Cardiac Output, Venous Return, and Their Regulation
World diabetes day
1.
2. Every year on November 14,
World Diabetes Day brings diabetes
to the attention of the world.
3. November 14 is the
birthday of Frederick
Banting, one of the
discoverers of insulin.
(c) Banting House National Historic Site of Canada
4. The global symbol for diabetes was developed during
the Unite for Diabetes campaign.
Why a circle?
A positive symbol across cultures, the circle
symbolizes life and health.
Why blue?
The colour blue reflects the sky that unites all nations.
The blue border of the circle reflects the colour of the
sky and the flag of the United Nations. The blue circle
signifies the unity of the global diabetes community
in response to the diabetes epidemic.
http://www.diabetesbluecircle.org
5. Diabetes Mellitus
• The name “diabetes mellitus means sweet
urine. It stems from ancient times when
physicians would taste a patients urine as a
part of a diagnosis.
7. What is Diabetes?
• A condition in which the
body cannot make or
cannot use insulin
properly
8. Diabetes
• A fast growing disease
• Diabetes is a major chronic disease affecting
many individuals, for which very high growth
rates are expected in the coming years.
• Due to changes in lifestyles more human
beings are becoming diabetic patients.
• The number of diabetes cases is increasing
day by day.
9. The Impact of Diabetes:
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Million lives are lost annually
Millions of $ lost income and Productivity.
1 million amputation per year.
Diabetes kills 1 person in every 8 seconds.
Every 10 seconds, 2 people develop diabetes.
-IDF Bulletin; November 2011.
13. Why are We Concerned about
Diabetes?
Every 24 hours...
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3,600 new cases of diabetes are diagnosed
580 people die of diabetes-related complications
225 people have a diabetes-related amputation
120 people with diabetes progress to end-stage renal
disease
55 people with diabetes become blind
ADA -2002
14. INDIAN SCENARIO
High prevalence
Life style changes further accentuate the high genetic predisposition
Under diagnosed due to low awareness
Perhaps occurs a decade earlier
Non obese/lean Type II fairly common
Treated less seriously as considered “Mild Disease”
15. Demographics
Current Age Distribution
Classification of Diabetes
Type 1
7.6%
Type 2
90.6%
Others
1.9%
50
25
0
<15
15-30
30-45
45-55
55-70
>70
Age Groups
Current Mean Age
Mean Age at Onset of Diabetes
Mean Diabetes Duration
53.4 ± 13.0 (n= 2269)
43.6 ± 12.2 (n= 2251)
10.0 ± 6.9 (n= 2251)
DiabCare Asia India
16. Magnitude of the Problem
• Diabetic retinopathy: most common cause of
blindness before age 65
• Nephropathy: most common cause of ESRD
• Neuropathy: most common cause of nontraumatic amputations
• 2-3 fold increase in cardiovascular disease
17. Risk Factors for Diabetes Mellitus
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Family history of diabetes (i.e., parent or sibling with type 2 diabetes.
Obesity (BMI > 25 kg/m2)
Physical inactivity
Mental Stress
Race/ethnicity (e.g., African American, Latino, Native American, Asian
American, Pacific Islander)
Previously identified with IFG, IGT, or an A1C of 5.7–6.4%
History of GDM or delivery of baby >4 kg (9 lb)
Hypertension (blood pressure 140/90 mmHg)
HDL cholesterol level <35 mg/dL (0.90 mmol/L) and/or a triglyceride level
>250 mg/dL (2.82 mmol/L)
Polycystic ovary syndrome or acanthosis nigricans
History of cardiovascular disease
18. More Risk Factors
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Goals:
Women < 35
Men < 40
Overweight (Abdominal)
Over 45 years old
Sedentary Lifestyle
Non-White Race
Family History of DB
Family History of High BP
History of High BP (self)
High Cholesterol
History of Gestational DB
Delivered a baby > 9 lbs.
21. Type 1 Diabetes Mellitus
• Formerly known as “juvenile onset” or
“insulin dependent” diabetes
• Most often occurs in people under 30 years
of age, but may occur at any age.
• Peak onset between ages 11 and 13
22. Type 1 Diabetes Mellitus
Etiology and Pathophysiology
• Progressive destruction of pancreatic
cells
• Autoantibodies cause a reduction of 80%
to 90% of normal cell function before
manifestations occur
23. Type 1 Diabetes Mellitus
Etiology and Pathophysiology
• Causes:
– Genetic predisposition
– Exposure to a virus
24. Type 1 Diabetes Mellitus
Onset of Disease
• Manifestations develop when the
pancreas can no longer produce insulin
– Rapid onset of symptoms
– Present at ER with impending or actual
ketoacidosis
25. Type 1 Diabetes Mellitus
Onset of Disease
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Weight loss
Polydipsia (excessive thirst)
Polyuria (frequent urination)
Polyphagia (excessive hunger)
Weakness and fatigue
Ketoacidosis
26. Type 1 Diabetes Mellitus
Onset of Disease
• Diabetic ketoacidosis (DKA)
– Life-threatening complication of Type 1 DM
– Occurs in the absence of insulin
– Results in metabolic acidosis
27. Type 2 Diabetes Mellitus
• Formerly known as “adult onset” or “
Non insulin dependent Diabetes”.
• Accounts for >90% of patients with
diabetes
• Usually occurs in people over 30 years
old
• 80-90% of patients are overweight
28. Risk Factors for Type 2 Diabetes
• Age
Obesity
• Race/ethnicity
Physical inactivity
• Previous gestational diabetes (GDM)
Impaired fasting glucose levels • Family history of diabetes
Impaired glucose tolerance (IGT) Body fat distribution
Can be modified
29. What Happens in Type 2 DM
Stomach empties 50%
faster than normal
Pancreas can’t make
enough insulin
Type 2
Diabetes
Liver puts too
much sugar
into the blood
Muscle cells and other tissues are
resistant to insulin
30. Type 2 Diabetes Mellitus
Onset of Disease
• Gradual onset
• Person may go many years with undetected
hyperglycemia
• Marked hyperglycemia (27.6 – 55.1 mmol/L)
32. Classification of Diabetes
Type I DM
Type II DM
Aetiology
Autoimmune
(- cell destruction)
Insulin resistance and -cell
dysfunction
Peak age
12 years
60 years
Prevalence
0.3%
6% (>10% above 60 years)
Presentation
Osmotic symptoms, weight
loss (days to weeks), DKA
Patient usually slim
Osmotic symptoms, diabetic
complications (months to years).
Patient usually obese
Treatment
Diet and insulin
Diet, exercise (weight loss), oral
hypoglycemics, Insulin later
33. Gestational Diabetes
• Develops during pregnancy
• Detected at 24 to 28 weeks of gestation
• Associated with risk for cesarean delivery,
perinatal death, and neonatal complications
34. Gestational Diabetes
• Develops during pregnancy
• Detected at 24 to 28 weeks of gestation
• Associated with risk for cesarean delivery,
perinatal death, and neonatal complications
35. Secondary Diabetes
• Results from another medical condition or
due to the treatment of a medical condition
that causes abnormal blood glucose levels
– Cushing syndrome (e.g. steroid administration)
– Hyperthyroidism
– Parenteral nutrition
42. LIFE STYLE BALANCE INTERVENTION
WEIGHT LOSS GOAL.
PHYSICAL ACTIVITY GOAL.
DIETARY MODIFICATION.
43. 150 mins / week moderate exercise.
Intensity to brisk walking.
Minimum 3 times/week.
Minimum 10 mins per session.
Maximum 75mins per session
Evidence based, effective, feasible.
Suitable for long term maintenance.
In 2010, it was estimated that over 300 million people worldwide were affected by diabetes. Within 20 years this number is expected to soar to about 500 million. This is an increase of more than 50%.Much of this increase will occur in the Indian and Asian subcontinents, due to a complex interplay of genetic, environmental and social factors, such as rural-urban migration and industrialisation.International Diabetes Federation. (2009). IDF Diabetes Atlas, 4th Ed. Brussels.
New in this edition:China takes the top spot, with India close behind. This is heavily influenced by the new study published in 2010. Our estimates are just under theirs at 90 million (compared to 91 million) and can be attributed to different age groups and a somewhat more conservative approach.Increases and changes in the position of countries relative to each other can be explained mostly by an ageing population and changes in urbanisation.Note, the BRIC countries are all in the top 10. Only the US is a high-income country.
