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