Transcript Intro to Diabetes Full Presentation (Pt. 1-3)

Diabetes 101
Nutrition & Exercise Therapy for Diabetes
Management
Preventing Complications from Diabetes
Course Objectives
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Define and describe the different types of diabetes.
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Describe the symptoms of a high or low blood sugar and how to treat a low if needed.
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Discuss the different types of medications used to treat diabetes.
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Name ways you can better manage your diabetes.
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Understand how healthy eating and physical activity relate to diabetes management.
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Explain the importance of monitoring blood sugar and HbA1C.
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Recognize the need for regular check-ups and developing a sick day plan with your provider.
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Describe steps you can take to prevent future complications.
Part 1: Diabetes 101
What Happens When I Eat?
Food is broken down into glucose
 Glucose = Sugar
 Pancreas makes insulin and helps
move glucose in the blood into cells
 Glucose helps the cells produce energy

Novo Nordisk: Changing Life with Diabetes
www.harboursidefitness.com
What’s the Difference?
Novo Nordisk: Changing Life with Diabetes
www.harboursidefitness.com
What is A1C?
• A1C gives the you the average blood
glucose over a 3 month period, but mostly
in the past 30 days
• Since this is an AVERAGE, it only represents
the middle ground
• You could be having really HIGH blood
glucose and really LOW blood glucose
How is Diabetes Diagnosed?
Diabetes
- A1C > 6.5%
- Fasting glucose >126
- 2 hrs after meal >200
- Random glucose >200 with
symptoms of high blood sugar
Pre Diabetes
- A1C 5.7-6.4%
- Fasting glucose 100-125
Normal
- A1C < 5.7%
- Fasting glucose < 100
Signs of HIGH Blood Sugar
• Frequent urination
• Increased thirst
• Hunger
• Blurred vision
• Fatigue
• Headache
Novo Nordisk: Changing Life with Diabetes
Signs of LOW Blood Sugar
• Heart palpitations
• Shakiness
• Anxiety
• Sweating
• Hunger
• Tingling sensation
• Weakness
• Sleepiness
• Dizziness
Novo Nordisk: Changing Life with Diabetes
Treating a LOW: Rule of 15
• Check your blood sugar!!!
• If your blood glucose is LESS than 80:
– Eat/drink 15 grams of sugar
»4 oz of Orange Juice
»4 oz of REGULAR Soda
»Chew 3-4 Lifesaver Candies
»3 Glucose Tablets
»1 Tube of Glucose Gel
• Recheck your blood sugar in 15 minutes and repeat
until blood glucose is greater than 80
Why Should I Monitor BG?
• Damage to the body’s cells occur when blood
sugars are ABOVE 180 constantly
• It gives you an idea of what happens on a daily
basis with your blood sugar
• It helps YOU manage your diabetes
Goals & Treatments
Goals for Diabetes
• Based on the 2015 Guidelines from the
American Diabetes Association (ADA):
– A1C: < 7%
– Fasting Sugar: 80-130
– 2-hours after meal sugar: < 180
– LDL “Bad Cholesterol”: < 100
– Blood Pressure: < 140/90
Treatment Options
• Oral medications and injectable medications
• Sometimes you may need to take more than
one medication because they work in different
areas of the body
Medications That Work
in the Liver
• Examples:
– Glucophage® (metformin)
Take with FOOD!
– Actos® (pioglitazone)
– Januvia® (sitagliptin)
– Onglyza® (saxagliptin)
– Tradjenta® (linagliptin)
Medications That Work
in the Pancreas
• Examples:
– Micronase® (glyburide), Amaryl® (glimepiride),
Glucotrol® (glipizide)
– Starlix® (Nateglinide), Prandin® (repaglinide)
Take 15-30 min before meals BUT
you MUST eat to prevent low blood sugar
Medications That Work
in the Muscle
• Examples:
– Glucophage® (metformin)
– Actos® (pioglitazone)
Medications That Work
in the Stomach
• Examples:
– Victoza ®, Byetta ®, and Bydureon ® (Injectables)
Take Byetta 30-60 minutes before meals
– Januvia® (sitagliptin), Onglyza® (saxagliptin), and
Tradjenta® (linagliptin)
Insulin
• Provides the body with insulin which helps bring
glucose into the cell and decreases your blood sugar
• Examples:
– Long Acting
• Lantus, Levemir
– Short or Rapid Acting (Meal Time Insulin)
• Humalog, Novolog, Apidra
Make sure you EAT!!!!!
What Can I Do To
Manage My Diabetes?
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Follow-up with your doctor at least 1x/year
Attend regular check ups with your doctor
Take medications properly
Eat right and exercise
Monitor blood sugar!
Comprehensive eye exam and foot exam yearly
Check feet daily
Flu vaccine yearly
Part 2 - Nutrition Therapy for
Diabetes Management
How Do You Control Blood
Sugar With Food?
Meal Planning
• Consistent meal times
• Consistent carbohydrates
• Combine protein foods with
carbohydrates
How Nutrients Affect Blood Sugar
CARBOHYDRATE
PROTEIN
FAT
Total Carbohydrates Count
Carbohydrates give energy
ENERGY
But too much carbohydrate can raise blood sugar
above your target range
Total Carbohydrates Count
Men
45-60 grams per meal
15-30 grams per snack
Women
30-45 grams per meal
15-30 grams per snack
Carbohydrates (CHO) in
Each Food Group
Breads, Cereals, Grains & Starchy
Vegetables Have CHO
Each serving has about 15 grams carbohydrates
One serving is:
• 1 slice of bread
• ¼ bagel
• 1/3 cup cooked rice, pasta or oatmeal
• ½ cup starchy vegetables
– potatoes, beans, peas, corn
Fruits Have CHO
Each serving has about 15 grams carbohydrates
One serving is:
• 1 small fruit (size of tennis ball)
• ½ cup fruit
• ½ large banana
• 17 small grapes
• 2 Tbsp raisins or dried fruit
Non-starchy Vegetables Have
Very Few CHO
Each serving has about 5 grams carbohydrates
One serving is:
• 1 cup raw vegetables
• ½ cup cooked vegetables
Dairy Products Have CHO
Each serving has about 15 grams carbohydrates
One serving is:
• 8 oz cow’s milk
• 6 – 8 oz plain yogurt
– Flavored yogurt = 18 – 45 g! Check the label!
Meats & Protein Alternatives
Have No CHO
• Meats, eggs and cheeses have very little CHO but
can be high in fat and cholesterol
• Beware of breading and sugary sauces
• Protein alternatives have very little CHO:
– Nuts, nut butters, seeds, soy & tofu
– Veggie burgers DO have CHO – check the label!
Sweets & Sugars Have CHO
• Count towards total carbohydrates
• ‘Sweets’ have little nutritional value but can
be high in fat and calories, which can cause an
increase in weight and triglycerides
• Sugar free products still have CHO
• Limit ‘sweets’ to 1-2 servings each week
Portion Sizes
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3 oz of meat = size of deck of cards
1 cup = size of baseball
½ cup = ice cream scoop
1 serving of fruit = size of baseball
1 Tbsp of fat = thumb tip
1 serving of bread = size of CD
Use the Plate Method
½ Plate Veggies
¼ Plate Protein
¼ Plate Starches, Grains, Fruit or Milk
Reduce Saturated Fat
Roasting
Baking
Broiling
Grilling
• Remove skin from poultry & choose white meat
• Choose lean proteins
– chicken, turkey, fish, tofu or pork tenderloin
• Eat fewer high-fat foods
– cold cuts, hot dogs, sausage, bacon & fried food
• Use less fat in cooking or use cooking sprays
Meal Planning: Timing
• Eat every 3-5 hours
• Do NOT skip meals
• Try to eat at the same time
every day
• Eat a snack if meal is
delayed
Reading a Label
Always check
the serving size!
Look for total
CALORIES
Check the FAT
Nutrition Facts
Serving Size 1 cup (236 g)
Servings Per Container 2
Amount Per Serving
Calories 230
Calories from fat 120
% Daily Value*
Total Fat 14g
22%
Saturated Fat 7g
35%
Trans Fat 1g
Cholesterol 40mg
13%
Sodium 950mg
40%
Total Carbohydrate 16g
5%
Dietary Fiber 2g
8%
Sugars 3g
Protein 11 g
Vitamin A 20%
Calcium 2%
Vitamin C 0%
Iron 6%
Check for
CARBS
*Check the first
3 items on the
ingredients list
for hidden fats
and sugars
Water & Non-Calorie Liquids =
8 cups per day
Sugar-free drinks do count, but water is best!
SF Tang
Diet Soda
Herbal Tea
Crystal Light
Flavored Water
Coffee or Tea
Your Meal Plan:
Deciding What to Eat
Lunch Sample
2 slices whole wheat bread
2 oz of turkey
1 slice of 2% cheese
1 Tbsp lite mayo
Lettuce/tomato
1 small piece of fruit
Noncalorie beverage
Total Carbohydrates
30 grams
0 grams
0 grams
0 grams
0-2 grams
15 grams
0 grams
= 45 grams
Exercise Therapy for
Diabetes Management
Carbohydrates
Count
GoodTotal
News
About Physical
Activity
Lose weight
Gain energy
Lower risk of
heart disease
Increase
well-being
Possibly reduce
the need
for some
medications
Improve overall
health
Keep It Fun!
Add Variety
to Your Daily
Routine
Choose
Enjoyable
Activities
Enjoy
Activities
with Friends
Blood Sugar & Exercise
Blood Glucose Level
Guidelines
Lower than 100 mg/dL
(5.6 mmol/L)
Your blood sugar may be too low to
safely exercise. Eat a carbohydrate
containing snack.
You're good to go!
This is a safe pre-exercise zone.
100 to 250 mg/dL
(5.6 to 13.9 mmol/L)
> 250 mg/dL
(13.9 mmol/L) or higher
Your blood sugar may be too high
to exercise safely. Postpone your
workout until your blood sugar
drops to a safe pre-exercise range.
Diabetes & Exercise
•Exercise only when feeling well
• Become familiar with blood
glucose patterns
•Know the symptoms of highs and
lows
Diabetes & Exercise
• 30 – 45 minutes of exercise is safe when
diabetes is under good control
• Eat a meal 1 – 3 hours before exercise
• Insulin
– Administer insulin more than 1 hour before exercise
– Administer insulin in abdomen
– Avoid extremity injection
Diabetes & Exercise
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During exercise, drink plenty of fluids
Remember: sports drinks contain sugar
After exercise, monitor your blood glucose
Wear shoes and socks at all times
Always wear properly fitted footwear
Check your feet after every session
Consult your physician if any symptoms develop
during or after exercise
Where Can You Find
Shoes & Socks for Exercise?
• Pharmacies
• Podiatrists
– Wilmington Foot & Ankle
• Omega Sports (Oleander Dr)
• Diabetic socks can be purchased
at the EFC, most pharmacies and
large retail stores
– Dr. Scholl’s brand
What is Exercise?
•Exercise is anything you want it to be
– walking the dog, cleaning, taking the stairs,
working out at the Employee Fitness Center
•Focus on duration over intensity
– three 10 min sessions or one 30 min session; every
minute counts!!
•Adding to your normal, daily activity is important
– if you walk all day at work, you still need planned
exercise or additional physical activity in your routine
Time to Get Started
Want to get started now?
Your safety is very important to us. Follow the guidelines we have provided, and remember that you can
always contact a trainer at the EFC for more specific advice on physical activity and exercise. Always seek
help with each new exercise.
Can’t start the 12toLife just yet?
Try a group exercise class offered at the EFC, take a walk with some friends or coworkers during lunch,
take the stairs, or even contact a trainer for an appointment.
Not sure if you can participate in any of the NHRMC EFC programs?
Remember our guidelines, and seek help when needed. Your team is here to help you. For more
information on outdoor resources for exercise and physical activity in your area, contact a member of
the Diabetes Health Plan Team or an EFC staff member! Even if you live farther away, always remember
that you are not alone.
Preventing Complications
from Diabetes
Preventing Complications
• Having pre-diabetes and diabetes puts you at a
higher risk for developing other health problems
HOWEVER…
• If you understand the risks, you can take steps
now to lower your chance of diabetes related
complications
Managing Diabetes
• What percentage of diabetes is managed by
you vs. your healthcare provider?
• 20% of your diabetes control is managed by
your healthcare provider
• 80% is managed by you
Preventing progression of DM
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Healthy eating
Exercise
Monitoring BG
Taking medications
Stop smoking
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Long Term Complications of
Poorly Controlled Diabetes
Heart Disease and Stroke
Kidney Disease
Eye Complications
Nerve Damage
Foot Complications
Skin Complications
Depression
Sexual Dysfunction
Gum Disease
The good news is:
Better control =
Less complications
Heart Disease and Stroke
• People with diabetes are 2x more likely to
have heart disease or stroke than people
without diabetes
• How can we prevent long term
complications?
– Cut out sugary and fattening foods
– Daily exercise
– Get your lipid panel done 2x/year
http://www.diabetes.org/living-with-diabetes/complications/mens-health/serious-health-implications/heart-disease-and-stroke.html
Kidney Disease
• The kidneys clean our blood
• High blood sugar can put too much stress on
the kidneys and can cause damage over time
• How is the long term complication prevented?
– Get your kidney function tests 2x/year
http://www.diabetes.org/living-with-diabetes/complications/kidney-disease-nephropathy.html
Eye Complications
• Diabetes can damage the blood vessels of the
eyes, potentially leading to blindness
• Diabetes can also cause glaucoma or cataracts
• How is the long term complication prevented?
– Get a comprehensive eye exam by an optometrist
or ophthalmologist 1x/year
http://www.diabetes.org/living-with-diabetes/complications/mens-health/serious-health-implications/blindness-or-vision-problems.html
Nerve Damage (Neuropathy)
• High sugar can harm the walls of the tiny blood
vessels that connect to your nerves
• Described as a tingling, numbness, burning or
pain in legs or fingers
• How is the long term complication prevented?
– Get a foot exam by a physician 1x/year
– Use proper foot care
http://www.diabetes.org/living-with-diabetes/complications/mens-health/serious-health-implications/nerve-damage.html
Foot Care
• Check your feet every day
– Look at your bare feet for red spots, cuts, swelling, and blisters
• Wash your feet, dry, and moisturize every day
– Rub lotion over the tops and bottoms but not between your toes
• If you can see and reach your toenails, trim them
– File the edges with a nail file
• Protect your feet from hot and cold
– Never use hot water bottles, heating pads, or electric blankets
• Never walk barefoot
– Wear comfortable shoes that protect your feet
– Check inside your shoes before wearing them
• Keep the blood flowing to your feet
– Don't cross your legs for long periods of time
Depression
• Studies show that people with diabetes have
an increased risk of depression
• How is the long term complication prevented?
– Exercise and see your physician at least 1x/year,
or as often as the two of you feel is appropriate
• Don’t be afraid to reach out for help
– Employee Assistance Program (EAP)
1-800-822-4847 (24 hours a day)
– 5 free sessions/year
Gum Disease
• There is an increased risk for gum disease
because diabetes decreases your ability to
fight bacteria that invade the gums
• How is the long term complication prevented?
– Brush and floss regularly
– Have a dental exam at least 2x/year
http://www.diabetes.org/living-with-diabetes/treatment-and-care/oral-health-and-hygiene/diabetes-and-oral.html
Reducing Risk &
Sick Day Management
Reduce Risk: Quit Smoking
• This is 1 risk factor YOU can control
• IT IS NEVER TOO LATE TO QUIT
• Smoking and diabetes have a lot of the same
complications
• Talk to a health care professional if you are
interested in quitting
• 1-800-Quit-Now
Reduce Risk: Get Vaccinated
• Flu vaccine 1x/year
– Free to all employees and dependents in Employee
Health!
• Pneumonia vaccine 1x before 65, 1x after age 65
• Hepatitis B vaccine 1 time series between
age 19-59
Know your ABC’s
Target:
Less than 7%
Target:
Less than 140/90
Target: LDL “bad
cholesterol”
Less than 100
A1C
• A1C – your doctor will likely tell you how often
to have this lab drawn
• For the DHP: 2x/year at Employee Health
As a general rule:
A1C < 7%
A1C > 7%
2x/year
4x/year
Blood Pressure
• Blood pressure will be checked at every doctor
visit and Employee Health & Clinic visit
Systolic
Diastolic
(top number)
(bottom number)
140 or less
90 or less
Cholesterol
• Cholesterol will be drawn at least 2x/year at
Employee Health & Clinic
Sex
Male
Total
HDL
Cholesterol
< 200
> 40
Female < 200
> 50
LDL
TG
< 100
< 150
< 100
< 150
Daily Monitoring
Goal fasting BG before meals:
80-130 mg/dL
Helps you see how food,
physical activity and
medications affect your
blood glucose level
Goal 2 hours after the start of a meal:
Less than 180 mg/dL
Sick Day Management
• Discuss your sick day plan with your physician
• Make sure you get an annual flu vaccine
www.jimchines.com
S.I.C.K.
S
I
Is for Sugar testing more often
C
Is for Carbohydrate - keep intake as normal as possible
K
Is for Keep well hydrated - drink at least 8 oz of calorie
free fluids every hour
Is for continue to take your Insulin or oral medications
http://www.health.gov.sk.ca/Type-2-diabetes-on-insulin-sick-day-mgmt
Things To Do on a Daily Basis
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Eat healthy
Keep active
Check your sugar
Reduce risky behaviors – smoking, drinking alcohol
Practice proper foot care habits
Wear proper footwear
Brush your teeth and floss regularly
Manage daily stressors
Ask for help when necessary
AADE7 Self Care Behaviors – Reducing Risk
http://diabeteshealth.com/
Contact Information
For appointments with Dietitian or Pharmacist
Contact Dee Freeman at 667-5183 or
[email protected]
For other questions related to the
Diabetes Health Plan, contact the DHP
Administrator at 667-5959 or
[email protected]
DHP Hotline 667-7777
References
• American Diabetes Association
http://www.diabetes.org/
• Novo Nordisk
http://www.cornerstones4care.com/
Other Resources
• http://www.health.gov.sk.ca/Type-2-diabeteson-insulin-sick-day-mgmt
• http://www.diabetes.org
• 1 -800-QUIT NOW- for smoking cessation