HISTORY | |SYMPTOMS|
FOR DIABETES| |TREATING DIABETES|
|pREVENTING DIABETES| | pREVENTING DIABETES COMPLICATIONS| |BLOOD SUGAR DIAGNOSTIC CRITERIA| |GOALS| |FAQ|
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California Diabetes Foundation is a Southern California based non-profit organization, established with the aims of creating awareness of the emerging national epidemic of the new millennium - Diabetes among the general population. It is rightly said,“ the diabetic who knows most lives longest”. Diabetes Mellitus has taken epidemic proportions in USA in the last decade. Our mission is to educate Americans about Diabetes to create awareness and help in the prevention of this disease.
Some of the underlying factors for Diabetes, include faulty and unbalanced diet leading to obesity (especially “Perivisceral Fat Accumulation” which causes Insulin resistance and Type 2 Diabetes Mellitus), sedentary life-style and genetic predisposition. Type 1 Diabetes Mellitus on the other hand is an autoimmune disease seen in younger people who are thin or normal weight and prone to Ketosis and managed by Insulin and tight control of blood sugar is the goal to prevent complications. We hope to contribute to the well-being of this population by proper education and surveillance of diagnosed, undiagnosed and Pre-Diabetes. So our bottom line is to give information and knowledge about Diabetes to people for primary prevention of Diabetes and for secondary prevention of long-term complications in those who already have the disease.
Diabetes Mellitus is a group of diseases characterized by high levels of blood glucose resulting from defects in insulin production, insulin action, or both. It is a common yet complex multifaceted disorder, needing multidisciplinary approach to deal with it. It is due to relative or absolute deficiency or resistance of Insulin.
Classification of Diabetes Mellitus:
Type 1 Diabetes - It develops when the body's immune system destroys pancreatic beta cells, the only cells in the body that make the hormone insulin that regulates blood glucose. This form of Diabetes usually strikes children and young adults, who need several insulin injections a day or an insulin pump to survive. Type 1 Diabetes may account for 5% to 10% of all diagnosed cases of diabetes. Risk factors for Type 1 Diabetes include autoimmune, genetic, and environmental factors.
Type 2 Diabetes - This account for about 90% to 95% of all diagnosed cases of Diabetes. It usually begins as insulin resistance, a disorder in which the cells do not use insulin properly. As the need for insulin rises, the pancreas gradually loses its ability to produce insulin. Type 2 Diabetes is associated with older age, obesity, family history of Diabetes, prior history of Gestational Diabetes, impaired glucose tolerance, physical inactivity, and race/ethnicity. African Americans, Hispanic/Latino Americans, American Indians, and some Asian Americans and Pacific Islanders are at particularly high risk for Type 2 Diabetes. Type 2 Diabetes is increasingly being diagnosed in children and adolescents.
Gestational Diabetes is a form of glucose intolerance that is diagnosed in some women during pregnancy. Gestational Diabetes occurs more frequently among African Americans, Hispanic/Latino Americans, and American Indians. It is also more common among obese women and women with a family history of diabetes. During pregnancy, Gestational Diabetes requires treatment to normalize maternal blood glucose levels to avoid complications in the infant. After pregnancy, 5% to 10% of women with Gestational Diabetes are found to have Type 2 Diabetes. Women who have had Gestational Diabetes have a 20% to 50% chance of developing Diabetes in the next 5-10 years.
Other specific types of Diabetes result from specific genetic conditions (such as maturity-onset Diabetes of youth), surgery, drugs, malnutrition, infections, and other illnesses. Such types of Diabetes may account for 1% to 5% of all diagnosed cases of Diabetes.
”Type 2 Diabetes Mellitus is the most common type among all the above. In North America the ratio of Type-2 to Type-1 is approximately 7:3 ”
In US more than 34 million Americans have Diabetes Mellitus and approximately 88 million Americans have Pre-Diabetes (which is impaired glucose tolerance). Epidemiological studies have noted a dramatic increase in prevalence of type 2 Diabetes Mellitus in younger individuals (20s and 30s) . The prevalence is already high in older individuals in 50- 80 yrs and above age group.
In US there are certain high risk ethnic groups like African-Americans, Hispanic Americans, Native Americans, Asian Americans and Pacific islanders have increasing prevalence and predilection of Types 2 Diabetes Mellitus. There is an increased incidence of ‘metabolic syndrome’ (‘Syndrome-X’ Insulin Resistance Syndrome’ or ‘Cardiovascular Dysmetabolic Syndrome’) in these ethnic groups. It may be present many years before development of full-blown Diabetes Mellitus. In this syndrome, there is abdominal obesity (perivisceral fat collection-increased free fatty acids, due to eating more and lack of exercise) hyperinsulinemia, Insulin resistance with dyslipidemia, increased prothrombolitic activity, hypertension and accelerated atherosclerosis. Such population groups should be tested for Diabetes Mellitus at regular intervals & have medical checkup for co-morbidities in heart, kidney, CNS (peripheral nerves, TIA and stroke), Eyes, Skin and Peripheral arteries.
There is genetic predisposition in type 2 Diabetes Mellitus. If both parents are Diabetic 90% chances are that the children will be Diabetic, and if one parent is Diabetic, only 60% offspring will become Diabetic.
SYMPTOMS AND SIGNS:
While Type1 Diabetics do not present with complications at the very outset, 10-20% of Type 2, may present with complications. Common initial symptoms include Polyuria, Polydipsia, Polyphagia, weight loss, fatigue, proneness to infection and delay in healing. Often people are asymptomatic for years and are diagnosed only when incidental blood testing is done for another reason. By that time patients actually have evidence of Diabetic complications in eyes, kidneys, nerves and arteries. Silent and fatal heart attacks stroke are common in Diabetics specially neglected and uncontrolled. Certain high-risk population should be screened for Diabetes at frequent intervals.
HIGH-RISK FOR DIABETES:
1. Age over 45 years
2. ‘Metabolic Syndrome’ : overweight individuals with abdominal paunch, HDL Cholesterol less than 35 mg/dl and triglyceride level more than 250 mg/dl
3. Impaired glucose tolerance and impaired fasting glucose
4. High-risk ethnic population viz., African-American, African-Asians, Hispanic Americans, Native Americans and Pacific Islanders.
5. Females delivering overweight babies and diagnosed as Gestational Diabetes Mellitus
6. Hypertensives more than 140/90(BP)
7. History of Diabetes in first-degree relative.
In order to survive, people with Type 1 Diabetes must have insulin delivered by injections or a pump.
Many people with Type 2 Diabetes can control their blood glucose by following a careful diet and exercise program, losing excess weight, and taking oral medication.
Many people with Diabetes also need to take medications to control their cholesterol and blood pressure.
Among adults with diagnosed Diabetes, about 11% take both insulin and oral medications, 22% take insulin only, 49% take oral medications only, and 17% do not take either insulin or oral medications.
Research studies in the United States and abroad have found that Lifestyle changes can prevent or delay the onset of Type 2 Diabetes among high-risk adults. Lifestyle interventions included diet and moderate-intensity physical activity (such as walking for 2 1/2 hours each week). For both sexes and all age and racial and ethnic groups, the development of Diabetes was reduced 40% to 60% during these studies that lasted 3 to 6 years.
Studies have also shown that medications have been successful in preventing Diabetes in some population groups. In a Diabetes Prevention Study, a large prevention study of people at high risk for diabetes, people treated with the drug Metformin reduced their risk of developing Diabetes by 31%. Treatment with Metformin was most effective among younger, heavier people (those 25-40 years of age who were 50 to 80 pounds overweight) and less effective among older people and people who were not as overweight.
There are no known methods to prevent Type 1 Diabetes. Several clinical trials are currently in progress.
Research studies in the United States and abroad have found that improved Glycemic control benefits people with either Type 1 or Type 2 Diabetes. In general, for every 1% reduction in results of A1C blood tests, the risk of developing Microvascular Diabetic Complications (eye, kidney, and nerve disease) is reduced by 40%.
Blood Pressure control can reduce cardiovascular disease (Heart Disease and Stroke) by approximately 33% to 50% and can reduce Microvascular Disease (eye, kidney, and nerve disease) by approximately 33%.
In general, for every 10 millimeters of mercury (mm Hg) reduction in systolic blood pressure, the risk for any complication related to diabetes is reduced by 12%.
Improved control of cholesterol and lipids (for example, HDL, LDL, and Triglycerides) can reduce cardiovascular complications by 20% to 50%.
Detecting and treating Diabetic Eye Disease with laser therapy can reduce the development of severe vision loss by an estimated 50% to 60%.
Comprehensive foot care programs can reduce amputation rates by 45% to 85%.
Detecting and treating early Diabetic Kidney Disease can reduce the development of kidney failure by 30% to 70%.
BLOOD SUGAR DIAGNOSTIC CRITERIA:
a) Fasting Plasma Glucose
|Impaired Fasting Glucose
Plasma Glucose (2 hrs after
Lunch or Meal)
< 140 mg/dl
|Impaired Fasting Glucose
|> 200 mg/dl
Random Plasma Glucose:
> 200 mg/dl
NB: In elderly and young, the criteria are same as above.
· Our mission statement is “Get Tested For Diabetes”. We would like to see everyone get tested for Diabetes at regular intervals. That is the first step towards controlling this epidemic. We will do this by facilitating Diabetes Awareness and Education Program.
· We hope to inspire and mobilize community involvement in the fight against Diabetes. Starting at the school level and ending at the level of senior citizens, Diabetes should be part of the lives of each one of us. We need to understand Diabetes, so as to fight it better.
· We will collaborate with scientific bodies and national leaders in the field of Diabetes to bring the latest information regarding diagnosis and management issues to the public.
· We would like to see greater healthcare personnel (physicians, dieticians, nurses etc) involvement in the community, especially with the minority groups who are at a higher risk of Diabetes than the general population.
Diabetes can cause serious health complications including heart disease, blindness, kidney failure, and lower-extremity amputations. Diabetes is the seventh leading cause of death in the United States.
People who think they might have Diabetes must visit a physician for diagnosis. They might have SOME or NONE of the following symptoms:
Nausea, vomiting, or stomach pains may accompany some of these symptoms in the abrupt onset of Insulin-dependent Diabetes, called Type 1 Diabetes.
Management strategies should be planned along with a qualified health care team.
The following information on treatments for Diabetes:
Diabetes knowledge, treatment, and prevention strategies advance daily. Treatment is aimed at keeping blood glucose near normal levels at all times. Training in self-management is integral to the treatment of Diabetes. Treatment must be individualized and must address medical, psychosocial, and lifestyle issues.
Treatment of Type 1 Diabetes: Lack of Insulin production by the pancreas makes Type 1 Diabetes particularly difficult to control. Treatment requires a strict regimen that typically includes a carefully calculated diet, planned physical activity, home blood glucose testing several times a day, and multiple daily insulin injections.
Treatment of Type 2 Diabetes: Treatment typically includes diet control, exercise, home blood glucose testing, and in some cases, oral medication and/or insulin. Approximately 40% of people with Type 2 Diabetes require insulin injections.
The causes of Type 1 Diabetes appear to be much different than those for Type 2 Diabetes, though the exact mechanisms for development of both diseases are unknown. The appearance of Type 1 Diabetes is suspected to follow exposure to an "environmental trigger," such as an unidentified virus, stimulating an immune attack against the beta cells of the pancreas (that produce insulin) in some genetically predisposed people.
A number of studies have shown that regular physical activity can significantly reduce the risk of developing Type 2 Diabetes. It also appears to be associated with obesity. Researchers are making progress in identifying the exact genetics and "triggers" that predispose some individuals to develop Type 1 Diabetes, but prevention, as well as a cure, remains elusive.
In response to the growing health burden of Diabetes Mellitus (Diabetes), the Diabetes Community has three choices: Prevent Diabetes; Cure Diabetes; and Take better care of people with Diabetes to prevent devastating complications. All three approaches are actively being pursued by the US Department of Health and Human Services.
Several approaches to "Cure" Diabetes are being pursued:
Islet Cell Transplantation (islet cells produce insulin)
Artificial Pancreas Development
Genetic Manipulation (fat or muscle cells that don’t normally make insulin have a human insulin gene inserted — then these "pseudo" islet cells are transplanted into people with Type 1 Diabetes).
Each of these approaches still has a lot of challenges, such as preventing immune rejection; finding an adequate number of insulin cells; keeping cells alive; and others. But progress is being made in all areas.
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California Diabetes Foundation
2975 Huntington Drive, Suite 202
San Marino, CA 91108
*NDEP is a Joint Program of the National Institutes of Health and the Centers for Disease Control and Prevention