PA and Diabetes Chapter 9

PA and Diabetes Chapter 9 - PA and Diabetes Chapter 9...

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PA and Diabetes Chapter 9 Introduction Chronic disease Caused by a deficiency in the production of insulin or its use to transport glucose from the blood into other tissues Results in excess glucose in the blood hyperglycemia toxic Leading cause of adult blindness, end-stage kidney failure and non-traumatic amputations in the USA Increases the risk of CHD, hypertension, and stroke by 2-4x 98$ billion a year in USA Characteristic symptoms o Excessive urination polyuria o Persistent thirst polydipsia o Weight loss o Chronic fatigue or apathy Magnitude of the Problem WHO diabetes 120-140 million Expected to double by 2025 if trends of increasing obesity and inactivity persist USA diabetes 1958:1.6 million adults diagnosed (2/3 of all cases) 1997: 10 million 1998: 6.5% 1999: 6.9% 2000: 7.3%; almost all states >6% (Dishman fig 9.1a) 2001: 7.9%; 71,000 deaths (2/3 CVD) Early 2000’s: 17 million another 35% of people haven’t been diagnosed #6 killer Demographics USA The prevalence of diabetes among American Indians and Alaska natives is the highest of any cultural group in the US approaching 50% among women Increasing incidence Elderly and minorities in US African Americans Hispanic Americans Native Americans Asian and Pacific Island Americans Higher prevalence in elderly and minorities (Dishman fig 9.1b) Non-Hispanic White: 7.8% Hispano/Latino: 10% Non-Hispanic Black: 13.0% Native:15.1% (of those receiving care from IHS) Especially some groups (Dishman tbl 9.1) Clinical Features Major forms of Diabetes Mellitus Type 1 (IDDM; juvenile) Insulin-dependent Pancreas unable to produce insulin 10% of cases Type 2 (NIDDM; adult-onset)
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Insulin insensitivity poor transport of insulin from the blood into cells Non-insulin-dependent 90% of cases (80% in USA) Occurs mostly in adults over age 40 Type 2 can be normalized 50% by low glycemic index CHO Example: fruit, vegetables, pasta don’t cause blood glucose to spike Islet of Langerhans Cells in the pancreas β cells produce insulin Insulin regulates blood glucose and is required by all tissues (except the brain and intestines) for glucose to be transported from the blood across the cell membrane Deficiencies in the normal production of insulin or in its transport into cells leads to hyperglycemia and ketosis damages tissues, especially blood vessels and nerves Dysfunction can also result from impaired insulin sensitivity α cells produce glucagon Symptoms Hyperglycemia Additional Extreme thirst polydipsia Weight loss Frequent urination polyuria Chronic fatigue Dry skin Hunger Drowsiness Nausea Blurred vision Testing for diabetes Hours 0 1 2 3 Serum glucose (mg/dl) 50 100 150 200 250 300 350 Normal Borderline Oral 75g glucose Diabetes 28: 1039, 1979. Diabetic
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This note was uploaded on 08/13/2008 for the course EDKP 330 taught by Professor Koziris during the Fall '07 term at McGill.

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PA and Diabetes Chapter 9 - PA and Diabetes Chapter 9...

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