Department of Public Health School of Health and Life Sciences North South University munia.islam01@northsouth.edu A Global Perspective • 7th leading cause of deaths globally, with rates similar in women and men • As of 2019: • An estimated 463 million people had type 2 diabetes worldwide (~90% of the cases of diabetes) • More than 1.1 million children and adolescents are living with type 1 diabetes • More than 20 million live births (1 in 6 live births) are affected by diabetes during pregnancy • Diabetes at least doubles a person's risk of early death • In 2019, diabetes resulted in approximately 4.2 million deaths • 80% of diabetes deaths occur in low- and middle-income countries. And 80% of people with diabetes live in low- and middle-income countries. • In Bangladesh, the prevalence of diabetes in adults is 8.1% with a total number of cases at 8.3 million in adults What is Diabetes? Diabetes mellitus (DM) • A chronic condition that is characterized by raised blood glucose levels (hyperglycemia) with disturbances of carbohydrate, fat and protein metabolism from defects in insulin production, insulin action, or both • due to either the pancreas not producing enough insulin or the cells of the body not responding properly to the insulin produced • The effects include long–term damage, dysfunction and failure of various organs Risk Factors • Family history of Diabetes • Genetically (type 1 diabetes, pre-diabetes, gestational) • Overweight or obesity • Unhealthy diet • Physical inactivity • Gestational Diabetes Symptoms of Diabetes People with diabetes often have typical complaints/symptoms • Thirst and frequent drinking (polydipsia) • More frequent urination, particularly at night (polyuria) • Unexplained weight loss • Constant hunger • Fatigue • Blurred or change in vision • Frequent infections (e.g. skin, genital) Insulin and Diabetes • Normal Insulin Function • Blood sugar and glucose are sources of energy for the body • Food and drinks are absorbed into the blood • Insulin is produced by the pancreas when blood sugar is high to keep blood sugar levels within the normal range for good health • Insulin Function in Diabetics • Insufficient insulin to meet the body’s needs, which can be either a complete lack (type 1) or relative lack (type 2) of insulin causing raised blood glucose levels • Untreated diabetes results in short-term symptoms and serious long-term complications • Treatment aims to keep blood glucose levels as close to the normal range as safely possible Types of Diabetes • Pre-diabetes • Starts with unhealthy eating habits & inadequate exercise • Above average blood glucose levels, not high enough to be classified under type 1 or type 2 diabetes • Type 1 Diabetes • Usually diagnosed in childhood and affected by hereditary • Caused by a pancreas's failure to produce enough insulin due to loss of beta cells, which is caused by an autoimmune response • Frequently called the ‘insulin-dependent’ group since patients with type 1 diabetes need insulin daily to survive the body makes little or no insulin Types of Diabetes • Type 2 Diabetes (most common) • Usually occurs in adulthood but diagnosis is increasing in the younger generations • Begins with insulin resistance, a condition in which cells fail to respond to insulin properly • Rates rising due to increased obesity and failure to exercise and eat healthy • Gestational Diabetes • Blood sugar levels are high during pregnancy in women and usually resolves after having the baby • Oftentimes these women give birth to children over 4 kg (9 lbs.) Type 1 vs Type 2 Diabetes Type 1 Type 2 Onset Sudden Gradual Age of onset (usually) Childhood Adult BMI Normal Often overweight/obese Insulin Low or absent, therefore Normal, high or low, required therefore not necessarily required Prevalence ~10% ~90% Untreated Diabetes • Acute complications: • Diabetic ketoacidosis • body starts breaking down fat at a rate that is much too fast causing blood to become acidic • Hyperosmolar hyperglycemic state • person’s blood glucose (sugar) levels are too high for a long period, leading to severe dehydration (extreme thirst) and confusion • Death • Serious long-term complications: • Cardiovascular disease • Stroke • Chronic kidney disease • Foot ulcers • Damage to the nerves • Damage to the eyes and cognitive impairment Management of Diabetes • Maintain a healthy diet such as through heathy meal planning • Weight-loss surgery can help those with severe obesity • Adhere to treatment options • Type 1 diabetes must be managed with insulin injections • Type 2 diabetes may be treated with medications such as insulin sensitizers with or without insulin • Regular Exercise • To maintain a normal weight • Test blood sugar regularly • Avoid usage of tobacco and control blood pressure and maintain proper food and eye care Nutritional Management of Diabetes • Type I Diabetes • Consistency and timing of meals • Timing of insulin • Monitor blood glucose regularly • Type II Diabetes • Weight loss • Smaller meals and snacks • Physical activity • Monitor blood glucose and medications Prevention of Diabetes • At present, type 1 diabetes cannot be prevented • Eating healthier • diet rich in whole grains and fiber, and choosing good fats, such as the polyunsaturated fats found in nuts, vegetable oils, and fish • limiting sugary beverages and eating less red meat and other sources of saturated fat • Being active (more than 90 minutes per day) and taking care of your body • Check feet to make sure there is no nerve damage or interruption of blood flow • Take care of teeth • Control blood pressure and high • No smoking • Regular check-ups with the doctor including blood sugar checked along with weight, blood pressure, and feelings Key Summary Points • Diabetes is due to an absence of producing or responding to insulin and can have an onset across age groups. • Although type 1 diabetes cannot be prevented, pre-diabetes, type 2 diabetes and gestational diabetes can be prevented through lifestyle and behavioral changes. • Treatment and management of diabetes can help to prevent acute and serious long-term complications.