august 17, 2019 kevin lee, m.d. department of internal medicine...
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August 17, 2019
Kevin Lee, M.D.Department of Internal Medicine
Fontana Medical Center
DM in USA
1 in 10 Americans 18 years and older have diabetes
1 in 3 of adult Americans have pre-diabetes
1 in 12 Asian Americans 18 years and older have diabetes
About 50% of people do not know they have diabetes
What is DM?
Fasting blood sugar ≥ 126
(空腹血糖 ≥ 126)
Hba1c ≥ 6.5
What causes DM
Insulin levels ↓ (胰島素 ↓)
Insulin stops working efficiently
Type I DM
Insulin dependent
Type II DM
Insulin independent
Not enough insulin
or
Insulin does not work efficiently
Symptoms
Polyuria
Polydipsia
Polyphagia Malaise
Dizziness
Blurred vision
Unexpected weight loss
Confusion
Coma
Complications
Stroke
Eye problems --> blindness
Heart attack (acute MI), heart failure
Gastroparesis --> nausea, vomiting
Kidney failure --> dialysis
Sexual dysfunction (male)
Peripheral neuropathy
Peripheral vascular disease --> gangrene --> amputation
Complication continued
Immune system impaired --> frequent infection
Hypertension
DKA (diabetic keto-acidosis)
HHNK (hyperosmolar hyperglycemic non-ketoticcoma)
Complications continued
➢ The risk of heart attack, stroke and death in uncontrolled DM-2 is 3-4 times compared to the general population
➢The risk is the same as the general population if Hba1c < 7
LDL < 99
Bp < 140/80
No protein in the urine
No smoking or has quit smoking
Risk Factors
Obesity
Sedentary
Age > 40
Hypertension, Hyperlipidemia
Family history
Gestational DM
BMI19~24.9 Normal25~29.9 Overweight>30 Obese
Treatment and PreventionMedication
Diet Exercise
Weight Loss
Treatment and Prevention continued
Monitoring
• Hba1c: 3 - 6 months
• Urine protein: 6 months
• Eye exam (retinal photo): yearly
• Foot exam (monofilament): yearly
Treatment and Prevention continued
Diet Control
Frequent small meals
Low carb, low fat, low salt
High fiber
Calories < 1800
For losing weight <1500
BG 150
BG 150
Treatment and Prevention continued
Exercise
30 minutes daily, 5 days a week
Weight Loss
10% of body weight
Medications Oral medication
For DM, Bp, LDL
Injection
insulin
Treatment and Prevention continued
Hypoglycemia
Weakness
Shaking
Palpitations
Sweating
Summary
❖ High impact to many Americans, the incidence is increasing
❖Asian Americans can get DM even they are not obese
❖DM can be prevented and the risk of complications can be reduced with lifestyle change, exercise, diet control and losing weight
❖If DM is well controlled, life expectancy is similar tothat of the normal population
Thank you