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Diabetes MellitusSocial Implications
Jon Douds and Sophia PengSecond Year Medical StudentsPenn State College of Medicine
Why is Diabetes a problem?
Diabetes is the seventh leading cause of death and the leading cause of adult blindness, kidney failure, and non-traumatic lower extremity amputation. Heart disease deaths are 2–4 times higher for adults with diabetes.
~CDC
Diabetes Geographic Prevlance
Obesity Rates
Diabetes Rates
Obesity Prevalence by ethnicity
African American – 3.7 million Latino – 10.4% Native American/Alaskan – 16.5% Asian American – 7.5%
Prevalence of diabetes
Under 20 years of age 186,300, or 0.22% of all people in this age group have diabetes About one in every 400 to 600 children and adolescents has type 1
diabetes 2 million adolescents (or 1 in 6 overweight adolescents) aged 12-19
have pre-diabetes
Age 20 years or older 23.5 million, or 10.7% of all people in this age group have diabetes
Age 60 years or older 12.2 million, or 23.1% of all people in this age group have diabetes
Men 12.0 million, or 11.2% of all men aged 20 years or older have diabetes
Women 11.5 million, or 10.2% of all women aged 20 years or older have
diabetes
Cost of Diabetes
Diabetes is one of the top 10 killers in the U.S.
The total costs on the U.S. economy from diabetes is…
$132 billion▪ $92 billion from direct medical costs▪ $40 billion from indirect medical costs such
as disability, work loss, and premature mortality
CDC: Health Protection Goal of Healthy People in a Healthy World.
Cost effective intervention: if the annual per-person cost can be reduced to $100–
$200 if the programs can maintain the quality standards
established in the clinical trials. A CDC-funded primary prevention pilot in Minnesota was
sucessful! An annual cost of $160 per participant for lifestyle
interventions delivered in group settings. The estimated 5%–7% weight loss in these participants
CDC’s Diabetes Primary Prevention Initiative (DPPI) identifying individuals with prediabetes and referring them to lifestyle programs in group settings such as those at the YMCA.
Community Screening Day
Your client: Latino female 56yo HPI: Presenting with obesity, polyuria,
polydipsia Occupation: clean houses
What are some issues? Medical Socioeconomic
Family History
Family history: Father had high sugar in the blood and developed glaucoma, foot ulcers that he did not even feel, and bad kidneys.
Physical: height?, weight? BP? What are key points?
Risks & Complications
Complications
Will I suffer the same diseases as my father who had diabetes?
What do you tell the patient?
What are complications
Eye Foot Skin Heart/Vasculature: Hypertension Brain: Stroke Kidney: Nephropathy Acute: Ketoacidosis Mental health
Videos
Lifestyle tips about diabetes and pre-diabetes What would you tell our patient?
Social Implications: FOOD!
The more carbohydrates you eat, the more your blood sugar can rise!
Foods that contain carbohydrates include…
Advice on meals for diabetics ¼ carbohydrates ½ vegetables ¼ meat
Social Implications: FOOD!
Carbohydrates can be counted by reading the “total carbohydrate” row on Nutrition Facts labels
For a 2,000 calorie diet, food should contain 250 grams of carbohydrates per day That’s only 5 cans of soda per day!
Social Implications: FOOD!
Easy nutrition tips 1 fist = 1 cup of fruits, vegetables, pasta 1 thumb tip = 1 teaspoon of oil or butter 1 small palm = 3 ounces of fish, poultry,
meat 2 cupped palms = 1 ½ ounces of snack
foods 1 index finger = 1 ounce of cheese
“Sugar free” actually means < 0.5 grams of sugar per serving!
Social Implications: Medications
Patients need to keep a list of pills with name, strength, how often they take them, etc.
Patients must use caution when taking steroids Prednisone
Patients must also watch when taking cough syrups that may contain sugar
Insurance companies may only pay for certain medications
Social Implications: Medications
Insulin Must be kept in refrigerator if unopened Cannot be used for > 30 days All insulins are not the same! Must be injected
▪ Commonly in stomach, thighs, or back of upper arm
▪ Must rotate injection sites between different spots
May be given through syringes, pens, pumps, and by inhalation
Social Implications: Wellness
Key Points Stay within your target blood sugar or
Hgb A1C range Exercise! Maintain a healthy diet Maintain a good cholesterol and blood
pressure
Social Implications: Wellness
Blood pressure Should be maintained less than 130/80
▪ Through diet, decreased sodium, stress, increased exercise
Cholesterol LDL should be < 100 or possibly below
70 if past history of heart attack▪ Through diet, exercise, use of “statin” drugs
Social Implications: Wellness
Eyes Retinopathy may develop with
uncontrolled blood sugar▪ Have eyes checked yearly, maintain blood
pressure Kidneys
Nephropathy may develop▪ Maintaining blood sugar cuts the risk in half!▪ Have kidneys checked every year▪ Maintain blood pressure and cholesterol
Social Implications: Wellness Nerves
Neuropathy may develop with “tingling or burning” in hands or feet as if your extremity “fell asleep”
Feet Wash feet daily with warm water Use moisturizer Check for cracks, red areas, corns Never soak feet Use cotton/wool socks without elastic
Social Implications: Wellness
Mouth High sugar can allow germs to grow! Visit dentist every 6 months Watch for red, sore gums
Vaccines Receive flu vaccine and pneumonia
vaccine
Social Implications: Wellness
As you can see, it’s more than just monitoring your blood sugar! Cost Time Energy
Social Implications: Daily Life Sick days!
Check blood sugar every 2-4 hours If blood sugar runs high, try
▪ Water▪ Tea▪ Sugar free ginger ale
If blood sugar runs low, try▪ Jell-O▪ Popsicles▪ Juice▪ Milk
Don’t skip medications
Social Implications: Daily Life
Diabetes travel checklist Medications Syringes Alcohol swabs Extra prescriptions Snacks in case of low sugar Medical identification Blood glucose meter with supplies Insurance information
Social Implications: Daily Life
Emotions Consider journaling Share thoughts with family and close
friends Put mistakes aside and keep moving
forward
Source: Penn State Diabetes Playbook
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