When Type 2 Diabetes Runs in the Family… Tyrell Hardtke Diabetes in the Family: A Case Study CDC’s 2005 Science Ambassador Program

Today’s Question: You learn that type 2 diabetes “runs in the family.” How can you avoid developing type 2 diabetes? ? ? ? ? Diabetic Photo: Adam Hardtke, 2005. Used with permission.

Presentation Overview I. Diabetes A. What is it? B. Who has it? C. How do you get it? D. What does it do? E. How do you fix it? II. Family History A. What is it? B. How can we use it to stay healthy? Microsoft Office Clip Art. 2003. [cited 28 August 2005].

What is Diabetes? A person’s blood sugar levels are too high Type 1: Pancreas produces little to no insulin Type 2: Over time, lose ability to use the insulin that the body makes Pizza [Ask students:] What do you know about diabetes? [Students will probably bring up sugar, but not much else.] Great! You are on the right track. Normally, the food we eat is turned into glucose, or sugar, in our bodies. The blood circulating in the body carries glucose to the cells. The cells use the glucose, along with other materials, to make energy. Glucose leaves the bloodstream and enters the cells through “doors” called receptors. A substance called insulin works like a key to unlock the receptors. Insulin is a substance that your body makes in an organ called the pancreas. So in general, diabetes is a group of diseases marked by high levels of blood glucose resulting from defects in insulin production, insulin action, or both. Two types of diabetes are type 1 and type 2. Type 1 diabetes occurs when the body produces little to no insulin, and therefore, is unable to process sugar. Individuals with this form of diabetes must use insulin injections to provide insulin for the body. In type 2 diabetes, the body does not respond properly to insulin. Cells may not have enough receptors present to allow glucose to enter. In the beginning, the body is able to keep up with the demands of insulin production, but it loses this ability over time. [1,2] Now let’s look at your brother, who is eating a slice of pizza. As he eats the pizza, his blood sugar rises. Then, his body uses insulin to bring it back down. [Ask students]: If he has type 1 diabetes, what parts of the picture would be different? What would be different if he has type 2 diabetes? Microsoft Office Clip Art. 2003. [cited 28 August 2005]. Blood sugar Blood sugar Insulin

Who has Diabetes? About 7% of the population (21 million people) had diabetes in 2005 (2) Type 1: Usually diagnosed in children and young adults About 5-10% of people with diabetes have type 1 Type 2: Older Adults Children, adults, and older adults!!! About 90-95% of people with diabetes have type 2 diabetes Type 1 diabetes used to be known as juvenile diabetes, because it is usually first diagnosed in children or young adults. About 5-10% of people with diabetes have type 1 diabetes. Type 2 diabetes used to be known as adult-onset diabetes, because it used to be most frequently diagnosed in adults. However, now kids are regularly diagnosed with type 2 diabetes as well. About 90-95%, the overwhelming majority, of people with diabetes have type 2 diabetes. [3] [Note:] Today we will be studying the case of a Hispanic woman who is at risk for type 2 diabetes. However, every ethnic group is at risk for developing type 2 diabetes; it is not a disease found only in people of Hispanic or Latino descent. [2] Microsoft Office Clip Art. 2003. [cited 28 August 2005].

What are the risk factors for type 2 diabetes? Age Physical inactivity Being overweight For women: gestational diabetes Some racial/or ethnic groups Type 2 diabetes in the family Lots of factors contribute to getting type 2 diabetes. [Ask students] What factors do you think work together to cause type 2 diabetes? A lot of you mentioned diet and exercise, and you’re absolutely right! Being overweight or physically inactive are risk factors for type 2 diabetes. One of the biggest risk factors for type 2 diabetes is age. As you get older, your risk for developing type 2 diabetes goes up. That doesn’t mean that young people don’t get diabetes, it just means that your risk for type 2 increases as you get older. Gestational diabetes is a type of diabetes that can occur in pregnant women who have not been known to have diabetes before. Although gestational diabetes usually goes away after pregnancy, women who have had gestational diabetes have a higher risk of developing type 2 diabetes later in life. People in some racial or ethnic groups have a higher risk of developing type 2 diabetes than people in other racial or ethnic groups. If you are of African-American, Latino, Pacific Islander or Native American descent, you have a higher risk for type 2 diabetes. Type 2 diabetes can also “run in the family”. Think back to our discussion at the beginning of class about something “running in the family”, and we’ll discover what that actually means in just a few slides. [1] Microsoft Office Clip Art. 2003. [cited 28 August 2005].

How Bad is Type 2 Diabetes, Really? Increases your risk of…. Heart disease, high blood pressure and stroke by about two times. Other complications include blindness, numbness, amputation, impotence, and kidney failure! Type 2 diabetes increases your risk of heart disease, high blood pressure and stroke by about two times. Having type 2 diabetes puts you at the same risk of having a heart disease as a person who has already had one heart attack! Diabetes can also cause blindness, numbness in your limbs, impotence, and kidney failure. People with diabetes also have a much higher risk of having their lower limbs amputated. [4] Microsoft Office Clip Art. 2003. [cited 28 August 2005].

How Can We Treat and Prevent Type 2 Diabetes? Treatments: Medications Lifestyle changes Prevention: Learn about your family history Work with doctor to monitor health closely, if it runs in family Eat a healthy diet and be physically active! Once someone is diagnosed with diabetes, there are effective treatments to help their quality of life. For type 1 diabetes, patients must use insulin to control their blood sugar. Ask students: As a review, why do type 1 diabetics need to take insulin? For type 2 diabetes, patients can take medications that increase the rate that sugar is absorbed into cells from the blood or take medications that stimulate insulin production by their pancreas. Surprisingly, sometimes people with type 2 diabetes are able to control their blood sugar through diet and exercise, and don’t need to take medicine at all. To prevent type 2 diabetes, we can find out if it is part of our family history (or ‘runs in the family’) to see if we are already at a higher risk. If type 2 diabetes is part of our family history, we can work with our doctors to monitor our health. Then, we can make smart diet and activity choices to prevent or delay type 2 diabetes. [1,3] Microsoft Office Clip Art. 2003. [cited 28 August 2005].

What Do You Mean “It Runs In The Family?!?” Family history of a disease: one or more of your relatives had a disease If you have a family history of a disease, you might have a higher risk of developing the disease than the average person Some combinations of your family history, your environment, and your behavior put you at higher risk for developing diseases If a disease runs in your family, that means it is part of your family history. If you have a family history of a disease, you might have a higher risk of developing the disease than the average person. Some combinations of your family history, your environment, and your behavior put you at higher risk for developing certain diseases, like type 2 diabetes, cancer, heart disease, and stroke. [3]

The Risk Triangle: A Type 2 Diabetes Example Your Genetics Your Risk You can think of your risk of developing a disease as a triangle, with your genetics, environment, and behavior all influencing your risk. Genetics is part of your family history. You might also share an environment and behaviors with your family. [Ask class] Can you think of some examples of how your behavior might influence your risk of developing a disease? [Some examples are smoking tobacco and lung cancer, physical inactivity and heart disease] [Ask class] What is your environment? That’s right, it’s the world around you. Can you think of some examples of how your environment might influence your risk of developing a disease? [Two examples are working in a coal mine and developing lung disease, and chemical exposure and cancer] Let’s think about how we can lower our risk. [Ask students]: If you are at high risk for lung cancer, what risk factors can you change to prevent getting it? How could you change them? [Answer: you could change your behavior by quitting smoking] Your Environment Your Behavior

Using Family History for Prevention Environment and behavior are modifiable risk factors Genetic make-up is a non-modifiable risk factor You can prevent disease by changing modifiable risk factors While genetics, environment, and behavior all contribute to your risk of developing a disease, only environment and behavior can be changed to prevent the disease. Later on in class we will figure out how to use family history knowledge to prevent type 2 diabetes. [3] Behavior Risk Risk Risk Genetics Environment

In Summary… Diabetes is a serious, preventable disease that strikes about 21 million Americans! We can use knowledge of family history to prevent type 2 diabetes! Now, let’s look at a case of a woman who might be at risk, and see if we can help her… Microsoft Office Clip Art. 2003. [cited 28 August 2005].

References Diabetes and Public Health Speak: A crash course on the public health aspects of diabetes. PowerPoint presentation by Pamela Allweiss, CDC Science Ambassador Program, June 2005. www.nlm.nih.gov/medlineplus/tutorials/diabetesintroduction/id029102.pdf [Accessed 10/27/05] http://www.cdc.gov/nchs/fastats/diabetes.htm [Accessed 3/27/06] Family History: A disease prevention tool for public health and preventative medicine. PowerPoint presentation by Paula Yoon, CDC Science Ambassador Program, June 2005. http://www.diabetes.org/diabetes-statistics/heart-disease.jsp [Accessed 8/28/05]