Scope of the Problem

    I believe that educators benefit from having a deeper understanding of the conditions they teach about and work to prevent.  That includes pathophysiology of diabetes. I love anatomy and physiology so I thought the image below was interesting and helpful.

 

    Diabetes is a very complex condition which affects every single part of the body. There is much we don’t understand about diabetes but we do know a lot.  In type 2 diabetes, either the body does not produce enough insulin or the cells are not using insulin properly (insulin resistance).  Insulin helps the body use glucose for energy/fuel by taking the sugar from the blood and delivering in into the cells. When there is insulin resistance or deficiency, too much glucose builds up in the blood stream instead of entering the cells. This is called hyperglycemia or high blood sugar, which lead to complications such as blindness, kidney disease, amputations, nervous system disease, and oral complications like gum disease and tooth loss (NDEP, 2007). Cardiovascular disease is the major cause of death in people with diabetes (NDEP, 2007).

     The diagram below shows how insulin resistance and hyperglycemia (high blood sugar) lead to cardiovascular disease. Insulin resistance leads to decreased glucose uptake by the muscles, an increased breakdown of fat to supply the body’s energy needs which then also leads to an even further increase of glucose production resulting in hyperglycemia, too much sugar in the blood (Pitta, 2004). Insulin resistance & hyperglycemia increase risk for CVD by increasing blood pressure, affecting blood lipid levels (cholesterol & triglycerides) and increasing clotting.

     There are many factors that affect an individual’s risk for developing diabetes but the major factors are weight, activity level, eating habits and genetics.  Three out of these four are modifiable and closely inter-related.  

Obesity is a major problem in the U.S. and is largely affected by our poor dietary habits and sedentary lifestyles. There is a clear association between obesity and insulin resistance. Increased fat makes it harder for the body to use insulin, it increases insulin resistance. Most people are overweight when they are diagnosed with diabetes (NDEP, 2007).

Figures 1 & 2 below show an increase in diabetes prevalence from 1990 – 2000s parallel to the increase in obesity prevalence. 

Source: NDEP, 2007

The two are so closely related they are often referred to as diabesity. We have to address both obesity and diabetes to truly have an impact on our country’s health status.

References

U.S. Centers for Disease Control and Prevention. (2012). Diabetes data and trends. Retrieved from http://www.cdc.gov/diabetes/statistics/

National Diabetes Education Program. (2007). Working together to manage diabetes: a guide for pharmacists, podiatrists, optometrists, and dental professionals, 2007. Retrieved from 

http://ndep.nih.gov/publications/PublicationDetail.aspx?PubId=26#page6

Pitta, A. G. (2004). Diabetes Mellitus: Diagnosis and Pathophysiology. Retrieved from Tufts University Open Courseware website: http://ocw.tufts.edu/Content/14/lecturenotes/265878

DIABETES PSA

Did you know that Hispanics are almost twice as likely to have diabetes? Diabetes is the 5^th leading killer of Latinos in the U.S, they are 60% more likely to die from diabetes than Non-Hispanic whites. Unhealthy foods, too little exercise and obesity all increase the risk for developing diabetes.

A recent study by Hu, Wallace and Tesh looked into Quality of Life measures in the Hispanic community. It was a small group of 59 Hispanic Adults from the Southeastern U.S. Quality of Life (QOL) is an indicator of health; it refers to happiness, a feeling of well-being and life satisfaction. Having a good quality of life is as important as being in good physical health. Race and language affect health outcomes. More Hispanics (31.1%) report fair or poor health than non-Hispanic Whites (12.9%), and more Spanish-speaking Hispanics report poor or fair health status (39%) than English-speaking Hispanics (17%).

Hispanics have higher prevalence of diabetes as well as diabetes complications which can often lead to low QOL. Persons with diabetes are more likely to not meet minimum exercise requirements and nutrition requirements. Not meeting these requirements is linked to lower QOL and decline in health functioning.

Hispanics exercise less than other ethnic groups in the U.S. Exercise helps with diabetes management but also with improved QOL. Some benefits of exercise in regards to QOL are improved mobility, less pain and improved mental health. Physical limitations can negatively impact QOL so it’s important to maintain high levels of mobility and physical independence. Following nutrition recommendations was also linked to higher QOL. Following nutrition recommendations can reduce diabetes complications which can impact the individual’s physical wellbeing and emotional health. Although feeling restricted in what can or cannot be eaten also reduces QOL.

The participants in the study mostly had low levels of QOL but most did not meet exercise recommendations and nutrition recommendations. Good physical function, good mental health, overall sense of well-being and social expectations influence an individual’s QOL. It’s important to have programs that focus on the patient and take into account their personal needs and preferences. For example, food and nutrition changes need to be fit the Hispanic culture and physical activity should include families. This can help improve health outcomes and QOL.

Reference

Hu, J., Wallace, D., & Tesh, A. (2010). Physical activity, obesity, nutritional health and quality of life in low-income Hispanic adults with diabetes. Journal Of Community Health Nursing, 27(2), 70-83. doi:10.1080/07370011003704933

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