Diabetes A Growing Epidemic Michael McKee, MD, MPH March 28, 2013
Goals Diabetes Introduction Types of Diabetes Testing Prevention Treatments
In Memory of Benno Houver Bernd Benno Houver (1973-2013)
Diabetes Info 25.8 million people in the USA (8.3%) have diabetes ~25% of people with diabetes do not know they have it! 231,000 known or documented deaths $245 billion in health care costs!! *American Diabetes Association www.diabetes.org
Types of Diabetes Mellitus Prediabetes Type I Diabetes Type II Gestational Diabetes
Prediabetes Glucose (sugar) is higher than normal but not high enough to diagnose diabetes Most people do not have symptoms Three types: Impaired Glucose Tolerance Impaired Fasting Glucose Mildly elevated hemoglobin A1c (to discuss later)
Prediabetes
Prediabetes Red Flag Warning: BIG RISK for future diabetes! Not everyone will have diabetes though Weight loss can reverse this 10-15 lbs (example: average 200 lb man) along with regular exercise can usually reverse prediabetes
What is a hemoglobin A1c? Hemoglobin A1c is a diabetes test Useful to show glucose ranges over a 3 month time frame Glucose causes oxidative changes ( rust ) to your red blood cells (hemoglobin) A1c measures the % of red blood cells with damage from the glucose
What is a hemoglobin A1c? Normal: A1c 4.0-5.6% Prediabetes: A1c 5.7-6.4% Diabetes: A1c 6.5% and above For those with diabetes- A1c should be less than 7.0%
Type I Diabetes ( Juvenile Diabetes ) 5-10% of diabetics Children and young adults Insulin dependent Autoimmune cause
Type I Diabetes *Medline Plus Medical Encyclopedia Images
Insulin and Glucagon: Glucose Dance Partners International Diabetes Federation www.idf.org
Type II Diabetes 90-95% of diabetics Older and obese adults May require insulin injections Insulin resistance OBESITY IS THE #1 RISK FACTOR!!
Gestational Diabetes Impact to Mothers Up to 18% of pregnancies 25% of mothers with gestational diabetes will have type 2 diabetes Impact to Babies Risk of fat babies that are not developed Babies are at risk for future obesity and diabetes
Why Worry About Diabetes? Heart Disease Stroke Peripheral Arterial Disease Depression Blindness Leg amputation Infection High cholesterol Kidney failure Hearing loss Numbness and nerve pain Gastroparesis (stomach paralysis) Foot ulcers High blood pressure Mouth/Gum disease
So, what do we do? Increase awareness Identify symptoms Get tested early Improve diet Exercise!
Who s at Risk? Overweight or Obese Family Members with Diabetes Sedentary (little or no exercise) Hispanics, African-Americans, Native American Indian, Pacific Islander History of High Blood Pressure History of Pancreatitis
How do I know if I got it? Symptoms: Frequent urination Very thirsty Tired all the time Dizziness Weight loss (not intended) **But most have no symptoms when they start diabetes!
Lab Testing Finger stick glucose Hemoglobin A1c Oral glucose tolerance test (used for pregnancy)
Prevention Physical activity Lose weight Eat healthy Avoid smoking Avoid excessive alcohol
Physical Activity Helps us to get stronger Helps us to lose weight Helps us to control our blood sugar Goal is 45-60 minutes daily Examples: Swimming, biking, running, walking, weight lifting, sport activities
Healthy Diet Whole Grains Vegetables and Fruits Lean Protein
Power Foods! Almonds and Most Nuts Beans and Lentils Green Vegetables (e.g. spinach or broccoli) Low Fat Dairy Oatmeal Eggs
Power Foods! Turkey and lean meats (fish) Peanut Butter Olive Oil Whole Grains Whey Protein Berries *Zinczenko, D. (2006). Power 12 Foods: Never Go Hungry. Men s Health. www.menshealth.com
Killer Foods Trans fatty acids Examples: Partially hydrogenated oils, Crisco, hydrogenated oils, cakes, pies, french fries Processed grains Excessive animal meats These cause us to age faster.
Common Diabetic Medications Metformin (Glucophage) Pioglitazone (Actos) Glipizide (Glucotrol) Glyburide (Micronase) Glimipremide (Amaryl) Sitaglipin (Januvia)
Treatments- Insulin Examples Long Acting (once daily) Lantus/Levemir Medium Acting (twice daily) Novulin 70/30 Rapid or Short acting (prior to meals) Regular insulin Novolog Lispro
Aspirin Aspirin is usually recommended for diabetes Helps to lower heart disease risk
Questions? Next Deaf Health Talk on April 25: Town Hall Meeting by National Center for Deaf Health Research Finger Lakes Deaf Health Fair on Saturday, April 20 from 10-4 pm at the Rochester School for the Deaf
Contact Information Michael McKee, MD, MPH Email: michael_mckee@urmc.rochester.edu