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DIABETES and its managemntPROMOTIONAL GROUP.pptx
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- 2. Key facts • 10.5%of adults aged 20–79 worldwide, or 537 million people, have diabetes. This includes both type 1 and type 2 diabetes, as well as diagnosed and undiagnosed cases. • The International Diabetes Federation (IDF) projects that this number will increase to 643 million by 2030 and 783 million by 2045, • Prevalence has been rising more rapidly in low- and middle-income countries than in high-income countries. • Diabetes is a major cause of blindness, kidney failure, heart attacks, stroke and lower limb amputation. • Between 2000 and 2019, there was a 3% increase in diabetes mortality rates by age. • In 2019, diabetes and kidney disease due to diabetes caused an estimated 2 million deaths.
- 3. Overview • Diabetes isa chronic disease that occurs either when the pancreas does not produce enough insulin or when the body cannot effectively use the insulin it produces. • Insulin is a hormone that regulates blood glucose. • Hyperglycaemia, also called raised blood glucose or raised blood sugar, is a common effect of uncontrolled diabetes and over time leads to serious damage to many of the body's systems, especially the nerves and blood vessels.
- 6. When does type2 diabetes occur? • Type 2 diabetes occurs when the body develops “insulin resistance” and can’t efficiently use the insulin it makes or/and when the pancreas gradually loses its capacity to produce insulin. • The body can gradually develop ‘insulin resistance’ – this process is called pre- diabetes.
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- 9. What are thehealth effects related to type 2 diabetes? • Nerve damage: High blood sugar levels can damage nerves, a condition called diabetic neuropathy. • This can lead to numbness in the fingers, hands, toes and feet or tingling, burning or shooting pains that usually begins at the fingers or toes and spread upwards.
- 10. • Blood vesseldamage: Nerves and blood vessels in body can sustain damage from prolonged high blood sugar. • In the eyes, damage to the blood vessels can eventually lead to blindness. • Minor cuts and blisters in your feet can lead to ulcers, and infections. In your brain it can help contribute to Alzheimers.
- 11. • Kidney damage:Kidneys filter blood, removing waste and extra fluid from your body. • Over time, diabetes can damage your kidneys so they no longer work effectively, resulting in kidney failure. • Kidney failure is not reversible and can only be treated by undergoing dialysis treatments numerous times per week.
- 12. • Osteoporosis: Thisapplies to people with Type 1 diabetes. This condition makes your bones brittle.
- 15. What Causes Type2 Diabetes? • Type 2 diabetes develops when the pancreatic beta cells secrete less insulin than the body requires (decreased insulin levels), and the cells in the body stop responding to insulin (insulin resistance). • In other words, type 2 diabetes is an insulin- resistant condition with associated pancreatic beta cell dysfunction.
- 16. It is suggestedinsulin resistance can be caused by: • Metabolic Syndrome (3 or more of the following) – High blood glucose – Low levels of HDL (good) cholesterol – High levels of triglycerides – Large waist circumference – High blood pressure
- 17. • Obesity -Adipose tissue promotes insulin resistance through inflammatory mechanisms • Lack of exercise • Poor diet • Genetics - Abnormal gene functioning can lead to insulin resistance and/or pancreatic beta cell dysfunction
- 21. FASTING SUGAR • Afasting blood sugar test (also known as fasting plasma glucose, FPG) is a blood test that checks the blood sugar levels after having not consumed any food or drink (except water) for at least 8 hours prior to the test. • Patients usually begin fasting at midnight and have the blood test performed in the morning prior to breakfast. • Fasting blood glucose levels can be interpreted as: • Less than 100 mg/dL (5.6 mmol/L) = Normal • 100-125 mg/dL (5.6-6.9 mmol/L) = Prediabetes • 126 mg/dL (7 mmol/L) or higher on 2 separate tests = Diabetes
- 22. Oral Glucose ToleranceTest • The oral glucose tolerance test (OGTT) involves taking a fasting blood glucose level first, followed by the patient drinking a beverage containing 75g of glucose. • The blood glucose is then measured again, 2 hours after drinking the sugary beverage to analyze how the blood sugar level has changed. • This test is more commonly used to test pregnant patients. • A 2 hour blood glucose level of less than 140 mg/dL (7.8 mmol/L) = Normal • A 2 hour blood glucose level of 140-199 mg/dL (7.8-11.0 mmol/L) = Prediabetes • A 2 hour blood glucose level of 200 mg/dL (11.1 mmol/L) or higher = Diabetes
- 23. RBS • A randomblood sugar test (also known as random plasma glucose) is a blood test that checks the blood sugar levels at any random time regardless of when the last meal was. • Regardless of when the last meal was, a blood glucose level of: • 200 mg/dL (11.1 mmol/L) or higher = Diabetes
- 24. OTHER TESTS • Oninvestigation for type 2 diabetes, the patient should also have their lipid profile tested and a urinalysis performed to check for proteinuria (protein in the urine) and ketones. • If ketones are present in the urine, it may indicate the patient has type 1 diabetes. • Renal (kidney) and liver function tests should also be performed via blood work.
- 25. Treatment of Type2 Diabetes • Education and Lifestyle Changes – Diet – Exercise • Medication – Oral diabetes medications – Insulin • Careful Glucose Monitoring
- 27. Diet may include: •More fiber-rich fruits and vegetables - Apples, berries, bananas, broccoli, leafy greens, etc. • More high fiber, complex carbohydrates (good carbs) - Brown rice, brown bread, whole wheat, whole grains, etc. • Less low fiber, simple carbohydrates (bad carbs) - White rice, white bread, pastas, etc. • Less simple sugars - Soda, candy, fruit juice concentrates, etc. • Low calorie diet
- 28. Exercise may include: •Aerobic Exercise - 150 minutes/week (walking, biking, swimming, etc.) • Resistance Exercise - 2-3 times/week (yoga, weightlifting, etc.) • Limit inactivity (take breaks from couch to walk around, etc.) • If the patient is overweight, then the primary care staff may encourage the patient to lose 5-10% of their body weight. • Losing this proportion of weight has been shown to decrease cardiovascular risk, improve glycemic control, and prevent diabetic complications.
- 29. Medication • If diet,exercise, and lifestyle modifications alone are not sufficient to treat type 2 diabetes and maintain target glucose levels, then medications may need to be added. • Medications include: • Oral diabetes medications (antidiabetic/hypoglycemic agents) • Insulin
- 30. Oral Diabetes Medications- Hypoglycemic Agents • Oral diabetes medications are routinely used before insulin for the treatment of type 2 diabetes. • Examples of oral diabetes medications include: • Biguanides (metformin) • Thiazolidinediones (pioglitazone, rosiglitazone) • Sulfonylureas (glimepiride, glyburide, glipizide) • SGLT-2 Inhibitors (dapagliflozin, canagliflozin, empagliflozin) • DPP-4 Inhibitors (alogliptin, linagliptin, saxagliptin, sitagliptin) • GLP-1 Mimetics/Agonists (exenatide, liraglutide) • Meglitinides/Glinides (nateglinide, repaglinide) – Similar to sulfonylureas but act more quickly • Alpha-Glucosidase Inhibitors (acarbose, miglitol)
- 34. Complications of Type2 Diabetes Microvascular Complications • Diabetic Retinopathy (Eyes) - May cause loss of vision in both eyes • Diabetic Nephropathy (Kidneys) - May require dialysis • Diabetic Neuropathy (Nerves) - Diabetic peripheral neuropathy has a high mortality rate due to infection, and can often lead to lower limb amputation due to gangrene
- 35. Macrovascular Complications High bloodsugar can cause plaque formation in blood vessels, called atherosclerosis. This can increase the risk of: • Cardiovascular Disease • Heart Attack (Myocardial Infarction) • Stroke • Peripheral Vascular Disease (PVD)
Editor's Notes
- #31 Sodium-Glucose Transport Protein 2 (SGLT2) Inhibitors Dipeptidyl peptidase-4 inhibitor Glucagon-Like Peptide-1 Receptor Agonists - StatPearls