Diabetes

1. Diabetes

2. Diabetes Prevalence in U.S., 1994 (CDC)

3. Diabetes Prevalence in U.S., 1995 (CDC)

4. Diabetes Prevalence in U.S., 1996 (CDC)

5. Diabetes Prevalence in U.S., 1997 (CDC)

6. Diabetes Prevalence in U.S., 1998 (CDC)

7. Diabetes Prevalence in U.S., 1999 (CDC)

8. Diabetes Prevalence in U.S., 2000 (CDC)

9. Diabetes Prevalence in U.S., 2001 (CDC)

10. Diabetes Prevalence in U.S., 2002 (CDC)

11. Diabetes Prevalence in U.S., 2003 (CDC)

12. Diabetes Prevalence in U.S., 2004 (CDC)

13. Diabetes Prevalence in U.S., 2004, county-wide (CDC)

14. Diabetes Prevalence in U.S., 2005 (CDC)

15. Diabetes Prevalence in U.S., 2006 (CDC)

16. Diabetes Prevalence in U.S., 2007 (CDC)

17. Diabetes Prevalence in U.S., 2008 (CDC)

18. Diabetes Prevalence in U.S., 2009 (CDC)

19. Diabetes Prevalence in U.S., 2010 (CDC)

20. Prevalence (continued) • Another view: Millions living with diabetes 1980-2010 (CDC) • Percentage of those living with diabetes, by age, 1980-2010 (CDC) • Ethnicity and sex - diabetes prevalence increased 1980-2010 (CDC) • WA estimates of diagnosed diabetes: percentage of adults (CDC)

21. Diagnosis Changes • Diabetes knowledge has increased in last four decades • Criteria for diabetes have changed (Source: American Diabetes Association) • Criteria change may explain some of the increase seen in the 1990s

22. World Prevalence • Which country has the most diabetes? • Top 10 - International Diabetes Federation • International Diabetes Federation

23. Diabetes • An excess of glucose (sugar) in the blood • Inadequate insulin production • Inefficient insulin use

24. Diabetes Symptoms • Frequent urination • Thirst • Hunger • Weight loss (despite thirst, hunger) • Fatigue • Irritability • Type 2 diabetes may often have no symptoms until later

25. Insulin • Hormone produced by pancreas beta cells (WebMD) • After a meal, blood glucose levels rise • Insulin moves glucose into body’s cells • For use • For storage • Animation (WebMD; click “Anatomy/Function”)

26. Insulin • Insulin released from pancreas • Insulin binds to specific receptors on cells (WebMD; click “Anatomy/Function;” 2nd animation) • 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

27. Types of Diabetes • Type 1 • Type 2 • Latent Autoimmune Diabetes of Adulthood • Others: prediabetes, gestational diabetes

28. Type 1 Diabetes • 5-10% of the 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)

29. Type 1 Diabetes • Cause: Autoimmune response • Antibodies destroy pancreas’ beta cells (WebMD; click “Causes,” select 1st animation) • YouTube animation (4 min) • Genetics, infant diet may be related to susceptibility • The most common form of Type 1 diabetes • Insulin production is halted • Insulin injections required

30. 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

31. 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

32. 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 • Animation (WebMD)

33. Type 2 Diabetes • Video: insulin resistance • YouTube

34. 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

35. Type 2 Diabetes and Ethnicity • Some minority populations at increased risk • Japanese • 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. ClinPediatr (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.

36. 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

37. 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

38. 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)

39. 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)

40. 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

41. 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

42. 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