1. Diabetes: What
Everyone Needs to
Know!
Hongbiao (Hank) Liu MD PhD
Luna Medical Care

2. What is Diabetes?
 A condition in
which the body
cannot make or
cannot use insulin
properly

3. Fasting BS Random
BS
Over 200
126 and Diabetes With
above Symptoms
100 - 125 Pre - Diabetes 140 – 200
Under 100 No Diabetes
Under 140

4. Types of Diabetes
Mellitus
 Type 1
 Type 2
 Prediabetes

Impaired Fasting Glucose

Impaired Glucose Tolerance
 Gestational DM
 Other

5. Risk Factors Type 2 DM

6. More Risk Factors
 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
Goals:
DB
Women < 35  Delivered a baby > 9 lbs.
Men < 40

7. What Happens in Type 2 DM
Pancreas can’t make Stomach empties 50%
enough insulin faster than normal
Type 2
Diabetes
Liver puts too Muscle cells and
much sugar other tissues are
into the blood resistant to insulin

8. Signs / Symptoms of
Type 2 Diabetes

9. Additional Symptoms
 Frequent Urination
 Skin Infections
 Thirst
 Slow Healing
 Yeast Infections
 Appetite Changes
 Urinary Infections
 Blurred Vision  Dry Skin; Itching
 Tiredness;  Numbness; Tingling
Sleepiness  Feeling / Acting “Evil”
 Weight Changes  High Blood Pressure
 Headaches  Cholesterol Problems

10. Insulin Resistance
Skin Tags
Acanthosis

11. Polycystic Ovarian
Syndrome
 Fertility problems
 Acne
 Hair loss
 Facial Hair
 Weight problems
 Deadly triangle
 High Blood
Pressure
 High Cholesterol
 High Blood Sugar

12. Metabolic Syndrome
Definition
“A Clustering of
Multiple
Cardiometabolic
Risk Factors”

13. Criteria ATP III WHO AACE IDF
(AHA/
NHLB)
M > 102 cm BMI > 30 or BMI > 25 *M > 94 cm
W > 88 cm W : H Ratio *W > 80 cm
Abdominal M > 0.9 or BMI > 30
Obesity W> 0.85 + 2 others
Triglycerides > 150 mg/dl same same Same or on
meds
HDL M < 40 M < 35 M < 40 M < 40 (or on
W < 50 W < 39 W < 50 W < 50 meds)
Blood Pressure > 130/85 > 140/90 > 130/85 > 130/85 or on
or on meds or on meds meds
Fasting > 100 mg/dl T2 DM, IFG or Btw. 110 – > 100 or T2DM
Glucose or on meds IGT * 126 mg/dl
+2 others
Other Urinary Albumin 2 hr PP > 140;
Excretion Rate > PCOS; family
20 or alb:creatine hx; other
ratio > 30

14. 90% of T2DM: IR and MS
Adapted from International Diabetes Center (IDC), Minneapolis, Minnesota.

15. Increases in Diabetes

18. Diabetes in the United States
 Estimated prevalence: Nearly 24 million
 Nearly 8% of the U.S. population

Almost 25% of persons over age 60
 90 - 95% have type 2
 25% do not know they have it!
 57 million have pre-diabetes
 24% have Metabolic Syndrome
 Projected 44-68% increase in diabetes by 2015
 8% per year

19. Diabetes in the United States
 NOT an Equal Opportunity Disease!
Among those diagnosed…
 16.5% of Native Americans/Alaskan Natives
 11.8% of Black Americans
 10.4% of Latinos*

12.6% of Puerto Ricans

11.9% of Mexicans
 8.2% of Cubans
 7.5% Asian Americans
 6.6% Caucasians
 Lifetime DM risk (born after 2000)

33% men; 39% women; 50% Hispanic women

20. Diabetes
+
Obesity
=
Diabesity

21. Obesity and Diabetes
 1:3 Americans are obese
 1:5 Americans are morbidly obese
 80% of all Type 2 diabetics are
overweight
 Obesity in children has
doubled in 20 years
 Type 2 diabetes in
children has tripled
in the last 5 years

22. Children and Type 2
Diabetes
 Mean age: 12-14
years old
 Girls > Boys
 Overweight
 94% are in minority
groups
 74-100% have a
strong family history

23. Overweight Kids Become
Overweight Adults
 50% of overweight
children become
overweight adults
 26-41% overweight
preschool children
will become
overweight adults

24. What about our children?
 In a study done involving 111 children,
57% were obese, 12% were super-
obese
 In families of children who were obese
~ the caregiver thought the child’s
weight was a problem in only 44% of
the cases
Young-Hayman, D. et al Obesity Research 2000:8:241-8

25. Saturday Morning
Influence
61% of all
commercials
are for FOOD
90% are for sugared
cereals, candy bars,
fast food,
and chips

26. INDIANA
Diabetes Obesity
 State ranking for  State ranking for
prevalence (2008) prevalence (2008)
 Adults: Ranked 38th  Ranked 31st
 Diabetes in Indiana is  Adults in Indiana
above the national (2006)
average:  27.5 % obese
National Average:  35% overweight
8.0%
Indiana Average:
8.5%

27. Diabetes…
… wehave pills and insulin to
control it, so what is the big
deal?

28. Costs of Diabetes in the
U.S.
 $174 billion each year
 $116 billion in direct
medical costs
 $58 billion in indirect
costs
 Missed work
 Lost productivity
 1 in 10 healthcare
dollars spend on
diabetes/complications
 Human costs
 leading cause of
7th
death

29. Type 2 DM is Progressive
350
Post-meal glucose
250
Glucose Fasting glucose
(mg/DL) 150
50
-10 -5 0 5 10 15 20 25 30
300 Insulin resistance
Relative 200
function
(units) 100
At risk for Normal insulin level
diabetes Beta cell failure
0
-10 -5 0 5 10 15 20 25 30
Years of Diabetes
Adopted from D. Kendall, R. Bergenstal © International Diabetes Center

30. Health Impact of
Diabetes in the United
States
6th leading cause of death
Leading cause of 73% of adults have
kidney failure HTN and/or take meds
Diabetes
Leading cause Heart disease is the
of adult blindness leading cause of
death
Neuropathy in 60-70% of patients contributes
to high incidence of lower-limb amputation
National Diabetes Fact Sheet, United States, November 2003.
Available at http:;;www.cdc.gov/diabetes/pubs/factsheet.htm.

31. Diabetes Increases Death Rate
0.25
0.2
Event rate
Diabetes/CVD
0.15 Diabetes/No CVD
No Diabetes/CVD
0.1
No Diabetes/No CVD
0.05
3 6 9 12 15 18 21 24 Months
0
Organization to Assess Strategies for Ischemic Syndromes
Malmberg K, et al. Circulation. 2000;102:1014-1019. www.hypertensiononline.org

32. Causes of Death in Diabetes
50
40
40
30
20 15
13 13
10
10 4 5
s h ae d f o t necr e P
0
er
ic e s r
en ia/
as rt
te ce
za
th
m s
se a
e
he sea be an ke
flu n
di he
lo
in mo
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ro
C
Is di
er
Al
D
St
eu
t
th
ar
Pn
O
he
Geiss LS, et al. In: Diabetes in America.
t
National Institutes of Health;1995. www.hypertensiononline.org

33. Diabetes Management
Receives
a Failing Report Card…
Indicator of Diabetes Percent of Patients
Mgmt at Goal
A1C 37%
NHANES III
 1988-1994 7.8%
NHANES
 1999-2000 8.1%
LDL Cholesterol 23%
Systolic BP 41%
Beaton, S.et al. Diabetes Care 27: 694-698, 2004

34. Now the Good News:
Diabetes Can Be
Prevented
 Diabetes Prevention Program
 N= 3,234 people with IGT
 Ages 25-85 (mean 51)

Average BMI 34

45% minorities
 Goals
 Achieve/maintain weight loss of 7%
 Maintain moderate physical activity at
least 150 minutes/week

36. Preventing Diabetes
--or Living Healthy with It!
 Lifestyle Changes
 Healthy Eating
 Regular Exercise
 Healthy Weight

Weight Loss (7% of weight)
 Medications
 Weight Loss Surgery

37. Healthy Eating

38. Reading Food Labels

39. Plate Method
Fill ½ of the plate with non-starchy vegetables
Finish with
Don’t forget
a fruit
the dairy!
Choose a carb
serving Add a serving
of a protein food

40. The Supersizing P henomenon
Portion Control - I t Does
M t er !
at
29G
26G
700 77G
610
22G 68G
600
500 10G Fat 57G 450
Calories
400 320
26 Grams Carbs
300
210
200
100
0
1960 1978 1995 1999
Year

41. Activity and Exercise
 30 minutes of moderate activity
on most days of the week
This does
NOT
Count!

42. Inactivity and Diabetes
What’s wrong with this picture?

43. Healthy Weight

44. Height Normal Overweight Obese Extreme
Obesity
BMI=<25 BMI=25-29 BMI=30-39 BMI=>40
5 ft 0 in Up to 127 Up to 152 Up to 203 Over 203
5 ft 1 in Up to 131 Up to 157 Up to 210 Over 210
5 ft 2 in Up to 135 Up to 163 Up to 217 Over 217
5 ft 3 in Up to 140 Up to 168 Up to 224 Over 224
5 ft 4 in Up to 144 Up to 173 Up to 231 Over 231
5 ft 5 in Up to 149 Up to 179 Up to 239 Over 239
5 ft 6 in Up to 154 Up to 185 Up to 246 Over 246
5 ft 7 in Up to 158 Up to 190 Up to 254 Over 254
5 ft 8 in Up to 163 Up to 196 Up to 261 Over 261
5 ft 9 in Up to 168 Up to 202 Up to 269 Over 269
5 ft 10 in Up to 173 Up to 208 Up to 277 Over 277
5 ft 11 in Up to 178 Up to 214 Up to 285 Over 285
6 ft 0 in Up to 183 Up to 220 Up to 293 Over 293
6 ft 1 in Up to 188 Up to 226 Up to 301 Over 301
6 ft 2 in Up to 193 Up to 232 Up to 310 Over 310
6 ft 3 in Up to 199 Up to 239 Up to 318 Over 318
6 ft 4 in Up to 204 Up to 245 Up to 327 Over 327

45. Medications
 Prevention of Diabetes
 Metformin (Glucophage)
 Controlling Diabetes
 Pills, Insulin, and other Injectables
 Weight Loss
 Orlistat (Alli- OTC)
 Meridia
 Others

46. “Diabetes Surgery”
 Lab-Band (1 year)
 64% of patients showed resolution
 26% of patients showed improvement
 Roux-en-Y Gastric Bypass
 76.8% of patients showed resolution
- other studies showed 83% - 98%

47. Surgical Outcomes:
Comorbidities
Comorbidity Resolved Improved or
Resolved
Diabetes 76.8% 86.0%
Hyperlipidemia 70%
Hypertension 61.7% 78.5%
Sleep Apnea 85.7%

48. ”The distance is nothing; it is only the first step that is difficult.”