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Type 2 Diabetes Mellitus

All About Type 2 Diabetes: Science of Obesity, Brandman University
by

Karl Kurtz

on 28 April 2014

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Transcript of Type 2 Diabetes Mellitus

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I love to read... vampires now
APA Style BABY!

INTRODUCTION

In this presentation, I will be covering a variety of issues in and around the subject of Type 2 Diabetes. They include:
Definition
Symptoms
Hemoglobin & the A1C
Risk Factors
Exams & Tests
Demographical Statistics
Long-term effects
Related Conditions
Medications
Treatments/ Therapies
Lifestyle Changes
Food Pyramid for Diabetics
Interventions


Science of
O
Diabetes Mellitus 2
BESITY
Karl Kurtz
De-fin-i-tion
The World Health Organization states
that Diabetes is : "...Diabetes is a chronic disease
that occurs either when the pancreas does not produce enough insulin or when the body cannot effectively use the insulin it produces..." 1
The American Diabetes Association advises that early detection is KEY!
Thus, Type 2 Diabetes, formally known as Non-Insulin Dependent Diabetes, is a condition that begins in your Endocrine System which causes the blood sugar in your body to not be used or metabolized as it should, resulting in problems with many other systems of your body.
Frequent urination
Often feeling very thirsty
Increased appetite
Extreme tiredness
Blurry vision
Slow healing cuts & bruises
Symptoms of neuropathy: Tingling, pain, or numbness in the hands/feet

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This is what happens when Diabetics don't take care of their feet and doctors don't check at EVERY appointment!
So, when we eat, it doesn't matter if it's "sugar free", as long as there are carbs it will turn to sugar or glucose which has caloric value. Anything with caloric value can be burned as energy!
*Glucose, dextrose, etc = SUGAR

So, the sugar goes into the bloodstream which passes through to blood vessels through a process called OSMOSIS... and it sits there waiting for the soldiers to come along and move it and use it. Remember: Move it or Lose it!

The pancreas, which is a big factory for Insulin, makes it...

And so Insulin, which is the hormone created by the Pancreas to move it, marches into the bloodstream. But because of Diabetes it's not able to actually move it by itself.

So the Glucose, unless it's moved by the Insulin sits and just stays in your blood stream trying to get to your cells so they can have energy to move. This is why you feel tired when your sugar is too HIGH!

The solution??? If you go out and exercise, it stimulates the Glucose to move into the cells and then your blood glucose level reduces!
IT'S ALL ABOUT THE A1C
HbA1C= Hemoglobin Type A
A= Adult Type
A1C= specific component of hemoglobin that Glucose sticks to in the blood stream...
Which is how we can measure it, because it sticks to that part of the blood and therefore becomes measurable.
Every three months you are supposed to have labs drawn in order to see what your average A1C is. Hemoglobin's lifespan is 3 months and that's why it's every 3 months.
Your number is read, as we said before by
how much glucose sticks to the Hemoglobin.
The higher the number, worse off. The lower your number the more you are controlling your blood sugar sitting in your blood vessels and keeping your diabetes from progressing quickly and not having the symptoms we saw above. It also means
better doctor visits.
TESTS!!!
Other than the 4x a year A1C test, it's very important that you have some others done.
OR the "Glycated Hemoglobin Test"
IT IS VERY IMPORTANT:
that you monitor your blood sugar! If you are handling your diabetes well with diet and exercise it's not necessary to constantly prick your finger. That is, if your A1C is in the low range of 7 or below. If it's not, then you need to test more often to make sure your levels are in good range.
In order to test yourself, it's good practice to clean the finger you're going to use. Use the lancet on the lowest setting possible to pierce the skin and get a decent drop of blood. Place the test strip in the glucose reader, it should automatically activate. Prick your finger with the lancet and get the drop on the test strip. In just a few seconds it will show a number. Before you eat, it should be in range of 70-130 mg/dl* or if after meals (1-2 hrs) 180mg/dl or less. If it is 400 mg/dl* above, please go to the ER! It's too high! If you keep it in the 70-135 range your A1C should be in good range. If not, it's time to revise your plan. 3
* mg/ dl = milligram/ deciliter
RISK FACTORS
You might be a diabetic if:
If you're overweight- The more adipose tissue you carry around, the less likely your insulin will work right.
If you're an Apple versus any other body type- Carrying a "beer belly" or having most of your fat in the trunk of your body increases your risk.
If you're a couch potato- Sitting and not being active increases because you keep fat instead of lose it, You don't burn that sugar and your sensitivity to insulin increases.
If you have other family members that are too!
If you happen to have a certain racial background.
If you're an old fart- the closer you are to 45 and older increases that chance, too.
If you have Pre-diabetes or Hyperglycemia- having increased blood sugar all the time.
If you had Gestational Diabetes or gave birth to a WHOPPER- if you had diabetes when pregnant or delivered a baby 9# or greater also puts you at risk.
Resources:
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The STATS

25.6 M adults over 20y.o. are diabetic
10.9 M seniors are diabetic
13 M men and 12.6 M women have diabetes

DEMOGRAPHICS
As you can see by the color key on the maps, diabetes is much more prevalent in the Southern regions of the country.
And in the world area, you can see on the world level, Mexico, Northern Africa, Middle East are the highest, with the US, India, Brazil, Russia, Chile and other countries on the next highest level.
7.1% of non-Hispanic whites
8.4% of Asian Americans
12.6% of non-Hispanic blacks
11.8% of Hispanics

Among Hispanics rates were:

7.6% for Cubans
13.3% for Mexican Americans
13.8% for Puerto Ricans.


As the statistics show, African Americans, American Indians and Hispanics have the highest percentage of Diabetes. Notice how much lower the Asian population is. Perhaps we have something to learn from them.
Youth & Type 2 Diabetes
What are we feeding our children?
What are they learning from us?

Diabetes is no longer an adult only condition. It is now an epidemic running rampant.
Why is there more prevalence of Type 2 Diabetes in children?
Dr. Jon Oden, Children's Medical Center of Dallas
It's Complicated...
Diabetes doesn't just go away or stand still. The more that you avoid being proactive and taking care of yourself, the more that it reeks havoc on your body...

The long-term effects can be devastating, excruciating, debilitating and very much life changing...

Let's take a look at the complications.
Long- Term Complications and Effects
According to the American Diabetes Association, and the Mayo Clinic, complications include:
Heart Disease
Blood vessel deterioration
Stroke
Neuropathy
Hypertension
Kidney Disease
Erectile Dysfunction
Gastroparesis
Eye Damage/ Blindness
Amputation
Foot damage
Osteoporosis
Skin & Mouth problems
Alzheimer's Disease
Hearing loss
Ketoacidosis
Cardiovascular Issues
The American Heart Association states that Diabetics are at risk 2-4 times more of getting and/or dying from a heart related disease, such as heart attack or angina, or chest pain because the heart muscle dies or is not working properly.
Diabetics are at a higher risk for things like Atherosclerosis, the narrowing of the blood vessels.
Stroke or Cerebral Accidents, occur when the blood vessel in your brain becomes blocked and that portion of the brain dies resulting in immobility of parts of your body.The AHA also tells us Diabetics are at an elevated risk of 2-4x more likely to have a stroke.
Neuropathy is a term used to describe nerve damage which results in tingling, loss of feeling in your hands and feet. This occurs in Diabetic patients frequently.
Kidney disease occurs because of poor circulation. Kidney dialysis is, unfortunately, a reality for many diabetics.
Nerve and Kidney Disease
Hypertension, also known as High Blood Pressure, is caused when the Kidneys are not functioning correctly and because of this poor circulation, it puts more pressure on the heart to perform, revving up your blood pressure to pump blood. Sixty-seven percent of adult diabetics are Hypertensive.
ED & Foot Issues
Erectile Dysfunction, E.D., is a disorder affecting men because of loss of circulation making it difficult for sex. Though it is a more sensitive issue, it affects Diabetic men and their partners physically and emotionally.
Limb amputation hits Diabetics hard. 60% of the patients who have "non-trauma related" amputations are Diabetic. These usually occur because of lack of circulation, and not taking care of festering sores and cuts.
Foot problems occur because of lack of circulation, which leads to neuropathy and when sores and cuts happen, Diabetics can't feel them, they become infected and then a part of your foot has to be removed.
Skin Issues & Osteoporosis
Cellulitis, fungal infections, Gingivitis may not be a big thing to you, but for Diabetics, infections become big because they are so much harder to fight and heal. So, brush, floss, use Neosporin and move on!
Osteoporosis apparently has become a big issue for Diabetics because of minerals in the bones being lower. Take Calcium and drink Milk.
Hearing loss has also become a problem for Diabetics as well.
"Type 2 diabetes may increase the risk of Alzheimer's disease and vascular dementia. The poorer your blood sugar control, the greater the risk appears to be. So what connects the two conditions? One theory is that cardiovascular problems caused by diabetes could contribute to dementia by blocking blood flow to the brain or causing strokes. Other possibilities are that too much insulin in the blood leads to brain-damaging inflammation, or lack of insulin in the brain deprives brain cells of glucose. "
Ketoacidosis, Gastroparesis & Retinopathy
Gastroparesis is a condition where the food you ingest does not move due to muscle weakness and problems with the Pyloric Valve, the part that connects the Stomach and opening of the Small Intestine. When food finally moves through, sugars are absorbed into the blood at that point and it can heighten blood sugar causing problems. This can occur because Neuropathy issues more specifically with the Vegas nerve, which stimulates stomach muscle movement, hinders the muscles from contracting and moving the food.
Ketones are acids made in the Kidneys due to a lack of Insulin. They build up in the bloodstream as a signal of getting sick or that you're not managing your Diabetes. Your breath smells like Polish Remover, hence the picture of the Nail Polish Remover.
Treatments & Therapy
There are a myriad of medications to choose to treat Type 2 Diabetes...
The different classes are ;
Sulfonylureas- stimulate beta cells to make Pancreas release Insulin

Biguanides- lowers blood glucose levels by decreasing Insulin released

Meglitinides-also stimulates beta cells to release Insulin

Thiazolidinediones-increases Insulin useage in muscle and fat; reduce glucose production in Liver

DPP-4 inhibitors-assists in improving A1C w/o causing Hypoglycemia

SGLT2 Inhibitors-reabsorbs glucose into bloodstream

Alpha-glucosidase inhibitors-blocks breakdown of starches in the intestine, so no glucose released

Bile Acid Sequestrants-reduces cholesterol and reduces blood sugar levels in Diabetics
Examples of Medication
Sulfonylureas: Amaryl, Diabeta, Diabinese, glipizide, Glucotrol Glyburide, Glynase, Minodiab, Tolinase

Biguanides: Metformin, Riomet

Meglitinides: Prandin, Starlix

Thiazolidinediones: Actos, Avandia, Oseni

DPP-4 inhibitors: Januvia, Juvisync, Nesina, Onglyza,Tradjenta

SGLT2 Inhibitors: Farxiga, Invokana, Empagliflozin

Alpha-glucosidase inhibitors: Glyset, Precose

Combination Drugs: PrandiMet, ACTOPlus Met, Glucovance, Metaglip, Duetact

Natural/ Homeopathic Remedies
Even though research doesn't support it very much, there are actually a number of natural foods, herbs & spices. As we discussed toward the beginning of the presentation, the Asian population, particularly the Asian-American population have a much lower incidence of Diabetes, you have to wonder what they're doing. Well, as I have been dealing with my own battle with Type 2 Diabetes, I have asked! -in grocery stores, in drug stores, in natural food stores and on the internet.
Alternative Treatments
Acupuncture- The placement of small needles into pressure points in the body are sometimes used as treatment of Neuropathy and tingling side effects of nerve damage caused by Diabetes.
Dietery Supplements
Chromium

Magnesium

Zinc

Valadium

CoQ10
Interventions/ Preventions
Lifestyle Changes
Stem Cell Treatment- Researchers have found that it's possible to help Type 2 Diabetes using a transplant of Bone Marrow Cells.
When blood sugar rises too much, it causes damage to blood vessels as discussed previously. Because it effects the blood vessels all over the body, the eyes are no exception. The deterioration results in clots, fill with fluid, thicken and even become so enlarged that they become closed off, It causes major vision problems such as internal bleeding known as hemorrhaging, edema and even blindness.
Cinnamon- spice that increases metabolism of sugar and stimulates Insulin

Ginseng- Chinese herb that specifically Korean and Panax, helps naturally reduce blood sugar levels by almost half

Aloe Vera- succulent plant with certain compounds within help lower glucose levels

Bitter Melon- Chinese vegetable known in Eastern World to lower glucose and Insulin levels; do not combine with antidiabetic mediation because it will cause hypoglycemia

Fenugreek- Middle Eastern plant which helps increase fiber and therefore lowers glucose

Ginger- rhizome & spice that is scientificly proven to move glucose from blood to cells

Bilberry- berry high in flavenoids that have a number of benefits for reducing effects of Diabetes like making blood vessels stronger, lessening chances of retinopathy and lowering blood sugar levels

Mulberry- flavenoid berry that also decreases glucose in blood stream

Clove Oil- spice that decreases blood glucose levels and assists in the function of Insulin

Nopal- cactus fruit that may help reduce risk of diabetes by lowering blood sugar
- uses a form of Niacin, Nictotinic acid, to make glucose move from the bloodstream into cells to be used for energy.
- keeping levels good helps decrease effects of Diabetes and makes it easier to control blood sugar
- helps regulate blood sugar levels
- assists in making the cells make the energy they need for normal function
- assists in producing Insulin and keeping it because Diabetics tend to have low levels of Zinc
It's always difficult to change old habits especially when it comes to food & diet.
Exercise at least 30-45 min daily
Reduce fats
Eat fried foods and
pasta Sparingly!
Test frequently
Have yearly physicals

Make appointments to have your feet and eyes checked

Lose weight

Daily exercise vigorously minimum 30-45 min

Monitor your sugar

Make a plan with small goals

Complications - American Diabetes Association®. (n.d.). American Diabetes Association. Retrieved April 26, 2014, from http://www.diabetes.org/living-with-diabetes/complications/?loc=symptoms#sthash.GGOL3cE1.dpuf
Diabetes. (n.d.). WHO. Retrieved April 26, 2014, from http://www.who.int/topics/diabetes_mellitus/en/
Checking Your Blood Glucose - American Diabetes Association®. (n.d.). American Diabetes Association. Retrieved April 26, 2014, from http://www.diabetes.org/living-with-diabetes/treatment-and-care/blood-glucose-control/checking-your-blood-glucose.html
Type 2 diabetes. (n.d.). Risk factors. Retrieved April 26, 2014, from http://www.mayoclinic.org/diseases-conditions/type-2-diabetes/basics/risk-factors/con-20031902
Statistics About Diabetes - American Diabetes Association®. (n.d.). American Diabetes Association. Retrieved April 27, 2014, from http://www.diabetes.org/diabetes-basics/statistics/
Type 2 diabetes. (n.d.). Complications. Retrieved April 27, 2014, from http://www.mayoclinic.org/diseases-conditions/type-2-diabetes/basics/complications/con-20031902
What Are My Options? - American Diabetes Association®. (n.d.). American Diabetes Association. Retrieved April 27, 2014, from http://www.diabetes.org/living-with-diabetes/treatment-and-care/medication/oral-medications/what-are-my-options.html#sthash.8ug6zP1T.dpuf
Type 2 Diabetes Natural Remedies: Chromium, CoQ10, Acupuncture, and More. (n.d.). WebMD. Retrieved April 27, 2014, from http://www.webmd.com/diabetes/guide/natural-remedies-type-2-diabetes
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