Presentation on theme: "Type 2 Diabetes – An Overview"— Presentation transcript:
1Type 2 Diabetes – An Overview What is it?Is it common?What are the risk factors?How does it start?What is the best diet?This show is an overview for type 2 diabetes. It will help the audience realize that it is a common disease.This show emphasizes the importance of weight loss and a heart healthy diet to improve the quality of life and outcome for persons with type 2 diabetes or persons who are overweight and want to avoid type 2 diabetes. It promotes treating the disease and lowering the need for medications instead of just treating the symptoms (high blood sugar) of type 2 diabetes.Another show in this package, Common Sense Guide to Eating with Type 2 Diabetes discusses food, meal planning, label reading, etc. in much greater depth.
2What Is Type 2 Diabetes? High fasting blood sugar levels Excessively high non-fasting BS levelsPeople with Type-2 diabetes usually have some degree of both:resistance to the action of insulindecrease in the capacity to produce insulinNonfasting blood sugar levels are often referred to as postprandial blood sugar levels.Type-2 diabetes is diagnosed:when fasting plasma glucose test is equal to or greater than 126 mg/dl on 2 occasionsor when a non-fasting blood sugar is 200 mg/dl or higher (this is usually reconfirmed by a fasting plasma glucose test)
3True or False?Diabetes has specific symptoms that are easy for most people to diagnose.Answer: FalseMost people are not aware that they have diabetesMany people with Type-2 DM are not aware they have it even though it usually produces symptoms such as increased thirst and urination. However, because these symptoms come on so gradually, they are often missed or dismissed as being a normal part of the aging process. Type-2 DM is diagnosed when fasting blood sugar (FBS) is consistently >125 mg/dl or when a random nonFBS is>200 mg/dl and the patient has symptoms such as increased thirst and urination. A glycosylated hemoglobin (Hb A 1-c) is generally regarded as the best measure of average BS control over the last 2-4 months. In people with normal BS levels, it should be no more than 5-6%, in people with untreated or poorly treated DB, values are more than 7%, when above 10% the patient is considered in very poor control.
4What Are the Symptoms?Increased thirstIncreased urinationBlurred visionLack of energyMore frequent infections, especially gum disease and bladder infectionsThe symptoms of DM include increased thirst, increased urination, blurred vision, and lack of energy. The symptoms come on gradually and are often view as a normal part of the again process. Because of this, many people are unaware that they have diabetes.Symptoms come on gradually and are often viewed as a normal part of the aging process
5True or False?Type 2 diabetes is the most common type of diabetes in the United States.Answer: True Type 2 accounts for about 90% of the 21 million Americans with diabetes?Type-2 DM accounts for about 90% of the 16 million Americans with DM. By age 75, about 1 in 5 Americans have Type 2 diabetes. This type of diabetes is usually characterized by some degree of resistance to the BS lowering action of insulin (also known as insulin resistance).Currently more than 21 million Americans have diabetes and about a third do not know they have the disease.
6Diabetes DoublesLook at how diabetes has increased in the US since CDC statistics for 2005 showed that diabetes now affects 7% of the population or about 21 million people.
7Type 2 DiabetesWhat is the annual cost of treatment for type 2 diabetes?The cost of treating diabetes in the U.S. is over $100 billion annually. This includes actual cost of treatment plus dollars lost in productivity.Over $100 billion dollars
8What Are the Risk Factors? Increasing ageFamily history of type 2 diabetesPrior history of gestational diabetes, impaired glucose tolerance, and/or insulin resistanceBeing overweight or obesePhysical inactivityConsumption of a high fat, high sugar, refined carbohydrate dietRisk factors you can controlThe risk of developing Type-2 DM increases with age primarily in areas where sedentary lifestyles and high fat, high sugar, refined carbohydrate diets prevail. It is well established that obesity increases the risk of developing diabetes. Genetic traits strongly influence the development of diabetes. In studies of identical twins, the concordance rate is nearly 100%. A prior history of gestational diabetes, IGT and/or IR will also increase the risk of developing Type-2 DM. Physical inactivity can lead to weight gain as can the consumption of a high fat, high sugar, refined carbohydrate diet, thus resulting in an increased risk of developing Type-2 DM.
9The Progression of Type 2 Diabetes 1. Insulin resistanceCancer, heart disease2. Impaired glucose tolerance3. Type 2 diabetesSome people who have insulin resistance never develop impaired glucose tolerance; however they are at a high risk for cardiovascular disease because they usually have metabolic disturbances usually associated with insulin resistance. Some people who have insulin resistance or impaired glucose tolerance die before reaching type 2 diabetes; they are at an increased risk for cancer, cardiovascular disease or other causes.Some people with insulin resistance continue to manufacture a high level of insulin that is necessary to keep their sugars from rising too high. This keeps them from developing impaired fasting glucose or type 2 diabetes. They might still have impaired glucose tolerance.Impaired glucose tolerance can be present even when blood sugars are close to normal. IGT is a stage in the development towards type 2 diabetes. Your body is showing signs of the sugar being cleared more slowly. The rise of insulin does not shoot up after a meal so the sugar rises but then becomes cleared after some time – it is cleared before your blood sugar rises high enough for a diagnosis of diabetes. Most people are tested on fasting blood sugar levels instead of postprandial levels (after a meal). There are lots of people who have diabetes because doctors never think to check their HbA1c levels. If that level is 7% or higher it means the patient has type 2 diabetes. If it is 5-6% then it means that blood sugar is rising high after meals. If it is below 5% it means they don’t have IGT or Type 2 diabetes (unless they are on medication).Some people who have insulin resistance or impaired glucose tolerance die of cardiovascular disease before reaching type 2 diabetes.
10Insulin ResistanceResistance to the blood sugar lowering action of insulinPresent for many years before fasting blood sugar levels rise above normalNot everyone who has insulin resistance will develop diabetes but everyone with type 2 diabetes has insulin resistancePeople with Type-2 DM usually have some degree of both resistance to the action of insulin and also some decrease in the capacity to produce insulin. This is known as insulin resistance (IR). When muscle, fat, and liver cells resist the action of insulin they are said to be IR. In some Type-2 DM patients, the IR is more severe while in others the capacity to produce insulin is severely depressed. As a result, the insulin levels in Type-2 DM patients may be higher than normal, close to normal, or below normal.
11Insulin ResistanceA risk factor for the development of coronary artery disease and type 2 diabetesFasting insulin levels are often elevatedInsulin resistance is a risk factor for the development of coronary artery disease (CAD) and Type-2 DM. It has been estimated to occur in 20-30% of the US population. There are currently no routine laboratory procedures for establishing its presence. However, the ability of insulin to move out of the blood and into cells can be determined by using the euglycemic, hyperinsulinemic clamp technique (“glucose clamp”). This technique utilizes a constant rate of insulin being infused for a long enough time to attain steady-state metabolic conditions. IR can also be estimated using an intravenous glucose tolerance test, but this is less accurate than the “glucose clamp” technique. An intravenous glucose tolerance test is often abnormal when diabetes is present.It is impractical to measure and screen people for IR. The tests mentioned here are usually reserved for laboratory/research use. Unfortunately there is no quick, accurate, inexpensive way to measure for IR before impaired glucose tolerance and type 2 diabetes develop.Usually fasting insulin levels are elevated and often there are lipid abnormalities although these are not diagnostic of IR.These are all suggestive of the presence of IR:Family history of diabetesOverweightInactiveCardiovascular disease in familyHigh triglycerides and low HDL are oftenHigh waist to hip ratioExcessive energy intake, particularly when combined with lack of physical activity, leads to the development of IR in genetically predisposed individuals. It doesn't ‘t make them gain weight, it is the result of being overweight. This is contrary to several popular diet books that claim that IR leads to excessive weight gain. They have confused cause and effect. (Zone Diet and Sugar Busters)Currently there is no cost effective, easy way to detect insulin resistance
12Insulin Resistance Family history of diabetes Overweight Lack of Physical ActivityCardiovascular disease in familyHigh triglycerides and low HDL (good cholesterol)High waist to hip ratioInsulin levels increase with weight gain. IR can be present for many years before fasting blood sugar levels rise above normal. In some cases, fasting BS levels rise greatly, but still remain below the DM range.These are all suggestive of the presence of insulin resistance
13Heart Disease & Type 2 Diabetes Even if fasting blood sugar is in normal range, risk of heart disease is elevated if insulin resistance syndrome is presentInsulin resistance and disturbances in lipid metabolism increase risk of heart disease. An estimated 20-30% of the U.S. population has what’s termed as the “deadly quartet,” “syndrome X,” “the metabolic syndrome,” and “the insulin resistance syndrome.” This syndrome is generally characterized by IR, hyperinsulinemia, dyslipidemia, central or visceral adiposity, and often hypertension or IFG, or Type-2 DM. Even if fasting blood sugar is in normal range, risk of heart disease is elevated if insulin resistance syndrome is present. Disturbances in lipid metabolism frequently lead to a more atherogenic blood lipid pattern, thus increasing risk of heart disease.
14What Is the Best Way to Reduce Insulin Resistance Exercise regularlyLose excess body fatEat a high-fiber, whole food diet that is low in fat, sugar and refined carbohydratesThese are the best strategies to reduce insulin resistance.
15Impaired Glucose Tolerance A pre-diabetic stateA large percentage will progress to type 2 diabetes with timeOccurs in about 20 million AmericansImpaired glucose tolerance (IGT) occurs in about 20 million Americans. It is considered as pre-diabetic state. A large percentage will progress to Type-2 DM with time. IGT is characterized by insulin resistance.
16Impaired Glucose Tolerance Often present when fasting blood sugar is between mg/dlUsually not associated with any symptomsUsually associated with an increased waist to hip ratioOften associated with a family history of type 2 diabetesIGT is often present when fasting blood sugar is between mg/dl. Because IGT is not usually associated with any symptoms, most people who have this condition are not aware of it. IFG is associated with an increased risk of CVD and is often a prelude to the development of Type-2 DM.
17Impaired Glucose Tolerance Associated with an increased risk of cardiovascular diseaseIncreased blood clotsInsulin resistance is presentImpaired glucose tolerance is associated with an increased risk of cardiovascular disease and is often a prelude to the development of Type-2 diabetes. Insulin resistance is present. Dyslipidemia is frequently present.Dyslipidemia is frequently presentLow HDLHigh triglyceridesSmall dense LDL particles
18What Is the Best Way to Reduce or Reverse Impaired Glucose Tolerance? Exercise regularlyLose excess body fatEat a high-fiber, whole food diet that is low in fat, sugar and refined carbohydratesThe best way to reduce or reverse impaired glucose tolerance is to follow these strategies. Note how they are the same as the ones given for insulin resistance.
19Complications of Diabetes Damage to small blood vessels and peripheral nervesRisk of dying of a heart attack is 2-3 times greaterNumber one cause of kidney failure in USElevated blood sugar levels causes damage to small blood vessels.About half of patients with diabetes develop nerve damage and or damage to the retinaThose with poorer blood sugar control are more likely to see these microvascular complications develop.Patients with diabetes should have their eyes checked every year. They should also learn to check their own feet for lesions or sores and keep their practitioner informed if they see anything abnormal.The risk of dying of a heart attack is about 3-5 times greater in people with diabetes. Cardiovascular disease accounts for about 2/3 of all death in patient with Type-2 diabetes. People with Type-2 diabetes at least 2-3 times more likely to diet from heart disease for any given serum cholesterol level.Nerve damageDamage to retinaNumber one cause of amputations in US
20Most Important Strategies for Type 2 Diabetes Focus on calories so you lose weightEat a heart-healthy dietKeep your blood pressure under controlExercise regularly:Aids weight loss without hungerReduces insulin resistanceLowers blood sugar levelsImproves blood lipidsReduces blood pressureReduces risk of heart attack & strokeExercising every day is important because the beneficial effects of exercise wear off after about a day. You can see that exercise provides 6 important benefits in controlling type 2 diabetes.If you have been sedentary for a while, see a physician before embarking on any strenuous exercise program.
21What Is the Optimal Diet for Type 2 Diabetes? 5 or more servings of whole grainsExamples of whole grains are whole wheat pasta, brown rice, barley, oats or oatmeal, whole grain cereals, etc. Look on the package to see if it says 100% whole grain. Also read the ingredient list to make sure a product contains whole grains such as whole wheat instead of white flour.
22What Is the Optimal Diet for Type 2 Diabetes? 5 or more servings of vegetablesIt is important to consume enough vegetables if you are trying to lose weight. They contain fiber and are low in calorie density so they fill you up with fewer calories than foods that are high in refined carbohydrates, such as cookies, muffins and bagels.
23What Is the Optimal Diet for Type 2 Diabetes? 3-5 servings of fresh or whole fruitIt is important to eat fresh or whole fruit instead of fruit juice or dried fruit because the former is more satiating.
24What Is the Optimal Diet for Type 2 Diabetes? 2-3 servings of nonfat dairy productsIt is important to eat nonfat dairy products because regular, whole fat versions are high in saturated fat which causes LDL to rise.
25What Is the Optimal Diet for Type 2 Diabetes? 1-2 servings of heart-healthy, protein-rich food such as beans, fish, nuts, tofu, lean poultry, etc.These are more heart healthy than fatty versions of meat. Fish is a good choice, especially cold water fatty fish, because it contains omega 3 fatty acids. Beans and tofu can actually help lower cholesterol.
26What Is the Optimal Diet for Type 2 Diabetes? Choose whole, carbohydrate-rich foods that are satiating and low in calorie densityA potato is lower in calorie density than potato chips. Baked potatoes are high on the satiety index – higher than croissants or Danish. The key to weight loss is to fill up on whole foods that are not high in calories. Most people eat until they feel full and if they eat plenty of whole grains, fruits, vegetables and beans/legumes with little added fat or sugar then will consume fewer calories and not feel hungry. More is mentioned on this topic in the Weight Loss Show of the Diet and Type 2 Diabetes Kit.
27What Is the Optimal Diet for Type 2 Diabetes? Limit foods that are high in refined carbohydratesFoods that are made with white flour and white sugar are high in refined carbohydrates. Some examples include candy, cake, brownies, cookies, white bread, white pasta, bagels, baked goods, etc. Also foods like white rice, instant white rice and instant mashed potatoes are more refined and they produce a higher spike in blood sugar. These foods are also much higher in calorie density than their whole counterparts.
28What Is the Optimal Diet for Type 2 Diabetes? Eat a low salt diet, especially if blood pressure is highEating a low salt diet will help keep your blood pressure from going too high. Look at the label – this food contains 100 calories and 100 mg of sodium – it is ideal to find foods that keep the sodium the same or lower as the number of calories.
29Important Dietary Strategies for Type 2 Diabetes Choose whole, carbohydrate-rich foods that are satiating and high in fiberLimit refined carbohydrate foods such as cookies, cake, baked goods with white flour, etc.Limit foods that are high in saturated fat and hydrogenated fatEat a low salt diet, especially if blood pressure is highA potato is lower in calorie density than potato chips, French fries or instant mashed potatoes. Baked potatoes are high on the satiety index meaning they make you feel relatively full for the amount of calories they contain as compared to other foods like a croissant. The key to weight loss is to fill up on whole foods that are not high in calories. Most people eat until they feel full and if they eat plenty of whole grains, fruits, vegetables and beans/legumes with little added fat or sugar then will consume fewer calories and not feel hungry. More is mentioned on this topic in the Weight Loss Show of the Diet and Type 2 Diabetes Kit.
30“Make no little plans; they have no magic to stir men's blood “Make no little plans; they have no magic to stir men's blood... Make big plans, aim high in hope and work.”-- Daniel H. BurnhamTake each day one day at a time. Set small obtainable goals for yourself and stick to them. Pretty soon you will have made major changes in your lifestyle that will take you on a road to better health.