TYPE 2 DIABETES – THE #1 PREVENTABLE CHRONIC DISEASE!

Dorothy D. Zeviar

17 April 2009

WHAT IS TYPE 2 DIABETES?

• The inability of insulin to act to get glucose into the cells– Sometimes called “insulin resistance”– Causes hyperglycemia – too much glucose in the

bloodstream and not enough in the cell • “Lock and key mechanism”

WHAT HAPPENS IN TYPE 2 DIABETES?

• Cells require glucose (sugar) and oxygen to survive– Cellular respiration– C6H12O6 + 6O2 6CO2 + 6H2O + 38 ATP

• Cells receive both from the bloodstream

• When insufficient glucose is available to the cells, the liver tries to compensate by releasing glucagon (a counter-regulatory hormone).

• When this is insufficient, the body compensates thru lipolysis and proteolysis (attempting to get its energy requirements thru breakdown of fats and proteins).

WHAT HAPPENS, con’t.

• Hyperglycemia in the bloodstream fluid and electrolytes imbalances osmotic diuresis – Polyuria dehydration and loss of electrolytes – Polydipsia cell starvation – Polyphagia starvation mode – Lipolysis fatty acids Kussmaul breathing/fruity breath – Metabolic acidosis– Hyperviscosity of blood – HTN – Hypoperfusion – Kidney and cardiac insufficiencies, etc – Neuropathies– Necrosis amputations– Erectile dysfunction

WHAT HAPPENS, con’t

WHAT HAPPENS IN VASCULATURE?

• Microvasculature– Sugar “scars” the epithelium, making it more porous – Large pores and structural changes in basement membrane– Chronic ischemia due to lack of oxygen exchange – Tissue hypoxia skin ulcers – Tissue hypoxia necrosis amputations– Retinopathy blindness– Neuropathy permanent loss of fx

• Macrovasculature– Tissue hypoxia coronary heart disease, CVA, PVD– Tissue “scarring” platelet agglutination clots/occlusion – AS, MI left ventricular dysfx, heart failure– Hyperglycemia albuminuria nephron occlusion Kidney failure

RISK FACTOR CORRELATES OF DIABETES

• Highly correlated with HTN, obesity, sedentary lifestyles, poor nutrition/poor glucose control

• HTN > 140/90 mm Hg• BMI > 25 • LDL > 130 mg/dl • HDL < 40 mm/dl• Triglycerides > 250 mg/dl• History of frequent yeast infections• History of poor/slow wound healing• Increased risk for infection • Poor oral hygiene

EPIDEMIOLOGY OF TYPE 2 DIABETES

• Seventh leading cause of death in US• 17 million people or 6+% of population• 6 million people are undiagnosed with diabetes• Prevalence same for men and women• Incidence higher among African-Americans, Native

Americans and Hispanic-Americans• 20% of healthcare dollars is spent

on people w/ diabetes• 88 million disability days• 176,000 cases of permanent

disability -- $7.5 billion!

LABS AND DIABETES

• Blood glucose values dx Diabetes• Fasting blood glucose --

two separate test results > 126 mg/dL

• Oral glucose tolerance test --blood glucose > 200 mg/dL after 120 mins

• Glycoselated hemoglobin assay -- HbA1c -- “sugar-coated” RBCs long-term glycemic control > 8%

• Ketoneuria ketoacidosis• Proteinuria kidney failure

MEDICATIONS AND DIABETES

• Oral therapy

– Sulfonylurea agents stimulate remaining beta cells insulin risk of hypoglycemia

– Caution w/ warfarin, beta-blockers, Ca+ channel blockers, H2

antagonists, MAO inhibitors, NSAIDS, tetracycline, anti-fungals, steroids, thiazide diuretics, Lasix, estrogen, thyroxine

– Biguanides (metformin) decrease cellular resistance, so no risk of hypoglycemia

• Insulin

– Short-acting (Humulin R), intermediate-acting (NPH, Humulin N), Lente (Humulin L), Long-acting (Humulin U, glargine)

– Basal insulin levels = 40-50U daily; maintained by pancreas secretions

KEY TEACHING POINTS FOR DIABETES

• Controlling glycemic levels • Hypoglycemia• Diet • Exercise• Foot care

THE END IS THE BEGINNING!