drive if blood glucose is less than 70. 70.

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High Blood Glucose High Blood Glucose

  • Thirst

Thirst

  • Tiredness

Tiredness

  • Excessive urination

Excessive urination

  • Hunger

Hunger

  • Difficulty seeing

Difficulty seeing

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High Blood Glucose High Blood Glucose

  • Treat with a couple of glasses of water or

Treat with a couple of glasses of water or sugar free non caffeinated drinks. sugar free non caffeinated drinks.

  • Check your Blood sugar more often

Check your Blood sugar more often

  • Check for

Check for ketones ketones if your BG is > 240 if your BG is > 240

  • Call your doctor if you have 2 readings >

Call your doctor if you have 2 readings > 240. 240.

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Ketone Ketone Testing Testing

  • Usually seen in Type 1

Usually seen in Type 1 diabetics diabetics

  • Ketones

Ketones build up from build up from breakdown of fats in body breakdown of fats in body

  • Seen if BG is too high.

Seen if BG is too high.

  • Can cause nausea,

Can cause nausea, vomiting, stomach pain, vomiting, stomach pain, fatigue, sweet smelling fatigue, sweet smelling breath. breath.

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SLIDE 38

Treatment Treatment

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Treatment of Diabetes Treatment of Diabetes

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Exercise Exercise

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Exercise Exercise

Frequency: Exercise at least 5 days per

week

Intensity: This means how hard you work

during exercise. You should feel like you are working harder than usual but still be able to carry on a conversation

Duration: Exercise for at least 20 - 30

minutes at a time.

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SLIDE 42

Exercise Tips Exercise Tips

Type 1: do not exercise if sugars <70 or

>300 or if ketones are present

Type 2: do not exercise if sugars < 70 or

>350

Exercise can cause low blood sugars

several hours after you are done.

Schedule exercise 45-60 minutes after

eating a complex carbohydrate/ protein meal.

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Guidelines Guidelines

Check with your physician prior to starting a

program

Check Blood sugar before and after exercise Keep a daily log Wear Medical ID Drink plenty of fluids Exercise with a partner Modify Caloric Intake to correspond to activity

level and carry Sugar to treat low BG.

Wear good shoes and check feet daily for

blisters.

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Caloric/Food modification Caloric/Food modification

No extra food No Exercise > 300 mg/dl No extra food No extra food 15 gm Carb Low Moderate Strenuous 171-300 mg/dl No extra food 15 gm Carb 30 gm Carb Low Moderate Strenuous 101-170 mg/dl 15 gm Carb 30 gm Carb 60 gm Carb Low Moderate Strenuous < 100 mg/dl

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Diabetic Diet Diabetic Diet

  • Do not miss meals or snacks

Do not miss meals or snacks

  • Eat every 4

Eat every 4-

  • 6 hours

6 hours

  • Eat at the same time every day

Eat at the same time every day

  • Test your blood sugar often

Test your blood sugar often

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SLIDE 47

Diabetic Diet Diabetic Diet

  • Monitor carbohydrate

Monitor carbohydrate intake to maintain intake to maintain blood sugar control blood sugar control

  • Using carbohydrate

Using carbohydrate counting, counting,

  • The exchange system,

The exchange system,

  • r other methods to
  • r other methods to

estimate your estimate your carbohydrate intake carbohydrate intake

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Diabetic Diet Diabetic Diet

  • Consume at least 130 grams carbohydrate per

Consume at least 130 grams carbohydrate per day (do not use low day (do not use low-

  • carbohydrate diets to treat

carbohydrate diets to treat diabetes) diabetes)

  • Use sugar substitutes if desired

Use sugar substitutes if desired

  • Limit saturated fat, trans fat, and dietary

Limit saturated fat, trans fat, and dietary cholesterol cholesterol

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Diabetic Diet Diabetic Diet

  • Obtain carbohydrates

Obtain carbohydrates mainly from fruits, mainly from fruits, vegetables, whole grains, vegetables, whole grains, legumes, and low legumes, and low-

  • fat or

fat or skim milk, these foods skim milk, these foods are are high in fiber and high high in fiber and high in nutrients your body in nutrients your body needs needs

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Diabetic Diet Diabetic Diet

  • AVOID FAT

AVOID FAT

  • Grill

Grill

  • Dry

Dry-

  • roast

roast

  • Microwave

Microwave

  • Steam

Steam

  • Increase Fish intake

Increase Fish intake

  • Olive oil

Olive oil

  • Canola oil

Canola oil

  • Nuts

Nuts

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SLIDE 51

Medications Medications

  • Oral Agents

Oral Agents

  • Newer

Newer Injectable Injectable meds like meds like Byetta Byetta, , Symlin Symlin. .

  • Insulin

Insulin Long Acting Long Acting Short Acting Short Acting

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Future Developments Future Developments

  • Implantable Insulin

Implantable Insulin pump with continuous pump with continuous Blood glucose Blood glucose monitoring monitoring

  • The

The MiniMed MiniMed Paradigm Insulin Paradigm Insulin Pumps have a list Pumps have a list price of $6,195 price of $6,195

  • Artificial Pancreas

Artificial Pancreas

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Taking care of Diabetes Taking care of Diabetes

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Thanks you! Thanks you!

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