Overview of Diabetes Management. By Cindy Daversa, M.S.,R.D.,C.D.E. UCI Health

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1 Overview of Diabetes Management By Cindy Daversa, M.S.,R.D.,C.D.E. UCI Health

2 Objectives: Describe the pathophysiology of diabetes. From a multiorgan systems viewpoint. Identify the types of diabetes. Review diabetes treatment goals. Increase awareness of the psychological, and cultural aspects on diabetes management.

3 Diabetes: What is it? Disorder of metabolism with multiple metabolic defects.

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6 Physiology of Insulin Secretion (-) Liver Gut Hepatic Glucose Output Intestinal CHO Absorption Plasma Glucose Basal insulin Pancreas Bolus Insulin

7 How we make Energy: Food (1. carbohydrate) (2. protein) (3. fat) Without Energy, No wound healing No PT No OT No RT Cell death

8 Multiple Metabolic Defects Beta-cell dysfunction adipocyte insulin resistance insulin resistance in peripheral tissues

9 Complications Include: Heart Disease and Stroke Hypertension Blindness and Eye Problems Kidney Disease Nervous System Disease Decubitus, Amputations Dental Disease Depression Overall, the risk for death among people with diabetes is about twice that of people of similar age but without diabetes.

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11 Other causes for Hyperglycemia Genetic defects Cushing disease Cystic fibrosis Prader Willi Downs syndrome Medications Prednisone, anabolic steroids, cortisol Chemicals that destroy beta cells. Infections Rubella Sepsis Stress

12 Prediabetes Defined: Glucose: 101mg-125mg 33% of U.S. adults have Prediabetes Increased risk of developing type 2 Less than 10% of U.S. adults with Prediabetes report that they have ever been told they have it. losing 5% 7% of their body weight can prevent or delay the onset of type 2 diabetes Rec: at least 150 minutes per week of moderate physical activity. Diabetes Care. 2011;32(2): N Engl J Med. 2002;346(6):

13 Types of Diabetes Type 1: Accounts for about 5% of all diagnosed cases of diabetes. Type 1 is usually first diagnosed in children and young adults, although it can occur at any time. Absolute insulin deficiency. Need to inject insulin or infuse via a pump Causes: Can be autoimmune, genetic, or environmental.

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17 LADA: Latent autoimmune Diabetes of adulthood

18 Type 2 DM Type 2 Diabetes: Accounts for 95% of diagnosed diabetes in adults. Still producing insulin, but not enough or Insulin Resistant

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21 Figure 1. The progressive nature of type 2 diabetes: increasing insulin resistance, declining insulin secretion; early postprandial hyperglycemia followed by elevated fasting plasma glucose concentrations.igt, impaired glucose tolerance; T2DM, type 2 diabetes mellitus.adapted from AACE Diabetes Mellitus Clinical Practice Guidelines Task Force. Kruger D F The Diabetes Educator 2012;38:4S-11S Copyright by American Association of Diabetes Educators; Published by SAGE Publications

22 Figure 2. Advancing therapies with stages of T2DM.HOMA, homeostasis model assessment.based on data from UK Prospective Diabetes Study Group. Kruger D F The Diabetes Educator 2012;38:4S-11S Copyright by American Association of Diabetes Educators; Published by SAGE Publications

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24 Diagnosis-GDM: GDM- Gestational diabetes usually diagnosed at weeks. 75g OGTT after overnight fast of at least 8 hours. Diagnosis of GDM if any one value exceeds: Fasting >92mg/dl 1 hour >180mg/dl 2 hour >153mg/dl NIH Publication No February 2011

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26 Diagnostic Criteria Hemoglobin A1c >6.5%

27 A1c >6.5%

28 For Diabetes Treatment algorithms Nutrition &exercise Nutrition, exercise one oral medication Nutrition,exercise and a combination of orals Nutrition, exercise and insulin intensive or in combination

29 Prevalence of Diagnosed Diabetes, U.S. Adults, by Age years 2.6% years 11.7% >65 years 18.9% U.S. Adults Aged >20 Years, by Race and Ethnicity American Indian and Alaska Native 16.1% Asian American 8.4% Hispanic 11.8% Non-Hispanic black 12.6% Non-Hispanic white 7.1% National Diabetes Fact Sheet, 2011.

30 Year: 2013 Incidence of Diagnosed Diabetes

31 World prevalence of diabetes and impaired glucose tolerance*, 2007 and 2025 (ages 20-79) Diabetes prevalence (%) Number of people with diabetes (millions) IGT prevalence (%) Number of people with IGT (millions) *People with impaired glucose tolerance (IGT) have a significant risk of developing type 2 diabetes. Source: IDF Diabetes Atlas 2006

32 AADE Position Statement re: Cultural Sensitivity and Diabetes Education Our patients come to us with health beliefs developed within the context of their respective cultures. To provide quality care, it is crucial to incorporate important aspects of culture into direct patient care and diabetes education programs targeting ethnically diverse populations. Volume 38, Number 1, January/February 2012

33 Results: Negative Perceptions: Insulin kills Insulin scares Insulin is the last resort Insulin itself causes problems and damages the body Perceived Positive A few of them: I feel better Perceived barriers to insulin: Insulin is inconvenient Lack of family support for using insulin Families may not have seen the effectiveness of insulin Cultural beliefs that insulin is toxic and perceptions that it contributes to complications.

34 Lack of knowledge associated with fear TEAM effort Diabetes Education should integrate cultural values and beliefs about diabetes For UCIMC: Use our trays as a teaching tool; portions, composition, timing Discuss each time purpose, timing, type, of DM medication Include family members Dispel their negative perceptions about insulin Never use or discuss insulin as a threat or personal failure. Hu, J., Amirehsani, K., Wallace, D., Letvak, S. The meaning of insulin to Hispanic Immigrants with Type 2 diabetes and their families. The Diabetes Educator. 2012: 38(2):

35 By 2025 over 380 million people will live with diabetes. The challenge presented by the diabetes pandemic is enormous. Jean-Claude Mbanya Vice Dean and Professor of Medicine and Endocrinology, University of Yaoundé, Member of Changing Diabetes Barometer International Advisory Board

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