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