www.diabetes.org 1-800-diabetes world kidney day march 11, 2010 dr. joyce m. richey, presenter keck...
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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
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Diabetes -Greek derivation, Diabetes -Greek derivation, to siphon, passing through to siphon, passing through
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What Is Diabetes ??What Is Diabetes ??
INSULIN Glucose (Sugar)Goes where it’s needed for energy!
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Insulin – the “Miracle” Drug
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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
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Diabetes TreatmentDiabetes Treatment
Type I Type I InsulinInsulin
Type IIType II InsulinInsulin
Oral MedicationsOral Medications
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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
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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
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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
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Diabetes and Obesity Diabetes and Obesity EpidemicEpidemic
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Obesity and DiabetesObesity and Diabetes
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Causes of ObesityCauses of Obesity
Lack of physical activity/sedentaryLack of physical activity/sedentaryGeneticsGenetics
Unhealthy eating patternsUnhealthy eating patterns
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““Digging Our Graves”Digging Our Graves”
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Apple or Pear?Apple or Pear?
Android Gynoid
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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
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Obesity is not Restricted to Humans
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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
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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)
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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
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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
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Major ComplicationsMajor Complications
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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
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Kidney FailureKidney Failure
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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
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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
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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
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Kidney DiseaseKidney Disease
Later Signs and SymptomsLater Signs and SymptomsLoss of appetiteLoss of appetiteFeeling coldFeeling coldPoor concentrationPoor concentrationItchy skinItchy skinBruisingBruisingWeight lossWeight lossMuscle crampsMuscle cramps
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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
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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
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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
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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)
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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
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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
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Diabetes Prevention and Diabetes Prevention and TreatmentTreatment
Increase Physical Activity!Increase Physical Activity!
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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
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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)
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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
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Remember the 3 P’s of Remember the 3 P’s of PreventionPrevention
PlanningPlanning
PreparationPreparation
PortionsPortions
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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
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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