1. www.diabetes.org 1-800-DIABETES World Kidney Day March 11, 2010 Dr. Joyce M. Richey, Presenter Keck School of Medicine of USC

2. www.diabetes.org 1-800-DIABETES Diabetes -Greek derivation, to siphon, passing through

3. www.diabetes.org 1-800-DIABETES What Is Diabetes ?? INSULIN Glucose (Sugar) Goes where it’s needed for energy!

4. www.diabetes.org 1-800-DIABETES Insulin – the “Miracle” Drug

5. www.diabetes.org 1-800-DIABETES Types of Diabetes Type I “juvenile” IDDM  Usually in children, can be adults  0.5% of populations  Family History  Fatal if not treated  Usually normal weight Type II “adult” NIDDM  Usually in adults, increasing in children  5-10% of population (epidemic)  Family History  Increased prevalence in minorities  80% of patients are obese Gestational Diabetes

6. www.diabetes.org 1-800-DIABETES Diabetes Treatment Type I Insulin Insulin Type II Insulin Insulin Oral Medications Oral Medications

7. www.diabetes.org 1-800-DIABETES Who Does Diabetes Affect? Prevalence  >20 million; one third don’t know they have it  >41 million with pre-diabetes Greater in minority populations  African Americans; ~2 times than Caucasians  Hispanic Americans, ~2 times than Caucasians  Native Americans, 50% of the Pima Indians

8. www.diabetes.org 1-800-DIABETES Pre-Diabetes What is Pre-Diabetes? Comes before type 2 diabetes Comes before type 2 diabetes Blood glucose higher than normal but not yet diabetes Blood glucose higher than normal but not yet diabetes Normal fasting glucose: Below 100 Normal fasting glucose: Below 100 Pre-diabetes: 100 – 125 Pre-diabetes: 100 – 125 Diabetes: 126 and above Diabetes: 126 and above

9. www.diabetes.org 1-800-DIABETES Pre-Diabetes What Does It Mean? You have a greater chance of getting type 2 diabetes You have a greater chance of getting type 2 diabetes You are more likely to get heart disease or have a stroke or kidney disease You are more likely to get heart disease or have a stroke or kidney disease

10. www.diabetes.org 1-800-DIABETES Diabetes and Obesity Epidemic

11. www.diabetes.org 1-800-DIABETES Obesity and Diabetes

12. www.diabetes.org 1-800-DIABETES Causes of Obesity Lack of physical activity/sedentary Lack of physical activity/sedentary Genetics Genetics Unhealthy eating patterns Unhealthy eating patterns

13. www.diabetes.org 1-800-DIABETES “Digging Our Graves”

14. www.diabetes.org 1-800-DIABETES Apple or Pear? Android Gynoid

15. www.diabetes.org 1-800-DIABETES RF-107, Female, Age 41, BMI 49.5 WC: 118 cm VAT volume: 559 cm 3 SAT volume: 11,658 cm 3 RF-149, Male, Age 40, BMI 54.4 WC: 142 cm VAT volume: 3162 cm 3 SAT volume: 9158 cm 3 Variability of VAT among obese subjects

16. www.diabetes.org 1-800-DIABETES Obesity is not Restricted to Humans

17. www.diabetes.org 1-800-DIABETES Symptoms of Diabetes Frequent urination (bedwetting in children) Frequent urination (bedwetting in children) Excessive thirst Excessive thirst Extreme hunger Extreme hunger Unusual weight loss Unusual weight loss Increased fatigue Increased fatigue Irritability Irritability Blurry vision Blurry vision

18. www.diabetes.org 1-800-DIABETES Diabetes Testing Urine Analysis Urine Analysis Blood Test (Fasting Glucose) (less than or equal to 100 mg/dl;101 – 126 mg/dl, pre- diabetes; greater than 126 mg/dl, diabetic) Blood Test (Fasting Glucose) (less than or equal to 100 mg/dl;101 – 126 mg/dl, pre- diabetes; greater than 126 mg/dl, diabetic) Oral Glucose Tolerance Test (OGTT) Oral Glucose Tolerance Test (OGTT)

19. www.diabetes.org 1-800-DIABETES Diabetes Testing “ A1C?” Diabetes Testing “ A1C?” Measures your sugar level for the past 2-3 months Measures your sugar level for the past 2-3 months Should be checked at least twice a year Should be checked at least twice a year The higher the number, the higher risk for diabetes complications The higher the number, the higher risk for diabetes complications

20. www.diabetes.org 1-800-DIABETES What should your A-1-C be? Ideally it should be less than 7! Ideally it should be less than 7! However, please check with your healthcare provider for a reasonable goal. However, please check with your healthcare provider for a reasonable goal.

21. www.diabetes.org 1-800-DIABETES Major Complications

22. www.diabetes.org 1-800-DIABETES Complications of Diabetes Heart disease and stroke; 2-4 greater risk Heart disease and stroke; 2-4 greater risk accounts for > 65% of all deaths in people with diabetes accounts for > 65% of all deaths in people with diabetes Leading cause of blindness (retinopathy) Leading cause of blindness (retinopathy) Leading cause of kidney failure (nephropathy) Leading cause of kidney failure (nephropathy) Nerve disease and amputations (neuropathy) Nerve disease and amputations (neuropathy) >300,000 diabetes-related deaths/year >300,000 diabetes-related deaths/year

23. www.diabetes.org 1-800-DIABETES Kidney Failure

24. www.diabetes.org 1-800-DIABETES Kidney Disease Also known as Nephropathy (neh- FROP-uh-thee) Over time kidney disease is caused by Over time kidney disease is caused by Diabetes Diabetes High blood pressure High blood pressure

25. www.diabetes.org 1-800-DIABETES Your Kidneys Your kidneys are two bean-shaped organs about the size of your fist. Your kidneys are two bean-shaped organs about the size of your fist. They are located just below the rib cage, near your back They are located just below the rib cage, near your back

26. www.diabetes.org 1-800-DIABETES Kidney Disease Signs and Symptoms Signs and Symptoms Swelling in extremities, ankles, legs, hands Swelling in extremities, ankles, legs, hands Shortness of breath Shortness of breath Feeling tired Feeling tired Nausea and vomiting Nausea and vomiting

27. www.diabetes.org 1-800-DIABETES Kidney Disease Later Signs and Symptoms Later Signs and Symptoms Loss of appetite Loss of appetite Feeling cold Feeling cold Poor concentration Poor concentration Itchy skin Itchy skin Bruising Bruising Weight loss Weight loss Muscle cramps Muscle cramps

28. www.diabetes.org 1-800-DIABETES Tests to find kidney problems A blood test helps to measure your GFR A blood test helps to measure your GFR GFR stands for Glomerular (glo-MEH- yoo-lur) Filtration Rate. The GFR shows how well your kidneys are filtering wastes from the blood. GFR stands for Glomerular (glo-MEH- yoo-lur) Filtration Rate. The GFR shows how well your kidneys are filtering wastes from the blood. Microalbumin (My-crow-alb-YOU-min) Microalbumin (My-crow-alb-YOU-min) A urine test that measure the amount of protein in the urine A urine test that measure the amount of protein in the urine

29. www.diabetes.org 1-800-DIABETES What You Can Do to Prevent, Delay, or Treat Kidney Damage Keep your blood glucose levels in your target range Keep your blood glucose levels in your target range ADA suggests: ADA suggests: 70 to 130 when you wake up and before meals 70 to 130 when you wake up and before meals Under 180 two hours after eating a meal Under 180 two hours after eating a meal Ask your doctor about the best blood glucose targets for you Ask your doctor about the best blood glucose targets for you

30. www.diabetes.org 1-800-DIABETES What You Can Do to Prevent, Delay, or Treat Kidney Damage Have an A-1-C check (A-one-see) at least twice a year Have an A-1-C check (A-one-see) at least twice a year Shows your blood glucose level for the Shows your blood glucose level for the past 2 to 3 months The higher the A-1-C, the greater the risk The higher the A-1-C, the greater the risk for kidney disease If 7 or higher, you may need a change in your plan If 7 or higher, you may need a change in your plan

31. www.diabetes.org 1-800-DIABETES What You Can Do to Prevent, Delay, or Treat Kidney Damage Aim for your target blood pressure level Aim for your target blood pressure level ADA suggests under 130 over 80 ADA suggests under 130 over 80 Ask your doctor about your target blood pressure Ask your doctor about your target blood pressure Ask your doctor about medicines that slow down kidney disease Ask your doctor about medicines that slow down kidney disease ACE Inhibitors (AYCE in-HIB-ih-tor) ACE Inhibitors (AYCE in-HIB-ih-tor) ARBs (ay-ar-bee) ARBs (ay-ar-bee)

32. www.diabetes.org 1-800-DIABETES Slowing Down Kidney Disease Eat a well-balanced meal plan Eat a well-balanced meal plan Cut back on salt and high sodium foods Cut back on salt and high sodium foods Limit your protein if your doctor tells you to Limit your protein if your doctor tells you to Limit potassium and phosphorus Limit potassium and phosphorus Limit supplements and drugs that are hard on your kidneys Limit supplements and drugs that are hard on your kidneys Watch out for injected dyes used in X-rays Watch out for injected dyes used in X-rays

33. www.diabetes.org 1-800-DIABETES Steps to Delay or Prevent Type 2 Diabetes Weight loss Weight loss Regular physical activity, such as walking or gardening about 30 minutes a day Regular physical activity, such as walking or gardening about 30 minutes a day Healthy eating Healthy eating

34. www.diabetes.org 1-800-DIABETES Diabetes Prevention and Treatment Increase Physical Activity!

35. www.diabetes.org 1-800-DIABETES Healthy Eating Choose low-fat dairy products, lean meats, poultry without skin, and fish Choose low-fat dairy products, lean meats, poultry without skin, and fish Limit saturated fats Limit saturated fats Minimize trans fats Minimize trans fats Limit high cholesterol foods Limit high cholesterol foods Eat more fruits and vegetables Eat more fruits and vegetables

36. www.diabetes.org 1-800-DIABETES Fried Vs. Baked (4) 7 inch fillets (4) 7 inch fillets 1 egg 1 egg Cornmeal Cornmeal Salt/pepper Salt/pepper 1 stick of butter of half cup of oil 1 stick of butter of half cup of oil (4) 7 inch fillets (4) 7 inch fillets 2 teaspoons of lemon 2 teaspoons of lemon Salt/pepper Salt/pepper Bread crumbs Bread crumbs Spices (oregano,oil,parsley sprigs, lemon wedges, tomato wedges) Spices (oregano,oil,parsley sprigs, lemon wedges, tomato wedges)

37. www.diabetes.org 1-800-DIABETES Fried vs. Baked Nutritional Value Calories 410 Calories 410 Fat = 26 grams Fat = 26 grams 57% fat calories 57% fat calories Cholesterol = 183 mg Cholesterol = 183 mg Sodium = 859 mg Sodium = 859 mg Protein = 36 mg Protein = 36 mg Carbohydrate = 7 mg Carbohydrate = 7 mg Fiber = 1 g Fiber = 1 g Calories 290 Calories 290 Fat = 8 grams Fat = 8 grams 25% fat calories 25% fat calories Cholesterol = 66 mg Cholesterol = 66 mg Sodium = 263 mg Sodium = 263 mg Protein = 35 mg Protein = 35 mg Carbohydrate = 19 mg Carbohydrate = 19 mg Fiber = 2 g Fiber = 2 g

38. www.diabetes.org 1-800-DIABETES Remember the 3 P’s of Prevention Planning Planning Preparation Preparation Portions Portions

39. www.diabetes.org 1-800-DIABETES Remember Learn all you can about diabetes and kidney disease Learn all you can about diabetes and kidney disease Keep your blood pressure and blood glucose levels in your target range Keep your blood pressure and blood glucose levels in your target range Take your medicines Take your medicines Have regular checkups Have regular checkups Get lab tests each year to know how well your kidneys are working Get lab tests each year to know how well your kidneys are working

40. www.diabetes.org 1-800-DIABETES KEEP IT HEALTHY! “Know that your body is a temple” 1Cor. 6:19-20