Scientific Principles of Health and Disease
Scientific Principles of Health and Disease HES 1823
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Date Created: 10/26/15
Diabetes M ellitus x 9 v x v HES 1823 I Scientific Principles of Health and Disease Learning Objectives Define diabetes Know the characteristics of each type of diabetes Know what type of diabetes is most common in what population Understand how insulin action is related to diabetes Know general signs and symptoms Understand diagnostic testscriteria Learning Objectives Understand risk factors Understand complications associated with diabetes Understand how kidney disease can develop with diabetes Know the meaning of hyperglycemia Understand the relationship between exercise and uptake of blood glucose Know how long the effects of one exercise session can last Know the exercise training response Understand the precautions that must be taken when a diabetic exercises What is Diabetes Diabetes mellitus diabetes is a disease in which the body does not produce or properly use insulin Characterized by chronic hyperglycemia high blood sugar Hyperglycemia causes vascular and neurological problems Disturbances of carbohydrate protein amp fat metabolism What is Diabetes Diabetes can be classified as An ENDOCRINE disease Because it involves a gland the pancreas and a hormone insulin A METABOLIC disease Because it interferes with protein fat and carbohydrate metabolism A VASCULAR disease Because hyperglycemia damages blood vessels Type I Diabetes is an AUTOIMMUNE disease Immune system attacksdestroyed pancreatic cells Insulin is the Key Diabetes is related to the hormone insulin Insulin is secreted by the pancreas after people eat in response to sugar s presence in the bloodstream lnsulin s role is to stimulate the uptake of glucosesugar by the cells Beta 3 cells are the cells in the pancreas that secrete insulin Normal Insulin Function 1015 minutes after secretion any insulin that is not bound to cells are degraded mainly in the liver Insulin is counterregulated by Catecholamines epinephrine and norepinephrine GH Glucagon Cortisol WHEN quotI a 5mm exams w 81155299 1mm mgm Genswam 3 M39 I ktogevfa ao Q 9 13690696 139 lb 1 9 o 6 o e 53 a mmm 6mm EEIEMIGF l F mIg L ummmpmm Gmiu m man 397 Why is Diabetes on the Rise The CDC considers diabetes to be at epidemic levels for three reasons Increased sedentary lifestyle increase in obesity Increased highrisk ethic populations in the US Increasing age of the population R ate per mm Anew U44 4554 6574 75 Adults 65 and over account for 38 of diabetics Types of Diabetes Type I 510 of cases Immune system destroys pancreatic beta cells only cells in the body that make insulin Usually begins in childhood or adolescence Type ll90 95 of cases Insulin resistancelinsulin receptors sensitivity and glucose utilization at cellular level 9 4 then eventually in insulin production by pancreas burnout Usually gt age 40 but now also among children and teens Linked to obesity and physical inactivity Gestational Occurs during pregnancy 25 of pregnancies 20 to 50 women with gestational diabetes develop type II diabetes within 510 years Type Diabetes Immune mediated autoimmune disease Formerly juvenile diabetes Onset usually before age 30 510 of total cases 1020 of cases in Caucasians In children Rapid onset may be life threatening from diabetic ketoacidosis Adult onset More gradual onset process Pancveas 1 nggghzgpngn s 7 IQOMQHIEW Type 7 39 Diabetes quot 39 l v 39 quot39 ff i a if A I af tmnx A i e caucus quot limeor nalnsulln 39 Type II Diabetes NIDDM noninsulin dependent diabetes mellitus Usually onsets after age 40 May have asymptomatic Hyperglycemia for many years Obesity hyperinsulinemia insulin resistance are characteristic Able to produce insulin but the body does not respond to it appropriately Eventually pancreas can t produce enough insulin to meet needs requiring treatment with insulin process Pancveas Type II Diabetes fun 6 if Stomach Pancveas Type II Diabetes Associated with abnormalities of insulin action due to abnormalities of Intracellular glucose disposal most common Insulin receptor function Insulin structure Insulin secretion abnormalities due to Abnormal signaling Enzyme mutations Partial destruction of Bcells Unknown pathogenesis Gestational Diabetes Most often diagnosed during the 2nol trimester More common in obese mothers Higher risk if mother has previously delivered a large birthweight gt9 lbs baby Usually disappears after delivery but increases mother s risk of type II diabetes 50 develop diabetes within 10 years Signs amp Symptoms Type I Acute ketoacidosis Type II Asymptomatic initially Fa gue Energy deficiency catabolic state Blurred vision Increased hunger Sores that do not heal decreased wound healing Hyperglycemia l urine production Dehydration dry mucous membranes poor skin turgor 4 thirst Ketoacidosis Ketoacidosis occurs when the body is producing high levels of ketone bodies via the metabolism of fatty acids and insufficient insulin to slow this production The excess ketone bodies can significantly acidify the blood The presence of high blood sugar levels hyperglycemia caused by the lack of insulin can lead to further acidity in the blood In healthy individuals this normally does not occur because the pancreas produces insulin in response to rising ketoneblood sugar levels Diagnosis Fasting plasma glucose testFPG measure blood glucose after fast 2 8 hours Normal 5 99 mgdL Prediabetic 100125 mgdL Diabetic 2 126 mgdL confirmed by repeat test on another day Oral glucose tolerance testOGTTmeasure blood glucose after fast 2 8 hours 2 hours after drinking a glucosecontaining beverage Normal 5 139 mgdL Prediabetic 140199 mgdL Diabetic 2 200 mgdL confirmed by repeat test on another day Random plasma glucose testmeasure blood glucose without regard to when you ate your last meal 2 200 mgdL confirmed by repeat test on another day Impaired Glucose Tolerance IGT and Impaired Fasting Glucose IFG IGT and IFG prediabetic reversible conditions IGT blood sugar level is elevated but is not high enough to be classified as diabetes 140199 mgdL 9 2hour OGTT lFGfasting blood sugar level is elevated but is not high enough to be classified as diabetes 110125 mgdL after an overnight fast Among US adults 4074 years of age 16 million 156 have IGT and 10 million 97 have IFG T2DM Nonmodifiable Risk Factors Age over 45 years old Family history 9 parent or sibling History of gestational diabetes Birth to at least 1 baby of gt 9 lbs birth weight History of hypertension gt 14090 mmHg History of obesity African American HispanicLatino Asian American or Pacific Islander or Native America T2DM LifestyleRisk Factors Overweight or obese particularly visceral fat deposition Physical inactivity active lt 3wk Abnormal lipid levels LDLC gt 160 mgdL Triglycerides 2 250 mgdL HDLC s 35 mgdL Smoking Current Type II Diabetics Currem STkag PHyswca ract rvity Overwewght Dbeswty Hypenenswonquot ngh B ood Cm esiero O 10 20 so 40 SO 50 7O 8 90 100 Percent We Complications of Diabetes Associated complications of diabetes are categorized as acute and chronic Acute complications are related to high and low blood sugar levels Chronic complications are generally more serious and are related to the comorbidities that accompany diabetes Hyperglycemia Occurs when diabetes is uncontrolled 4glucose in the blood Eventually leads to serious complications organ damage Treatment includes monitoring blood glucose levels and taking medication to lower blood glucose Chronic Complications of Diabetes Chronically high blood sugar levels can affect the cardiovascular and nervous systems Macrovascular large vessel disease Coronary artery disease Ml Microvascular small vessel disease Affects kidneys and eyes Neuropathy Involves the peripheral and autonomic nervous system 7 Ereas39evi 39 urinaqu lmpa red extremities Nerve damage peripheral neuropalhy Chronic Complications of Diabetes Eye disease and blindness In 2005 21 of adults with diabetes reported visual impairment Diabetics are 40 more likely to develop glaucoma 60 more likely to develop cataracts Leading cause of new cases of blindness among adults aged 2074 years old Eye Complications A Retinopathy Kidney Disease High levels of blood sugar make the kidneys work harder Increase amount of blood filtered This is hard on the kidneys Kidney Disease When kidney disease is caught late end stage renal disease ESRD usually follows Kidneys eventually fail A person with ESRD needs to have a transplant or to have the blood filtered by dialysis 38000 develop kidney failure each year Diabetes is the leading cause of treated end stage renal disease 9 43 of new cases Nervous System Complications Peripheral Neuropathy Typically begins in the legs Tingling Weakness Burning sensations Loss of sensitivity to warmth or cold Numbness if the nerves are damaged enough you may be unaware that a blister or minor wound has become infected Nervous System Complications Autonomic Neuropathy Indigestion Vomiting diarrhea or constipation Incontinence Sexual difficulties Dizziness or faintness Loss of the typical warning signs of a heart attack Loss of the warning signs of low blood glucose Increased or decreased sweating Changes in how your eyes react to light and dark Nervous System Complications Focal neuropathy A nerve or a group of nerves is affected causing sudden weakness or pain Double vision Paralysis on one side of the face Bell39s palsy Pain in the front of the thigh or other parts of the body Complications of Diabetes Amputation 82000 people have diabetesrelated leg and foot amputations each year gt 60 of nontraumatic lowerlimb amputations in US The rate of amputation for people with diabetes is 10 times higher than for people without diabetes Other Complications Poor circulation blood flow can impair immune system function and wound heaHng Blood vessels of the foot and leg may narrow and harden Foot ulcers More susceptible to bacterial and fungal infections Complications of Diabetes Cardiovascular disease Leading cause of diabetesrelated deaths 9 65 Diabetics with CHD or stroke Death rates 24 X higher Dental disease Periodontal or gum diseases 9 2X higher in young adults with diabetes 13 of diabetics have severe periodontal diseases Complications of Diabetes Pregnancy complications Poor control before and during lst trimester 1520 spontaneous abortions or stillbirths 510 severe congenital malformations Poor control in 2 damp 3rd trimester Excessively large babies Ineed for cesarean sections Complications of Diabetes Flu and pneumoniarelated deaths 1030K die of complications from flu or pneumonia 3X greater than for people without diabetes Biochemical imbalances Coma More susceptible to other illnesses and worse prognoses than people without diabetes Treatment There is no cure for diabetes It must be managed with Exercise Nutrition Self blood glucose monitoring Self management education Medication Exercise Muscle contraction allows glucose to be taken up by the muscle without insulin Lowers blood glucose levels regardless of insulin abnormalities Acute response to exercise Decreased blood glucose Increased insulin sensitivity Exercise Effect lasts less than 72 hours Frequent 3 times per week exercise is necessary Chronic exercise training response Increased insulin sensitivity Less insulin to have same biological effect Increase number of insulin receptors Insulin does not decrease as much during exercise Exercise Risks for Diabetics Acute hypoglycemic response Most often occurs during unusually long or strenuous exercise Important to understand the relationship of exercise to Time when medications were taken Pre and post exercise nutrition Last blood glucose assessment Nutrition The development of atherosclerosis in type II diabetes has traditionally led to the recommendation of a lowfat high carbohydrate diet High fiber low sugar carbohydrate sources However the data to support this recommendation is mixed at best Effect of Dietary Carbohydrate on the Metabolism of Patients with Noninsulin Dependent Diabetes Mellitus Gerald M Haavsn MD Plasma Glucose mgd Time hrs Figure 5 Mean SEM plasma glucose concen trations in patients wnh NIDDM beiore and after meals containing variable proportions of complex and snmple carbohydrates