After eating, most food is turned into glucose, the body’s main source of energy. What Happens When We Eat? American Diabetes Association

In people without diabetes, glucose stays in a healthy range because Normal Blood Glucose Control Insulin is released at the right times and in the right amounts Insulin helps glucose enter cells American Diabetes Association

In diabetes, blood glucose builds up for several possible reasons… High Blood Glucose (Hyperglycemia) Too little insulin is made Liver releases too much glucose Cells can’t use insulin well American Diabetes Association

 Type 1 › Pancreas makes too little or no insulin  Pre-diabetes  Gestational Diabetes  Type 2 › Cells do not use insulin well (insulin resistant) › Ability for pancreas to make insulin decreases over time  Type 3??

Number of Americans with Diagnosed Diabetes,

 Currently affects about 25.8 million Americans of all ages. › About 8% of the population (U.S.) › Estimated 7 million undiagnosed › Hispanics/Latinos – about 12% diagnosed › African Americans – about 13% diagnosed › Asian Americans – about 8% diagnosed

(Oregon.gov, 2006)

 Increased thirst  Increased urination  Blurry vision  Fatigue  Weight loss  Nausea and vomiting  More frequent infections

 Know your numbers: › A1C < 7 › BP 130/80 or lower › Cholesterol:  LDL: <100  HDL: >40 men; >50 women  10 important tests: › A1C › BP › Cholesterol › Eye exam › Urine test › Foot exam › Dental exam › Weight › Flu shot › Pneumonia shot

 A leading cause of blindness  Leading cause of non-accident amputations  Kidney disease  Nerve damage (peripheral neuropathy)  Heart attack / stroke

Oral medication only 58% No medication 16% Insulin only 12% Insulin and oral medication 14% Treatment of Diabetes National Diabetes Information Clearinghouse. National Diabetes Statistics, Available at:

 Estimated to cost more than $174 billion annually. › Direct medical costs = $116 billion › Indirect costs = $58 billion  $1 in every $5 health care dollars spent on caring for someone diagnosed with diabetes

 “The best time to plant a tree is 20 years ago. The second best time is now.”  Chinese Proverb  Good news with diabetes prevention › Small steps matter

 Active interventions (vs placebo) would: Cost-Effectiveness of Lifestyle Modification or Metformin: DPP Herman WH, et al for the Diabetes Prevention Program Research Group. Ann Intern Med. 2005:142: Intensive Lifestyle Metformin Delay onset of type 2 diabetes by 11.1 years3.4 years Reduce incidence of type 2 diabetes by 20%8% Increase life expectancy by 0.5 years0.2 years Cost per QALY$1,124$31,286 QALY = Quality Adjusted Life Years