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Recognizing the Signs and
Symptoms of Diabetes
Diabetes Mellitus : Increasing Prevalence
of Diagnosed Cases
8,000,000
8
Persons With
Diagnosed Diabetes
(millions)
7
6
5
4
5X increase
3
2
1
0
1958
1963
1968
1979
Year
1984
1989
1994
Diabetes Overview. October 1995 (updated 1996). NIDDK publication NIH 96-1468.
Kenny SJ et al. In: Diabetes in America. 2nd ed. 1995:47-67.
Diabetes Mellitus:
Health Impact of the Disease
6th leading cause
of death
Renal
failure*
Blindnes
s*
Life expectancy
5 to 10 yr
Diabetes
Amputation*
Cardiovascular
disease 2X to
4X
Nerve damage in
60% to 70% of
patients
*Diabetes is the no. 1 cause of renal failure, new cases of blindness, and nontraumatic amputations
Diabetes Statistics. October 1995 (updated 1997). NIDDK publication NIH 96-3926.
Harris MI. In: Diabetes in America. 2nd ed. 1995:1-13.
What is diabetes?
• Diabetes is a disease wherein:
• The body is unable to properly use
and store glucose (a form of sugar).
• Glucose backs up into the bloodstream
— causing your blood glucose or
"sugar" to rise too high
NORMAL
• KUMPLETO ANG
MANGGAGAWA
AT LAHAT AY
NAGTATRABAHO
• LAHAT AY
GUMAGAWA NG
INSULIN
There are two major types
of diabetes
• Type 1 (also called juvenile-onset or
insulin-dependent) diabetes
• The body completely stops producing
any insulin
• The patient must take daily insulin
injections to survive
• It usually develops in children or young
adults
Causes of Diabetes
Peripheral Tissues
(Muscle)
Receptor +
postreceptor defects
Glucose
Insulin
resistance
Liver
Increased glucose
production
Pancreas
Impaired insulin
secretion
Saltiel AR, Olefsky JM. Diabetes. 1996;45:1661-1669.
DIABETES TYPE 1
• KULANG ANG
MANGGAGAWA
(ng insulin)
• KULANG SA
PRODUKSYON
NG INSULIN
There are two major types of diabetes
• Type 2 (also called adult-onset or non
insulin-dependent) diabetes
– The body produces insulin but not
enough to properly convert food into
energy
– usually occurs in people who:
• Are over 40 years old
• Are overweight
• Have a family history of diabetes.
Causes of Diabetes
Peripheral Tissues
(Muscle)
Receptor +
postreceptor defects
Glucose
Insulin
resistance
Liver
Increased glucose
production
Pancreas
Impaired insulin
secretion
Saltiel AR, Olefsky JM. Diabetes. 1996;45:1661-1669.
DIABETES TYPE 2
• KUMPLETO ANG
MANGGAGAWA
PERO HINDI
LAHAT MAY
GINAGAWA (na
insulin)
• AYAW GUMAWA
NG INSULIN
• AYAW
I-PROCESO ANG
INSULIN
Who May Get Diabetes?
• Diabetes can happen to anyone but the
following are more likely to develop
diabetes:
 Those who have close relatives with diabetes
 Those who are over 40 years old
 Overweight people
 Those with an Asian heritage
 Women who develop diabetes while pregnant
(gestational diabetes)
How will we know if
we have diabetes?
• People with diabetes may experience
the following symptoms:
• Being very thirsty
• Having to go to the bathroom very
frequently to urinate
• Unexplained weight loss
• Increased hunger
• People with diabetes may experience
the following symptoms
•
•
•
•
•
•
Blurry vision
Irritability
Tingling or numbness in the hands or feet
Frequent skin, bladder or gum infections
Wounds that don't heal
Extreme unexplained fatigue / tiredness
In some cases, there are no
symptoms!
How is Diabetes Diagnosed?
• All individuals aged 45 years and
above should be tested for
diabetes
– If normal, they should be re-tested
every three years.
Testing should be conducted earlier
and more frequently in the following:
• Overweight people
• Those with a first degree relative who has
diabetes
• Members of a high-risk ethnic population
(African American, Hispanic, Native American,
Asian)
• Women who delivered a baby weighing more
than 9 pounds
Testing should be conducted earlier
and more frequently in the following:
• Women who had gestational diabetes
• Those who have HDL cholesterol levels equal
to or less than 35 mg/dl or triglyceride levels
equal to or greater than 250 mg/dl
• Those who have high blood pressure
• Those who had impaired glucose tolerance or
impaired fasting glucose
How is Diabetes Diagnosed?
• Fasting plasma glucose is above 126 mg/dl
• Diabetes symptoms exist and casual plasma
glucose is equal to or above 200 mg/dl; or
• Plasma glucose is equal to or above 200 mg/dl
during an oral glucose tolerance test.
• Testing should be repeated on a different day
to confirm the diagnosis.
• If a casual plasma glucose equal to 200 mg/dl
or above is detected, the confirming test used
should be a fasting plasma glucose or an oral
glucose tolerance test.
Criteria for the Diagnosis of
Diabetes: 1997 ADA Guidelines
Stage of
Glycemic
Control
Plasma Glucose Level (mg/dL)
Fasting Plasma
Glucose
Normal
<110
IFG
or
IGT
110 – 125
Diabetes*
126
OGTT
(2-hr Postload Glucose)
<140
140 – 199
200
*Third criterion: 200 mg/dL casual plasma glucose (regardless of time since
last meal) plus symptoms of diabetes (polyuria, polydipsia, unexplained
weight loss)
ADA. Diabetes Care.1997;20:1183-1197.
What is Borderline Diabetes?
• Impaired fasting glucose.
• Fasting plasma blood glucose in the
110-125 mg/dl range
• If your blood glucose two hours after the
oral glucose tolerance test is between
140-199 mg/dl
What Should I Eat?
• It's not so much "what" you should eat but
“how much”
 If overweight, lose weight.
 Eating more foods that are broiled and fewer
foods that are fried.
 Cutting back on butter or oil in cooking.
 Eating fish and chicken more often and only lean
cuts of beef and pork
 Eating more meatless meals
• Begin an exercise program,
• exercise will help you use the insulin you produce
to convert the food you eat into energy
• this will help keep your blood sugars lower
Can diabetes be prevented?
• Research suggests that type 2 diabetes risk
can be lowered by as much as 58% through a
program of moderate sustained weight loss
and moderate daily exercise.
• Metformin, a medication used to treat type 2
diabetes, has been shown to lower diabetes
risk by 31%.
What other problems can
diabetes cause?
• Poorly managed diabetes can lead to long-term
complications
•
•
•
•
•
Heart attacks
Strokes (brain attack)
Blindness
Kidney failure
Blood vessel disease that may require
amputation of a limb
• Nerve damage
• Impotence in men
If people keep their blood sugars
as close to normal as possible,
they can reduce their risk of
developing some of these
complications by 50 percent
or more.
Davies MJ. Circulation. 1996;94:2013-2020.
ADA Targets for Glycemic Control and
Recommended Action Levels
• Biochemical Index
FPG (preprandial), mg/dL
Bedtime glucose, mg/dL
HbA1c, %
Goal
Action Suggested
80 - 120
>140
100 - 140
>160
<7
>8
Values are for nonpregnant individuals
ADA. Diabetes Care. 1997;20(suppl 1):S5-S13.
The Philippine College of Physicians wishes to
acknowledge the following for their invaluable
contribution in the preparation of this module
Institute for the Study of Diabetes
Foundation (ISDF)
American Diabetes Association
(ADA)
James Wee, MD, FPCP