Www.diabetes.org 1-800-DIABETES World Kidney Day March 11, 2010 Dr. Joyce M. Richey, Presenter Keck...

www.diabetes.org 1-800-DIABETES

World Kidney DayWorld Kidney DayMarch 11, 2010March 11, 2010

Dr. Joyce M. Richey, PresenterDr. Joyce M. Richey, Presenter

Keck School of Medicine of Keck School of Medicine of USCUSC


Diabetes -Greek derivation, Diabetes -Greek derivation, to siphon, passing through to siphon, passing through


What Is Diabetes ??What Is Diabetes ??

INSULIN Glucose (Sugar)Goes where it’s needed for energy!


Insulin – the “Miracle” Drug


Types of DiabetesTypes of Diabetes

Type IType I““juvenile” IDDMjuvenile” IDDM

Usually in children, Usually in children, can be adultscan be adults

0.5% of populations0.5% of populations Family HistoryFamily History Fatal if not treatedFatal if not treated Usually normal Usually normal

weightweight

Type IIType II““adult” NIDDMadult” NIDDM

Usually in adults, Usually in adults, increasing in childrenincreasing in children

5-10% of population 5-10% of population (epidemic)(epidemic)

Family HistoryFamily History Increased prevalence in Increased prevalence in

minoritiesminorities 80% of patients are 80% of patients are

obeseobese•Gestational Diabetes


Diabetes TreatmentDiabetes Treatment

Type I Type I InsulinInsulin

Type IIType II InsulinInsulin

Oral MedicationsOral Medications


Who Does Diabetes Affect?Who Does Diabetes Affect?

PrevalencePrevalence >20 million; one third don’t know they have it>20 million; one third don’t know they have it >41 million with pre-diabetes>41 million with pre-diabetes

Greater in minority populationsGreater in minority populations African Americans; ~2 times than CaucasiansAfrican Americans; ~2 times than Caucasians Hispanic Americans, ~2 times than CaucasiansHispanic Americans, ~2 times than Caucasians Native Americans, 50% of the Pima IndiansNative Americans, 50% of the Pima Indians


Pre-DiabetesPre-Diabetes

What is Pre-Diabetes?What is Pre-Diabetes?

Comes before type 2 diabetesComes before type 2 diabetes Blood glucose higher than normal but not Blood glucose higher than normal but not

yet diabetesyet diabetes Normal fasting glucose: Below 100 Normal fasting glucose: Below 100 Pre-diabetes: 100 – 125Pre-diabetes: 100 – 125 Diabetes: 126 and aboveDiabetes: 126 and above


Pre-Diabetes Pre-Diabetes What Does It Mean?What Does It Mean?

You have a greater chance You have a greater chance of getting type 2 diabetes of getting type 2 diabetes

You are more likely to get You are more likely to get heart disease or have a heart disease or have a stroke or kidney diseasestroke or kidney disease


Diabetes and Obesity Diabetes and Obesity EpidemicEpidemic


Obesity and DiabetesObesity and Diabetes


Causes of ObesityCauses of Obesity

Lack of physical activity/sedentaryLack of physical activity/sedentaryGeneticsGenetics

Unhealthy eating patternsUnhealthy eating patterns


““Digging Our Graves”Digging Our Graves”


Apple or Pear?Apple or Pear?

Android Gynoid


RF-107, Female, Age 41, BMI 49.5WC: 118 cmVAT volume: 559 cm3

SAT volume: 11,658 cm3

RF-149, Male, Age 40, BMI 54.4WC: 142 cmVAT volume: 3162 cm3

SAT volume: 9158 cm3

Variability of VAT among obese subjects


Obesity is not Restricted to Humans


Symptoms of DiabetesSymptoms of Diabetes

Frequent urination (bedwetting in Frequent urination (bedwetting in children)children)

Excessive thirstExcessive thirstExtreme hungerExtreme hungerUnusual weight lossUnusual weight loss Increased fatigueIncreased fatigue IrritabilityIrritabilityBlurry visionBlurry vision


Diabetes TestingDiabetes Testing

Urine AnalysisUrine Analysis

Blood Test (Fasting Glucose) (less Blood Test (Fasting Glucose) (less than or equal to 100 mg/dl;101 – 126 than or equal to 100 mg/dl;101 – 126 mg/dl, pre-diabetes; greater than mg/dl, pre-diabetes; greater than 126 mg/dl, diabetic)126 mg/dl, diabetic)

Oral Glucose Tolerance Test (OGTT)Oral Glucose Tolerance Test (OGTT)


Diabetes Testing “ A1C?”Diabetes Testing “ A1C?”

Measures your sugar level for the Measures your sugar level for the past 2-3 monthspast 2-3 months

Should be checked at least twice a Should be checked at least twice a yearyear

The higher the number, the higher The higher the number, the higher risk for diabetes complicationsrisk for diabetes complications


What should your A-1-C be?What should your A-1-C be?

Ideally it should be Ideally it should be less than 7!less than 7!

However, please However, please check with your check with your healthcare provider healthcare provider for a reasonable for a reasonable goal.goal.

A1C Blood Glucose% mg/dl

5 906 1207 1508 1809 210

10 24015 390


Major ComplicationsMajor Complications


Complications of DiabetesComplications of Diabetes Heart disease and stroke; 2-4 greater riskHeart disease and stroke; 2-4 greater risk accounts for > 65% of all deaths in accounts for > 65% of all deaths in

people with diabetes people with diabetes Leading cause of blindness (retinopathy)Leading cause of blindness (retinopathy) Leading cause of kidney failure Leading cause of kidney failure

(nephropathy)(nephropathy) Nerve disease and amputations Nerve disease and amputations

(neuropathy)(neuropathy) >300,000 diabetes-related deaths/year>300,000 diabetes-related deaths/year


Kidney FailureKidney Failure


Kidney DiseaseKidney DiseaseAlso known as Nephropathy (neh-Also known as Nephropathy (neh-

FROP-uh-thee)FROP-uh-thee)Over time kidney disease is caused Over time kidney disease is caused

bybyDiabetesDiabetesHigh blood pressureHigh blood pressure


Your KidneysYour KidneysYour kidneys are Your kidneys are

two bean-shaped two bean-shaped organs about the organs about the size of your fist.size of your fist.

They are located They are located just below the rib just below the rib cage, near your cage, near your backback


Kidney DiseaseKidney Disease

Signs and Symptoms Signs and Symptoms Swelling in extremities, ankles, Swelling in extremities, ankles,

legs, handslegs, handsShortness of breathShortness of breathFeeling tiredFeeling tiredNausea and vomitingNausea and vomiting


Kidney DiseaseKidney Disease

Later Signs and SymptomsLater Signs and SymptomsLoss of appetiteLoss of appetiteFeeling coldFeeling coldPoor concentrationPoor concentrationItchy skinItchy skinBruisingBruisingWeight lossWeight lossMuscle crampsMuscle cramps


Tests to find kidney Tests to find kidney problemsproblems

A blood test helps to measure your GFRA blood test helps to measure your GFR

GFR stands for Glomerular (glo-MEH-yoo-lur) Filtration Rate. The GFR shows how well your kidneys are filtering GFR stands for Glomerular (glo-MEH-yoo-lur) Filtration Rate. The GFR shows how well your kidneys are filtering wastes from the blood. wastes from the blood.

Microalbumin (My-crow-alb-YOU-min)Microalbumin (My-crow-alb-YOU-min)

A urine test that measure the amount of protein in the urineA urine test that measure the amount of protein in the urine


What You Can Do to Prevent, What You Can Do to Prevent, Delay, or Treat Kidney DamageDelay, or Treat Kidney Damage

Keep your blood glucose levels in your Keep your blood glucose levels in your target rangetarget range

ADA suggests:ADA suggests:70 to 130 when you wake up and before 70 to 130 when you wake up and before

mealsmealsUnder 180 two hours after eating a mealUnder 180 two hours after eating a meal

Ask your doctor about the best blood Ask your doctor about the best blood glucose targets for youglucose targets for you


What You Can Do to What You Can Do to Prevent, Delay, or Treat Prevent, Delay, or Treat

Kidney DamageKidney Damage Have an A-1-C check (A-one-see) at least twice a Have an A-1-C check (A-one-see) at least twice a

yearyear Shows your blood glucose level for the Shows your blood glucose level for the

past 2 to 3 monthspast 2 to 3 months The higher the A-1-C, the greater the risk The higher the A-1-C, the greater the risk

for kidney diseasefor kidney disease If 7 or higher, you may need a change in your If 7 or higher, you may need a change in your

planplan


What You Can Do to What You Can Do to Prevent, Delay, or Prevent, Delay, or

Treat Kidney Treat Kidney DamageDamageAim for your target blood pressure Aim for your target blood pressure

levellevelADA suggests under 130 over 80ADA suggests under 130 over 80

Ask your doctor about your target Ask your doctor about your target blood pressureblood pressure

Ask your doctor about medicines that Ask your doctor about medicines that slow down kidney diseaseslow down kidney diseaseACE Inhibitors (AYCE in-HIB-ih-tor) ACE Inhibitors (AYCE in-HIB-ih-tor) ARBs (ay-ar-bee)ARBs (ay-ar-bee)


Slowing Down Kidney Slowing Down Kidney DiseaseDisease

Eat a well-balanced meal planEat a well-balanced meal plan Cut back on salt and high sodium foodsCut back on salt and high sodium foods Limit your protein if your doctor tells you toLimit your protein if your doctor tells you to Limit potassium and phosphorusLimit potassium and phosphorus Limit supplements and drugs that are hard Limit supplements and drugs that are hard

on your kidneyson your kidneys Watch out for injected dyes used in X-raysWatch out for injected dyes used in X-rays


Steps to Delay or Prevent Steps to Delay or Prevent Type 2 DiabetesType 2 Diabetes

Weight lossWeight lossRegular physical activity, Regular physical activity,

such as walking or gardening such as walking or gardening about 30 minutes a dayabout 30 minutes a day

Healthy eatingHealthy eating


Diabetes Prevention and Diabetes Prevention and TreatmentTreatment

Increase Physical Activity!Increase Physical Activity!


Healthy EatingHealthy EatingChoose low-fat dairy products, Choose low-fat dairy products,

lean meats, poultry without lean meats, poultry without skin, and fishskin, and fish

Limit saturated fats Limit saturated fats Minimize trans fatsMinimize trans fatsLimit high cholesterol foodsLimit high cholesterol foodsEat more fruits and vegetablesEat more fruits and vegetables


Fried Vs. BakedFried Vs. Baked

(4) 7 inch fillets(4) 7 inch fillets 1 egg1 egg CornmealCornmeal Salt/pepperSalt/pepper 1 stick of butter of 1 stick of butter of

half cup of oilhalf cup of oil

(4) 7 inch fillets(4) 7 inch fillets 2 teaspoons of 2 teaspoons of

lemonlemon Salt/pepperSalt/pepper Bread crumbsBread crumbs Spices Spices

(oregano,oil,parsle(oregano,oil,parsley sprigs, lemon y sprigs, lemon wedges, tomato wedges, tomato wedges)wedges)


Fried vs. BakedFried vs. BakedNutritional ValueNutritional Value

Calories 410Calories 410 Fat = 26 gramsFat = 26 grams 57% fat calories57% fat calories Cholesterol = 183 Cholesterol = 183

mgmg Sodium = 859 mgSodium = 859 mg Protein = 36 mgProtein = 36 mg Carbohydrate = 7 Carbohydrate = 7

mgmg Fiber = 1 gFiber = 1 g

Calories 290Calories 290 Fat = 8 gramsFat = 8 grams 25% fat calories25% fat calories Cholesterol = 66 mgCholesterol = 66 mg Sodium = 263 mgSodium = 263 mg Protein = 35 mgProtein = 35 mg Carbohydrate = 19 Carbohydrate = 19

mgmg Fiber = 2 gFiber = 2 g


Remember the 3 P’s of Remember the 3 P’s of PreventionPrevention

PlanningPlanning

PreparationPreparation

PortionsPortions


RememberRememberLearn all you can about diabetes and Learn all you can about diabetes and

kidney diseasekidney diseaseKeep your blood pressure and blood Keep your blood pressure and blood

glucose levels in your target rangeglucose levels in your target rangeTake your medicinesTake your medicinesHave regular checkupsHave regular checkupsGet lab tests each year to know how well Get lab tests each year to know how well

your kidneys areyour kidneys are working working


KEEP IT HEALTHY!KEEP IT HEALTHY!

““Know that your body is a temple”Know that your body is a temple”

1Cor. 6:19-201Cor. 6:19-20

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