Symptoms of Pre-Diabetes and Diabetes Prevention Tips
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Symptoms of Pre-Diabetes and Diabetes Prevention Tips



Learn about pre-diabetes and how asses your risk and tips on preventing diabetes from Inova Medical Group physicians.

Learn about pre-diabetes and how asses your risk and tips on preventing diabetes from Inova Medical Group physicians.

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Symptoms of Pre-Diabetes and Diabetes Prevention Tips Symptoms of Pre-Diabetes and Diabetes Prevention Tips Presentation Transcript

  • Pre-Diabetes Dr. Sung T. Kim Inova Medical Group - Centreville 1
  • Diabetes Facts – 2011 • Total prevalence of diabetes – 25.8 million, about 8.3% of population have diabetes • 1.9 million new cases of diabetes diagnosed in age 20 and older in 2010. • Men 13 million > Women 12.6 million • Diabetes complications contributed to total of 231,404 deaths in year 2007. • Pre-diabetes: 79 million people 2
  • Pre-diabetes – what does it mean? • Means that blood sugar is higher than normal, but it’s not yet high enough to be classified as type 2 diabetes. 3
  • What is the problem? 4
  • Why you have abnormally high glucose level? • Body not using insulin properly – insulin resistance. • Initially, pancreas makes extra insulin but over time, it’s not able to keep up and eventually can’t make enough insulin to keep up with blood glucose levels. 5
  • Basics of pre-diabetes • No clear symptoms, you may have it and not know it. • Most of diagnosis are done when blood test is done to look at glucose level(i.e. physical exam, health screening). • If you are diagnosed, should be screened for type 2 diabetes every year. 6
  • How do we prevent Type 2 diabetes? • Early treatment and lifestyle changes can return blood glucose levels to normal range. • Research shows risk of type 2 diabetes lowers by 58% if you: - loose 7% of you body weight(or 15 lbs. if you weight <200 lbs.) - appropriate dietary plan - exercise moderately 5 days a week, 30 minutes a day (i.e. brisk walking, cardio) 7
  • What are the complications? • Long-term damage of diabetes especially to your heart and circulatory system may already be starting • Adults with diabetes have 2-4 times higher risk of heart disease related deaths as well as 2-4 times risk of stroke. 8
  • What are the complications? • 67 % of diabetics have high Blood Pressure >140/90 or use prescription medication for hypertension. 9
  • What are the complications? • Leading cause of new cases of blindness among adults. • 4.2 million people with diabetes aged >40 had diabetic retinopathy, almost 0.7 million of them had advanced diabetic retinopathy that can lead to severe vision loss. 10
  • What are the complications? • Leading cause of kidney failure, responsible for 44% of new cases in 2008. • In 2008, Total of 202,290 people were living on chronic dialysis or with kidney transplant in US due to diabetes. 11
  • What are the complications? • >60-70% of diabetics have some form of Nervous system damage • 65k lower limb amputations were performed in people with diabetes in 2006. 12
  • Diabetic foot exam 13
  • Big picture... Goals… • First things first – understanding disease process - Educational material - INOVA Diabetes education classes – free • Lifestyle changes - diet and exercise • Continued goal oriented visits with your doctor • Patient-Centered Medical Home(PCMH) at INOVA • Prevention, Prevention, Prevention! 14
  • Pre-diabetic & diabetic patient benefits of weight loss Dr. Kajal Zalavadia 15
  • Obesity and Diabetes • Increased body weight = increased risk for impaired glucose tolerance/ type 2 diabetes - Strong association with obesity and type 2 diabetes - >80% of cases of type 2 diabetes can be attributed to obesity • Nurses Health Study - 100 fold increased risk for diabetes over 14 years in nurses with a BMI >35 compared to BMI <22 • Excess weight induces insulin resistance, impairs insulin-mediated blood sugar uptake by the body - Decreases beta cell sensitivity (cells in charge of insulin) 16
  • Obesity and Diabetes • Increased abdominal obesity raises the degree of insulin resistance and risk of diabetes - Waist circumference - Waist-to-hip ratio • Genes matter - diabetes risk significantly influenced by lifestyle factors positive and negative - Sedentary lifestyle lowers energy expenditure, promotes weight gain - Poor diet (i.e. sugar sweetened beverages) 17
  • Weight Loss • Weight loss can decrease risk of developing diabetes - 5 - 10% loss of body weight and maintenance of weight can reduce risk • For diabetic patients, weight-loss can improve glycemic control • Lifestyle changes are not temporary - Implement changes you can maintain forever - Take control of your health! 18
  • Basic Principles • Accept responsibility - Make your health your priority - Nothing can happen without your participation • Assess current health, habits and environment to identify changes you can make - Health Status: My Health Advisor - Diabetes Risk: Pre-diabetes/Insulin resistance Disease progression and multi-organ involvement - Know your healthy weight range: BMI - Home and workplace factors that affect your weight and health 19
  • Surroundings 20
  • Readiness Assessment • • • • • Are you ready to control your health? - Not ready for a change? Consider how change can benefit you and your family Want to change, only later? - What are your barriers? I want to start making a plan. - Congrats! Start date ___. Spell out your plan. I have started making some changes already - Good for you! - OK to make mistakes, just get back on board! I have integrated these changes to my lifestyle (>6 months) - Be proud! - Track your efforts - Sign yourself up for the next step! (Variation) 21
  • Readiness • • • • • • • A realistic and specific plan is a more achievable - What is my goal (I am 50 lbs. over my desired weight) Setting goals: - Changes are meant to be maintained forever (LIFESTYLE CHANGES) - Start small Be specific: - Instead of “I will walk more” go with “I plan to walk 30 minutes after lunch on M-F” Foresee Barriers Reward System Stay positive! - When things don’t go as planned, just pick yourself up and get back on track Next Goal!!! 22
  • Track Progress Start Tracking!!! •Accountability and Motivation - American Diabetes Association and My Food Advisor - Phone Apps: My Fitness Pal - Fitbit •Food +drinks •Physical activity •Recognize patterns •Emotions can influence eating - Boredom, stress, emotional, and triggers - Recognize when you’re hungry, and full/satisfied 23
  • Food • Education is the first (and important) step to control - More nutritious option - Whole grains, non-starchy veggies, lean proteins - Carb counting • Portions - Cultural distortion • Calorie Control (3500 cal. = 1-2 lbs.) • Planning your meal - Preparation! • Tools: - Diabetic Education - American Diabetes Association 24
  • Fitness • Diet gets weight off • Exercise keeps it off • Activity sensitizes cells to insulin so they work more efficiently • Improves blood glucose and A1C, decreases need for pills/insulin • Combination of aerobic and strength training is important for diabetes - Aerobic helps body use insulin better Aim for 30 minutes of moderate to intense aerobic activity, 5 days/ week - Strength training sensitizes body to insulin and lowers blood glucose More muscle = more calories you burn (even at rest). Aim for 2-3 days/week. ! 25
  • Medical Treatments • Inova Weight Loss Services - Medical Management (conservative) - Surgical Services • More aggressive options BUT - No short cuts - will NOT work if you don’t put in the time and effort - Make your health a priority • Medical Weight Loss Program - Weekly structured sessions, strict regimen, dedication - Team of healthcare professionals: obesity medicine physician, dieticians, behavioral therapist, nurse navigator and fitness trainers - Work with you to create a healthy lifestyle to follow long term 26
  • Medical Treatments • • • • • • • Weight Loss Surgery BMI>40 or BMI between 35-40 and with weight related medical conditions such as diabetes Still a TOOL and both dietary and fitness changes must take place for this to work successfully long term Center of Excellence for Bariatric Surgery at Inova Fair Oaks Hospital Surgical treatment in patients with diabetes has the largest range of sustained weight loss and thus improvement in blood glucose control Especially Rou-en-Y gastric bypass to follow long term 27
  • Resources & Contact Info Phone: 703.348.4716 Email: Web: FB: twitter: 28
  • Taking control of diabetes Dr. Shivam Champaneri Inova Medical Group Endocrinology 29
  • Diabetes Diagnosis - AACE Guidelines • Fasting plasma glucose of >126 mg/dl OR • Plasma glucose concentration of > 200 mg/dl 2 hours after ingesting 75 g oral glucose load in the morning after an overnight fast of at least 8 hours or • Symptoms of uncontrolled hyperglycemia (i.e. polyuria, polydipsia, polyphagia) & a random (casual, nonfasting) plasma glucose concentration of > 200 mg/dl OR • A1C level of >6.5% • Multiple tests are done or repeated to confirm the diagnosis • Hemoglobin A1C - a blood test providing a cumulative average sugar measure over the past 3 months 30
  • Hemoglobin A1C A1c level Estimated average blood sugar 5% 97 mg/dl 6% 126 mg/dl 7% 154 mg/dl 8% 183 mg/dl 9% 212 mg/dl 10 % 240 mg/dl 11 % 269 mg/dl 12 % 298 mg/dl 13 % 326 mg/dl 14 % 355 mg/dl 31
  • Diabetes Symptoms • Weight changes (may be related to diet/exercise/medication/degree of control) • Excessive thirst, urination (nighttime) • Blurred vision (eye complications), • Numbness/tingling (foot, nerve complications) 32
  • Diabetes – Taking Control • Blood sugar control - always bring a log of your sugars/meter to your doctor visits so appropriate medication adjustments can be made • Certain medications impact morning fasting sugars while others work more on prandial sugars (mealtime) • Insulin injections: inject in fat tissue to prevent pain, bruising, and improper insulin absorption 33
  • Diabetes – Taking Control • Diet: - Watching carbohydrate intake has direct impact on blood sugars - Dietary indiscretions - regular sodas, fruit juices, sweets, high carbohydrate foods (rice, breads, potatoes, pastas) - Visited diabetes educator/dietician? • Exercise • Weight has direct impact on blood sugars, cholesterol and blood pressure which affect cardiovascular health 34
  • Diabetes – Low blood sugar • How often is it happening and time of day ? Before or after meals? Overnight hours? - Associated symptoms: shakes, sweats, nervousness, weakness, confusion • Medic alert bracelet/necklace? • Carry sugar source with you? • Glucagon emergency kit ? (Particularly if on insulin). • Check sugar before driving/bedtime/exercise 35
  • Diabetes Complications • Retinopathy: annual eye exam 36
  • Diabetes Complications • Nephropathy: urine microalbumin or urine total protein/creatinine ratio • Often multiple tests are done or the test is repeated to confirm the diagnosis 37
  • Diabetes Complications • Gastroparesis: nausea, vomiting, bloating, early satiety • Erectile dysfunction • Cardiovascular: - high blood pressure, - high cholesterol - heart attack/stroke - peripheral artery disease • Acanthosis Nigricans 38
  • Diabetes – Check-up • Exam: - Blood pressure (<130/80) - Weight; body mass index - Thyroid examination; carotid arteries - Skin examination (acanthosis/insulin injection sites) - Comprehensive foot exam • Labs: - Hemoglobin A1C (checked every 3-6 months) - Fasting lipid panel (goal LDL in diabetics <100; some say <70 - Comprehensive metabolic panel (includes markers for kidney and liver function) - Urine microalbumin/Cr or spot urine total protein/Cr 39
  • Diabetes Foot Care • Wash feet daily with warm water & soap - dry well, especially between toes. • Check daily for blisters, cuts, sores, redness or swelling. Check between toes and use a mirror to check the bottom of your feet. Notify your doctor if you find something wrong. • Cut your toenails straight across (to prevent ingrown toenails) • Wear shoes that fit well and do not rub toes or heels • See your podiatrist if you have a wound that is not healing • Never walk barefoot indoors or outdoors • Never use a knife or razor blade to cut your toenails or feet • Never wear garters, tight socks or other clothing that cuts circulation to feet • Don’t smoke! 40
  • Correcting low blood sugar • Check your sugar if you experience low blood sugar symptoms • For glucose <70→ eat a 15-20 g carb snack → recheck glucose 15 min later → if still <70, eat another snack. • 15-20 grams of carbs = 1/2 cup fruit juice or (not diet) soda; 1 cup milk; 5 pieces hard candy; 1 tbsp. sugar, 3 - 4 glucose tablets • Friend /family member should administer glucagon emergency kit & CALL 911 if you are unresponsive, having a seizure, or can't take a snack due to unconsciousness • If your blood sugar is <100 mg/dL prior to exercise, or at bedtime, eat a snack to prevent hypoglycemia 41
  • Inova Medical Group Diabetes Care Team • Primary care physician • Endocrinologist - a doctor who specializes in treating diabetes and other diseases of the endocrine system • Physician assistant/nurse practitioner • Certified diabetes educator (CDE)/dietitian • Ophthalmologist (annually) • Podiatrist – foot specialist • Mental health professional • Dentist (every 6 months) Inova Medical Group Endocrinology Springfield Healthplex 6355 Walker Lane, Suite 405, Alexandria, VA