After eating, most food is turned into glucose, the body’s main source of energy. What Happens...

After eating, most food is turned into glucose, the body’s main source of energy.

What Happens When We Eat?

American Diabetes Association

In people without diabetes, glucose stays in a healthy range because

Normal Blood Glucose Control

Insulin is released at the right times and in the right amounts

Insulin helps glucose enter cells

In diabetes, blood glucose builds up for several possible reasons…

High Blood Glucose (Hyperglycemia)

Too little insulin is made

Liver releases too much glucose

Cells can’t use insulin well

Type 1› Pancreas makes

too little or no insulin

Pre-diabetes

Gestational Diabetes

Type 2› Cells do not use

insulin well (insulin resistant)

› Ability for pancreas to make insulin decreases over time

Type 3??

Number of Americans withNumber of Americans withDiagnosed Diabetes, 1980-2009Diagnosed Diabetes, 1980-2009

www.cdc.gov

Currently affects about 25.8 million Americans of all ages.› About 8% of the population (U.S.)

› Estimated 7 million undiagnosed

› Hispanics/Latinos – about 12% diagnosed› African Americans – about 13% diagnosed› Asian Americans – about 8% diagnosed

(Oregon.gov, 2006)

Increased thirst Increased urination Blurry vision Fatigue Weight loss Nausea and vomiting More frequent infections

Know your numbers:› A1C < 7› BP 130/80 or lower› Cholesterol:

LDL: <100 HDL: >40 men; >50

10 important tests:› A1C› BP› Cholesterol› Eye exam› Urine test› Foot exam› Dental exam› Weight› Flu shot› Pneumonia shot

A leading cause of blindness Leading cause of non-accident

amputations Kidney disease Nerve damage (peripheral neuropathy) Heart attack / stroke

Oralmedication

only58%

No medication

Insulin only 12%

Insulin and oral

medication14%

Treatment of DiabetesTreatment of Diabetes

National Diabetes Information Clearinghouse. National Diabetes Statistics, 2011. Available at: http://diabetes.niddk.nih.gov/dm/pubs/statistics/

Estimated to cost more than $174 billion annually.› Direct medical costs = $116 billion› Indirect costs = $58 billion

$1 in every $5 health care dollars spent on caring for someone diagnosed with diabetes

“The best time to plant a tree is 20 years ago. The second best time is now.”

Chinese Proverb

Good news with diabetes prevention› Small steps matter

Active interventions (vs placebo) would:

Cost-Effectiveness of Lifestyle Cost-Effectiveness of Lifestyle Modification or Metformin: DPPModification or Metformin: DPP

Herman WH, et al for the Diabetes Prevention Program Research Group.Ann Intern Med. 2005:142:323-332.

Intensive Lifestyle

Metformin

Delay onset oftype 2 diabetes by

11.1 years 3.4 years

Reduce incidence oftype 2 diabetes by

20% 8%

Increase life expectancy by

0.5 years 0.2 years

Cost per QALY $1,124 $31,286

QALY = Quality Adjusted Life Years

After eating, most food is turned into glucose, the body’s main source of energy. What Happens...

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