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  • DIABETES FACTS

                                                        DIABETES FACTS
    -The World Health Organization (WHO) estimates that more than 180 million people worldwide have diabetes. This number is likely to more than double by 2030
    -In 2005, an estimated 1.1 million people died from diabetes
    -Almost 80% of diabetes deaths occur in low and middle-income countries

    Almost half of diabetes deaths occur in people under the age of 70 years; 55% of diabetes deaths are in women
    -WHO projects that diabetes deaths will increase by more than 50% in the next 10 years without urgent action.
    Most notably, diabetes deaths are projected to increase by over 80% in upper-middle income countries between 2006 and 2015

    Almost half of diabetes deaths occur in people under the age of 70 years; 55% of diabetes deaths are in women
    -WHO projects that diabetes deaths will increase by more than 50% in the next 10 years without urgent action.
    Most notably, diabetes deaths are projected to increase by over 80% in upper-middle income countries between 2006 and 2015

    Insulin, a hormone produced by the pancreas, controls the level of glucose in the blood by regulating the production and storage of glucose.
     In the diabetic state, the cells may stop responding to insulin or the pancreas may stop producing insulin.

    PNDHYSIOLOGY A
    PATHOPHYSIOLOGYOF DIABETES

    -Insulin is secreted by beta cells, which are one of four types of cells in the islets of Langerhans in the pancreas.
    -When a person eats a meal, insulin secretion increases and moves glucose from the blood into muscle, liver, and fat cells.

    In those cells, insulin:
     -Transports and metabolizes glucose for energy
     -Stimulates storage of glucose in the liver and muscle (in the form of glycogen).
     -Signals the liver to stop the release of glucose.
     -Enhances storage of dietary fat in adipose tissue.
     -Accelerates transport of amino acids (derived from dietary protein) into cells.

    Another pancreatic hormone called glucagon
    (secreted by the alpha cells of the islets  of Langerhans) is released when blood glucose levels decrease and stimulate the liver to release stored glucose.
     -Initially, the liver produces glucose through the
    breakdown of glycogen (glycogenolysis).
     -After 8 to 12 hours without food, the liver forms
    glucose from the breakdown of noncarbohydrate
    substances, including amino acids

    Classification of Diabetes

    Type 1 diabetes (previously referred to as insulin-dependent diabetes mellitus)
     -Type 2 diabetes (previously referred to as non-insulin dependent diabetes mellitus)

    Type 1 diabetes

    5%- 10% of people with diabetes have type 1 diabetes, formerly known as juvenile , in which the insulin-producing pancreatic beta cells are destroyed by an autoimmune process.
     -Until now, nobody knew what caused the disease, some thought it might be inherited
    - As a result, they produce little or no insulin and require insulin injections to control their blood glucose levels.

    -It is thought that combined genetic, immunologic, and possibly environmental (eg, viral) factors contribute to beta cell destruction.
     -A genetic susceptibility is a common underlying factor in the development of type 1 diabetes.

    Because insulin normally inhibits glycogenolysis (breakdown of stored glucose) and Gluconeogenesis (production of new glucose from amino acids and other substrates).
    - In people with insulin deficiency, these processes contribute further to hyperglycemia.
     
    -In addition, fat breakdown occurs, resulting in an
    increased production of ketone bodies, which are
    the byproducts of fat breakdown.

    Ketone bodies are acids that disturb the acid–base
    balance of the body when they accumulate in
    excessive amounts.
    -The resulting diabetes ketoacidosis (DKA)
     -Initiation of insulin treatment, along with fluid and
    electrolytes as needed, is essential to treat hyperglycemia and DKA and rapidly improves the metabolic abnormalities.

    Diabetic ketoacidosis

    -Diabetic ketoacidosis (DKA) is an acute and dangerous complication that is always a medical emergency.
    -Low insulin levels cause the liver to turn to fat for fuel (ie, ketosis ;ketone bodies are intermediate substrates in that metabolic sequence. This is normal when periodic, but can become a serious problem if sustained. -Elevated levels of ketone bodies in the blood decrease the blood's pH, leading to DKA.

    On presentation at hospital, the patient in DKA is typically dehydrated, and breathing rapidly and deeply. Abdominal pain is common and may be severe. The level of consciousness is typically normal until late in the process, when lethargy may progress to coma.
    Ketoacidosis can easily become severe enough to cause hypotension, shock, and death. Urine analysis will reveal significant levels of ketone bodies (which have exceeded their renal threshold blood levels to appear in the urine, often before other overt symptoms).

    Prompt, proper treatment usually results in full recovery, though death can result from inadequate or delayed treatment, or from complications (eg, brain edema).
     DKA is always a medical emergency and requires medical attention. Ketoacidosis is much more common in type 1 diabetes than type 2.

    -90% of people with diabetes have type 2 diabetes
    which results from decreased sensitivity to insulin
    (called insulin resistance) and impaired beta cell
    functioning resulting in decreased insulin production.
     -Type 2 diabetes is first treated with diet and
    exercise.
     -If elevated glucose levels persist, diet and exercise are
    supplemented with oral hypoglycemic agents.

    TYPE 2 DIABETES

    Despite the impaired insulin secretion that is characteristic of type 2 diabetes, there is enough insulin present to prevent the breakdown of fat and the accompanying production of ketone bodies.
     -Therefore, DKA does not typically occur in type 2
    diabetes.
    - Uncontrolled type 2 diabetes may, lead to another acute problem, hyperglycemic hyperosmolar nonketotic syndrome

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