1. Sugar

2. Diabetes Mellitus 20.8 million children and adults in the United States, or 7% of the population, who have diabetes 6.2 million people (or nearly one-third) are unaware that they have the disease

3. Type I and II Type I = pancreas produces little to no insulin Type II = body cells become resistant to insulin (Gestational diabetes, Hypoglycemia)

4. Type I (insulin dependant) Historically in ages 8-19 Thought to be related to genetic predisposition Autommune response creates antibodies that attack one own pancreas (insulin secreting cells) Viral?

5. Type II (non-insulin dependant) More prevalent than I Genes and obesity are related Previously related to age …. in the last 15 years, childhood type II increased by 33%

6. Obesity = One in four (in 2004)

7. CDC trend is on the rise (1 in 3)?

8. BMI (www.diabetes.org) Warning: off track!off track!

9. Autoregulation

10. cycle High [Glucose and Insulin]

11. Damage Some cells “down regulate” Others get deluged with insulin and are stimulated all the time Insulin allows magnesium in and sodium out Insulin regulates GH, Prog and testosterone

12. Microvascular damage Small blood vessels – retina, kidney, heart, brain Small nerve endings – fingers, toes, genitals, pericardium White blood cells – poor chemotaxis and phagocytosis

13. “End Organ Damage” Heart attack….. Stroke…… Blindness….. Dialysis… Infertility….. Amputation… Infection….

14. Diabetes costs in 2002 Total (direct and indirect): $132 billion Direct medical costs: $92 billion Indirect costs: $40 billion (disability, work loss, premature mortality)

15. Death rates: Heart disease and stroke account for about 65% of deaths in people with diabetes Adults with diabetes have heart disease death rates about 2 to 4 times higher risk of death from stroke is 2.8 times higher among people with diabetes

16. Symptoms: Fatigue Excessive thirst Excessive hunger Increased weight Depression Increase blood pressure Poor brain function/depression

17. Testing - screening Blood glucose levels –fasting and OGTT Hemoglobin A1C Insulin level C-peptide

18. Pre-diabetes fpg ogtt

19. The ADA diet Insurance companies cover dietary evaluation if DM Nutritionist/naturopath Low glycemic index foods 1800-2000 calorie ADA

20. Glycemic index A ranking of carbohydrates based on their effect on blood glucose levels within 2 to 3 hours after a meal All-BranLow42 Porridge, non instant Low49 Oat branMedium55 MuesliMedium56 Mini Wheats (whole meal) Medium57 Shredded Wheat Medium69 Golden Graham s High71 Puffed wheat High74 WeetabixHigh77 Rice Krispies High82

21. Exercise Rx As a precaution for “fight or flight” encounters, skeletal muscle has a “back door” for glucose transport so exercise can be used as a tool to regulate plasma glucose levels

22. Medicines Insulin injection (inhalation) for type I or advanced type II Oral meds for type II

23. Sulfonylureas – stimulate pancreas to make more insulin (glucotrol, glynase) Biguanides – improve insulins ability to move glu into cells and halts liver release (glucophage) Thiaxolidinedions – improve insulins effectiveness in muscle/fat and halt liver release (avandia actos) Alpha-glucosidase inhibitors – block starch absorption (precose) Meglitinides – glucose dependant pancreas stimulation (prandin) Dipeptidyl peptidase 4 – (januvia)

24. Chromium Picolinate Human Nutrition Research Center of the United States Department of Agriculture conducted in 1996. Insulin effectiveness is improved Triglycerides decrease

25. Vitamins … Magnesium Fish oil Antioxidants vit E, C, B

26. www.diabetes.org www.americanheart.org