diabetes

World Prevalence• Which country has the most diabetes?• Facts and Figures - International Diabetes Federation (2015)• No images; reading: Russia has low rate, but: global growth ra

te is 2.7% per year, but 6+% in Russia (Fiona Clark, Lancet, May 23, 2015)

Diabetes

• An excess of glucose (sugar) in the blood• Inadequate insulin

production• Inefficient insulin use

Diagnosis Criteria Changes• Criteria change may explain some of the increase seen in the 1990s

Year of Reports

Criteria 1979 & 80 1997 & 99 2003

Fasting•Diabetes•Impaired fasting glucose

≥ 140 mg/dl

N/A

≥ 126 mg/dl

110-125 mg/dl

≥ 126 mg/dl

100-125 mg/dl

2-hour Test•Diabetes•Impaired fasting glucose

≥ 200 mg/dl140-199 mg/dl

≥ 200 mg/dl140-199 mg/dl

≥ 200 mg/dl140-199 mg/dl

Diabetes Symptoms

• Frequent urination• Thirst• Hunger• Weight loss (despite thirst,

hunger)• Fatigue• Irritability• Type 2 diabetes may often

have no symptoms until later

Insulin

• Hormone produced by pancreas beta cells

• After a meal, blood glucose levels rise

• Insulin moves glucose into body’s cells• For use

• For storage

• Video (Mechanisms in Medicine, via YouTube, 1:49)

Types of Diabetes• Type 1• Type 2• Latent Autoimmune Diabetes of Adulthood• Others: prediabetes, gestational diabetes• Diabetes video (YouTube, 2:43)

Insulin• Insulin released from pancreas• Insulin binds to specific receptors on cells

• Example:GLUT-4, found inside fat and muscle cells• Insulin binding triggers transporter GLUT-4 to move from inside cell

to cell membrane• GLUT-4 opens up, allowing glucose to move inside

Type 1 Diabetes• 5-10% of the diabetes population• Person with Type 1 has little or no insulin to move glucose into

cells• There may be different causes• Autoimmune – most common• Non-autoimmune: unknown, or idiopathic, causes (genetic, viral,

other) (Diabetes Care, January 2010; volume 33 no. Supplement 1, S62-S69)

Type 1 Diabetes

• Cause: Autoimmune response• The most common cause of Type 1 diabetes• Antibodies destroy pancreas’ beta cells• YouTube animation (4 min)• ClearlyHealth provides an additional video (YouTube, 2:14)• Genetics, infant diet (read) may be related to susceptibility• Various risk factors in infancy (image, diabetesandenvironment)• Caucasians more likely diagnosed; higher rates in Finland than

U.S. (400 x higher than Venezuela, per MayoClinic)• Individuals with other autoimmune disorders may increase risk

for developing immune-mediated diabetes

• Insulin production is halted• Insulin injections required

Type 1 Diabetes

• Cause: Of unknown origin• “Idiopathic diabetes”• Not due to autoimmune response• Chromosomal abnormality possibility• Viral infection possibility• Genetic predisposition may be triggered by environmental factor• Those of Asian, African American and Hispanic descent more

frequently diagnosed**

• Insulin production is halted• Insulin therapy• Oral medication may be used to control condition

**Diabetes Care. Jan 2009; 32(Suppl 1): S62–S67.

Type 2 Diabetes• Most common• Approximately 90% of diabetes cases

• Up to one half unaware they have Type 2• Stereotype: over age of 50 years• Type 2 increasing among youth• Treatments: diet, activity, medication

Type 2 Diabetes

• Inadequate insulin production• Uncontrolled insulin release rate• Reduced insulin sensitivity (also known as insulin

resistance)• A need for more insulin to keep blood glucose stable• Reasons uncertain (Diabetes.co.uk)

• Insulin receptor problems• Reduction in receptor number• Antibodies attaching to receptors, blocking insulin• Video (YouTube)

Type 2 Diabetes

• Video: insulin resistance• YouTube

Type 2 Diabetes Risk Factors• Poor diet (high fat, low fiber, simple carbohydrates)• Physical inactivity• Genetic predisposition & family history• History of gestational diabetes• Age• Obesity

Type 2 Diabetes and Ethnicity

• Some minority populations at increased risk• Japanese (Japanese Americans living in U.S. have higher rates

than Japanese living in Japan (Asian American Diabetes Initiative, Joslin Diabetes Center, 2010)

• Chinese• South African blacks• Native American

• Pimas, Navajos, Aleuts• Native Hawaiian• Latino

. 9 Maskarinec G, et al. Diabetes prevalence and body mass index differ by ethnicity: the multiethnic cohort. Ethnicity & Disease 19(1), 200; link to Kitagawa,T. Owada,M. Urakami,T. Yamauchi,K. Increased incidence of non-insulin dependent diabetes mellitus among Japanese schoolchildren correlates with an increased intake of

animal protein and fat. Clin Pediatr (Phila).1998; 37(2): 111-115Peer N, Steyn K, Lombard C, Lambert EV, Vythilingum B, et al. (2012) Rising Diabetes Prevalence among Urban-Dwelling Black South Africans. PLoS ONE 7(9):

e43336. doi:10.1371/journal.pone.0043336.

Type 2 Diabetes and Ethnicity• Reasons for increased risk are many• Lifestyle factors• Diet• Inactivity• Obesity

• Genetic factors• Thrifty gene controversy• Specific to ethnicity

SHAIKH-LESKO, RINA. "Diabetes' genetic underpinnings can vary based on ethnic background, studies say - Office of Communications & Public Affairs - Stanford University School of Medicine." Stanford University School of Medicine. N.p., n.d. Web. 16 Oct. 2013. <http://med.stanford.edu/ism/2013/may/diabetes_butte.html#sthash.ZbNZFsJ

Latent Autoimmune Diabetes of Adulthood• Per title, impacts adults• Also known as Type 1.5, Latent Type 1, Slow

onset Type 1, Autoimmune diabetes in adults• May be misdiagnosed• Person often normal weight, may lack family history• Onset is slow, with similar blood sugar challenges seen

in Type 2• Like Type 1, an autoimmune response results in

destruction of pancreatic beta cells• Approximately 10% of diabetes populationGebel, Erika, and PhD. "The Other Diabetes: LADA, or Type 1.5 | Diabetes Forecast Magazine." Diabetes Forecast Magazine. N.p., n.d. Web. 16 Oct. 2013.

<http://forecast.diabetes.org/magazine/features/other-diabetes-lada-or-type-15>. Wroblewski M, Gottsäter A, Lindgärde F, Fernlund P, Sundkvist G: Gender, autoantibodies, and obesity in newly diagnosed diabetic patients aged 40–75

years. Diabetes Care21 :250 –255,1998

Diabetes Complications

• Blood vessel damage• Increased CV disease risk• Atherosclerosis• More lipids in bloodstream

• Damage in kidneys affects filtration of waste• Damage in vessels leading to retina

• Nerve damage• Numbness, paralysis• Sores, amputation

• Video (WebMD)

Hyperglycemia & Hypoglycemia• Hyperglycemia• When glucose cannot enter cell, levels in bloodstream

remain elevated• If dysfunctional, pancreas cannot make enough insulin to

move glucose out of blood and into cells• If functional, pancreas releases more insulin• “hyperinsulinemia”

• Hypoglycemia• Too much insulin production• Can occur in those with diabetes (too much insulin, not

enough food)

Diabetes Resources• Support Groups• Little Kids with Insulin Dependent Diabetes - for parents, 10am

Saturdays, every other month beginning January, Seattle Children’s Hospital; Zuraya Aziz: 425-985-9199

• Parents of Kids Experiencing Diabetes - for family of those all-age children with Type I diabetes; email for newsletter: [email protected].

• Pacific Medical Centers (PACMed): adult support groups on various days

• Swedish Hospital & Medical Center: adult diabetes education classes

Diabetes Resources - Support Groups• Northwest Hospital Diabetes Support Group• Second Tuesday of each month, 1-2:30pm• Third Thursday of each month, 7-8:30pm• Diabetes Education Classroom/TCU Dining Room, NW

Hospital• Register by phone, 206-368-1564, or online

• Swedish Diabetes Education Center Group• First Wednesday of each month, 7:30am• First Hill, 206-215-2440

Diabetes Resources• American Diabetes Association: http://www.diabetes.org/• National Diabetes Education Program:

http://www.ndep.nih.gov/• Annual ADA Diabetes Expo• April, Seattle Convention Center

diabetes

Documents

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autoimmune disorders

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