diabetes for all

1. Module One
An Introduction to Diabetes
IDF Basic Diabetes Course

2. 1. Define diabetes and differentiate types of diabetes
2. Identify the signs and symptoms of diabetes
3. Understand the risk factors associated with type 2 diabetes
4. Define healthy living (Physical activity, balanced diet)
5. Know how to diagnose diabetes
6. Demonstrate an understanding of the basic pathophysiology of diabetes

5.  Diabetes that occurs when the body cannot produce enough insulin or cannot use
insulin effectively. is a chronic disease
 Insulin is a hormone produced in the pancreas that allows glucose from food to enter
the body’s cells where it is converted into energy needed by muscles and tissues to
function.
 A person with diabetes does not absorb glucose properly, therefore glucose remains
circulating in the blood (a condition known as hyperglycaemia) damaging body tissues
over time.
 This damage can lead to disabling and life-threatening health complications.
 The aim of diabetes care and education is to help people with diabetes keep their blood
glucose levels as near normal as possible, while living a normal life, in order to
minimise the risk of complications

6.  Type 2 diabetes is the most common type of diabetes representing
approximately 85% of all cases of diabetes. In type 2 diabetes, the body is able
to produce insulin but either the amount is insufficient or the body is unable to
respond to its effects (also known as insulin resistance).
 Type 2 diabetes usually occurs in adults, but is increasingly seen in children and
adolescents. Often both issues (insufficient insulin and/or insufficient response
to insulin) are present together and lead to a build-up of glucose in the blood.

7.  Gestational diabetes (GDM) is a transient type of diabetes that occurs during
pregnancy.
 It is associated with insulin resistance and thought to result from the hormone
changes that occur duping pregnancy
 As gestational diabetes normally develops later in pregnancy, the unborn baby
is already well-formed but still growing. The immediate risk to the baby is
therefore not as severe as for those whose mother had type 1 diabetes or type 2
diabetes before pregnancy (a condition known as diabetes in pregnancy).
Nonetheless, uncontrolled gestational diabetes can have serious consequences
for both a mother and her baby.

9. IMPACT OF DIABETES

12. INCREASING IN PREVALENCE
 Current estimates suggest 415 m1111on adults in the world have diabetes. This is
estimated to Increase by over 50% over the next twenty-five years – When it will
affect 10% of the world's adult population.
EXPENSIVE TO TREAT
 Treating complications can be very expensive and accounts for a large proportion of
the costs of managing diabetes . As a result , diabetes imposes a large economic
burden on individuals and families ,national health systems , and countries Health
spending on diabetes accounted for 11.6% of total health expenditure worldwide in
2015.
CAUSES EARLY DEATH
 The complications of diabetes account for many deaths of people with diabetes
during work1ng age In 2015 it was estimated that nearly 5 million people died as a
result of diabetes This estimated number of deaths is similar in magnitude to the
combined deaths from several infectious diseases that are major public health
priorities and is equivalent to one death every seven seconds

16. INCREASING IN PREVALENCE
 Current estimates suggest 415 m1111on adults in the world have diabetes. This is
estimated to Increase by over 50% over the next twenty-five years – When it will
affect 10% of the world's adult population.
EXPENSIVE TO TREAT
 Treating complications can be very expensive and accounts for a large proportion of
the costs of managing diabetes . As a result , diabetes imposes a large economic
burden on individuals and families ,national health systems , and countries Health
spending on diabetes accounted for 11.6% of total health expenditure worldwide in
2015.
CAUSES EARLY DEATH
 The complications of diabetes account for many deaths of people with diabetes
during work1ng age In 2015 it was estimated that nearly 5 million people died as a
result of diabetes This estimated number of deaths is similar in magnitude to the
combined deaths from several infectious diseases that are major public health
priorities and is equivalent to one death every seven seconds

18. INCREASING IN PREVALENCE
 Current estimates suggest 415 m1111on adults in the world have diabetes. This is
estimated to Increase by over 50% over the next twenty-five years – When it will
affect 10% of the world's adult population.
EXPENSIVE TO TREAT
 Treating complications can be very expensive and accounts for a large proportion of
the costs of managing diabetes . As a result , diabetes imposes a large economic
burden on individuals and families ,national health systems , and countries Health
spending on diabetes accounted for 11.6% of total health expenditure worldwide in
2015.
CAUSES EARLY DEATH
 The complications of diabetes account for many deaths of people with diabetes
during work1ng age In 2015 it was estimated that nearly 5 million people died as a
result of diabetes This estimated number of deaths is similar in magnitude to the
combined deaths from several infectious diseases that are major public health
priorities and is equivalent to one death every seven seconds

23.  The only recognised risk factors for type 1 diabetes are related to genetic
predisposition. Thus children of people with type 1 diabetes have an increased
risk of developing type 1 diabetes. Type 1 diabetes is most common in
Caucasians, and much less common in other ethnicity. These are so-called non-
modifiable risk factors and so there is nothing that an individual can do to affect
them and reduce their risk.
 There are many risk factors for type 2 diabetes. Some, as with type 1 diabetes,
are non-modifiable. However many others are modifiable, which suggests that
in some cases, type 2 diabetes could be prevented.

24. NON-MODIFIABLE RISK FACTORS
 Age
 Genetic predisposition
 Ethnicity
MODIFIABLE RISK FACTORS
 Abdominal or central obesity
 Overweight
 Physical inactivity
 Dietary factors (especially high consumption of sugar-sweetened food and
beverages)

26.  This study in China followed 577 people for six years. There were
three groups:
Those with a diet intervention
Those with an exercise intervention
Those with both diet and exercise
 The reductions in risk were as follows:
31% in the diet only group
46% in the exercise only group
41% in the diet and exercise group.

27.  In this program, all the 3234 people involved had IGT (impaired
glucose tolerance). There were three groups:
Control
Metformin
Diet and exercise
 The groups were followed for 2.8 years. The risk reductions were as
follows:
31% in the metformin group
58% in the diet and exercise group

28.  This study used an alpha glucosidase inhibitor, acarbose, in an attempt to
reduce the incidence of type 2 diabetes. 1368 people were followed for 3.3
years; a significant reduction (20%) in the incidence of type 2 diabetes was
demonstrated.
 We now know that type 2 diabetes can be delayed in people who have IGT.
Work needs to be done at community levels to reduce obesity by increasing
opportunities for (and perceived value in) increased physical activity, while at
the same time reducing people’s caloric and fat intake. A number of countries
have national initiatives in place to help people eat less and walk more.

29.  In this study 5269 people with either IGT or IFG were randomised to
groups using Ramipril or placebo or Rosiglitazone (a TZD) or placebo
and followed for 3 years.
 Diabetes or death was reduced by 60% in those randomised to the TZD
compared with placebo.
 The reduction in the group using ramipril was not significant.

30.  In this study 3305 patients (79% normal glucose tolerance, 21% with IGT)
were randomised to lifestyle plus either orlistat three times daily or a
placebo.
 Patients had a BMI > 30 kg/m2.
 After 4 years the cumulative incidence of diabetes was 9% in the placebo
group and 6.2% in the orlistat group; corresponding to a risk reduction of
37.3%.
 Reduction in diabetes was evident only in those with IGT.

32. TYPE 1 DIABETES:
Currently, there is no cure for type 1 diabetes, but it can be effectively
managed with insulin treatment, blood glucose monitoring and by following a
healthy, balanced diet and taking regular exercise. Effective management
greatly reduces the risk of complications
TYPE 2 DIABETES:
In the early 2000s, a number of studies demonstrated that it is possible to
prevent type 2 diabetes by adopting a healthy lifestyle. Moreover, recent
research has demonstrated that with weight loss it is possible to reverse the
underlying disease process.

35.  Type 1 diabetes is generally of quick onset, with the usual symptoms, plus
raised blood glucose
 level (above 11.1 mmol/1 or 199mg/dl). Absolute lack of insulin leads to a
breakdown of fats for energy, which leads to accumulated ketones in the
blood (and excreted in the urine). If untreated, this can lead to ketoacidosis -
a medical emergency that requires urgent insulin treatment and rehydration
in a hospital setup.
 Diagnostic strips are available to detect ketones in the urine or blood and the
presence of ketones in urine or blood suggests a diagnosis of type 1 rather
than type 2 diabetes.

36.  Type 2 diabetes can also present with the same symptoms as type 1
diabetes. However, in many cases, people may have no or only very mild
symptoms, and can have the disease for many years before diagnosis.
 Type 2 diabetes is diagnosed by blood tests. If a person has the usual
symptoms, but the blood tests are normal, then they do not have diabetes.
If the blood tests indicate diabetes, then they have diabetes, even if they
have no symptoms.

38. MAKING A DIAGNOSIS OF
DIABETES: SYMPTOMS

39. MAKING A DIAGNOSIS OF
DIABETES: SYMPTOMS

40. MAKING A DIAGNOSIS OF
DIABETES: SYMPTOMS

41. MAKING A DIAGNOSIS OF
DIABETES: SYMPTOMS

42. MAKING A DIAGNOSIS OF
DIABETES: SYMPTOMS

43. MAKING A DIAGNOSIS OF
DIABETES: SYMPTOMS

44. MAKING A DIAGNOSIS OF
DIABETES: SYMPTOMS

46. Fasting blood glucose level Interpretation
Up to 6.0 mmol/l or 109mgl/dl Normal
6.1 to 6.9 mmol/l or 110 to 125 mg/dl Impaired fasting hyperglycaemia
7.0 mmol/l or 126mg/dl or above Diabetes
FASTING BLOOD GLUCOSE
 This is a blood test taken after a fast of 8-10 hours, during which time only water can
be taken by mouth. The test is generally performed first thing in the morning. The
results are expressed as the amount of glucose molecules per litre of blood.
 You can interpret the results as follows:
If both the fasting and random glucose levels are normal, then the person
does not have diabetes.

47. Random blood glucose level Interpretation
Up to 7.7 mmol/l or 139mg/dl Normal
7.8 to 11 mmol/l or 140-199mg/dl Impaired glucose tolerance (IGT)
11.1 mmol/l or 200mg/dl or above Diabetes
RANDOM BLOOD GLUCOSE
 This is often the first test that will be done and can be performed at any time
of the day after breakfast. The result is expressed as the mmol of glucose
per litre (or mg/dl) of blood.
 You can interpret the results as follows:
 If the random glucose is normal it is unlikely that the person has diabetes;
however, if it is in the impaired glucose tolerance range, then a fasting
glucose or a glucose tolerance test will usually be performed.

48. This is a standardised test where a fasting glucose level is measured and then the
person is asked to drink a liquid that contains 75 grams of glucose. A further blood
test is taken two hours after the drink to see how high the glucose level has risen. The
results are interpreted in the same way as the fasting and random tests above. If
either the fasting OR the two-hour values are diagnostic, then the person has
diabetes. Both have to be normal to exclude the diagnosis.

49. When the level of blood glucose is higher than normal, the
excess glucose attaches to a number of different molecules
in the body.
This process of attachment is termed glycation. A small
amount of haemoglobin in each blood cell is glycated and
just how much will depend on the amount of glucose present
in the bloodstream.
Glycated haemoglobin (abbreviated as HbA1c), is used to
assess glucose levels over a 3 month period (the lifespan of
a red blood cell).

50. HbA1c

51.  Glycation describes the binding of glucose molecules to haemoglobin molecules in a red
blood cell.
 Measurement of HbA1c reflects the level of glycaemic control of an individual over the
past 8-12 weeks.

52.  HbA1c is normally expressed as the percentage of the total haemoglobin
that has been glycated (ie has glucose molecules attached to it) during the
past 2-3 months.
 It is generally accepted that a target HbA1c of 7.0% or 53mmols/mol would
significantly reduce the risk of microvascular complications. However,
consideration must be given to the social and medical circumstances of
each individual (for example a higher target would be more appropriate in
the elderly or those prone to unrecognized hypoglycemia).

53.  For many years this has been the standard means of assessing diabetic
control. Historically it is expressed in a % of total Hb but in 2007, it was
proposed that HbA1c reporting should be standardised reported as
mmol/mol of haemoglobin.
 However most countries continue to use %.An HbA1c of 6.5 %
(48mmol/mol) or above is diagnostic for type 2 diabetes.
 However it is important to note that a value below this does not exclude
diabetes.
 HbA1c cannot be used to diagnose type 1 diabetes and is unreliable in
people with certain blood disorders.

54. You will notice that for the blood glucose tests, there is a
middle category, which is higher than normal, but not yet
diagnostic of diabetes. This is sometimes termed 'pre-
diabetes'.
There is good evidence that lifestyle changes can help
prevent pre-diabetes progressing to diabetes - and in many
cases can lead to reversal to normal glucose tolerance.
It is essential that anyone diagnosed with impaired fasting
hyperglycaemia or impaired glucose tolerance is offered
appropriate lifestyle advice.