Gross Anatomy Endocrine • Gland • Hormone • Blood • Target tissues
What is Diabetes? • Diabetes is a disease in which the body doesn't produce or properly use insulin, a hormone that allows sugar, starches and other food to be converted into energy. • Type 2 diabetes is closely linked to obesity and places people who have the disease at greater risk of cardiovascular disease. • Type 1 diabetes is an autoimmune disorder where B-cells are destroyed by antibodies.
Symptoms • Symptoms such as thirst and frequent urination, complications like heart trouble or signs of excess glucose or sugar in blood and urine tests. From there the doctor can decide, based on these tests and a physical exam, whether someone has diabetes. If a blood test is borderline abnormal, the doctor may want to monitor the person's blood glucose regularly. If a person is overweight, he or she probably will be advised to lose weight. • In type 2 diabetes, the disease can be present while the person feels completely asymptomatic.
How Common is Diabetes? • About 18.2 million people in the United States -- 6.3% of the population -- have diabetes. • Incidence is increasing due to obesity. It’s type 2 that is a major health issue in America. • 1.3 million new cases diagnosed annually. The disease kills more than 200,000 Americans every year, making it the sixth leading cause of death in the United States. • Since 1990, obesity has increased by more than 60 percent in the United States.
Who Gets It • Family medical history is a strong indicator for many chronic diseases, including diabetes, stroke, obesity, cancer and heart disease. • Lack of exercise, excess weight often lead to Type 2 diabetes.
Diabetic Retinopathy • Damage to blood vessels in the retina.
Foot Amputations • 1995: doctors perform some 54,000 amputations on diabetics each year because of diabetic ulcers.
Diabetic Kidney Disease • Symptoms occur after extensive damage. • swelling -- usually around the eyes in the mornings; later, general body swelling may result • foamy appearance or excessive frothing of the urine • unintentional weight gain (from fluid accumulation) • swelling of the legs • poor appetite • nausea and vomiting • general ill feeling • fatigue • headache • frequent hiccups • generalized itching
Type 2 Diabetes • Type 2 diabetes, formally known as adult onset diabetes, often develops when people are overweight and inactive. • In the past, the cause of high blood sugar levels in children was type 1 diabetes, which was then known as juvenile diabetes. But today, more and more children and teenagers are being diagnosed with type 2 diabetes.
Insulin and Type 2 Diabetes • There are at least two problems with insulin in type 2 diabetes. • Insulin resistance, when your cells do not respond properly to the insulin signal and blood sugar is not stored or used • Poor insulin secretion, where the cells of the pancreas cannot make enough insulin to overcome the insulin resistance. In type 1 diabetes, there is an autoimmune process that destroys the cells that make insulin, so it's purely a problem with insulin production and secretion.
Diabetes Type 2 in Children • At least part of the rise is due to the presence of insulin resistance in some kids today, probably from obesity and being less active. Some youth don't have the ability to make more insulin to compensate for this resistance, and therefore they develop diabetes. According to a nationwide survey, 15 percent of kids are obese. And there's an even larger population that's at risk of becoming obese or overweight. Where exercise is not always a part of daily life puts a child at risk.
Which Children Should Be Screened? • The American Diabetes Association recommends screening for kids who have a body mass index (BMI) greater than the 85th percentile for their age and sex and who have at least two other risk factors. For these children, testing should be done every two years in children starting at age 10 or earlier if puberty begins sooner. Youth with multiple risk factors (obesity, hypertension, family history, inactive, high LDL, low HDL) and those who have symptoms should be screened.
How to Manage Type 2 Diabetes • In kids who come in very critically ill and with very high blood sugars, you begin with insulin therapy. Once you get the blood sugar under control with insulin, you then begin lifestyle changes and oral medication and try to wean them off the insulin. • With the kids in whom diabetes is found incidentally on a routine physical, or who have a few mild symptoms, we start with just exercise and nutrition if it's safe. Then we continue with lifestyle management and add oral medication as needed. And then, as the disease progresses, we may need to start insulin therapy.
Symptoms in Children • If they notice that the child is drinking more or going to the bathroom more, they should contact their pediatrician. Some kids will complain of blurry vision or vague abdominal pain and females may have yeast infections. In severe cases, nausea, vomiting, abdominal pain, and extreme fatigue or confusion can develop. • Many children don't have these symptoms, so the parents of children with excessive weight gain or something called acanthosis nigricans (a darkening or thickening of the skin in the back of the neck or under the arms, thought to be due to high insulin levels), should contact their pediatrician to see if they should be screened for diabetes.
Pre-diabetes • Pre-diabetes, the period when people at high risk of full-blown diabetes exhibit elevated blood-sugar levels. But they're still capable of processing that glucose -- the energy that fuels the body's cells. • But if those people don't take the necessary steps to bring their blood sugar levels under control, they could eventually succumb to such devastating diabetes-induced complications as heart disease, blindness, kidney failure and amputations. • Some 41 million Americans are estimated to have pre-diabetes.
Diagnosing Pre-diabetes • Pre-diabetes is diagnosed for sugar levels between 100 and 125 mg/dl after 8-hr fast. • Those elevated levels are doing harm to the body even though the person isn't suffering from diabetes. If you look at people whose blood sugars are at that level, you can already find evidence of the damage caused by diabetes. • People with pre-diabetes: 50 percent greater risk of heart attack and stroke. Once they actually have diabetes, their risk of heart disease increases to two to four times that of someone without diabetes. • Blood sugar between 100 and 110 have a 20 percent higher chance of developing diabetes than those whose blood sugar is healthier. Those with blood sugar between 110 and 125 are at 40 percent greater risk. Levels of 126 or above are considered diabetes. • The American Diabetes Association believes the rampant spread of diabetes and its precursors are caused by factors that can be managed by the individual.
Preventing DiabetesType 2 Lose weight by eating less and choosing more nutritious food. Exercise. It’s as simple as that! Read: Diabetes Are You at Risk? Time Dec. 8, 2003