2 t pi diabeet Miks inimesed haigestuvad

1. 2 t��pi diabeetMiks inimesed haigestuvad? Verner Fogel 2010

2. Teemad Haiguse kirjeldus Kas tegemist on t�sise probleemiga? Kes on ohustatud? Kaebused ja diagnoosimine Mis on erinevat tervel ja haigel patsiendil organismis Mis on veresuhkru omastamise h�ire? Mis on metaboolne s�ndroom? Kokkuv�te K�simused patsientidele

3. Haiguse kirjeldus

4. Diabeedi definitsioon Haigus, mille korral veresuhkur on normist k�rgem: Insuliini toime lihastes ja maksas on halvenenud H�iritud on insuliini tootmine k�hun��rmes Aastaid k�rge p�sinud veresuhkur p�hjustab erinevate organite kahjustusi

5. Diabeedi definitsioon Krooniliselt k�rge veresuhkur p�hjustab erinevate organite kahjustusi: Silmap�hjad Neerud N�rvid S�da ja veresooned kogu kehas

6. Diabeet on eluaegne haigus, mis v�ib p�hjustada raskeid t�sistusi Diabetes and increased blood glucose levels are associated with severe and life-threatening complications.1�4 These may either be macrovascular (e.g. stroke, myocardial infarction or peripheral arterial disease) or microvascular (e.g. diabetic retinopathy, kidney function deterioration or neuropathy). Heart disease and stroke account for about 65% of deaths in people with diabetes; adults with diabetes are 2�4 times more likely to die from heart disease and 2.8 times more likely to die from stroke than unaffected adults.5 Diabetic retinopathy causes 12�24,000 new cases of blindness each year; diabetes is the leading cause of new cases of blindness in adults aged 20�74 years. In people with type 1 diabetes, maintaining blood glucose levels as close to normal as possible reduces eye damage by 76%.5 Diabetes is the leading cause of kidney failure, accounting for 44% of new cases in 2002; in people with type 1 diabetes, maintaining blood glucose levels as close to normal as possible reduces kidney damage by 35�56%.5 Approximately 60�70% of people with diabetes have some form of nervous system damage; severe forms are a major contributing factor in lower-extremity amputations. Indeed, > 60% of non-traumatic lower-limb amputations occur in people with diabetes and the rate of amputation is 10 times higher than for people without diabetes.5 Therefore, the importance of blood glucose control in preventing or reducing diabetic complications cannot be underestimated. 1. UK prospective diabetes study 16. Overview of 6 years' therapy of type II diabetes: a progressive disease. UK Prospective Diabetes Study Group. Diabetes 1995;44:1249�58. 2. Khaw KT, et al. Association of hemoglobin A1c with cardiovascular disease and mortality in adults: the European prospective investigation into cancer in Norfolk. Ann Intern Med 2004;141:413�20. 3. Stratton IM, et al. Association of glycaemia with macrovascular and microvascular complications of type 2 diabetes (UKPDS 35): prospective observational study. BMJ 2000;321:405�12. 4. Saydah SH, et al. Subclinical states of glucose intolerance and risk of death in the US. Diabetes Care 2001;24:447�53. 5. Complications of Diabetes in the United States. Available at: http://www.diabetes.org/diabetes-statistics/complications.jsp. Last accessed 25 January 2007.Diabetes and increased blood glucose levels are associated with severe and life-threatening complications.1�4 These may either be macrovascular (e.g. stroke, myocardial infarction or peripheral arterial disease) or microvascular (e.g. diabetic retinopathy, kidney function deterioration or neuropathy). Heart disease and stroke account for about 65% of deaths in people with diabetes; adults with diabetes are 2�4 times more likely to die from heart disease and 2.8 times more likely to die from stroke than unaffected adults.5 Diabetic retinopathy causes 12�24,000 new cases of blindness each year; diabetes is the leading cause of new cases of blindness in adults aged 20�74 years. In people with type 1 diabetes, maintaining blood glucose levels as close to normal as possible reduces eye damage by 76%.5 Diabetes is the leading cause of kidney failure, accounting for 44% of new cases in 2002; in people with type 1 diabetes, maintaining blood glucose levels as close to normal as possible reduces kidney damage by 35�56%.5 Approximately 60�70% of people with diabetes have some form of nervous system damage; severe forms are a major contributing factor in lower-extremity amputations. Indeed, > 60% of non-traumatic lower-limb amputations occur in people with diabetes and the rate of amputation is 10 times higher than for people without diabetes.5 Therefore, the importance of blood glucose control in preventing or reducing diabetic complications cannot be underestimated. 1. UK prospective diabetes study 16. Overview of 6 years' therapy of type II diabetes: a progressive disease. UK Prospective Diabetes Study Group. Diabetes 1995;44:1249�58. 2. Khaw KT, et al. Association of hemoglobin A1c with cardiovascular disease and mortality in adults: the European prospective investigation into cancer in Norfolk. Ann Intern Med 2004;141:413�20. 3. Stratton IM, et al. Association of glycaemia with macrovascular and microvascular complications of type 2 diabetes (UKPDS 35): prospective observational study. BMJ 2000;321:405�12. 4. Saydah SH, et al. Subclinical states of glucose intolerance and risk of death in the US. Diabetes Care 2001;24:447�53. 5. Complications of Diabetes in the United States. Available at: http://www.diabetes.org/diabetes-statistics/complications.jsp. Last accessed 25 January 2007.

7. Kas 2 t��pi diabeet on t�sine probleem?

8. Diabeedi epideemia 230 miljonit inimest on juba haigsetunud diabeeti aastaks 2006 350 miljonit haigestub j�rgneva 20 aasta jooksul

9. Kes on ohustatud?Millised on kaebused?Kuidas diagnoositakse?

10. Mis soodustab haigusetumist 2 t��pi diabeeti? Vanus �le 40 eluaasta Perekonnas varasemalt olnud 2 t��pi diabeet Varasemalt juba teada veresuhkru omastamise h�ire S�dame ja veresoonte haigused varasemalt Naistel rasedusaegne veresuhkru omastamise h�ire v�i rasedusaegne diabeet

11. Mis soodustab haigusetumist 2 t��pi diabeeti? Verer�hk varasemalt k�rge Varasemalt teada normist k�rgemad kolesteroolid �lekaal ja/v�i k�hupiirkonna rasvumine

12. Kaebused haigestumisel Sage urineerimine Sage �ine urineerimine Sage joomine N�gemise halvenemine V�simus ja n�rkus Kehakaalu langus ( esineb harvem ) Sagedased p�letikud ( sageli m�danikud jalgadel )

13. Kuidas diagoositakse 2 t��pi diabeet?

14. NB! Hommikune veresuhkur v�ib olla normipiirides, kuid see ei v�lista haiguse olemasolu.

15. Mis on erinevat tervel ja haigel patsiendil organismis?

17. 2 t��pi diabeeti p�dev patsient 90-95% diabeetikutest p�evad 2 t��pi diabeeti Probleemiks on insuliini tundetus haiguse alguses ja hiljem insuliini puudumine 90% 2 t��pi diabeetikutest on �lekaalulised 2 t��pi diabeetikutel on tekkinud t�sistused juba enne haiguse diagnoosimist

18. The World Health Organization reports that around 90% of individuals with type 2 diabetes are overweight or obese.1 Fat distribution in the body may be either abdominal (android or central obesity � often referred to as �apple-shaped�) or affect the lower body (mainly thighs and buttocks; gynoid obesity � often referred to as �pear-shaped�).2 Central obesity (indicated by, for example, high waist:hip ratio; that is waist:hip ratio > 0.90 for men, > 0.85 for women) is a strong risk factor for insulin resistance.3 1 World Health Organization, 2005. http://www.who.int/dietphysicalactivity/publications/facts/obesity 2Basdevant A, et al. Presse Med 1987; 16:167�170. 3Ascaso JF, et al. Eur J Intern Med 2003; 14:101�106. The World Health Organization reports that around 90% of individuals with type 2 diabetes are overweight or obese.1 Fat distribution in the body may be either abdominal (android or central obesity � often referred to as �apple-shaped�) or affect the lower body (mainly thighs and buttocks; gynoid obesity � often referred to as �pear-shaped�).2 Central obesity (indicated by, for example, high waist:hip ratio; that is waist:hip ratio > 0.90 for men, > 0.85 for women) is a strong risk factor for insulin resistance.3 1 World Health Organization, 2005. http://www.who.int/dietphysicalactivity/publications/facts/obesity 2Basdevant A, et al. Presse Med 1987; 16:167�170. 3Ascaso JF, et al. Eur J Intern Med 2003; 14:101�106.

19. Veresuhkru taseme reguleerimine suhkruhaigust p�deval inimesel

20. Veresuhkru taseme reguleerimine suhkruhaigust p�deval inimesel

21. Insuliini tootvate rakkude hulk 2 t��pi diabeetikul �-Cell mass in Type 2 diabetes This slide shows the outcomes of a retrospective autopsy study that assessed human pancreatic �-cell mass in lean and obese subjects (n=124). Cases were categorized based on recent fasting plasma glucose (FPG) measurements as non-diabetic (ND), impaired fasting glucose (IFG), or Type 2 diabetes. For inclusion, cases were required to have had at least one FPG in the year prior to death. Cases were categorized as obese (body mass index [BMI] >27 kg/m2) or lean (BMI <25 kg/m2) and further classified as: ND (FPG <6.1 mmol/l [<110 mg/dl]); IFG (FPG=6.1-6.9 mmol/l [110-125 mg/dl]); or Type 2 diabetes (FPG >7.0 mmol/l [>126 mg/dl]). Relative �-cell volume percentage was used to estimate �-cell mass. Obese subjects with IFG or Type 2 diabetes had relative �-cell volumes of 40% (P<0.05) and 63% (P<0.01), respectively?representing a lower relative �-cell volume compared with ND-obese cases. Lean subjects with Type 2 diabetes cases had 41% less relative �-cell volume compared with ND cases (P<0.05). The ND-obese subgroup had approximately 50% greater �-cell volume compared with ND-lean (P=0.05), which may have been a result of the younger age at death for obese-ND (66.9 yr) compared with lean-ND (78.1 yr) cases. These results illustrate the link between �-cell mass, IFG, and Type 2 diabetes. REFERENCE Butler AE, Janson J, Bonner-Weir S, Ritzel R, Rizza RA, Butler PC. Diabetes. 2003;52:102-110.�-Cell mass in Type 2 diabetes This slide shows the outcomes of a retrospective autopsy study that assessed human pancreatic �-cell mass in lean and obese subjects (n=124). Cases were categorized based on recent fasting plasma glucose (FPG) measurements as non-diabetic (ND), impaired fasting glucose (IFG), or Type 2 diabetes. For inclusion, cases were required to have had at least one FPG in the year prior to death. Cases were categorized as obese (body mass index [BMI] >27 kg/m2) or lean (BMI <25 kg/m2) and further classified as: ND (FPG <6.1 mmol/l [<110 mg/dl]); IFG (FPG=6.1-6.9 mmol/l [110-125 mg/dl]); or Type 2 diabetes (FPG >7.0 mmol/l [>126 mg/dl]). Relative �-cell volume percentage was used to estimate �-cell mass. Obese subjects with IFG or Type 2 diabetes had relative �-cell volumes of 40% (P<0.05) and 63% (P<0.01), respectively?representing a lower relative �-cell volume compared with ND-obese cases. Lean subjects with Type 2 diabetes cases had 41% less relative �-cell volume compared with ND cases (P<0.05). The ND-obese subgroup had approximately 50% greater �-cell volume compared with ND-lean (P=0.05), which may have been a result of the younger age at death for obese-ND (66.9 yr) compared with lean-ND (78.1 yr) cases. These results illustrate the link between �-cell mass, IFG, and Type 2 diabetes. REFERENCE Butler AE, Janson J, Bonner-Weir S, Ritzel R, Rizza RA, Butler PC. Diabetes. 2003;52:102-110.

22. Mis on veresuhkru omastamise h�ire?

23. Veresuhkru omastamise h�ire Tegemist on haigusega, mis eelneb 2 t��pi diabeedi tekkele Veresuhkrud on juba �le normi, kuid ei saavuta 2 t��pi diabeedi v��rtusi Sageli tekib 3-4 aasta jooksul nendel patsientidel 2 t��pi diabeet Haigus oluliselt suurendab haigestumist s�dame ja -veresoonkonna haigustesse F��silise koormuse, elustiili muutmise ja kaalu langetamisega on v�imalik veresuhkruid parandada ja 2 t��pi diabeeti haigestumist v�hendada

24. Kuidas diagnoositakse veresuhkru omastamise h�ire?

25. NB! Hommikune veresuhkur v�ib olla normipiirides, kuid see ei v�lista haiguse olemasolu

26. Mis haigus on metaboolne s�ndroom?

27. Metaboolne s�ndroom Patsient on �lekaaluline Patsiendil on veresuhkru omastamise h�ire v�i 2 t��pi diabeet Patsiendil on verer�hud �le normi Patsiendil on kolesteroolid �le normi

28. Metaboolne s�ndroom 3 korda suurem v�imalus p�deda s�dame infarkti v�i insulti 2 korda suurem v�imalus surra s�damehaiguse t�ttu

29. Metaboolne s�ndroom Haiguste tekkimist on v�imalik v�ltida: Kui patsient langetab kehakaalu Kui patsient muudab elustiili Kui patsient hakkab tervislikult toituma Kui verer�hud, kolesteroolid ja veresuhkur on h�sti ravitud

30. Kokkuv�te 2 t��pi diabeet, veresuhkru omastamise h�ire ja metaboolne s�ndroom on v�ga sage haigus 2 t��pi diabeedil, veresuhkru omastamise h�irel ja metaboolsel s�ndroomil on v�ga palju t�sistusi 2 t��pi diabeedi, veresuhkru omastamise h�ire ja metaboolse s�ndroomi p�hjuseks on v�hene f��siline koormus ja vale dieet

31. Kokkuv�te F��siline koormus ja tervislik toitumine v�hendab haigestumist nendesse haigustesse F��siline koormus ja tervislik toitumine v�hendab v�imalust saada nende haiguste t�sistusi ( juhul kui patsient juba p�eb �hte nendest haigustest )

32. Kokkuv�te Teie sugulane v�i tuttav: Hommikune veresuhkur �le normi 2 tundi peale s��ki veresuhkur �le normi Kolesteroolid ja/v�i verer�hk �le normi �lekaaluline Soovitage p��rduda perearsti juurde. NB! Tuleb teha 2 tunni test magusa veega

33. K�simused patsiendile

34. K�simused Mis haigus on 2 t��pi diabeet? Milliseid t�sistusi p�hjustab 2 t��pi diabeet? Kas 2 t��pi diabeet on sage haigus? Kui palju insuliini tootvatest rakkudest on h�vinud 2 t��pi diabeedi diagnoosimisel? Mis haigus on veresuhkru omastamise h�ire? Milliseid t�sistusi p�hjustab see haigus?

35. K�simused Mis haigus on metaboolne s�ndroom? Mis t�sistusi p�hjustab metaboolne s�droom? Kas neid haigusi on v�imalik v�ltida v�i tekkimist pidurdada? Kuidas tuleks nende tekkimist v�ltida? Mitu protsenti suhkruhaigetest on �lekaalulised?

36. T�nan