Diabetes
C. Vassell Shettlewood
Diabetes
Prevalence of Diabetes: 25.8 million adults
in the US – 8.3%. UK rates are around 3.5-
5.0%
Metabolic Syndrome: Risk factors related
to obesity.
Type I: Beta cells produce little or no
insulin.
Type II: Fat, Liver, and muscle cells do not
respond to insulin (insulin resistance)
Gestational Diabetes: High sugars in Preg.
Pathophysiology of Diabetes
When you eat, your body
breaks food down into
glucose. Glucose is a
type of sugar that is
your body’s
main source
of energy.
6
Pathophysiology of Diabetes
As blood glucose
rises, the body
sends a signal to
the pancreas, which
releases insulin.
7
Pathophysiology of Diabetes
Acting as a key, insulin
binds to a place on the
cell wall (an insulin
receptor), unlocking
the cell so glucose can
pass into it. There,
most of the glucose is
used for energy right
away.
7
Blood glucose regulation
Blood glucose
goes up and down
throughout the
day:
As your blood
glucose rises
(after a meal), the
pancreas releases
insulin.
8
Type 2 diabetes
Your pancreas may not
produce enough insulin
(insulin deficiency).
Your cells don’t use
insulin properly.
The insulin can’t
fully “unlock” the
cells to allow
glucose to enter
13 (insulin resistance).
Natural History of Diabetes
Natural History of Type 2 Diabetes
Obesity IGT* Diabetes Uncontrolled
Hyperglycemia
Post-Meal
Glucose
Plasma
Glucose
Fasting Glucose
120 (mg/dL)
Relative -Cell Insulin Resistance
Function
100 (%)
Insulin Secretion
-20 -10 0 10 20 30
Years of Diabetes
*IGT = impaired glucose
tolerance.
Diagnosing diabetes
Fasting plasma glucose test
(FPG) results
diabetes 126 mg/dL or greater
pre-diabetes 125 mg/dL to 100 mg/dL
normal less than 100 mg/dL
28
Risk factors for type 2 diabetes
Type 2 is more common in people who:
Are overweight.
Are 45 or older.
Are physically inactive.
Have a parent or sibling with type 2
diabetes.
Are African American, Native American,
Hispanic American, or Pacific Islander.
Have abnormal cholesterol levels.
Have had gestational diabetes, or given
birth to a baby greater than 9 lbs.
14 Have high blood pressure.
Hyperglycemia Can Cause
Serious Long-Term Problems
Blood Glucose Targets for
Adults
Pre-meal or
fasting: 80-120
2 hours post-meal:
80-140
Bedtime: 80-140
or 100-140
When & How Often
Should I Be Testing?
On insulin: 4
times per day.
Not on insulin:
2 times per day.
Hypoglycemic Symptoms
How to care for yourself when
you’re hypoglycemic
Eat or drink 15 grams of fast-acting,
low-fat carbohydrate right away.
Quick energy sources
The following items are quick energy sources that contain about
15 grams of carbohydrate:
½ cup fruit of orange, apple, or grapefruit juice
1/3 cup grape, prune, or cranberry juice
2 tbsp raisins
6 crackers
3-5 pieces hard candy
1 cup skim milk
1 piece bread
3-4 glucose tablets, or 1 tube glucose gel
96
½ cup regular soft drink (not diet)
11 jellybeans
Introduction to self-management
Key pieces of diabetes self-management:
Following a
Monitoring meal plan
blood glucose
Getting regular
Taking exercise
medication
34
Good News About Physical
Activity
Exercise is boring.
Vary your routine and
don’t be afraid to try
something new.
Participate in things
you like to do.
Exercise with a friend
Use music or books on
tape to make the time
pass more quickly.
Tips for Safe Physical Activity
Long-Term Complications
Hyperglycemia Can Cause
Serious Long-Term Problems
Diabetes-CVD Facts
Nearly all adults with diabetes have
one or more cholesterol problems, such
as:
– high triglycerides
– low HDL (“good”) cholesterol
– high LDL (“bad”) cholesterol
4
ABC’s
A – A1c, or hemoglobin A1c test.
ADA goal is 7% or less.
AACE goal is 6.5% or less.
B – Blood pressure
< 130/80 mmHg for non-pregnant adults.
C – Cholesterol
HDL (good) cholesterol – >40 mg/dl (men); >50 mg/dl
(women)
LDL (bad) cholesterol – <100 mg/dl
Triglycerides – <150 mg/dl
Good News for Type 1
Diabetes
Good News for Type 2
Diabetes
Take Steps to Reduce Risk
Factors for Heart Disease
Aspirin Therapy
Recommended dose:
81-325 mg /day
Should not be used in
people with: Aspirin
allergies, a history of
gastric bleeding,
clotting disorders, or
people already taking a
blood-thinning agent.
Diabetes Can Lead to Nerve
and Small Blood Vessel
Damage
Getting regular medical care
Schedule for routine medical care
HbA1c 2-4 times/year
Blood pressure At least 2 times/year
Cholesterol At least every other year
Dilated eye exam 1 time/year
Foot exam At least 1 time/year
Dental exam 2 times/year
Urine microalbumin/ 1 time/year
creatinine ratio
Flu shot 1 time/year
76 Pneumococcal vaccine Once (repeat at age 65)
Scheme for Lowering Glucose
in Type II
Find Diabetes Educators in
Your Area
