1.Introduction to Diabetes 10th Annual Diabetes TrainingOctober 20, 2011SHELDON SMITH, MS, CDE

2. Introduction to Diabetes What is diabetes? Types of diabetes Diabetes statistics Risks for diabetes Diagnosing diabetes Complications of diabetes Diabetes prevention and control 3. What is Diabetes ? When you eat carbohydrates they are digestedand broken down into glucose which goes intoyour blood stream. The pancreas is thensignaled to secrete insulin to transport thisglucose from the blood into the muscle, fat andliver cells for energy and/or storage. In aperson without diabetes, glucose levels staynormal (70-120 mg/dl). Diabetes Mellitus (DM) is a chroniccondition characterized by abnormallyhigh levels of glucose in the blood. High levels of glucose can be caused byeither inadequate insulin production orineffective insulin or both. 4. Types of Diabetes There are three official types of DM: Type 1 Type 2 Gestational Pre-diabetes is not considered a type of diabetes, but is treated nonetheless 5. Type 1 Diabetes Due to an absolute insulin deficiency Previously called Insulin-Dependent DiabetesMellitus (IDDM) or Juvenile-Onset DM Originally diagnosed in children and youth butnow can be diagnosed in adults (Type 1 ) Exogenous insulin must be used for theseindividuals in the form of shots or a pump.Accounts for 5-10% of all diabetes cases 6. Cause for Type 1 Diabetes Genetics?Environment? Viruses? These can trigger an autoimmune response in which the bodys immune system attacks and destroys the insulin producing beta cells of the pancreas. 7. Type 2 Diabetes Due to a combination of ineffective insulinand/or a lack of insulin production Previously called Non-Insulin-Dependent DM(NIDDM) or Adult-Onset DM Historically linked to abdominal adiposity It used to be seen in only adults but is now seen inyouthAccounts for 90-95% of all diabetes cases 8. Cause for Type 2 Diabetes Insulin resistance is the primary culprit The pancreas secretes insulin but this insulin is not100% effective at helping glucose move intomuscle, fat and liver cells The body resists the effect of insulin, andconsequently sugar remains in the blood Now there is a link between abdominal adiposity and inflammation 9. Gestational Diabetes During pregnancy, women can develop insulin resistance Most common among African Americans, Hispanic/LatinoAmericans, and American Indians. It is also more commonamong obese women and women with a family history ofdiabetes. Insulin does not cross the placenta but glucose and othernutrients do. This allows the baby to grow anddevelop but since it is getting more energy thanit needs, the extra energy is stored as fat. 10. Gestational DiabetesAffects about 4% of all pregnant womenSuggested causes: Hormones from the placenta may block the action of the mothers insulin in her body causing insulin resistance The stress of the pregnancy may also cause insulin resistanceGD usually disappears after pregnancyGD increases risk for Type 2 diabeteslater in life 11. Diabetes Facts 2011Diabetes affects 25.8 million people8.3% of the U.S. populationDIAGNOSED: 18.8 million peopleUNDIAGNOSED: 7.0 million peopleNearly 30% of people with diabetes do not know they have it! http://www.cdc.gov/diabetes/pubs/pdf/ndfs_2011.pdf 12. Diabetes: A Growing EpidemicThe prevalence of diagnosed diabetes increased from 0.9% in 1958 to 6.3% in 2008. In 2008, 18.8 million people had diagnosed diabetes, compared to only 1.6 million in 1958. 13. Prevalence of Diabetes by State and Year19952000 2005 14. Diabetes by Age and Sex in US 2007 Age 20 years or older: 25.6 million or 11.3% of allpeople in this age group have diabetes. Age 65 years or older: 10.9 million or 26.9% of allpeople in this age group have diabetes. Men: 13.0 million or 11.8% of all men aged 20 years orolder have diabetes. Women: 12.6 million or 12.8% of all women aged 20years or older have diabetes. 15. Diabetes: A Growing Epidemic - 2010 An estimated 79 million adults have pre-diabetes (borderline DM, IFG, IGT) Alarming rise in incidence of type 2 in children: up to almost 50% of new childhood diabetes cases in some areas "Clinicians need to pay attention not just to the skinny children who are developing obvious type 1 diabetes, but to the overweight children of perhaps two diabetic parents," he said, "and be careful because they may be developing type 2 diabetes even though their age is not in the range that we typically consider for type 2 diabetes." , Dr. David Nathan, Harvard Med School. Among those diagnosed, less than 50% are at recommended control levelshttp://diabetes.niddk.nih.gov/dm/pubs/statistics/index.aspx#Pre-diabetesY20 16. The Diabetes Epidemic in Utah Over 120,000 people in Utah have diagnosed DM 1 out of every 17 adults 6.0 % of the Utah population Add 45,000 Utahns with diabetes who have NOT been diagnosed = 165,000 1 out of every 13 adults 8% of the Utah populationThe Utah Department of Health 2008 17. What Contributes to this Epidemic ??? More people are overweight or obese Growth in minority populations in whom theprevalence and incidence of diabetes areincreasing A growing elderly population 18. Obesity Trends* Among U.S. Adults Behavioral Risk Factor Surveillance System1990, 1998, 2006(*BMI 30, or about 30 lbs. overweight for 54 person) 19981990 2006No Data