Diabetes
Diabetes Prevalence in U.S., 1994
(CDC)
Diabetes Prevalence in U.S., 1995
(CDC)
Diabetes Prevalence in U.S., 1996
(CDC)
Diabetes Prevalence in U.S., 1997
(CDC)
Diabetes Prevalence in U.S., 1998
(CDC)
Diabetes Prevalence in U.S., 1999
(CDC)
Diabetes Prevalence in U.S., 2000
(CDC)
Diabetes Prevalence in U.S., 2001
(CDC)
Diabetes Prevalence in U.S., 2002
(CDC)
Diabetes Prevalence in U.S., 2003
(CDC)
Diabetes Prevalence in U.S., 2004
(CDC)
Diabetes Prevalence in U.S.,
2004, county-wide (CDC)
Diabetes Prevalence in U.S., 2005
(CDC)
Diabetes Prevalence in U.S., 2006
(CDC)
Diabetes Prevalence in U.S., 2007
(CDC)
Diabetes Prevalence in U.S., 2008
(CDC)
Diabetes Prevalence in U.S., 2009
(CDC)
Diabetes Prevalence in U.S., 2010
(CDC)
Prevalence (continued)
• Another view: Millions living with diabetes 19802011 (CDC)
• Percentage of those living with diabetes, by age,
1980-2011 (CDC)
• Ethnicity and sex - diabetes prevalence increased
1980-2011 (CDC)
• State estimates of diagnosed diabetes:
percentage of adults (CDC)
World Prevalence
• Which country has the most diabetes?
• Facts and Figures - International Diabetes Federation
• International Diabetes Federation
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
Fasting
•Diabetes
•Impaired
fasting
glucose
2-hour Test
•Diabetes
•Impaired
fasting
glucose
1979 & 80
1997 & 99
2003
≥ 140 mg/dl
≥ 126 mg/dl
≥ 126 mg/dl
N/A
110-125 mg/dl 100-125 mg/dl
≥ 200 mg/dl
≥ 200 mg/dl
≥ 200 mg/dl
140-199 mg/dl 140-199 mg/dl 140-199 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
• Animation (whfreeman.com; click animation, insulin)
Insulin
• Insulin released from pancreas
• Insulin binds to specific receptors on cells
• Insulin-receptor triggers a transporter to move glucose into the
cell
• 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
Types of Diabetes
•
•
•
•
•
Type 1
Type 2
Latent Autoimmune Diabetes of Adulthood
Others: prediabetes, gestational diabetes
Diabetes video (YouTube)
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) (Krishnamurthy Balasubramanian, et.al., Diabetes Care)
Type 1 Diabetes
• Cause: Autoimmune response
•
•
•
•
•
•
Antibodies destroy pancreas’ beta cells
YouTube animation (4 min)
ClearlyHealth provides an additional video (YouTube)
Genetics, infant diet may be related to susceptibility
The most common cause of Type 1 diabetes
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
• Insulin receptor problems
• Reduction in receptor number
• Antibodies attaching to receptors, blocking insulin
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): 111-115
Peer 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 population
Gebel, 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:
POKED.WA@gmail.com.
• 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