diabetes lecture 6a chapter 19 dudek. glucose circulating in the blood is a source of ready fuel for...

DiabetesDiabetes

Lecture 6a

Chapter 19 Dudek

• Glucose circulating in the blood is a source of ready fuel for body cells.

• The amount of carbohydrate consumed and, to a lesser extent, the type of carbohydrate eaten are the primary determinants of how quickly and how high blood glucose levels rise after eating.

• A rise in postprandial blood glucose levels stimulates the pancreas to secrete insulin.

• Canadian Clinical Practice Guidelines algorithm for diagnosing diabetes- next slide.

Diabetes-direct and indirect costsDiabetes-direct and indirect costs

DiabetesDiabetes

• Diabetes is one of the most costly and burdensome chronic diseases of our time.

• Increasing in epidemic proportions

• The estimated direct and indirect cost associated with diabetes was $ $13.5 billion in 2014 rising to $17 billion by 2024 in Canada.

• Number of diabetes cases are continuing to rise but we could reduce new cases by 50-90 % if the population would eat and exercise properly.

Diabetes—(cont.)Diabetes—(cont.)

• Type 1 diabetes

– Formerly known as insulin-dependent diabetes mellitus

– Characterized by the absence of insulin

– Risk factors for type 1 diabetes may be:

o Autoimmune

o Genetic

o Environmental-e.g. toxins

o Infections-certain viruses

o Dietary components or bodily derivatives thereof-controversial


• Type 1 diabetes—(cont.)

– No known way to prevent type 1 diabetes

– All people with type 1 diabetes require exogenous insulin to control blood glucose levels.

– Most often detected in children, adolescents, and young adults

– Classic symptoms of polyuria, polydipsia, and polyphagia


• Type 2 diabetes

– Occurs most often after the age of 45 years

– Accounts for 90% to 95% of diagnosed cases of diabetes

– A slowly progressive disease that usually begins as a problem of insulin resistance

– Type 2 diabetes is often asymptomatic.

Diabetes—(cont.)Diabetes—(cont.)• Type 2 diabetes—(cont.)

– Insulin resistance is strongly linked to obesity.

– Risk factors for type 2 diabetes

o Age 45 years or older

o Overweight (BMI ≥25 kg/m2) and obese (BMI ≥30 kg/m2)

o Even better than BMI are waist circumferences (≥ 94/80 or 90/80 M/F depending on ethnicity as per Nutr 2108 lab)

o First-degree relative with diabetes

o Physically inactive or exercises fewer than three times per week


• Type 2 diabetes—(cont.)

– Risk factors for type 2 diabetes—(cont.)

o Member of high-risk ethnic group: African Canadian, Latino, Aboriginal, Asian Canadian

o Previously identified with prediabetes such as impaired fasting glucose or impaired glucose tolerance

o History of gestational diabetes or giving birth to a baby weighing more than 9 pounds

o Hypertensive

o HDL-c < 0.9 mmol/L and/or triglyceride level ≥ 2.8 mmol/L

Diabetes—(cont.)Diabetes—(cont.)• Gestational diabetes

– Hyperglycemia that develops during pregnancy

– Risk factors

o A family history of gestational diabetes

o Obesity, being a member of a certain ethnic population (Aboriginals, African Canadians, Asian Canadians)

o A history of giving birth to an infant weighing more than 9 pounds


• Gestational diabetes—(cont.)

– All women are routinely screened between 24 and 28 weeks of gestation.

– women with gestational diabetes are at greater risk of type 2.

– Offspring exposed to gestational diabetes are more likely to get type 2 diabetes compared to those without such exposure

Acute Diabetes ComplicationsAcute Diabetes Complications

• Untreated or poorly controlled diabetes can lead to acute life-threatening complications.

• Conversely, hypoglycemia caused by overuse of medication, too little food, or too much exercise, can also be life threatening.

Acute Diabetes Complications—(cont.)Acute Diabetes Complications—(cont.)

• Diabetic ketoacidosis (DKA)

– People with type 1 diabetes are susceptible to diabetic ketoacidosis (DKA).

– Characterized by hyperglycemia (glucose levels > 13.8 mmol/L) and ketonemia

– Caused by a severe deficiency of insulin or from physiologic stress, such as illness or infection


• Diabetic ketoacidosis (DKA)—(cont.)

– Polyuria may lead to dehydration, electrolyte depletion, and hypotension.

– Hyperventilation occurs in an attempt to correct acidosis by increasing expiration of carbon dioxide.

– Fatigue, nausea, vomiting, and confusion develop.

– Diabetic coma and death are possible.


• Diabetic ketoacidosis (DKA)—(cont.)

– DKA is sometimes the presenting symptom when type 1 diabetes is diagnosed.

– DKA rarely develops in people with type 2 diabetes.

– DKA is treated with electrolytes, fluid, and insulin.

Acute Diabetes Complications—(cont.)Acute Diabetes Complications—(cont.)• Hyperosmolar hyperglycemic nonketotic

syndrome (HHNS)

– Characterized by hyperglycemia (>33.3 mmol/L) without significant ketonemia

– Occurs most commonly in people with type 2 diabetes

– Dehydration and heat exposure increase the risk.

– Illness or infection is usually the precipitating factor.

Acute Diabetes Complications—(cont.)Acute Diabetes Complications—(cont.)• Hyperosmolar hyperglycemic nonketotic syndrome

(HHNS)—(cont.)

– Older people may be particularly vulnerable.

– Develops relatively slowly

– Symptoms-dehydration, hypotension, decreased mental acuity, confusion, seizures and coma

– Best protection against HHNS is regular glucose monitoring.

– Treatment includes insulin and fluid and electrolyte replacement.


• Hypoglycemia

– Blood glucose level less than 4 mmol/L

– Commonly referred to as “insulin reaction”

– Occurs from taking too much insulin, inadequate food intake, delayed or skipped meals, extra physical activity, or consumption of alcohol without food

– Symptoms


• Hypoglycemia symptoms• Early signs and symptoms of diabetic hypoglycemia include:

• Shakiness

• Dizziness

• Sweating

• Hunger

• Irritability or moodiness

• Anxiety or nervousness

• Headache

• Nighttime symptoms

• Diabetic hypoglycemia can also occur while you sleep. Signs and symptoms, which can awaken you, include:

• Damp sheets or bedclothes due to perspiration

• Nightmares

• Tiredness, irritability or confusion upon waking


• Hypoglycemia symptoms

• Severe symptoms

• If diabetic hypoglycemia goes untreated, signs and symptoms of severe hypoglycemia can occur. These include:

• Clumsiness or jerky movements

• Muscle weakness

• Difficulty speaking or slurred speech

• Blurry or double vision

• Drowsiness

• Confusion

• Convulsions or seizures

• Unconsciousness

• Death


• Hypoglycemia—(cont.)

– Mild hypoglycemia is treated with 15 to 20 g of glucose.

o Symptoms normally improve in 10 to 20 minutes.

– Hypoglycemic unawareness

o Consistent monitoring of blood glucose is especially important.

Long-Term ComplicationsLong-Term Complications

• Retinopathy

• Nephropathy

• Neuropathy

• Myocardial infarction

• Stroke

• Peripheral vascular disease

Long-Term Complications—(cont.)Long-Term Complications—(cont.)

• Mild to severe forms of nervous system damage

• Impaired wound healing

• Periodontal disease

• Pregnancy complications

• Increased susceptibility to other illnesses

diabetes lecture 6a chapter 19 dudek. glucose circulating in the blood is a source of ready fuel for...

Documents