Post on 24-Feb-2016
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DIABETES
What is diabetes? Metabolic disease resulting from inability
of body to use or produce insulin High blood glucose Low cellular glucose/glycogen stores
Insulin Produced by Islet of Langerhans in the
pancreas Increases uptake of glucose in liver, muscle
and fat Stores glucose as glycogen in liver and
muscle
What is diabetes? Type 1
Lack of insulin production Commonly found in children and adults of
normal weight Treatment
Daily insulin necessary
What is diabetes? Type 1
Etiology Previously no known etiology but recent
research suggests viral infection may cause autoimmune destruction of insulin producing beta cells
Genetics
What is diabetes? Type 2
Insulin not recognized by receptors throughout body
Can have decreased insulin production Commonly seen in overweight adults
Disease is encroaching on younger populations Treatment
Lifestyle modification Pills Insulin
What is diabetes? Type 2
Etiology Lifestyle Factors
Obesity (55%) Hypertension Cholesterol Age Sedimentary Lifestyle
Genetics
Presentation Hyperglycemia
Extreme thirst Frequent urination Dry skin Hunger Blurred vision Drowsiness Decreased healing
Presentation Hyperglycemia
Causes: Excess food intake Insufficient medication Illness/Stress Sedintary Lifestyle
Very high levels of sugar may lead to diabetic coma
Chronic hyperglycemia can lead to eye, kidney, nerve and vasculature damage
Presentation Hyperglycemia
Extreme thirst Frequent urination Dry skin Hunger Blurred vision Drowsiness Decreased healing
DiagnosisNormal Pre-diabetes Diabetes
A1C 4-5.9% 6.0-6.4% >6.5%Fasting Glucose <100mg/dL 100-125mg/dL >126mg/dLGlucose Tolerance
<140mg/dL 140-199mg/dL >200mg/dL (1)
Both the fasting glucose and 75 g glucose tolerance test were suitable for diagnosing diabetes [2]
Both the fasting glucose and 75 g glucose tolerance test are suitable for diagnosing diabetes
Recommended to screen asymptomatic adults with BP greater than 135/80 mm Hg (treated or untreated)
Treatment Lifestyle Changes
Increase physical activity Cholesterol BP Heart Function Weight Loss Insulin Sensitivity
Diet 45-60 grams of carbohydrates/meal <15 grams of carbohydrates/snack
Treatment Insulin
Treats Type 1 and Type 2 Types
“Meal” Insulin Long-Acting Insulin Insulin Mixes Vials or pins
Insulin Care Must be refrigerated Never freeze Discard vial 4 weeks after first use Pen expirations vary widely
Treatment- Oral Metformin (Glucophage)
Prevents release of stored sugars First option oral treatment Can cause weight loss Side Effects:
Upset stomach Diarrhea
Treatment- Oral Sulfonylureas
Increase insulin production in Type 2 patients
Low blood sugar risk dependant on dose Use if patient not eligible for or intolerable
of MetforminBrand Name GenericDiabetaMicronaseGlynase
glyburide
GlucotrolGlucotrol XL
glipizide
Amaryl glimepiride
Treatment- Oral Glitazones (Avandia, Actos)
Increase efficacy of insulin Side Effects:
Weight gain Swelling
6-12 before full benefit High Cost
Alpha-glucosidase Inhibtors Slow absorption of carbohydrates from gut
Treatment- Oral Meglitinides (Prandin, Starlix)
Increase insulin production Short acting
Used if reaction to sulfonylureas Take with meals Side Effects:
Hypoglycemia High Cost
Hypoglycemia
Shaking Tachycardia Diaphoresis Dizziness Anxiety
Hunger Impaired Vision Fatigue Headache Irritability
Frequent side effect of excess insulin, meglitinides, and sulfonylureas
Also caused by increased exercise or inadequate food inatke
Can result in insulin shock Symptoms:
Long Term Effects Heart disease and stroke
2-4x increased risk 65% die from MI or stroke 33% have peripherial artery disease
Retinopathy Leading cause of new cases of blindness in
patients ages 20-74
Long Term Effects Retinopathy
Commonly latent until late stages of disease requiring laser treatment
Regular fundus exams needed Pathophysiology
Abnormal blood vessel permeability Ischemic vascular occlusion Neovascularization
Long Term Effects
Macular Edema Neovascularization
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Long Term Complications Nephropathy
Leading cause of kidney failure (44% in 2005)
First sign is proteinuria Albumin excretion 30-300mg/day is diagnostic Increased likelihood of hypoglycemia from
medication Amputation
>60% of non-traumatic lower-limb amputations are due to diabetes
Long Term Complications Neuropathy
60-70% have mild forms of nerve damage Can lead to foot complications like ulcers
and infection Inspection
Erythema, warmth, callus formation Bony deformities, join mobility, gait Pulse Loss of sensation
=Refer to podiatrist
Long Term Complications Neuropathy
Prophylaxis - Avoid going barefoot, even in the home - Test water temperature before stepping into a
bath - Trim toenails to shape of the toe; remove
sharp edges with a nail file. Do not cut cuticles. - Wash and check feet daily - Shoes should be snug but not tight and
customized if feet are misshapen or have ulcers - Socks should fit and be changed daily
McCullogh, David. Foot Care in diabetes mellitus. Up to Date. May 2010.
Diabetes in North Carolina In 2008 NC ranked 17th highest in the US
for adult diabetes prevalence with 9.3% of the population diagnosed (643,000)
An estimated 1.25 million adults in NC have some type of hyperglycemia
The estimated cost of diabetes in NC was 5.3 billion in 2006
7th leading cause of death (2,150) and contributed to 6,226 deaths in 2007
References
2009 Diabetes Fact Sheet. NC Diabetes Prevention and Control Branch. http://www.ncdiabetes.org/factsFigures/index.asp
Diabetes Basics and Living with Diabetes. American Diabetes Association. http://www.diabetes.org/
US Preventive Services Task Force. Screening for Type 2 Diabetes Mellitus in Adults: U.S. Preventive Services Task Force Recommendation Statement. Annals of Internal Medicine 2008;148:855-68. http://www.annals.org/cgi/reprint/148/11/846.pdf
References Olivia Linthavong. What is Diabetes? Diabetes
Maintenance and Prevention Program at the Open Door Clinic. 2009.
Olivia Linthavong. Carbohydrate Counting Handout. Diabetes Maintenance and Prevention Program at the Open Door Clinic. 2009.
Genuth, S, Alberti, KG, Bennett, P, et al. Follow-up report on the diagnosis of diabetes mellitus. Diabetes Care 2003; 26:3160.
Drugs for Type 2 Diabetes. Treatment Guidelines from the Medical Letter 2008; 6(71). http://medlet-best.securesites.com.libproxy.lib.unc.edu/restrictedtg/t71.pdf