Download Diabetes

Judith E. Brown
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Diabetes Now
Unit 13
Prof. Albia Dugger • Miami-Dade College
The Diabetes Epidemic
• Diabetes
• Disease characterized
by abnormal utilization of
carbohydrates by the
body and elevated blood
glucose levels
• Diabetes epidemic
• 6% of adults worldwide
• 10% of US adults (up
from <1% in 1960)
Three Types of Diabetes
• Three major forms of diabetes
• Type 1 diabetes
• Type 2 diabetes
• Gestational diabetes (diabetes during pregnancy)
• Diagnosed by fasting blood glucose of >126
mg/dl and higher
Key Terms
• Type 1 diabetes mellitus (formerly juvenileonset or insulin-dependent diabetes)
• High blood glucose resulting from destruction of
insulin-producing cells of the pancreas
• Type 2 diabetes mellitus (formerly adultonset or non-insulin-dependent diabetes)
• High blood glucose due to the inability to use
insulin normally, or to produce enough insulin
Diabetes Types 1 and 2
Effects of Insulin
• Insulin is a hormone produced by the
pancreas that helps glucose enter cells
• If glucose can’t get into cells:
• Cells become starved for glucose
• Cell and tissue functions decline, resulting in
elevated triglycerides and blood pressure,
hardening of arteries, chronic inflammation
Key Terms
• Chronic inflammation
• Low-grade inflammation that lasts weeks to years
• Inflammation
• Immune system response to infection or irritation
• Triggers release of biologically-active substances
that promote oxidation and other harmful
reactions
Health Consequences of Diabetes
• Short-term
• Blurred vision, frequent urination, weight loss,
infection, delayed wound healing, extreme hunger
and thirst
• Long-term
• Heart disease, hypertension, nerve damage,
blindness, kidney failure, stroke, amputation
Type 2 Diabetes
• Most likely to occur in
overweight or obese,
inactive people
• Usually develops in
people over 40
Obesity and Type 2 Diabetes
Development of Diabetes
• Years before type 2 diabetes, individuals tend
to develop insulin resistance
• Insulin resistance
• When cell membranes have reduced sensitivity to
insulin, more insulin than normal is required to
transport glucose into cells
• High levels of serum insulin, glucose and
triglycerides, and increased blood pressure
Prediabetes
• Prediabetes
• Condition in which blood glucose levels are
higher than normal but not high enough for
diagnosis of diabetes
• Impaired glucose tolerance (fasting blood glucose
levels 100-126 mg/dL)
• Risk factors include abdominal obesity, inactivity,
and genetic predisposition
Insulin Resistance
• Insulin binds to receptors on cell membranes
and allows glucose to pass into cells
• With insulin resistance, cell membranes
“resist” the effects of insulin
• Pancreas overworks to makes more insulin
• Eventually insulin production slows, blood glucose
rises
Insulin Resistance cont.
• Adverse health effects:
• Use of fat stores as the primary source of energy
increases blood levels of free fatty acids and
triglycerides
• Promotes development of fatty liver disease,
chronic inflammation, hypertension, and plaque
formation in arteries
• Results in many metabolic abnormalities
(metabolic syndrome)
Key Terms
• Fatty liver disease
• Reversible condition characterized by fat
infiltration of liver (10% or more by weight)
• Can produce liver damage and other disorders
• Associated with obesity, diabetes, and excess
alcohol consumption
Key Terms
• Metabolic syndrome (Syndrome X)
• Group of metabolic abnormalities that increase
the risk of heart disease and type 2 diabetes
• Characterized by insulin resistance, abdominal
obesity, high blood pressure and triglyceride
levels, low HDL cholesterol, impaired glucose
tolerance
Metabolic Syndrome
• Symptoms related to metabolic syndrome
•
•
•
•
•
Waist ≥ 40” in males, ≥ 35” in females
Blood pressure ≥130/85 mmHg
Triglycerides ≥150 mg/dL
HDL < 40 mg/dL in males, < 50 mg/dL in women
Fasting blood glucose ≥ 110 mg/dL
• Metabolic syndrome is diagnosed when 3 or
more metabolic abnormalities are identified
Managing Metabolic Syndrome
Managing Type 2 Diabetes
• Weight loss (if overweight)
• 5-10% of body weight
• Regular physical activity
• 150 minutes or more per week
• Dietary management to reduce risk of heart
disease and control blood glucose
Managing Type 2 Diabetes
• Diabetes 2 diet:
• Calorie reduction (if overweight)
• Complex carbohydrates, whole grains, high fiber,
fruits and vegetables, low-fat milk and meats, and
fish
• Unsaturated fats, especially monounsaturated
• Regular meals and snacks
Glycemic Index and Glycemic Load
• Carbohydrate-containing foods have a range
of effects on blood glucose
• Glycemic index (GI)
• Measure of the extent to which blood glucose
level is raised by a 50-gram portion of a
carbohydrate-containing food compared to 50
grams of glucose or white bread
Glycemic Index of Foods
Glycemic Load
• Glycemic load is less confusing than glycemic
index when determining what to eat
• Glycemic load (GL)
• A measure of the extent to which blood glucose
level is raised by a given amount of a
carbohydrate-containing food
• Calculated by multiplying a food’s GI by
carbohydrate content
Sugar Intake and Diabetes
• Total carbohydrate intake and glycemic index,
rather than sugars specifically, are strongly
related to blood glucose levels
• High sugar intake contributes to diabetes by
promoting weight gain, and may have other
effects in people with metabolic syndrome
Preventing Type 2 Diabetes
• People with prediabetes reduced their risk of
type 2 diabetes by:
•
•
•
•
Weight loss (~7% of body weight)
Exercise (150 minutes/week)
Diet rich in whole-grains and fiber
Coffee (1-4 cups/day) and moderate alcohol (1-2
drinks/day)
Type 1 Diabetes
• Type 1 diabetes is an autoimmune disease
that causes insulin deficiency
• Develops when the immune system destroys
insulin-producing beta cells in the pancreas
• Triggered by medications or viral infection in
genetically susceptible people
Key Terms
• Autoimmune disease
• Disease initiated by destruction of body cells by
components of the immune system that
misidentify certain body cells as harmful
• Immune system
• Body tissues that provide protection against
bacteria, viruses, foreign proteins, and other
harmful substances
Managing Type 1 Diabetes
• Diets are designed to match insulin doses to
keep blood glucose within normal ranges
• Carefully planned meals are consumed in
specific amounts at specific times
• Physical activity improves blood glucose
levels and insulin utilization
Insulin and New Technologies
• Type 1 diabetes requires insulin injections
• Amount and type depends on many factors
• Blood glucose levels are measured frequently
to determine the appropriate amount of insulin
injected
New Technology
• Insulin pumps with
continuous glucose
monitors give advance
warning if a problem
develops
Gestational Diabetes
• 5-6% of women develop gestational diabetes
during pregnancy
• Risk depends on age, body weight, ethnicity
• Increases risk of high-birth-weight babies who
have increased risk of diabetes later in life
• Often disappears after delivery
• Increased risk of type 2 diabetes later
Hypoglycemia
• Hypoglycemia
• Disorder resulting from abnormally low blood
glucose levels
• Caused by excess insulin in blood
• Symptoms include irritability, nervousness,
weakness, sweating, and hunger
Diabetes in the Future
• By 2030, cases of type 2 diabetes related to
overweight and obesity are expected to more
than double in some parts of the world
• Environmental and lifestyle changes could
reduce the risk
Diabetes Projections: 2000 to 2030