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Recognizing the Signs and Symptoms of Diabetes

Diabetes Mellitus : Increasing Prevalence Diabetes Mellitus : Increasing Prevalence of Diagnosed Casesof Diagnosed Cases

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Diabetes OverviewDiabetes Overview. October 1995 (updated 1996). NIDDK publication NIH 96-1468.. October 1995 (updated 1996). NIDDK publication NIH 96-1468.Kenny SJ et al. In: Kenny SJ et al. In: Diabetes in AmericaDiabetes in America. 2nd ed. 1995:47-67.. 2nd ed. 1995:47-67.

YearYear

88

77

66

55

44

33

22

00

11

19581958 19631963 19681968 19791979 19841984 19891989 19941994

8,000,0008,000,000

5X increase5X increase

Diabetes Mellitus:Health Impact of the Disease

*Diabetes is the*Diabetes is the no. 1 cause of renal failure, new cases of blindness, and nontraumatic amputationsno. 1 cause of renal failure, new cases of blindness, and nontraumatic amputations

DiabetesDiabetesBlindnesBlindness*s*

Renal Renal failure* failure*

Amputation*Amputation*

Life expectancy Life expectancy 55to 10 yrto 10 yr

CardiovascularCardiovasculardisease disease 2X to 2X to

4X4XNerve damage in Nerve damage in

60% to 70% of 60% to 70% of patientspatients

6th leading cause 6th leading cause of death of death

Diabetes StatisticsDiabetes Statistics. October 1995 (updated 1997). NIDDK publication NIH 96-3926. . October 1995 (updated 1997). NIDDK publication NIH 96-3926. Harris MI. In: Harris MI. In: Diabetes in America. Diabetes in America. 2nd ed. 1995:1-13. 2nd ed. 1995:1-13.

What is diabetes?

• Diabetes is a disease wherein:• The body is unable to properly use

and store glucose (a form of sugar). • Glucose backs up into the bloodstream

— causing your blood glucose or "sugar" to rise too high

NORMAL

• KUMPLETO ANG MANGGAGAWA AT LAHAT AY NAGTATRABAHO

• LAHAT AY GUMAGAWA NG INSULIN

There are two major types of diabetes

• Type 1 (also called juvenile-onset or insulin-dependent) diabetes • The body completely stops producing any insulin

• The patient must take daily insulin injections to survive

• It usually develops in children or young adults

Causes of Diabetes

Saltiel AR, Olefsky JM. Saltiel AR, Olefsky JM. DiabetesDiabetes. 1996;45:1661-1669.. 1996;45:1661-1669.

Peripheral TissuesPeripheral Tissues(Muscle)(Muscle)

GlucoseGlucose

LiverLiver

Impaired insulin Impaired insulin secretionsecretion

Increased glucose Increased glucose productionproduction

Receptor +Receptor +postreceptor defectspostreceptor defects

InsulinInsulinresistanceresistance

PancreasPancreas

DIABETES TYPE 1

• KULANG ANG MANGGAGAWA (ng insulin)

• KULANG SA PRODUKSYON NG INSULIN

There are two major types of diabetes

• Type 2 (also called adult-onset or non insulin-dependent) diabetes– The body produces insulin but not

enough to properly convert food into energy

– usually occurs in people who: • Are over 40 years old• Are overweight• Have a family history of diabetes.

Causes of Diabetes

Saltiel AR, Olefsky JM. Saltiel AR, Olefsky JM. DiabetesDiabetes. 1996;45:1661-1669.. 1996;45:1661-1669.

Peripheral TissuesPeripheral Tissues(Muscle)(Muscle)

GlucoseGlucose

LiverLiver

Impaired insulin Impaired insulin secretionsecretion

Increased glucose Increased glucose productionproduction

Receptor +Receptor +postreceptor defectspostreceptor defects

InsulinInsulinresistanceresistance

PancreasPancreas

DIABETES TYPE 2

• KUMPLETO ANG MANGGAGAWA PERO HINDI LAHAT MAY GINAGAWA (na insulin)

• AYAW GUMAWA NG INSULIN

• AYAW I-PROCESO ANG INSULIN

Who May Get Diabetes?

• Diabetes can happen to anyone but the following are more likely to develop diabetes:Those who have close relatives with diabetesThose who are over 40 years oldOverweight peopleThose with an Asian heritage Women who develop diabetes while pregnant

(gestational diabetes)

How will we know if we have diabetes?

• People with diabetes may experience the following symptoms:• Being very thirsty • Having to go to the bathroom very

frequently to urinate • Unexplained weight loss • Increased hunger

• People with diabetes may experience the following symptoms• Blurry vision • Irritability • Tingling or numbness in the hands or feet • Frequent skin, bladder or gum infections • Wounds that don't heal • Extreme unexplained fatigue / tiredness

In some cases, there are no symptoms!

How is Diabetes Diagnosed?

• All individuals aged 45 years and above should be tested for diabetes – If normal, they should be re-tested

every three years.

Testing should be conducted earlier and more frequently in the following:

• Overweight people• Those with a first degree relative who has

diabetes• Members of a high-risk ethnic population

(African American, Hispanic, Native American, Asian)

• Women who delivered a baby weighing more than 9 pounds

Testing should be conducted earlier and more frequently in the following:

• Women who had gestational diabetes• Those who have HDL cholesterol levels equal

to or less than 35 mg/dl or triglyceride levels equal to or greater than 250 mg/dl

• Those who have high blood pressure• Those who had impaired glucose tolerance or

impaired fasting glucose

How is Diabetes Diagnosed?

• Fasting plasma glucose is above 126 mg/dl • Diabetes symptoms exist and casual plasma

glucose is equal to or above 200 mg/dl; or • Plasma glucose is equal to or above 200 mg/dl

during an oral glucose tolerance test. • Testing should be repeated on a different day

to confirm the diagnosis. • If a casual plasma glucose equal to 200 mg/dl

or above is detected, the confirming test used should be a fasting plasma glucose or an oral glucose tolerance test.

Criteria for the Diagnosis of Criteria for the Diagnosis of Diabetes: 1997 ADA GuidelinesDiabetes: 1997 ADA Guidelines

Plasma Glucose Level (mg/dL)Plasma Glucose Level (mg/dL)

*Third criterion: *Third criterion: 200 mg/dL casual plasma glucose (regardless of time 200 mg/dL casual plasma glucose (regardless of time since last meal) plus symptoms of diabetes (polyuria, polydipsia, since last meal) plus symptoms of diabetes (polyuria, polydipsia, unexplained weight loss)unexplained weight loss)

Stage of Stage of Glycemic Glycemic ControlControl

Fasting Plasma Fasting Plasma GlucoseGlucose

OGTT OGTT (2-hr Postload Glucose)(2-hr Postload Glucose)

<110<110

110 –110 – 125125

126126

<140<140

140 –140 – 199199

200200

ADA. ADA. Diabetes Care.Diabetes Care.1997;20:1183-1197.1997;20:1183-1197.

NormalNormal

IFGIFGoror

IGTIGT

Diabetes*Diabetes*

What is Borderline Diabetes?

• Impaired fasting glucose. • Fasting plasma blood glucose in the 110-125

mg/dl range• If your blood glucose two hours after the oral

glucose tolerance test is between 140-199 mg/dl

What Should I Eat?

• It's not so much "what" you should eat but “how much” If overweight, lose weight. Eating more foods that are broiled and fewer

foods that are fried. Cutting back on butter or oil in cooking. Eating fish and chicken more often and only lean

cuts of beef and pork Eating more meatless meals

• Begin an exercise program, • exercise will help you use the insulin you produce

to convert the food you eat into energy• this will help keep your blood sugars lower

Can diabetes be prevented?

• Research suggests that type 2 diabetes risk can be lowered by as much as 58% through a program of moderate sustained weight loss and moderate daily exercise.

• Metformin, a medication used to treat type 2 diabetes, has been shown to lower diabetes risk by 31%.

What other problems can diabetes cause?

• Poorly managed diabetes can lead to long-term complications

• Heart attacks

• Strokes (brain attack)

• Blindness

• Kidney failure

• Blood vessel disease that may require amputation of a limb

• Nerve damage

• Impotence in men

If people keep their blood sugars as close to normal as possible,

they can reduce their risk of developing some of these

complications by 50 percent or more.

Davies MJ. Circulation. 1996;94:2013-2020.

ADA Targets for Glycemic Control and Recommended Action Levels

• Biochemical Index GoalGoal Action SuggestedAction Suggested

FPG (preprandial), mg/dLFPG (preprandial), mg/dL

Bedtime glucose, mg/dLBedtime glucose, mg/dL

HbAHbA1c1c, %, %

Values are for nonpregnant individualsValues are for nonpregnant individuals

ADA. ADA. Diabetes CareDiabetes Care.. 1997;20(suppl 1):S5-S13.1997;20(suppl 1):S5-S13.

80 80 120120

100 100 140140

<7<7

>140>140

>160>160

>8>8

The Philippine College of Physicians wishes to acknowledge the following for their invaluable contribution in the preparation of this module

Institute for the Study of Diabetes Foundation (ISDF)

American Diabetes Association (ADA)

James Wee, MD, FPCP