Diabetes Updated March 2020 Insulin Deficiency 1 Insulin

Diabetes Updated: March, 2020

Insulin Deficiency 1 Insulin Resistance 1 3 Major Types: 1 • Type II • Gestational Leading cause of: 1 • End-stage renal disease • Adult blindness • Amputations 34. 2% of Americans currently have diabetes 2 Men and women have different Clinical Presentations 3 and Responses to Treatment 4 Introduction

Pancreas Islets of Langerhans Cell Biology Beta Cell

Liver 4 GI Tract Skeletal Muscle 1 Glucose 3 2 Glucose uptake Insulin Pancreas Physiology Adipocytes

Liver 4 GI Tract Skeletal Muscle 1 Glucose 3 2 No Glucose uptake Insulin Pancreas Pathology Adipocytes

Glucose Lean muscle metabolizes glucose independent of insulin 1 • On average, men have more skeletal muscle than women 2 • Diabetic men achieve glucose control faster than women Skeletal Muscle

Liver Glucagon Diabetic women produce stress hormones: • During ovulation 4 • As a part of premenstrual syndrome 5 • During pregnancy 6 Pancreas Glucose Cortisol Glucagon and Cortisol

• The immune system destroys the insulinsecreting cells • Patients require insulin replacement • No Insulin Production Type I Diabetes t In re sul pl in ac em en Autoimmune Disease 1

Metabolic Disorder 1 • Insulin receptors do not bind insulin GIucose Insulin • No cellular signal produced • Insulin Resistance Type II Diabetes No Signal

Sex-Exclusive Disease • Occurs only in Women • High risk for Type 2 Diabetes 1 • High risk for Cardiovascular Disease 2 Gestational Diabetes

• Girls have more subcutaneous fat 1 • Insulin resistance is related to increased body fat 2 • Girls have higher insulin-resistance 1, 2 Type II Diabetes in Children

• 34. 2 Million Americans have diabetes • 10. 5% of the population • 95% of diabetic population has Type 2 Diabetes By the year 2050… 1 in 3 Will have Type 2 Diabetes Epidemiology

Frequent urination, polydipsea, polyphagia, fatigue, blurry vision, weight loss, numbness in hands and feet 1 Women Reoccurring yeast infections are commonly seen in both type 1 and type 2 females. Men Erectile dysfunction (ED) is common among type 2 diabetics. Clinical Presentation

Men and Women Only • • • Delivered a baby >9 lbs • Diagnosed with gestational diabetes • Polycystic Ovary Syndrome Physical inactivity Family history High risk ethnic population Hypertension Hx of vascular disease Dislipidemia Impaired glucose tolerance Clinical symptoms Screening

Classes of Medications 1 • • Insulin Biguanide Sulfonylurea GLP-1 RA Treatment • Thiazolidinedione • Dipeptidyl peptidase-4 inhibitor • SGLT-2 Inhibitors

Type I Diabetes Insulin Replacement is required 1 Type II Diabetes Insulin Replacement may become necessary 1 Women require more insulin 2 Insulin Therapy

Enhances insulin sensitivity in muscle and adipose tissue 1 Inhibits hepatic glucose production 1 • Increases cardiac glucose uptake in women 2 • Negatively effects heart metabolism in men 2 Biguanide Metformin (Glucophage; Glucophage XR)

Pancreas Stimulate insulin secretion from the beta cells in the pancreas 1 Insulin Beta Cell Side effects include hypoglycemia and weight gain 1 Sulfonylureas Glyburide (Diabeta, Glynase, Micronase); Glipizide (Glucotrol, Glucotrol XL); Glimepiride (Amaryl)

• GLP-1 is released from the small intestine after eating and enhances glucose-stimulated insulin secretion’ • GLP-1 RA action in the gastrointestinal tract suppresses appetite. • GLP-1 RA action in the pancreas decreases insulin resistance and glucose formation. GLP-1 RA

Reduces insulin resistance and redistributes fat 1 • Men and women are at higher risk for fractures 2 Signal • Women are at risk for osteoporosis 2 • May induce ovulation in women with PCOS 1 Thiazolidinediones Pioglitazone (Actos); Rosiglitazone (Avandia

Pancreas Decreases glucagon secretion 1 Stimulates insulin secretion 1 Glucagon Alpha Cell Less glucagon means less glucose production from the liver 1 Dipeptidyl Peptidase 4 Inhibitors Alogliptin (Nesina); Linagliptin (Tradjenta); Saxagliptin (Onglyza); Sitagliptin (Januvia)

• The glucose that is filtered by the kidney is reabsorbed by SGLT-2. • The remaining glucose is reabsorbed by SGLT-1. • SGLT-2 inhibitors inhibit the reabsorption at the level of the proximal convoluted tubule. SGLT-2

Men moderate their intake of unhealthy food (except in social environments)1 Nutrition Women Restrict unhealthy food from their diets 1

Men Women • • Higher incidence of depression and anxiety 5 Higher risk for blindness 3 • Higher risk for myocardial infarction 3 • Higher mortality after an MI 3 Prognosis • Higher rates of amputation 1, 2 • Greater risk for peripheral vascular disease 3 • Higher risk for erectile dysfunction 4

Women are more likely to… Men are more likely to… • Reveal their condition to friends and family • Keep their diabetes hidden from friends and family • Assimilate diabetes management into their schedule • Ignore their diabetes management in social situations Social Considerations