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4 Charts & Posters 27 Chart Collections 31 Reference Materials 35 Pediatric/Elementary 36 Alternative Therapy & Study Aids Reference Materials Resources 9781469894395_r2_DiabetesType1_3E_9781469894947 8/25/14 7:01PM Page 1

Whathappens inType 2Diabetes Much of the foodyou eat isbrokendown intoglucose.Glucose is the form of sugar in theblood and is themain source of energy for thebody. Glucoseneeds thehelp of ahormone called insulin to enter thebody cells.Normally thepancreas releases the right amount of insulinneeded to transferglucose fromyourblood toyour cells. InType 2diabetes,problems occurwhen the insulin that isproduced in thepancreasdoesn’twork correctly,not enough insulin ismade or thebody’s cells resist insulin. UNDERSTANDING TYPE 2 DIABETES

UNDERSTANDING TYPE 1 DIABETES

What is Diabetes? UNDERSTANDING DIABETES Types of Diabetes

What IsType 2Diabetes? Type 2 diabetes or T2DM, once known as non-insulin- dependent or adult-onset diabetes, is a progressive metabolic disorder that affects how your body uses sugar (glucose) from food. Glucose is an important source of energy for the cells of your body and organs. If you have diabetes, itmeans you have toomuch glucose (sugar) in yourblood,which can lead to serioushealthproblems. T2DM isacomplexdiseasewithmultiple factors linked to its cause and development, but ismainly characterized by a reduction in insulin secretion from the pancreas alongwith the body’s inability to use insulin properly (a condition called insulin resistance) tokeepbloodglucose (bloodsugar) levels normal. Insulin is the hormone that is needed to transportglucose (sugar) from the foodyoueat toyour cells. Type 2 diabetes is the most common and increasingly widespread form ofdiabetes, and it is believed that genetic and environmental factors play a role in its development. Being overweight is strongly linked to the development of T2DM, but not everyone with T2DM is overweight. It is most often associated with older age, but is a growing problem among U.S. children and adolescents. Type 2 diabetes in youth can have a devastating effect on one’s kidneys andheart at ayoung age. Symptoms (Manypatientsmayhaveno symptoms) • Increased thirst • Initialweightgain followedbyweight loss •Fatigue •Frequenturination •Dry skin •Blurredvision •Tingling inhands and feet •Erectiledysfunction,vaginaldryness RiskFactors High riskpatientswithout symptoms shouldbe screened every 3yearsbeginning at age 45.Patientswith symptoms shouldbe screened as soon aspossible. T2DM risk factors include: •High-risk ethnicity:AfricanAmerican,Latino, NativeAmerican,AsianAmerican,Pacific Islander •Womenwhohadgestationaldiabetes (highblood sugar duringpregnancy), orwhohavehad ababyweighing 9pounds ormore atbirth •History ofprediabetes,prediabetes isblood sugar levels higher thannormal,butnotyethigh enough tobe diagnosed asdiabetes •History ofhighbloodpressure (hypertension) and/or •Obesity or overweight •Lack ofphysical activity •Parent or siblingwithT2DM

What is Type 1 Diabetes?

Complications

Diabetesmellitus type1or type1diabetes (T1DM),onceknownas insulin-dependentor juvenilediabetes isachronic metabolic disorder that prevents the body frommaking energy from food.Most people develop T1DMwhen they are children oryoung adults,but it can occur at any age. People with T1DM cannot produce the hormone insulin, because their immune system (the body’s system for fighting infection)attacksordestroys the insulin-producingbetacells in thepancreas.Without thebetacells, thebody can no longerproduce the insulin needed to help sugar (glucose) enter the cell to beused for energy and the sugar (glucose)buildsup in theblood.Highblood sugar levels can lead tomany long-termhealthproblems. Although theexact causeof type1diabetes isnotknown, it is thought that thedestructionof thepancreaticbeta cells by the immune system is triggered ingenetically susceptible individuals after exposure to a series ofviral illnesses.

Type 1DiabetesMellitus (T1DM) Peoplewith T1DM do not produce insulin because their immune system (the body’s system for fighting infection)attacksanddestroys the insulin-producingbetacells in thepancreas, leaving littleorno insulin.Without insulin, sugarbuildsup in theblood instead ofbeing transferred to the cells. The cause of T1DM is not known but it is thought to be a combination of genetic and environmental factors (exposure to certain viruses).T1DM accounts for about 5% ofdiagnoseddiabetes in theUnited States. It can appear at any age, butdevelopsmost often in children andyoung adults. Type 2DiabetesMellitus (T2DM) iswhen thepancreasdoesnotproduce enough insulin, or the body cannotuse insulin properly (a condition called insulin resistance).T2DM is themost common formofdiabetesandgeneticsand environmental triggers mayplayapart in itsdevelopment.The following factorsplayan important role in causing highblood sugarand insulin resistance in individualsgeneticallyprone to type 2diabetes: • Beta cells in thepancreas slowly stopproducing insulin. • Alpha cells in thepancreasproduce toomuchofahormone calledglucagon that stimulates the liver tomake sugarwhich thebody can’tuse and it’s released into theblood. • The liver fails to store sugar as an energy source. • Thekidney overproducesglucose and INCREASES absorption ofglucose into theblood. • Low insulin levels cause the fat cells tobreakdown and release “free fatty acids” (FFAs).FFAs cause the liver tomakemore sugar, destroy the insulinproducingbeta cells in thepancreas andblock themuscles fromusingglucose for energy. • Muscle cells areunable to absorb anduseglucose for energy.Unusedglucose stays in theblood, increasing sugar levels. • Eating releaseshormones that tell thepancreas toproduce/release insulin,prevent the liver frommaking sugar, slow thepassage of food thru the stomach and send the brain amessage to “feel full”. In T2DM, these hormones are impaired resulting inweight gain and reduced insulin levels. • As onegainsweight, appetite is increased causingmoreweightgain and adding to insulin resistance.

Diabetesmellitusordiabetes isagroupofdiseases thataffect thebody’s cellsability to convertanduse sugar (glucose) from food for energy. The result is toomuch sugar (glucose) in the blood.Hyperglycemia (high blood sugar) candamageorgans suchas the eyes,kidneys,nerves,heartandbloodvessels, increasing riskof stroke andheart attacks. Patients with hypertension, high cholesterol, heart disease, a family history of diabetes, those who are overweight orHispanic orAfricanAmerican should be screened for diabetes beginning at age 45. Early diagnosis can slow theprogression of thedisease and lessen the risk of long term complications. Blood tests areused todiagnosediabetes.Alldiabetesblood tests involvedrawingblood and sending it to a lab for analysis.Yourhealth careprovidermayperform the following to test fordiabetes: •A1C blood test shows the average blood glucose levels over the past 3months, and is reported as a percentage, the higher the percentage, the higher your blood glucose levels have been.AnA1C test of greater than 6.5% is considered abnormal. •Fastingplasmaglucose test measuresbloodglucoseafter fasting forat least8hours.Fastingglucose levels above 126mg/dLare considered abnormal. • 2-HourOralGlucose test measuresbloodglucose levelsbefore and 2hours afterdrinking a special sweet liquid. 2-hourpostmealglucose levelsgreater than 200mg/dLare considered abnormal.

SHORT-TERM

CellularViewofPancreas

Hypoglycemia iswhenblood sugar fallsbelow70mg/dl.This is also known as an insulin reaction. Low blood sugar can be caused by eating too little, not eating often enough, by too much physical activity without eating, or toomuch insulin. Hypoglycemia candevelopquickly inpeoplewithdiabetes. Symptoms include: Hypoglycemia (low-blood sugar)

Alpha cell

Brain

Beta cell

Diabetic beta cells cannotproduce the insulinneeded tohelp cells convertglucose to energy

What happens in Type 1 Diabetes?

•Weakness/dizziness • Sweating •Headache •Loss of coordination

•Fatigue •Tremor • Irritability • Slurred speech •Awakening from sleep •Falling out ofbed •Facial tingling

Normal insulinproducing pancreatic cells

CellularViewofPancreas

• Seizure •Hunger

Insulin molecules

•Loss of consciousness • Inability to concentrate •Blurredvision

Destruction of beta cells

Insulinmolecules

Alpha cell

Beta cell

WhatHappens inDiabetes

Heart

Pre-diabetes iswhen the blood sugar level is higher than normal, but is still low enoughnot tobe considereddiabetes.92millionAmericanshaveprediabeteswhich isdefined ashaving fasting blood sugars levels of 100-125mg/dL, 2-hourpost meal blood sugars levels of 140-199mg/dL or anA1C of 5.7-6.4%. People withprediabetesareathigh risk for somediabetes related complications,

Diabetic pancreatic islet ofLangerhans

Glucose (sugar) fromdigestive system

Pancreas

Digestive System Food from the digestive system is broken down into sugar (glucose). It iseither stored in the liver or absorbed into the bloodstream, where it isusedby thebody for energy.

Normal pancreatic islet of Langerhans

especially heart disease. Weight loss and exercise can reverse prediabetes. 11% of patients with prediabetes convert to clinical diabetes eachyear. Gestationaldiabetes isacondition thatwomencangetwhen they are pregnant. The exact cause is unknown but it is believed that pregnancy hormones make your cells more resistant to insulin resulting inhighblood sugar.Gestationaldiabetesusually disappears after thebaby isborn,butwomenwhohavehad it are athigher risk ofdevelopingT2DM later.

Too little sugar in one’sblood Hypoglycemia

Liver

Stomach

Toomuch sugar in one’sblood Hyperglycemia

Lung

MultipleFactorsCauseHighBlood Sugar and InsulinResistance inType 2Diabetes

Insulin from pancreas

1 2

Food isbrokendown intoglucose.Glucose is a form of sugar in theblood and is the main source of energy for thebody. Glucoseneeds thehelp of ahormone called insulin to enter the cells. Ahormone is a chemical substancemade inonepartof thebodywhich travels to otherpartsof thebody tohelp cells andorgansdo their jobs. Insulin ismadeby special cells in

Pancreas

The followingmetabolicdisorders result in abovenormalblood sugar levels.

Heart

Large intestine

Glucosemolecules (fromdigestive system)

Hyperglycemia iswhenblood sugar increases and stays above the normal level (greater than 120 mg/dl before meals and greater than 180mg/dl aftermeals). Symptoms can develop slowly, sometimes over a period of days so it is important to monitor blood sugar levels.High blood sugar for an extended time can result indamage tovariouspartsof thebody. Symptoms include: Hyperglycemia (high-blood sugar)

Pancreas: •Not enough insulin ismade and secretedby thebeta cells of thepancreas •Alpha cells of thepancreasproduce toomuch of ahormone called glucagonwhich stimulates the liver tomake sugar Liver: •Toomuchglucagon stimulates the liver tomake extra sugarwhich thebody can’tuse and it’s released into theblood •Liver’s ability to store sugar is reduced Kidney: • Insteadof allowing extraglucose topass from thebody in theurine, thekidney

Small intestine

Symptoms ofDiabetes

Patients with type 1 diabetes usually report rapidly developing symptoms.With type 2 diabetes, symptoms usually develop gradually andmaynot appearuntilmanyyears after the onset of thedisease. •Weight loss evenwhen eatingproperly •Frequenturination

ThePancreas and Type 1Diabetes When you eat, your pancreas automatically makes the right amount of insulin to help glucose enter the cells. The cells in the pancreas that produce insulin are called beta cells. In type 1 diabetes, the body’s immune system sees the beta cells as a “potentialdanger“ anddestroys them.

Liver

thepancreas calledbeta cells. Insulinmakes itpossible for glucose toenter the cells.The insulinopensadoor in the cell thatallowsglucose toenter. Indiabetes,yourpancreas doesn'tmake enough insulin, oryour cellsdon’t respond properly to the insulin produced,ora combination ofboth. Without thehelp of insulin, glucosebuildsup inyourblood

•Frequenturination •Fatigue

• Increased thirst •Blurredvision

Glucosemolecules

•Excessive thirst •Extremehunger •Fatigue

Kidney

Pancreas

Ketoacidosis

Insulinmolecules

•Blurredvision •Dry, itchy skin •More infections thanusual

When the body cannotmake enough insulin to help glucose enter cells forenergy; thebodybegins tobreakdown fat.When fat isused forenergy, chemicals calledketonesare released into the blood. Some of the ketones are passed out of the body through theurine,butketonescanbuildup toapoisonous level in theblood causing diabeticketoacidosis (DKA) . This condition candevelop slowly and can lead to adiabetic

Large intestine

Diabeticbeta cells Duringpre-diabetes,up to 80% of beta cell function is lost, insulin levelsdrop,glucose levels rise while fasting and after eating.

Redblood cells

Normalbeta cells secrete insulinwhichdrives glucose intomuscle, liver and fat cellsmaintainingblood sugar levels in thenormal range

•Numbness in feet and/orhands • Slow-healing cuts or sores •No symptoms

Small intestine

causingyourblood sugar levels to rise.

Insulinmolecules

INCREASES absorptionofglucose whichmakes insulin resistanceworse •Thekidney itself increases the amount ofglucose itmakes

cardiovasculardisease •Abnormal cholesterol •Exposure to secondhand smoke

Risk factors

Insulin receptor

•Thirst •Fatigue •Nausea andvomiting coma or evendeath. Symptoms include:

Insulin

• Stomachpain •Possible Infection •Loss of consciousness

Type 2Diabetes andPrediabetes •Overweight or obesity •Physical inactivity/lack of exercise •Familyhistory ofdiabetes

•Abnormal sleeppatterns •History ofmental illness •Womenwith ahistory ofpolycystic ovarian syndrome

Insulin frompancreas attaches to cell

Brain: •As onegainsweight, appetite is increased •Obesepeoplehave ahigh risk ofdevelopingdiabetes because theyhavedifficulty controlling their appetite

Insulin cannot attach to cell

LONG-TERM

Glucose from food

•Certain racial and ethnicgroups (African Americans,Hispanic/LatinoAmericans,Asian Americans,Pacific Islanders,NativeAmericans andAlaskaNatives) •Older age –but onset is increasingdramatically among children,adolescentsandyoungeradults •History ofgestationaldiabetes ordelivery of ababyweighing 9pounds ormore atbirth •Highbloodpressure, lowHDL (good) cholesterol and/orhigh triglyceride levels •Polycystic ovary syndrome Type 1Diabetes •Parent or siblingwhohasT1DM •Environmental factors (exposure toavirusor toxin) •Race –T1DM ismore common inwhites than in other races •Geography - certain countries, such asFinland and Sweden,havehigher rates ofT1DM Diabetes inYouth

Glucosemolecules

Cell "door" is opened allowingglucose (sugar) to enter the cell

Glucosemoves into theblood

HeartDisease and Stroke

Glucosemoves into theblood

Celldoor is closed,glucose isnot able to enter and moves into the blood.

Glucose molecules

Poorbloodsugar (glucose)control,high blood pressure, and high cholesterol can damage arteries increasing risk for heartattackor stroke.

Celldoor is closed, glucose isnot able to enter andmoves into theblood

Energy- deprived cell

Glucose converted to energy

Opened glucose door

Insulin attaches to cell and opens a "door"

SkeletalMuscles: •Muscle cells areunable to absorb anduseglucose for energy •Unusedglucose stays in theblood, increasing sugar levels, adding to insulin resistance

Glucose converted to energy

Energy-deprived cell

Energy- deprived cell

Insulin attaches to cell and opens a "door" allowing glucose to enter

Glucose converted to energy

Redblood cells

Insulin molecules

KidneyDisease (Nephropathy)

ManagingType 2Diabetes People with T2DM can prevent or delay problems by keeping the levelofglucose (sugar) in thebloodas close to normal as possible (85-130 mg/dL), keeping blood pressure and cholesterol under control and by getting regular medical care. Although diabetes is a common disease, every individual needs personalized care. T2DM may be treated with a variety of different medications determinedby blood sugar levels and symptoms.Patients may be prescribed medicine to control cholesterol and blood pressure. Your diabetes healthcare provider will help you to maintain the correct balance between medications,blood sugarmonitoring,diet, and exercise.

High levelsofbloodglucosecandamage the glomeruli (the filtering units of the kidney),which can reduce thekidney’s ability to remove waste and retain importantnutrients such asprotein.

Closed glucose door

Increasedblood sugar (glucose) level

Fat cells: •Low insulin levels cause the fat cells tobreak down and release “free fatty acids” (FFAs) •FFAs cause the liver tomakemore sugar, destroy the insulinproducingbeta cells in thepancreas andblock themuscles from usingglucose for energy.

EyeProblems

Diabetes isoneof themost common chronicdiseases in children and adolescents.About 1 in 400 people younger than 20 years have type 1 or type 2 diabetes.Although type 1 diabetes ismore prevalentamongchildrennationwide, type2diabetes isbecomingmore common inU.S.kidsand teens,especially if theyareoverweight.There is noknownway toprevent type1diabetes,but, expertsagree thathealthy eatingandanactive lifestyle canhelp toprevent type2diabetes inyouth. DiabetesManagement Peoplewith type 1 diabetes require insulin tomanage their diabetes. Insulinpensand insulinpumpsare safe, effectiveandaccurateways to take insulin.Treatment for type 1diabetes is a lifelong commitment to blood sugarmonitoring, taking insulin, healthy eating, exercise and regularvisits toyourhealth careprovider. Type 2Diabetesmaybe treatedwith avarietyofdifferent anti-diabetic medications determined by blood sugar levels and symptoms. Patientsmay also be prescribedmedicine to control cholesterol and bloodpressure. Peoplewithdiabetes canprevent ordelayproblems by keeping blood sugar levels as close tonormal aspossible,keepingbloodpressure and cholesterol under control and by getting regular medical care. Although diabetes is a common disease, every individual needs personalized care.Consultingwithadiabeteshealthcare teamwillhelp you tomaintain the correct balance betweenmedication, blood sugar monitoring,diet, and exercise.

DiabeticBodyCell NormalBodyCell

• Diabetic Retinopathy occurs when oneof the arteries that suppliesblood to the retina becomes blocked causing diminishedblood flow to the retinaand can lead toblindness.

NormalBodyCell

DiabeticBodyCell

In Type 2 diabetes, the body’s cells develop a resistance to insulin, the pancreas does not make enough insulin or the insulin does not workcorrectly.Without insulin, thecellsdonot get the fuel they need for energy and sugar buildsup in theblood.

The insulin acts as a “key” to open a door in the cell that lets glucose enter the cell where it willbe converted to energy.

Redblood cell

Insulin acts as a “key” to open adoor in the cell that lets glucose enter,where itwillbe converted to energy.

Cellsdevelop a resistance to insulin, the insulindoesnotwork correctly ornot enough insulin ismadeby thepancreas.Cellsdonot get the fuel theyneed for energy and sugarbuildsup in theblood.

NormalBodyCell

BodyCellwithDiabetes

Increased blood sugar level

Alimentary canal orgut: •Whenyou eat,yourgut releaseshormones that tell thepancreas to: produce/release insulin,prevent the liver frommaking sugar, slow thepassage of food thru the stomach and send thebrain amessage to “feel full” • InT2DM, thesehormones are impairedwhich stops thepancreas frommaking insulin, stimulates the liver tomakemore sugar and causes the stomach to empty faster •Thebraindoesnot feel full after eating resulting inweightgain and increasedblood sugar levels

Glucose molecule

•DiabeticMacular Edema (DME) results in vision loss due to the effects of chronic inflammation from exposure to highblood sugar levels.

How InsulinWorks (NormalCellsvs.DiabeticCells)

1 .Knowyourmetabolic target levels forglucose,bloodpressure, and cholesterol. 2 . Incorporatehealthy lifestylepractices intoyour life: exercise, loseweight ifyou areoverweight, andmakehealthy food choices. 3. Stop smoking. 4. Takeyourprescribedmedicines. 5. Followup frequentlywithhealthcareproviderswho areknowledgeable indiabetes. The 5Keys toSuccessfulDiabetesManagement

5 Tips for Successful Diabetes Self-Management

GlucoseBuildup Asa resultofnoor little insulin,glucosebuildsup in theblood,damagingvessels andvitalorgans.

NerveDamage (Neuropathy)

Insulinmakes it possible for our cells to take in glucose (sugar). Insulin actsasa“key” toopenadoor in thecell thatallowsglucose from theblood to enter the cellwhere itwill be converted to energy.Without insulin, the doorsdonot open and the cellsdonotget the fuel theyneed.

High blood sugar levels can damage nerves resulting in pain and loss of function. Sensory neuropathy results in tingling andburning sensation in the feetwhileat rest. If sensation to the feet is lost completely, patients risk developing ulcers, infections and footdeformitieswhichmay require an amputation. Sleep andbalancemaybedisrupted.

Complications

Long-termdiabetes candamagemanypartsof thebody.Seeyourhealth careprovider at leastonce ayear to find and treat anyproblems early.

Managing Type 1 Diabetes At this time, there isno cureorprevention for type 1diabetes.Patientswith type 1diabetes require insulin tomanage theirdiabetes. Insulinpens and insulinpumps are safe, effective and accurateways to take insulin.Managing thisdisease requires individualized care from adiabeteshealthcare team tohelpmaintain the correctbalancebetweenmedication,blood sugarmonitoring,diet, and exercise. •Knowyourprescribedmetabolic targets (blood sugar (A1C), bloodpressure, cholesterol) •Exercise 5days eachweek for 30-45minutesper session •Eathealthymeals, see a certifieddiabetic educator or a registereddietician for assistance inmealplanning •Never stop takingyour insulin orprescriptionmedicineswithout the consent ofyourhealth careprovider • Stop smoking andminimizeyour alcohol consumption •Make sure thatyourhealth careprovider iswell trained inmanagingpatients with type 1diabetes UPDATED

HeartDisease and Stroke

High blood sugar levels can cause damage to the blood vessels of the retina.Bloodvesselsmay become blocked causing diminishedblood flow to the retinaandcan lead to blindness. UPDATED EyeDisease (DiabeticRetinopathy)

NerveDamage (Diabeticneuropathy)

KidneyDisease (Nephropathy)

Other examples ofdiabeticneuropathy include:

VascularDisease

2 UPDATED

•Rapidheart rate •Dizzinesswhen standingupright • Inability to completely empty thebladder or urinary incontinence •Fullness in the abdomen after eating a fewbites

•Diarrhea and/ or constipation •Erectiledysfunction/ vaginaldryness •Loss of ability to sweat •Excessive sweating while eating •Charcot foot and ankle

High levels of blood sugar can damage the smallbloodvessels inthe filtering units of the kidney (the glomeruli), andmay cause them to leakor lose their filtering ability leading to CKD (chronickidneydisease) andpossiblekidney failure.

Poor sugar control, high blood pressure, and high cholesterol can damage arteriesand increase risk ofheartattackor stroke. blood

Poor diabetes control can cause circulation problems in the blood vessels of the legs and feet.Healing ofwounds and infectionsmay also be affected. In extreme situations, gangrene can

High blood sugar levels can damage nerves that control vital functions and/orpainperception. Tinglingandpain in feet from nerve damage may progress to loss of feeling.Neuropathy can also affect balance, sleep, sexual function, and can causeurinary tract incontinence.

Anatomical Charts & Posters Knowyourmetabolic targets:blood sugar levels (A1C),bloodpressure, and cholesterol. Takeyourmedication asprescribed. Followup frequently withhealth careproviders who areknowledgeable aboutdiabetes. Stop smoking. Practice living ahealthy lifestyle: exercise, lose weight ifoverweight, and makehealthy food choices. Developed in consultationwith JeffUngerMD,ABFM,FACE. © 2015

develop and amputationsmaybenecessary.

Developed in consultationwith JeffUngerMD,ABFP,FACE.

Developed in consultationwith JeffUngerMD,ABFP,FACE

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