Class 21 Flashcards
SOME DIABETES FACTS
Between 1980 & 2008, Fasting Plasma Glucose (FPG) levels rose on average by 0.07 mmol/L for males & 0.09 mmol/L for females.
Worldwide diabetes prevalence for males in 1980 was 8.3%. In 2008 prevalence for males rose to 9.8%. Females prevalence rose from 7.5% to 9.2% in same time period.
Number of people with diabetes worldwide went from 153 million in 1980 to 347 million in 2008.
Almost no change in East Asia, Southeast Asia & Eastern Europe. Highest increase was in Oceania.
Lowest rise in FPG was in Sub-Saharan Africa & East & Southeast Asia (average rise males was 0.07 mmol/L, females 0.03 mmol/L).
Biggest rise in FPG was in North America (males
0.18 mmol/L, females 0.14 mmol/L).
Canadian Data (Public Health Agency of Canada 2011 Report)
• According to blood sample data, about 20% of diabetes cases remain undiagnosed.
• Ontario has highest provincial age-standardized prevalence rates of diagnosed diabetes in Canada.
• 1998/99 - 2008/09, prevalence of diagnosed diabetes among Canadians increased by 70%. Greatest relative increase in prevalence was seen in 35 to 39 & 40 to 44 year age groups, where proportion doubled. Increase in younger age groups is, in part, consequence of increasing rates of overweight & obesity.
• Based on available data, its calculated that more than one in ten deaths in Canadian adults could be prevented if diabetes rates were reduced to zero.
Canadian Data (Public Health Agency of Canada 2021)
• 3.4 million Canadians living with diabetes (8.1% of population) in 2017-18
• 3.3% annual prevalence increase since 2000-01
• 7.6% males, 6.4% females
• Inverse relationship between socioeconomic status, education, & diabetes incidence
Canadian Data (Diabetes Canada 2022)
• 30% of Canadians are prediabetic or diabetic (est. will be 33% by 2032)
• Est. 14% of Canadians are Type 1, Type 2 or undx’d Type 2
• Age-standardized prevalence: 14.4% South Asian descent, 12.9% African descent, 9.4% Arab/West Asian descent, 8.2% East/Southeast Asian descent
• Much higher incidence in indigenous peoples, esp. those living on reserves (17.2%)
• Individuals with diabetes 3+ times more likely to be hospitalized with cardiovascular disease than individuals without diabetes, 12 times more likely to be hospitalized with end-stage renal disease, & almost 20 times more likely to be hospitalized with non-traumatic lower limb amputations.
• Diabetes reduces lifespan by 5-15 years
What are Common Onset Signs/Symptoms of Type 1 Diabetes?
→ onset of symptoms is usually rapid, acute
→ weight loss
→ intense hunger
→ intense thirst
→ constant fatigue/exhaustion
→ weakness, numbness, paraesthesias (esp. hands & feet)
→ dizziness, feeling faint
→ cold/clammy feeling, shaking
→ intense reaction to sugar consumption (e.g., weakness,
sweats, shaking, dizzy, headachy)
→ frequent urination – urine may have sweet smell
→ prone to ketosis – may be noticeable acetone breath
→ disordered, often erratic blood pressure
→ blurred vision, diplopia
→ irritability
→ marked skin changes – itchy, very dry
→ highly susceptible to bacterial, yeast, fungal infections
What are Common Onset Signs/Symptoms of Type 2 Diabetes?
→ symptom development tends to be slow, gradual
→ many cases go undiagnosed
→ most S/S are often milder versions of above
→ fatigue, lethargy
→ unusual thirst & frequent urination, esp. at night
→ unusual hunger unrelated to frequency of eating
→ noticeable reaction to sugar consumption, unclear postprandial symptoms
→ hypertension
→ blurred vision, double vision
→ skin changes as above; also, acanthosis
nigricans – patches of dark, velvety skin in body
folds/creases, esp. neck/armpits
→ slow healing, poor quality healing
→ higher susceptibility to bacterial, yeast, fungal infections
→ erectile dysfunction
What is acanthosis nigricans?
patches of dark, velvety skin in body
Blood Glucose Regulation for Type 2 Diabetes
All types of diabetes, diet, exercise & compliant lifestyle choices are central aspect of managing condition.
Type 2 can be significantly modified, even reversed in some cases, by weight loss, revision of diet & daily life practices. Some Type 2 diabetics manage condition with these measures alone.
When drugs are being used, most cases Type 2 diabetics are taking oral medications: to stimulate pancreas to release more insulin (sulfonylureas or meglitinides) &/or to make body’s cells more sensitive to insulin (metformin or thiazolidinediones). Other common medications include SGLT2 inhibitors to cause kidneys to release glucose in urine. Medication or combination of medications doctor prescribes depends on individual case. Metformin is first medication doctors typically try.
At more severe end of Type 2 diabetes spectrum, some people use insulin as primary treatment or in addition to oral medication.
Blood Glucose Regulation (Blood Glucose Monitoring)
Diabetics, especially Type 1 diabetes, routinely sample drops of their blood to gauge current blood glucose status so they can react accordingly.
Blood Glucose Regulation (Insulin)
All Type 1 diabetics & some Type 2 must use external source of insulin. Insulin is broken down in digestive tract, so it cannot be taken orally & must be injected. Standard syringes or injection pens with insulin cartridges are one primary method.
Blood Glucose Regulation (Insulin Injection)
Insulin is injected into subcutaneous fatty tissue (not
muscle & not directly into blood). Injection into/near umbilicus, scars, moles, etc. is avoided – can interfere with uptake.
Can be minor redness irritation present at recent injection sites.
Sites must be rotated to prevent tissue hardening & fatty clumps that tend to develop at overused sites. It’s advised that person moves each injection site at least half inch from previous one, & body part being used is changed every 1-2 weeks.
Also recommended that person not inject into body part about to be exercised.
Insulin is absorbed more or less quickly depending on site used (abdomen is quickest). Different types of insulin are faster & slower acting. Most people use more than one type at different intervals in day, eg, shorter acting type is often taken before meal, & longer acting type makes more sense before sleep. Current trend is toward more frequent injections, since this more closely mimics natural insulin release.
Good control for insulin-dependent diabetics is blood glucose consistently between ________________.
4 and 7 mmol/l
Blood Glucose Regulation (Insulin Pumps)
Insulin pump is about size of cell phone. Consists of reservoir (insulin cartridge), battery operated pump, & computer chip controls exact amount of insulin being delivered. Attached to thin plastic tube at end of which is soft plastic needle called cannula. Cannula inserts under skin, usually abdomen, although buttocks, thigh & arm sites also used. Insertion point must be changed every 2-3 days.
Once cannula in place, pump can be clipped onto
undergarments such as bra, worn on waistband or belt, arm or leg band. For sleeping, pump can be clipped onto pajamas, or placed on bed next to user. No problem if person rolls/lies on it as long as tubing is secure.
Pump can deliver constant rate of insulin, known as basal rate, 24 hours day. This rate can be programmed by user to allow for variation in insulin need. Pump can deliver large dose of insulin, called bolus, before meals, or if excess food is consumed.
What are advantages of insulin pumps?
→ no need for individual injections
→ dosage is more accurate (majority opinion)
→ fewer swings in blood glucose levels
→ greater flexibility in planning meals
→ eliminates unpredictable effects of intermediate or long-lasting insulin
→ user can exercise without having to eat large amounts of carbohydrates first
What are disadvantages of insulin pumps?
→ can lead to weight gain
→ if tubing comes kinked or disconnected, can lead to diabetic ketoacidocis
→ can require full day in an outpatient centre to be
trained in how to use it; user error can be an issue (age, mental capacity)
→ price: $6000 - $7000 for pump, plus approximately $1200 in supplies yearly
→ may not be suitable with each individual’s daily activities (e.g., swimming)
