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Diabetes: What Everyone Needs to Know! Rose M. Flinchum, MSEd., MS, RN, Clinical Nurse Specialist...
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Diabetes: What Everyone Needs to Know!
Rose M. Flinchum, MSEd., MS, RN,Clinical Nurse Specialist – Board
CertifiedCertified Diabetes Educator
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What is Diabetes?
A condition in which the body cannot make or cannot use insulin properly
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Fasting BS Random BS
Under 100
100 - 125
Under 140
Diabetes
Pre - Diabetes
No Diabetes
140 – 200
126 and above
Over 200WithSymptoms
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Types of Diabetes Mellitus
Type 1
Type 2 Prediabetes
Impaired Fasting Glucose Impaired Glucose Tolerance
Gestational DM
Other
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Risk Factors Type 2 DM
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More Risk Factors
Overweight (Abdominal) Over 45 years old Sedentary Lifestyle Non-White Race Family History of DB Family History of High
BP History of High BP (self) High Cholesterol History of Gestational DB Delivered a baby > 9 lbs.
Goals: Women < 35Men < 40
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What Happens in Type 2 DM
Liver puts too much sugar into the blood
Muscle cells and other tissues areresistant to insulin
Pancreas can’t make enough insulin
Stomach empties 50%faster than normal
Type 2
Diabetes
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Signs / Symptoms of Type 2 Diabetes
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Additional Symptoms
Frequent Urination
Thirst Appetite Changes Blurred Vision Tiredness;
Sleepiness Weight Changes Headaches
Skin Infections Slow Healing Yeast Infections Urinary Infections Dry Skin; Itching Numbness; Tingling Feeling / Acting
“Evil” High Blood Pressure Cholesterol Problems
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Insulin Resistance
Acanthosis Acanthosis
NigricansNigricans
Skin Tags
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Polycystic Ovarian Syndrome
Fertility problems Acne Hair loss Facial Hair Weight problems Deadly triangle
High Blood Pressure
High Cholesterol High Blood Sugar
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Metabolic Syndrome Definition
“A Clustering of Multiple
Cardiometabolic Risk Factors”
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Criteria ATP III(AHA/ NHLB)
WHO AACE IDF
Abdominal Obesity
M > 102 cmW > 88 cm
BMI > 30 orW : H Ratio M > 0.9 W> 0.85
BMI > 25 *M > 94 cm*W > 80 cmor BMI > 30 + 2 others
Triglycerides > 150 mg/dl
same same Same or on meds
HDL M < 40 W < 50
M < 35W < 39
M < 40W < 50
M < 40 (or on W < 50 meds)
Blood Pressure
> 130/85 or on meds
> 140/90or on meds
> 130/85 > 130/85 or on meds
Fasting Glucose
> 100 mg/dl or on meds
T2 DM, IFG or IGT * +2 others
Btw. 110 – 126 mg/dl
> 100 or T2DM
Other Urinary Albumin Excretion Rate > 20 or alb:creatine ratio > 30
2 hr PP > 140; PCOS; family hx; other
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90% of T2DM: IR and MS
Adapted from International Diabetes Center (IDC), Minneapolis, Minnesota.
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Increases in Diabetes
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Estimated prevalence: Nearly 24 million
Nearly 8% of the U.S. population Almost 25% of persons over age 60 90 - 95% have type 2
25% do not know they have it! 57 million have pre-diabetes 24% have Metabolic Syndrome Projected 44-68% increase in diabetes by
2015 8% per year
Diabetes in the United States
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NOT an Equal Opportunity Disease!
Among those diagnosed… 16.5% of Native Americans/Alaskan Natives 11.8% of Black Americans 10.4% of Latinos*
12.6% of Puerto Ricans 11.9% of Mexicans 8.2% of Cubans
7.5% Asian Americans 6.6% Caucasians Lifetime DM risk (born after 2000)
33% men; 39% women; 50% Hispanic women
Diabetes in the United States
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Diabetes
+Obesity=Diabesity
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Obesity and Diabetes 1:3 Americans are obese 1:5 Americans are morbidly obese 80% of all Type 2 diabetics are
overweight Obesity in children has doubled in 20 years Type 2 diabetes in children has tripled in the last 5 years
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Children and Type 2 Diabetes
Mean age: 12-14 years old
Girls > Boys Overweight 94% are in
minority groups 74-100% have a
strong family history
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Overweight Kids Become Overweight Adults 50% of overweight
children become overweight adults
26-41% overweight preschool children will become overweight adults
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What about our children? In a study done involving 111
children, 57% were obese, 12% were super-obese
In families of children who were obese ~ the caregiver thought the child’s weight was a problem in only 44% of the cases
Young-Hayman, D. et al Obesity Research 2000:8:241-8
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Saturday Morning Influence
61% of all commercials
are for FOOD
90% are for sugared cereals, candy
bars, fast food, and chips
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INDIANA Diabetes Obesity
State ranking for prevalence (2008)
Adults: Ranked 38th
Diabetes in Indiana is above the national average:
National Average: 8.0% Indiana Average: 8.5%
State ranking for prevalence (2008)
Ranked 31st
Adults in Indiana (2006)
27.5 % obese 35% overweight
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Diabetes…
…we have pills and insulin to control it, so what is the big
deal?
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Costs of Diabetes in the U.S.
$174 billion each year
$116 billion in direct medical costs
$58 billion in indirect costs
Missed work Lost productivity 1 in 10 healthcare
dollars spend on diabetes/complications
Human costs 7th leading cause of
death
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Type 2 DM is ProgressiveType 2 DM is Progressive
Relative function(units)
0
100
200
300
-10 -5 0 5 10 15 20 25 30
Years of Diabetes
Insulin resistance
Normal insulin levelBeta cell failure
At risk for diabetes
Adopted from D. Kendall, R. Bergenstal © International Diabetes Center
Glucose(mg/DL)
50
150
250
350
Fasting glucose
Post-meal glucose
-10 -5 0 5 10 15 20 25 30
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Health Impact of Diabetes in the United States
Diabetes
National Diabetes Fact Sheet, United States, November 2003.Available at http:;;www.cdc.gov/diabetes/pubs/factsheet.htm.
6th leading cause of death
73% of adults have HTN and/or take meds
Heart disease is theleading cause of death
Leading cause ofkidney failure
Leading causeof adult blindness
Neuropathy in 60-70% of patients contributes to high incidence of lower-limb amputation
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0
0.05
0.1
0.15
0.2
0.25
Even
t ra
te
Months6 9 153 18 2112 24
Diabetes/CVD
Diabetes Increases Death Rate
www.hypertensiononline.orgMalmberg K, et al. Circulation. 2000;102:1014-1019.
Organization to Assess Strategies for Ischemic Syndromes
No Diabetes/CVD
Diabetes/No CVD
No Diabetes/No CVD
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40
15 13 1310
4 5
0
10
20
30
40
50
Perc
en
t of
death
s
Geiss LS, et al. In: Diabetes in America. National Institutes of Health;1995.
Causes of Death in Diabetes
Isch
emic
heart
disea
se
Oth
er h
eart
dise
ase
Diabe
tes
Canc
er
Stro
ke
Pneu
mon
ia/
influe
nza
All
other
www.hypertensiononline.org
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Diabetes Management Receives a Failing Report Card…
Beaton, S.et al. Diabetes Care 27: 694-698, 2004
Indicator of Diabetes Mgmt
Percent of Patients at Goal
A1C 37%NHANES III 1988-1994 7.8%NHANES 1999-2000 8.1%
LDL Cholesterol 23%
Systolic BP 41%
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Now the Good News: Diabetes Can Be Prevented Diabetes Prevention Program
N= 3,234 people with IGT Ages 25-85 (mean 51) Average BMI 34 45% minorities
Goals Achieve/maintain weight loss of 7% Maintain moderate physical activity at
least 150 minutes/week
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Preventing Diabetes--or Living Healthy with
It!
Lifestyle Changes Healthy Eating Regular Exercise Healthy Weight
Weight Loss (7% of weight)
Medications Weight Loss Surgery
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Healthy Eating
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Reading Food Labels
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Plate MethodFill ½ of the plate with non-starchy vegetables
Add a servingof a protein food
Choose a carbserving
Don’t forget the dairy!
Finish with a fruit
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210
320
450
610
0
100
200
300
400
500
600
700
1960 1978 1995 1999
Year
Ca
lori
es
The Supersizing PhenomenonPortion Control - It Does Matter!
77G
68G
57G
26 Grams Carbs
10G Fat
22G
26G 29G
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Activity and Exercise
30 minutes of moderate activity on most days of the week
This does NOT
Count!
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Inactivity and DiabetesInactivity and Diabetes
What’s wrong with this picture?
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Healthy Weight
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Height Normal
BMI=<25
Overweight
BMI=25-29
Obese
BMI=30-39
Extreme Obesity BMI=>40
5 ft 0 in Up to 127 Up to 152 Up to 203 Over 203 5 ft 1 in Up to 131 Up to 157 Up to 210 Over 210
5 ft 2 in Up to 135 Up to 163 Up to 217 Over 217 5 ft 3 in Up to 140 Up to 168 Up to 224 Over 224
5 ft 4 in Up to 144 Up to 173 Up to 231 Over 231
5 ft 5 in Up to 149 Up to 179 Up to 239 Over 239
5 ft 6 in Up to 154 Up to 185 Up to 246 Over 246 5 ft 7 in Up to 158 Up to 190 Up to 254 Over 254
5 ft 8 in Up to 163 Up to 196 Up to 261 Over 261
5 ft 9 in Up to 168 Up to 202 Up to 269 Over 269
5 ft 10 in Up to 173 Up to 208 Up to 277 Over 277 5 ft 11 in Up to 178 Up to 214 Up to 285 Over 285
6 ft 0 in Up to 183 Up to 220 Up to 293 Over 293
6 ft 1 in Up to 188 Up to 226 Up to 301 Over 301
6 ft 2 in Up to 193 Up to 232 Up to 310 Over 310 6 ft 3 in Up to 199 Up to 239 Up to 318 Over 318
6 ft 4 in Up to 204 Up to 245 Up to 327 Over 327
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Medications Prevention of Diabetes
Metformin (Glucophage) Controlling Diabetes
Pills, Insulin, and other Injectables Weight Loss
Orlistat (Alli- OTC) Meridia Others
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“Diabetes Surgery” Lab-Band (1 year)
64% of patients showed resolution 26% of patients showed
improvement
Roux-en-Y Gastric Bypass 76.8% of patients showed
resolution - other studies showed 83% - 98%
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Surgical Outcomes:Comorbidities
Comorbidity Resolved Improved or Resolved
Diabetes 76.8% 86.0%
Hyperlipidemia
70%
Hypertension 61.7% 78.5%
Sleep Apnea 85.7%
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”The distance is nothing; it is only the first step that is difficult.”