Four Steps to Control Diabetes

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A presentation designed for the community to increase awareness of diabetes prevention and goals of care.

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  • Diabetes Educational Services© (530) 893 - 8635
  • Diabetes Educational Services© (530) 893 - 8635
  • KEY MESSAGE: Although diabetes is serious, people with diabetes can live active, full, and productive lives by taking charge of their health. Supporting Points With proper care, diabetes complications can be prevented or delayed. People with diabetes can reduce their risk of complications if they are educated about their disease, practice skills to manage blood glucose levels, and receive regular checkups from their health care team.
  • KEY MESSAGE: The A1C test measures a person’s average blood glucose over the previous 2 to 3 months. Supporting Points The A1C test is used to monitor blood glucose control. The test measures the level of glycosylated hemoglobin, which forms when glucose binds to hemoglobin in red blood cells. Because the lifespan of red blood cells is approximately 120 days, the glycosylated hemoglobin level is a good measure of average blood glucose over the past 2 to 3 months. The American Diabetes Association recommends an A1C goal of less than 7% for people with diabetes. In people without diabetes, the normal A1C level is below 6%. For most people with diabetes, the A1C test is recommended at least twice yearly. Some people are advised to have more frequent (quarterly) A1C testing. An A1C value of 8% or higher almost always necessitates a change in the person’s treatment plan. The American College of Endocrinology (ACE) and American Association of Clinical Endocrinology (AACE) recommend an A1C goal of 6.5% or less. An ACE consensus panel recommended this lower A1C goal to further reduce the risk of complications in people with diabetes. The American Association of Diabetes Educators has stated its support of this lower A1C goal.* The ADA recommends considering more stringent A1C goals (normal A1C; less than 6%) in individual patients. Keeping the A1C level within the goal range can prevent or delay long-term complications of diabetes. Improved glycemic control is associated with reduced risk of cardiovascular events and microvascular complications, such as retinopathy, neuropathy, and nephropathy. The United Kingdom Prospective Diabetes Study found that lowering blood glucose in type 2 diabetes with intensive therapy (median A1C of 7%) reduced overall microvascular complications by 25%. The Diabetes Control and Complications Trial found that for every 1% reduction in A1C, the risk of microvascular complications was reduced by 40% on average. * Berkowitz KJ. AADE supports new guidelines for diabetes management. Diabetes Educator . 2002;28(1):26,29.
  • Diabetes Educational Services© (530) 893 - 8635
  • Diabetes Educational Services© (530) 893 - 8635
  • KEY MESSAGE: In people with diabetes, blood pressure should be measured at each doctor’s visit and, if elevated, treated to reduce the risk of complications. Supporting Points Hypertension is extremely common in people with diabetes. Up to 60% of people with diabetes have hypertension, which is defined as a blood pressure of 140/90 mm Hg or higher. In type 2 diabetes, hypertension is often part of the metabolic syndrome of insulin resistance, which also includes hyperglycemia, obesity, and dyslipidemia. In type 1 diabetes, hypertension may signal the onset of diabetic nephropathy. Controlling blood pressure reduces the risk of both macrovascular and microvascular complications. The UKPDS showed that for every 10 mm Hg decrease in mean systolic blood pressure, the risk of any diabetes complication was reduced by 12% and the risk of death was reduced by 15%. Hypertension can be managed through lifestyle changes and, for many people, use of medications. Nondrug treatment usually includes weight reduction, dietary sodium restriction, and moderately intense physical activity, such as 30 to 40 minutes of brisk walking on most days of the week. Many people also need one or more daily medications to control high blood pressure. Angiotensin-converting enzyme (ACE) inhibitors are considered first-line drug therapy for most patients with diabetes, but many types of antihypertensive medications are available. The goal of treatment is to lower blood pressure to a target of 130/80 mm Hg or less.
  • Diabetes Educational Services© (530) 893 - 8635
  • KEY MESSAGE: Good diabetes care is a team effort that includes the person with diabetes, his or her physician, and other health care professionals. Supporting Points Because diabetes affects many aspects of health and daily living, a team approach to care is recommended. The person with diabetes is the captain of the team, whose job is to help develop an individualized care plan and follow through on advice to manage the disease. Encourage people to work with their providers to adjust care plans to fit their own lives, including their preferred foods and activities, cultural backgrounds, and other medical problems. Review the roles of different health professionals on the care team. An important team member is the physician, who may have specialized training in diabetes, such as board certification in endocrinology. Another key team member is the diabetes educator, who may be a nurse, dietitian, pharmacist, or physician. Other team members who may be consulted as needed include a podiatrist, eye doctor, exercise physiologist, social worker, and a psychologist or other therapist. Teach people how to find qualified diabetes care providers. Explain that a certified diabetes educator (CDE) has passed a national exam in diabetes and is up to date in diabetes care. People can find CDEs who practice in their areas by contacting the American Association of Diabetes Educators (800-832-6874 or www.diabeteseducator.org ). Tip: Effective communication is integral to teamwork and good diabetes care, but some people may feel intimidated by doctors and other health professionals. Share tips or brainstorm ways to encourage good communication with providers. Strategies include writing down questions before a medical visit, asking the provider to clarify technical terms, and bringing along a family member or friend on the visit.
  • KEY MESSAGE: Most people with diabetes should see their health care team at least twice a year for regular checkups and laboratory tests. Supporting Points Although guidelines need to be individualized, most people with diabetes are advised to have a blood test to measure A1C and a blood pressure check every 6 months . Some people with diabetes are advised to have an A1C test every 3 months. Because gum disease is more common in people with diabetes, regular dental visits (usually, twice a year) also are important. At least once year, people with diabetes should have a blood test to measure lipids, a urine test to check protein, a comprehensive eye exam, and a complete foot exam . An annual flu shot is recommended. Advise people to check with their diabetes care team about other immunizations that may be recommended, such as the pneumococcal vaccine.
  • Four Steps to Control Diabetes

    1. 1. 4 Steps to Control Diabetes for Life Beverly Thomassian Diabetes Nurse for a really long time
    2. 2. Goals for Tonight <ul><li>The state of diabetes </li></ul><ul><li>What is diabetes? </li></ul><ul><li>If you have pre diabetes or diabetes, what can you do to increase your healthspan? </li></ul><ul><li>Getting the most out of your doctor or provider visit. </li></ul>
    3. 3. Step 1 <ul><li>Learn about Diabetes </li></ul>
    4. 4. CDC Announces <ul><li>1 in 3 Americans may have Diabetes by 2050 </li></ul><ul><li>Boyle, Thompson, Barker, Williamson </li></ul><ul><li>2010, Oct 22:8(1)29 </li></ul><ul><li>www.pophealthmetrics.co m </li></ul>
    5. 6. Diabetes in America 2011 <ul><li>26 > 28 million or 8% > 8.3% </li></ul><ul><li>79 million have pre diabetes </li></ul><ul><li>New cases increased 90% in past 10 years. </li></ul><ul><ul><li>4.8 per 1,000 people during 1995-1997 to </li></ul></ul><ul><ul><li>9.1 per 1,000 in 2005-2007 in 33 states. </li></ul></ul><ul><li>CDC 2011 </li></ul>
    6. 7. <ul><li>34% BMI 30 +, 34% BMI 25-29 </li></ul><ul><li>We burn 100 cals less a day at work </li></ul><ul><li>1/3 of all overwt people don’t get diabetes </li></ul>
    7. 8. Diabetes 2 - Who is at Risk? (ADA Clinical Practice Guidelines ) <ul><li>Testing should be considered in all adults who are overweight (BMI  25) and have additional risk factors : </li></ul><ul><ul><li>First-degree relative w/ diabetes </li></ul></ul><ul><ul><li>Member of a high-risk ethnic population </li></ul></ul><ul><ul><li>Habitual physical inactivity </li></ul></ul><ul><ul><li>PreDiabetes </li></ul></ul><ul><ul><li>History of heart disease </li></ul></ul>
    8. 9. Diabetes 2 - Who is at Risk? (ADA Clinical Practice Guidelines ) <ul><li>Risk factors cont’d </li></ul><ul><ul><li>HTN - BP > 140/90 </li></ul></ul><ul><ul><li>HDL < 35 or triglycerides > 250 </li></ul></ul><ul><ul><li>baby >9 lb or history of Gestational Diabetes Mellitus (GDM </li></ul></ul><ul><ul><li>Polycystic ovary syndrome (PCOS) </li></ul></ul><ul><ul><li>Other conditions assoc w/ insulin resistance: </li></ul></ul><ul><ul><ul><li>Severe obesity, acanthosis nigricans (AN) </li></ul></ul></ul>
    9. 12. Natural History of Diabetes Development of type 2 diabetes happens over years or decades Yes! NO
    10. 13. Can we stop the progression? Insulin Resistance  Pre Diabetes  Diabetes  and what about cardiovascular risk factors?
    11. 14. Preventing Pre Diabetes
    12. 15. Can Type 2 be Prevented in Older Adults? <ul><li>Overall, 9 of 10 new cases of diabetes attributable to these 5 lifestyle factors. </li></ul><ul><li>89% risk reduction when all at goal. </li></ul><ul><li>35% rel risk reduction for each additional </li></ul><ul><li>Physical activity (30 mins a day) </li></ul><ul><li>Dietary score (higher fiber intake, low saturated fat and trans -fat, lower mean glycemic index) </li></ul><ul><li>Not Smoking </li></ul><ul><li>Alcohol use (up to 2 drinks a day); </li></ul><ul><li>BMI <25 and waist circumference </li></ul><ul><li>Dariush Mozaffarian, MD, </li></ul><ul><li>Arch Intern Med.  2009;169(8):798-807. </li></ul>
    13. 17. The Good News About Diabetes
    14. 18. Step 2 <ul><li>Know your </li></ul><ul><li>ABC’s </li></ul>
    15. 19. Why bother? Blood sugars matter! <ul><li>Every 1 point drop in A 1 c causes a 35% decrease in diabetes problems </li></ul><ul><li>Insulin and pills work equally well </li></ul><ul><li>Keep your pancreas happy. </li></ul><ul><li>It’s worth it! </li></ul>
    16. 20. A1C Blood Test
    17. 21. A1c and Estimated Avg Glucose (eAG) 2008 <ul><li>A1c (%) eAG </li></ul><ul><li>5 97 </li></ul><ul><li>6 126 </li></ul><ul><li>7 154 </li></ul><ul><li>8 183 </li></ul><ul><li>9 212 </li></ul><ul><li>10 240 </li></ul><ul><li>11 269 </li></ul><ul><li>12 298 </li></ul><ul><li> </li></ul><ul><li>eAG = 28.7 x A1c-46.7 ~ 29 pts per 1% </li></ul><ul><li>Translating the A1c Assay Into Estimated Average Glucose Values – ADAG Study </li></ul><ul><li>Diabetes Care: 31, #8, August 2008 </li></ul>Order teaching tool kit free at diabetes.org
    18. 23. Know Your Check every 3 - 6 months <ul><li>A1c </li></ul>
    19. 24. Glucose Goals Targets are individualized <ul><ul><li>Before meals: 70 - 130 </li></ul></ul><ul><ul><li>1-2 hr after meal: less than 180 </li></ul></ul><ul><ul><ul><li>* for nonpregnant adults </li></ul></ul></ul>
    20. 25. Keep Your Blood Pressure In Check
    21. 26. UKPDS Blood Pressure Findings <ul><li>By controlling your blood pressure you reduce your risk of: </li></ul><ul><ul><li>Heart failure (56%) </li></ul></ul><ul><ul><li>Stroke (44%) </li></ul></ul><ul><ul><li>Death from diabetes (32%) </li></ul></ul>
    22. 27. Blood Pressure Goal <ul><li>Less than </li></ul><ul><li>130 / 80 </li></ul><ul><li>(check each office visit ) </li></ul>
    23. 28. Blood Fat (Cholesterol Goals) <ul><li>Cholesterol Levels: </li></ul><ul><li>Check once a year </li></ul><ul><ul><li>HDL (happy cholesterol) more than 40 </li></ul></ul><ul><ul><li>LDL (lousy cholesterol) less than 100 </li></ul></ul><ul><ul><li>Triglycerides (bad fat) less than 150 </li></ul></ul>
    24. 29. Diabetes ABC’s <ul><li>A 1c </li></ul><ul><li>B lood Pressure </li></ul><ul><li>C holesterol </li></ul>
    25. 30. ABCs of Diabetes – <ul><li>A 1c less than 7% (avg 3 month BG) </li></ul><ul><ul><li>Pre-meal BG 70-130 </li></ul></ul><ul><ul><li>Post meal BG <180 </li></ul></ul><ul><li>B lood Pressure < 130/80 </li></ul><ul><li>C holesterol </li></ul><ul><ul><li>HDL >40 </li></ul></ul><ul><ul><li>LDL <100 (if CHD, <70) </li></ul></ul><ul><ul><li>Triglyceride < 150 </li></ul></ul>
    26. 31. Your Diabetes Care Team
    27. 33. Getting the Most out of your Doctor visit <ul><li>Write down your numbers in the back of this book –keep track </li></ul><ul><li>Bring your blood sugar log book to each visit. Circle levels you want to discuss. </li></ul><ul><li>Jot down important topics to discuss </li></ul><ul><li>Bring someone if you have trouble remembering everything. </li></ul>
    28. 34. Getting the Most out of your Doctor visit <ul><li>Keep log of your current medications on your person. </li></ul><ul><li>While waiting take off shoes/socks. </li></ul><ul><li>Work with the team to make one goal to work on until next visit. </li></ul>
    29. 35. Step 3 <ul><li>Manage your Diabetes </li></ul>
    30. 36. Goal Ideas <ul><li>Eat healthier foods </li></ul><ul><li>Eat 3 oz portions of lean meat / fish </li></ul><ul><li>Eat foods that have less fat and salt </li></ul><ul><li>Eat foods with more fiber </li></ul>
    31. 37. USDA Food Pyramid www.myplate.gov <ul><li>Balancing Calories   </li></ul><ul><ul><li>Enjoy your food, but eat less.   </li></ul></ul><ul><ul><li>Avoid oversized portions.     </li></ul></ul><ul><li>Foods to Increase   </li></ul><ul><ul><li>Make half your plate fruits and vegetables.   </li></ul></ul><ul><ul><li>Make at least half your grains whole grains.   </li></ul></ul><ul><ul><li>Switch to fat-free or low-fat (1%) milk.     </li></ul></ul><ul><li>Foods to Reduce   </li></ul><ul><ul><li>Compare sodium in foods like soup, bread, and frozen meals ― and choose the foods with lower numbers.   </li></ul></ul><ul><li>Drink water instead of sugary drinks. </li></ul>
    32. 38. Foods that do not raise blood sugar <ul><li>Vegetables </li></ul><ul><li>Meat </li></ul><ul><li>Fat </li></ul><ul><li>“ Free” foods </li></ul>
    33. 39. Don’t limit the Vegetables <ul><li>Non-starchy vegetable category </li></ul><ul><li>Contains about 5 gm carb per serving </li></ul><ul><li>But much of the carb comes from fiber </li></ul><ul><ul><li>Not digested </li></ul></ul><ul><ul><li>Has minimal affect blood sugar* </li></ul></ul><ul><ul><li>Helps to keep us full </li></ul></ul><ul><ul><li>Aim for 25-35 gm fiber daily </li></ul></ul>
    34. 41. Go Lean with Protein <ul><li>Choose lean protein </li></ul><ul><ul><li>Poultry, fish, egg, lean beef </li></ul></ul><ul><ul><li>Plant sources- beans, lentils, nuts </li></ul></ul><ul><ul><li>Low fat cheese- cottage cheese, mozzarella cheese </li></ul></ul><ul><li>Limit high fat protein </li></ul><ul><ul><li>Bacon & sausage </li></ul></ul><ul><ul><li>High fat cuts of beef </li></ul></ul><ul><ul><li>Whole milk cheese </li></ul></ul><ul><li>Serving size </li></ul><ul><ul><li>1 oz = ¼ cup </li></ul></ul><ul><ul><li>3 oz = deck of cards </li></ul></ul>
    35. 42. Fats- Aim for heart health <ul><li>Monounsaturated </li></ul><ul><ul><li>Olive & canola oils </li></ul></ul><ul><ul><li>Nuts </li></ul></ul><ul><ul><li>Avocado </li></ul></ul><ul><li>Polyunsaturated </li></ul><ul><ul><li>veg oils: canola, corn, walnut, safflower, soybean </li></ul></ul><ul><li>Saturated fats ( LIMIT ) </li></ul><ul><ul><li>Solid </li></ul></ul><ul><ul><li>Animal </li></ul></ul><ul><ul><li>Tropical (palm, coconut) </li></ul></ul><ul><ul><li>Trans fats (deep fried) </li></ul></ul><ul><li>Serving sizes </li></ul><ul><li>1 tsp butter, margarine, oil, mayonnaise </li></ul><ul><li>1 Tbsp salad dressing, cream cheese, seeds </li></ul><ul><li>2 Tbsp avocado, cream, sour cream </li></ul><ul><li>1 slice bacon </li></ul>
    36. 43. Goal Ideas – <ul><li>Get more active </li></ul><ul><li>Ask for help if you feel down </li></ul><ul><li>Learn to cope with stress </li></ul><ul><li>Stop smoking </li></ul><ul><li>Check your feet everyday </li></ul>
    37. 44. Other stuff to do… <ul><li>Brush and floss daily </li></ul><ul><li>Check your blood glucose </li></ul><ul><li>Check your blood pressure </li></ul><ul><li>Report changes in eyesight right away. </li></ul>
    38. 45. Step 4 <ul><li>Get Routine Care </li></ul>
    39. 46. Schedule Regular Visits with Diabetes Care Providers
    40. 47. Which Famous Person with Type 2 Diabetes? “ Too much of a good thing is wonderful?”
    41. 48. Mae West - lived into her 80’s
    42. 49. Thank You!

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