new dm lecture

4/28/2009 1

•What is Diabetes

•How is it treated

•Side effects and prevention

4/28/2009 2

•There are 21 million people in the U.S. with Diabetes Mellitus

•This represents 6% of the population

•1 million new cases are diagnosed each year

•5 million are undiagnosed

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•Although there are genetic factors, the number one cause of diabetes mellitus is poor diet, leading to obesity which is why exercise and diet control is so important in the management of the disease

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A fasting glucose test is good, but complicated by epinephrine:

-blocks insulin secretion

-stimulates glucagon release

-activates glycogen breakdown

-impairs insulin action via increased hepatic glucose production

Also complicated in the face of:

-illness

-diet

-decreased physical exercise

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•Poor glucose control•Glycation of tissues causing change in cells, with basement membrane thickening and small vessel disease•Neurologic, immunologic and vascular compromise results

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The changes that happen to the tissues causes more than loss of sensation

Changes lead to:

• retinopathy

• nephropathy

• coronary arterial disease and stroke

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Neuropathy–Autonomic

-Dry skin which is easily injured because it is thick, rough, non- pliable

–Motor–Atrophy of muscles with contractures of digits

–Sensory

-Loss of sensation leads to injured skin which is unrecognized

-Wound extending to bone means amputation

-One amputation usually leads to another

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Primary: Type I Diabetes Mellitus

-autoimmune

Type II Diabetes Mellitus

-non-obese

-obese

-maturity onset of the young

Secondary:Pancreatic (β-cell mass loss)

-Hormonal (pheochromocytosis, acromegaly, Cushing's, steroids)

-Drug or chemical induced

-Insulin receptor abnormalities

-Genetic syndromes (lipodystrophy, myotonic dystrophy, ataxia/telangiectasias)

-Other

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Type I (<40 years of age)

-genetically susceptible (HLAD region)

-environmental event (virus)

-insulinitis (action of T- lymphocytes)

-autoimmunity

-β-cell attack (islet cell Ab)

-DM (>90% of β-cells)

Ketoacidosis follows decreased insulin and increased glucagon, leading to osmotic diuresis and dehydration

Type II (>40 years of age)

-abnormal insulin secretion

-resistance to insulin @ target tissues

-both β

and α

cell mass is intact, but α

mass is increased

-insulin levels are normal to high

-rare ketoacidosis, usually lactic acid HHNK (hyperglycemic,

hyperosmolar, non-ketoacidosis) induced coma

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Most oral diabetes medications act to either increase the production of insulin to match caloric intake or increase the effectiveness of the insulin at the target cell via up regulation of receptors

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•Never ignore a red mark, a bruise or blister

•Never ignore an ingrown nail or local trauma

•A ‘little thing’ can become a big thing—with unfortunate results!

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High Pressure Points

Insect or animal bites

Look for:

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Look for hot spots

Good shoes Not good shoes

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•Check feet daily

• Wear shoes at all times

• Shake out shoes before wearing

• Wear proper fitting shoes

• Don’t use hot water on your feet

• Check glucose levels every day

• Visit primary care doctor regularly

• Visit foot care specialist regularly

• Attend diabetic classes

• Avoid complications by living right, eating right, exercising and staying under control

Final Points………

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Thank you!

Office: 5350 South Stapes Street, Suite 100 (New York Life Building),

Corpus Christi, TX 78411

Phone: 361 888 8878

Fax: 361 888 8815