Diabetes: What

Everyone Needs to
Know!
Rose M. Flinchum, MSEd., MS, RN,
Clinical Nurse Specialist Board
Certified
Certified Diabetes Educator

What is Diabetes?

A condition in
which the body
cannot make or
cannot use insulin
properly

Fasting BS
BS
126 and
above

100 - 125

Under 100

Diabetes

Pre - Diabetes

No Diabetes

Random
Over 200
With
Symptoms

140 200

Under 140

Types of Diabetes
Mellitus

Type 1

Type 2

Prediabetes

Impaired Fasting Glucose

Impaired Glucose Tolerance

Gestational DM

Other

Risk Factors Type 2 DM

More Risk Factors

Goals:
Women < 35
Men < 40

Overweight (Abdominal)
Over 45 years old
Sedentary Lifestyle
Non-White Race
Family History of DB
Family History of High BP
History of High BP (self)
High Cholesterol
History of Gestational DB
Delivered a baby > 9 lbs.

What Happens in Type 2

DM
Pancreas cant make
enough insulin

Stomach empties 50
faster than normal

Type 2

Liver puts
too
much sugar
into the
blood

Diabete
s

Muscle cells and

other tissues are
resistant to
insulin

Signs / Symptoms of
Type 2 Diabetes

Additional Symptoms

Frequent
Urination
Thirst
Appetite Changes
Blurred Vision
Tiredness;
Sleepiness
Weight Changes
Headaches

Skin Infections
Slow Healing
Yeast Infections
Urinary Infections
Dry Skin; Itching
Numbness; Tingling
Feeling / Acting
Evil
High Blood Pressure
Cholesterol Problems

Insulin Resistance

Skin Tags

Acanthosis

Polycystic Ovarian
Syndrome

Fertility problems
Acne
Hair loss
Facial Hair
Weight problems
Deadly triangle

High Blood
Pressure
High Cholesterol
High Blood Sugar

Metabolic Syndrome
Definition

A Clustering of
Multiple
Cardiometabolic
Risk Factors

Criteria

ATP III
(AHA/
NHLB)

WHO

AACE

IDF

M > 102 cm BMI > 30 or

W > 88 cm
W : H Ratio
M > 0.9
W> 0.85

BMI > 25

*M > 94 cm
*W > 80 cm
or BMI > 30
+ 2 others

Triglycerides

> 150
mg/dl

same

same

Same or on
meds

HDL

M < 40
W < 50

M < 35
W < 39

M < 40
W < 50

M < 40 (or on
W < 50 meds)

Blood
Pressure

> 130/85
> 140/90
or on meds or on meds

> 130/85

> 130/85 or
on meds

Fasting
Glucose

> 100
T2 DM, IFG or
mg/dl
IGT *
or on meds +2 others

Btw. 110
126 mg/dl

> 100 or
T2DM

Abdominal
Obesity

Other

Urinary Albumin
Excretion Rate
> 20 or
alb:creatine
ratio > 30

2 hr PP >
140; PCOS;
family hx;
other

90% of T2DM: IR and MS

Adapted from International Diabetes Center (IDC), Minneapolis, Minnesota.

Increases in Diabetes

Diabetes in the United

States

Estimated prevalence: Nearly 24

million

Nearly 8% of the U.S. population

Almost 25% of persons over age 60

90 - 95% have type 2

25% do not know they have it!

57 million have pre-diabetes

24% have Metabolic Syndrome

Projected 44-68% increase in diabetes by 2015

8% per year

Diabetes in the United

States

NOT an Equal Opportunity Disease!

Among those diagnosed

16.5% of Native Americans/Alaskan Natives

11.8% of Black Americans

10.4% of Latinos*

12.6% of Puerto Ricans

11.9% of Mexicans

8.2% of Cubans

7.5% Asian Americans

6.6% Caucasians

Lifetime DM risk (born after 2000)

33% men; 39% women; 50% Hispanic women

Diabetes

+
Obesity

Obesity and Diabetes

1:3 Americans are obese

1:5 Americans are morbidly obese
80% of all Type 2 diabetics are
overweight
Obesity in children has
doubled in 20 years
Type 2 diabetes in
children has tripled
in the last 5 years

Children and Type 2

Diabetes

Mean age: 12-14

years old
Girls > Boys
Overweight
94% are in minority
groups
74-100% have a
strong family
history

Overweight Kids Become

Overweight Adults

50% of overweight
children become
overweight adults

26-41% overweight
preschool children
will become
overweight adults

What about our

children?

In a study done involving 111

children, 57% were obese, 12%
were super-obese

In families of children who were

obese ~ the caregiver thought the
childs weight was a problem in
only 44% of the cases

Young-Hayman, D. et al Obesity Research 2000:8:241-8

Saturday Morning
Influence
61% of all
commercials
are for FOOD
90% are for sugared
cereals, candy
bars,
fast food,
and chips

INDIANA
Diabetes
Obesity

State ranking for

prevalence (2008)

Adults: Ranked 38th

Diabetes in Indiana is
above the national
average:
National Average:
8.0%
Indiana Average:
8.5%

State ranking for

prevalence (2008)

Ranked 31st

Adults in Indiana
(2006)

27.5 % obese
35% overweight

Diabetes

we

have pills and insulin to

control it, so what is the big
deal?

Costs of Diabetes in the

U.S.

$174 billion each

year

$116 billion in direct

medical costs
$58 billion in indirect
costs

Missed work
Lost productivity
1 in 10 healthcare
dollars spend on
diabetes/complication
s

Human costs

Type 2 DM is Progressive
Post-meal glucose

350
250

Glucose
(mg/DL) 150

Fasting glucose

50
-10

-5

10

300

Relative 200
function
(units) 100
0

15

20

25

30

Insulin resistance

Normal insulin level

At risk for
diabetes
-10

-5

Beta cell failure

0

10

15

20

25

30

Years of Diabetes
AdoptedfromD.Kendall,R.BergenstalInternationalDiabetesCenter

Health Impact of
Diabetes
in
the
United
6 leading cause of death
States
th

73% of adults have

HTN and/or take meds

Leading cause of
kidney failure

Diabetes
Leading cause
of adult blindness

Heart disease is the

leading cause of
death

Neuropathy in 60-70% of patients contributes

to high incidence of lower-limb amputation
National Diabetes Fact Sheet, United States, November 2003.
Available at http:;;www.cdc.gov/diabetes/pubs/factsheet.htm.

Diabetes Increases Death

Rate

Event rate

0.25
0.2
Diabetes/CVD
Diabetes/No CVD

0.15

No Diabetes/CVD

0.1

No Diabetes/No CVD

0.05
0

12

15

18

21

24 Months

Organization to Assess Strategies for Ischemic Syndromes

Malmberg K, et al. Circulation. 2000;102:1014-1019.

www.hypertensiononline.org

Causes of Death in Diabetes

50

40

30
15

20

13

13

10

10

O
th
er
di he
se a
as rt
e

ic e
m s
e
h sea
c
Is di
rt
a
he

Geiss LS, et al. In: Diabetes in America.

National Institutes of Health;1995.

ia
D

es
t
be

an
C

r
e
c

Pn
eu
in mo
flu n
en ia/
za
Al
lo
th
er

0
St
ro
ke

Percent of deaths

40

www.hypertensiononline.org

Diabetes Management
Receives
a Failing Percent
Report
Card
Indicator of
of Patients
Diabetes Mgmt
A1C

at Goal
37%
NHANES III 1988-1994
NHANES
1999-2000

LDL Cholesterol

23%

Systolic BP

41%

7.8%
8.1%

Beaton, S.et al. Diabetes Care 27: 694-698, 2004

Now the Good News:

Diabetes Can Be
Diabetes Prevention Program
Prevented
N= 3,234 people with IGT

Ages 25-85 (mean 51)

Average BMI 34
45% minorities

Goals

Achieve/maintain weight loss of 7%

Maintain moderate physical activity at
least 150 minutes/week

Preventing Diabetes
--or Living Healthy with
Lifestyle Changes
It!

Healthy Eating
Regular Exercise
Healthy Weight

Weight Loss (7% of weight)

Medications
Weight Loss Surgery

Healthy Eating

Reading Food Labels

Plate Method
Fill of the plate with non-starchy vegetables

Finish with
a fruit
Choose a carb
serving

Dont forget
the dairy!
Add a serving
of a protein food

The Supersizing
700Phenomenon
77G
610
68G
600Portion Control
- It Does
26G

29G

Calories

22G

10G Fat

57G

Grams Carbs

320

Matter!

500
400
300

26

450

210

200
100
0
1960

1978

1995

Year

1999

Activity and Exercise

30 minutes of moderate
activity on most days of the
week

This does
NOT
Count!

Inactivity and Diabetes

Whats wrong with this picture?

Healthy Weight

Medications

Prevention of Diabetes

Controlling Diabetes

Metformin (Glucophage)
Pills, Insulin, and other Injectables

Weight Loss

Orlistat (Alli- OTC)

Meridia
Others

Diabetes Surgery

Lab-Band (1 year)

64% of patients showed resolution

26% of patients showed
improvement

Roux-en-Y Gastric Bypass

76.8% of patients showed resolution

- other studies showed 83% - 98%

Surgical Outcomes:
Comorbidities
Comorbidity

Resolved

Improved or
Resolved

Diabetes

76.8%

86.0%

Hyperlipidemi
a

70%

Hypertension

61.7%

Sleep Apnea

85.7%

78.5%

The distance is nothing; it is only the first step that is difficult.