Diabetes is a serious chronic medical condition characterized by high levels of glucose (sugar) in the blood.
Glucose is a source of energy for the cells but too much glucose is harmful to health. Glucose comes from food but is also created in the liver and muscles.
Glucose is required by all cells in your body.
Insulin, a hormone, released by the pancreas, is essential in the transportation of glucose into the cells. Without insulin glucose cannot be transported into the cells and the cells are “starved”.
There are 3 types of Diabetes -
- Type 1 Diabetes - the pancreas does not produce insulin. Glucose can not be utilized by cells — “starvation”. People with type 1 need insulin every day.
- Type 2 Diabetes -the pancreas does not produce enough insulin and cells develop resistance to insulin. People with type 2 often need to take pills and/or insulin. Type 2 is the most common form of diabetes (90%-95%).
- Gestational Diabetes - caused when the body of a pregnant woman does not secrete enough insulin required during pregnancy, leading to increased blood sugar levels. Reported rates of gestational diabetes range from 2% -10% of pregnancies. Women with gestational diabetes are at increased risk of developing type 2 Diabetes later in life.
The goals in caring for diabetes patients are -
- Eliminate symptoms such as hypoglycemia
- Prevent (or at least slow) the development of complications
“The prognosis in patients with diabetes mellitus is strongly influenced by the degree of control of their disease.”
Diabetes affects 25.8 million people - 8.3% of the U.S. population (2010)
- Diagnosed - 18.8 million people
- Undiagnosed - 7.0 million people
Among U.S. residents aged 65 years and older, 10.9 million (26.9%) had diabetes in 2010.
In 2005-2008, based on fasting glucose or hemoglobin A1C levels, 35% of U.S. adults aged 20 years or older had pre-diabetes (50% of adults aged 65 years or older).
Applying the percentage above to the entire U.S. population in 2010 yields an estimated 79 million American adults aged 20 years or older with pre-diabetes.
20-44 - 3.7%, 45-64 - 13.7%, >65 - 26.9% (for table above)
Diabetes in different ethnic populations (CDC 2002)
Source - (for all above facts)
Centers for Disease Control and Prevention. National diabetes fact sheet: national estimates and general information on diabetes and pre-diabetes.
The main complications that affect diabetic patients are -
- Heart disease - 2/3 of patients die of heart disease or stroke (2-4 times the risk)
- Blindness - diabetic retinopathy accounts for 12,000-24,000 newly blind persons every year
- Kidney failure - leading cause of renal failure necessitating dialysis.
- Amputation - leading cause of non-traumatic lower limb amputations with over 71,000 performed in 2004
Cardiovascular disease (Heart disease) is the leading cause of mortality among patients with diabetes.
- 65% of diabetic patients die from heart disease and an additional 20% from stroke.
- 75% of diabetic patients have high blood pressure, a major risk factor for cardiovascular disease.
Diabetes is the leading cause of blindness in the US. People with diabetes are more likely to develop cataracts — a clouding of the eye’s lens, and glaucoma — optic nerve damage. Laser surgery can help in these conditions.
Nerve damage is the major cause behind foot disease in the diabetic patient. Any damage to the feet is very difficult to treat and can lead to amputations. Comprehensive foot care programs can reduce amputation rates by more than 45 percent!
Almost 30 percent of people with diabetes aged 40 years or older have impaired sensation in the feet (i.e., at least one area that lacks feeling).
CDC Diabetes Task Force (2002) - “we strongly recommend close patient monitoring of the following to improve the outcome in diabetic patients:”
- glycemic control (Hb A1C) — recommended 7.0 or lower (6.5 or lower in patients with heart disease)
- diabetic retinopathy
- Foot lesions and nerve damage
- diabetic nephropathy
- HDL/LDL levels (LDL — below 100, HDL- above 50)
- Aspirin as directed by physician
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