If you have diabetes, you are not alone. One out of every 12 Americans – nearly 26 million persons - has diabetes. Reference Centers for Disease Control and Prevention. National diabetes fact sheet: national estimates and general information on diabetes and prediabetes in the United States, 2011. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, 2011. http://www.cdc.gov/diabetes/pubs/pdf/ndfs_2011.pdf Accessed March 7, 2011.
Diabetes is characterized by chronically elevated blood sugar. In patients with type 1 diabetes, production of insulin by the pancreas is completely absent. Patients with type 2 diabetes have increased blood sugar because of a defect in the ability of the pancreas to secrete insulin or a defect in the ability to use insulin (ie, insulin resistance). Another less common type of diabetes is only diagnosed during pregnancy and is called gestational diabetes. The fourth type of diabetes is a catch-all that includes diabetes caused by specific events, such as a genetic defect in beta-cell function or insulin action, pancreatic diseases (eg, cystic fibrosis), and exposure to certain drugs or chemicals. Reference ADA. Standards of medical care in diabetes – 2011. Diabetes Care . 2011;34(Suppl 1):S11-S61.
The American Diabetes Association (ADA) has identified risk factors that are associated with the development of diabetes. The likelihood of developing type 2 diabetes can increase in people with certain risk factors. Two very common risk factors are being overweight and physically inactive. Having high blood pressure, with readings of 140/90 mmHg or greater, or taking medication for high blood pressure also increases the risk of developing type 2 diabetes. Other risk factors, which cannot be changed, are growing older, having a family member with diabetes, belonging to certain ethnic groups (eg, African Americans, Mexican Americans, native Hawaiians), being pregnant, and having a baby weighing more than 9 pounds. Reference ADA. Standards of medical care in diabetes – 2011. Diabetes Care . 2011;34(Suppl 1):S11-S61.
Your doctor can determine if you have diabetes several different ways. The first test is called the A1C, which the American Diabetes Association (ADA) recommends as a diagnostic test for diabetes. The A1C test tells your doctor how high (or low) your blood sugar has been over the past several months. According to the ADA, persons with an A1C value of 6.5% or greater are considered to have diabetes. Another measurement is called fasting plasma glucose – or FPG. An FPG of 126 mg/dL or greater indicates that a person has diabetes. When you take this test, you do not eat for at least 8 hours, which is why it is often taken in the morning before breakfast. A third test is called the oral glucose tolerance test – or OGTT – in which your blood sugar is measured after you drink a mixture of sugar and water. Persons with blood sugar levels of 200 mg/dL or greater two hours after drinking the sugar mixture have diabetes. A fourth way that your doctor can tell if you have diabetes is if you have symptoms of high blood sugar and a blood sugar level of 200 mg/dL or more. The results of your tests may not show that you have diabetes, but the results may be high enough to indicate that you have prediabetes. Persons with prediabetes are at increased risk of developing full-blown diabetes sometime in the future. You have prediabetes if you A1C test is 5.7% to 6.4% or if you have a blood sugar level of 100-125 mg/dL or more after not eating for at least 8 hours. Unless you have symptoms of high blood sugar or a blood sugar level of 200 mg/dL or more, your diagnostic tests for diabetes and prediabetes should be repeated to be sure that there is no laboratory error. Reference ADA. Standards of medical care in diabetes – 2011. Diabetes Care . 2011;34(Suppl 1):S11-S61.
There are some tell-tale signs of very high blood sugar levels. 1 Having to urinate frequently, being more thirsty or hungry than usual, having blurry vision, losing weight unexpectedly, and being more prone to infections than usual are all signs of very high blood sugar. 1 Diabetes is different in every person. Not everyone with diabetes will have these symptoms. Some people have different symptoms, and some don’t have any symptoms at all. 1 In fact, many people with diabetes do not even suspect that they have the disease. 2 Persons with type 1 diabetes usually have very noticeable symptoms of high blood sugar, which helps their doctor make a diagnosis quickly. 2 However, type 2 diabetes often is not diagnosed until complications occur, and as many as one out of every four persons with type 2 diabetes does not know they have it. 2 References 1 ADA. Diagnosis and classification of diabetes mellitus. Diabetes Care . 2011;34(Suppl 1):S62-S69. 2 ADA. Standards of medical care in diabetes – 2011. Diabetes Care . 2011;34(Suppl 1):S11-S61.
Low blood sugar, also called hypoglycemia, happens when your blood sugar is too low. It is something that people with diabetes need to be prepared to treat. You might get low blood sugar if you ate too little food or carbohydrates or skipped or delayed meals or snacks. Low blood sugar can also happen if you are more active than usual or take too much insulin or too many diabetes pills. With low blood sugar, you may feel weak or tired, hungry, dizzy or shaky, nervous or upset, sweaty, like your heart is beating too fast, or like your vision is blurry. The signs and symptoms of low blood sugar may become less noticeable after a person has had diabetes for a while. Some signs and symptoms might be so subtle that it is hard to react to them in time. Having signs and symptoms of low blood sugar without realizing it is called "hypoglycemic unawareness.“ Ask your diabetes care team what low blood sugar is for you. For most people, it is less than 70 mg/dL. Check your blood sugar right away if you have any symptoms of low blood sugar. If your blood sugar is low, or if you think your blood sugar is low but you cannot check at that time, eat or drink something high in sugar right away, such as 4 ounces (1/2 cup) of regular fruit juice, 4 ounces (1/2 cup) of regular soda pop (not diet), or glucose tablets. Reference ADA. Diabetes A to Z (6th edition). American Diabetes Association, Alexandria, VA. 2010;15-16.
People with diabetes need to be prepared to treat low blood sugar. If you feel like you are low, check your blood sugar right away. If your blood sugar is below your target range, follow the Rule of 15. If you cannot check your blood sugar, play it safe and treate it anyway. The Rule of 15 is a simple and easy to remember way to treat low blood sugar: Eat or drink something with 15 grams of carbohydrate Wait 15 minutes and check your blood sugar again If your blood sugar is still low, eat or drink another 15 g of carbohydrates Check again after 15 minutes Keep some fast-acting carbohydrates on hand just in case your blood sugar becomes low. Some fast-acting carbohydrates are: One-half cup of fruit juice or regular soda; do not use diet soda 4 or 5 hard candies; chocolate is not a good choice because it contains fat, which doesn’t give you the burst of sugar that you need 3 glucose tablets Reference ADA. Hypoglycemia - Planet D. 2010. http://www.diabetes.org/living-with-diabetes/parents-and-kids/planet-d/new-to-diabetes/hypoglycemia.html Accessed April 16, 2011.
Now let’s talk about using what you’ve learned about diabetes to stay healthy.
The food we eat is used by our bodies as fuel to stay healthy and keep going. 1 This animation shows how a certain type of food – carbohydrate – is broken down into sugar. You may sometimes hear sugar referred to as glucose. Glucose travels from the stomach into the blood. 1 Once in the blood, we call this fuel blood sugar – or blood glucose. Increasing levels of sugar in the bloodstream cause the pancreas to release insulin into the blood. 2 Insulin helps move the sugar from the blood to the inside of the cells so it can be used as energy. 1,2 Carbohydrates make blood sugar increase, and insulin (and other important substances not shown here) makes blood sugar decrease. 2 References 1 Schaefer EJ, Gleason JA, Dansinger ML. Dietary fructose and glucose differentially affect lipid and glucose homeostasis. J Nutr . 2009;139:1257S-1262S. 2 Kahn RC, Saltiel AR. The molecular mechanism of insulin action and the regulation of glucose and lipid metabolism (Chapter 9). In: Joslin’s Diabetes Mellitus . 14th ed. Lippincott Williams & Wilkins; 2005:145-168.
There is a simple way to choose healthy foods in the right portion sizes: it is called the ‘plate method’ of diabetes meal planning. The plate method allows you to spread the amount of carbohydrates that you eat evenly over your daily meals and snacks. By using the plate method, you will be your way to managing your blood sugar. It is easy to create a plate of healthy food with the right portions: Draw a picture of a typical dinner plate Split the plate in half and then split one of the sections in 2 Fill the big section with nonstarchy vegetables, like spinach or broccoli Put starchy foods, like whole wheat bread or rice, in one of the small sections Put protein-containing foods, like meat, chicken, or eggs, in the other small section Add one 8-ounce glass of skim milk and a serving of fruit. Reference ADA. Diabetes A to Z (6th edition). American Diabetes Association, Alexandria, VA. 2010;125-126.
Eating healthy food is important, but so is eating the right amounts. Start by weighing and measuring your food to be familiar with what the right portion size looks like. Although all hands are different, a general rule is that your fist equals one cup, your palm equals 3 ounces, and your thumb equals one ounce. Reference Diabetes America. Nutrition measuring and portion control in diabetes. 2011. http://www.diabetesamerica.com/da-nutrition_measuring.cfm Accessed March 13, 2011.
One important part of taking charge of your diabetes is learning about the food that you eat. Food labels are a great source of information about the carbohydrates, fats, cholesterol, sodium, and fiber in a serving of that food. It is important that you carefully read the Nutrition Facts label. The number of calories, fat, carbohydrates, and other nutrients shown on the label are for a specific serving of that food. Many food containers have more than one serving. So in the example shown on this slide, the serving size is one cup and there are 2.5 servings in the container. That means that one cup of that food contains 150 calories. However, because there are 2.5 servings in the container, if you eat the entire container, you will be eating 375 calories and corresponding amounts of fat, carbohydrates, and the other nutrients. Reference ADA. Diabetes A to Z (6th edition). American Diabetes Association, Alexandria, VA. 2010;67.
Carbohydrate counting – or carb counting - is another way to manage your diabetes. Your body changes carbohydrates into sugar faster than proteins or fats, and it is the carbohydrates in your diet that are responsible for the increases and decreases in your blood sugar levels. The carbohydrate counting method of diabetes meal planning is simple: you keep track of the number of carbohydrates that you eat in each meal. Don’t worry about counting food that is mostly protein and fat because these types of foods contain very few carbohydrates. If you take insulin to control your blood sugar, carb counting will help you adjust your dose of insulin because you will be aware of how many carbohydrates you have eaten in each meal. If you do not take insulin, “carb counting” will help you learn to space your carbohydrates over the course of the day and better manage your blood sugar. Reference ADA. Diabetes A to Z (6th edition). American Diabetes Association, Alexandria, VA. 2010;125.
A healthy diet includes protein, which is found in foods from both animals and plants. According to the American Diabetes Association, a healthy meal plan will include about 6 ounces of meat or meat substitutes. Your dietician will recommend that you choose protein from foods that are low in fat, calories, and cholesterol. Meats, eggs, cheese, and cottage cheese are high-protein foods, but they may also be high in fat and calories. For healthy eating, you should try to choose lean cuts of meat (baked or broiled) and low-fat dairy products. Healthy choices of protein-rich foods are chicken (without skin), fish, shellfish, beans, peas, lentils, grains, nuts, and seeds. Reference ADA. Diabetes A to Z (6th edition). American Diabetes Association, Alexandria, VA. 2010;87,126.
Your healthy eating plan should consist of meals and snacks that are low in saturated fat. There are three types of fat: saturated fat, unsaturated fat, and trans fat. Saturated fats will increase your cholesterol levels. Cholesterol is found only in foods from animal sources, such fatty cuts of meat and high-fat dairy products, like butter or sour cream. Unsaturated fats are found in foods from plants. Some unsaturated fats will help you reduce your cholesterol. Some foods that contain monounsaturated fats are olive oil, canola oil, peanut oil, avocados, and almonds. Polyunsaturated fats are found in foods, such as corn oil, safflower oil, cottonseed oil, sunflower oil, and avocados. Trans fats are a type of unsaturated fat that are particularly unhealthy because they can increase your cholesterol. Check the labels on your food to see if it contains trans fat and if so, the healthy choice is to choose another type of food. Reference ADA. Diabetes A to Z (6th edition). American Diabetes Association, Alexandria, VA. 2010;85.
According to the American Diabetes Association, regular exercise will help you stay healthy and can improve your blood sugar control, reduce your risk for heart disease, and help you lose weight. Your diabetes team may suggest that you try to do at least 150 minutes of moderate-intensity exercise each week. Reference ADA. Standards of medical care in diabetes – 2011. Diabetes Care . 2011;34(Suppl 1):S11-S61.
Because diabetes is associated with an increased risk of heart disease or other diabetes-related complications, you must see your physician before beginning an exercise regimen. 1 One great way to get started is to identify activities that you enjoy. Work with your diabetes team to find activities that burn calories (eg, walking) as well as activities that build muscle (eg, walking with light weights). 1 Begin slowly by exercising for 10 minutes three times a week, then increase the duration of each exercise session, then increase the number of exercise sessions each week. 1 Find a partner or join an exercise group to make exercising social and more fun. 1 The American Diabetes Association recommends that persons with diabetes get at least 2.5 hours of moderate-intensity aerobic exercise each week. 2 Don’t feel that if you can’t exercise for 30 minutes at a time, you should quit. Ten minutes here and there for a total of 30 minutes may be more practical for some people. 1 Find times throughout the day to increase your level of activity. For example, you can find a parking spot farther away from the grocery store, take the stairs instead of the elevator, and get up to change the television channel rather than using the remote. 1 References 1 ADA. Be active, but how? 2010. http://www.diabetes.org/food-and-fitness/fitness/fitness-management/be-active-but-how.html. Accessed January 4, 2011. ADA. 2 Standards of medical care in diabetes – 2011. Diabetes Care . 2011;34(Suppl 1):S11-S61.
Please ask the attendees if they have any questions at this time.
Diabetes Management 101
Diabetes: You Are Not Alone Centers for Disease Control and Prevention. 2011. http://www/cdc/gov/diabetes/pubs/pdf ndfs_2011.pdf. Accessed March 7, 2011.
What Are Different Kinds of Diabetes? Body doesn’t make Body doesn’t enough insulin or can’t make insulin use insulin properly Diagnosed during Steroids, cystic pregnancy fibrosis ADA. Diabetes Care. 2011;34 (Suppl 1):S11-S61.
Who Is Most Likelyto Have Type 2Diabetes? • Overweight • Not physically active • High blood pressure • 45 years or older • Diabetes during pregnancy • Diabetes in the family or having a baby more than • Some ethnic groups 9 pounds ADA. Diabetes Care. 2011;34(Suppl 1):S11-S61.
How Does Your DoctorKnow That You HaveDiabetes? • A1C blood test of 6.5% or higher* • Blood sugar of 126 mg/dL or more after not eating for at least 8 hours* • Oral glucose tolerance test of 200 mg/dL or higher* • High blood sugar symptoms and blood sugar of 200 mg/dL or more when tested at any time • Prediabetes: A1C of 5.7% - 6.4% or blood sugar of 100-125 mg/dL after not eating* *May need to be repeated to be sure. ADA. Diabetes Care. 2011;34(Suppl 1):S11-S61.
What Are SomeSymptoms of Very HighBlood Sugar? • Urinating often • Weight loss • More thirsty or hungry • Increased infections than usual • Blurry vision ADA. Diabetes Care. 2011;34(Suppl 1):S62-S69.
Low Blood Sugar (Hypoglycemia)What can How do you Does everyonecause it? feel? feel the same?• Too little food or • Hungry • People have carbohydrates different • Angry/tense• Skipped or symptoms • Sick to stomach delayed meals • Some people • Light-headed have no• More active than • Clammy/sweaty/ symptoms at all usual pale• Too much insulin or too many • Shaky diabetes pills • Tired ADA. Diabetes A to Z (6th edition). American Diabetes Association, Alexandria, VA 2010; 15-16.
Treating Low Blood Sugar Check your The Rule of 15 Fast-acting blood sugar sugars • Eat or drink 15g• Is it in your carbs • ½ cup fruit juice target range? or regular soda • Wait 15 minutes• If you can’t and check blood • 4 or 5 hard check your sugar candies blood sugar, • If still low, eat • 3 glucose treat it anyway another 15g carbs tablets• If you’re low, follow the Rule • Check again after of 15 15 minutes ADA. Hypoglycemia - Planet D. 2010. http://www.diabetes.org/living-with-diabetes/parents-and- kids/planet-d/new-to-diabetes/hypoglycemia.html Accessed April 16, 2011.
How Does Food Turn Into Energy? • Certain foods (carbohydrates) break down into sugar during digestion1 • Sugar enters bloodstream1 • Rising sugar level in blood causes pancreas to release insulin2 • Insulin moves sugar from blood to the cells where it is used for energy1,2 • Carbohydrates make blood sugar go up and insulin makes blood sugar go Pancreas down2 Schaefer EJ et al. J Nutr. 2009;139:1257S-1262S.2 Kahn RC, Saltiel AR. In: Joslin’s Diabetes 1 Mellitus. 14th ed. Lippincott Williams & Wilkins; 2005:145-168.
Create YourPlate • Draw imaginary line across center of plate • On one side, cut again so there are 3 sections • Fill largest section with non- starchy vegetables • Fill one small section with starchy foods • Fill the other small section with protein • Add 8-oz non-fat or low-fat milk and fruit ADA. Diabetes A to Z (6th edition). American Diabetes Association, Alexandria, VA. 2010;125-126.
cup 1Portion Control: It’s Easy! • Eating healthy food is important, but so is eating the right amounts 3 oz. • Start by weighing and measuring your food to learn what the right portion size looks like • After that, use your hands as measuring tools* • Your fist = 1 cup • Your palm = 3 ounces 1 oz. • Your thumb = 1 ounce *Hand sizes vary. Estimates are based on the size of a small hand. They are intended to be guides only. Diabetes America. Nutrition measuring and portion control in diabetes. 2011. http://www.diabetesamerica.com/da-nutrition_measuring.cfm. Accessed March 13, 2011.
Know Your Serving Size Servings per Nutrients ContainerSaturated Fat and Trans Fat Cholesterol Carbohydrates (Carbs) Sodium Fiber ADA. Diabetes A to Z (6th edition). American Diabetes Association, Alexandria, VA. 2010;67.
Keep Track of Your Carbohydrates * • Starches (bread, cereal, rice, pasta) • Starchy vegetables (corn, peas, potatoes, dry beans) • Fruit and fruit juice • Milk and yogurt • Sugary foods • Sweets * These foods turn to sugar in your body ADA. Diabetes A to Z (6th edition). American Diabetes Association, Alexandria, VA. 2010;125.
Protein-Rich Foods • Meat* • Poultry • Fish • Cheese, cottage cheese • Eggs * Choose lean cuts of baked or broiled meat, such as chicken or fish. ADA. Diabetes A to Z (6th edition). American Diabetes Association, Alexandria, VA. 2010;87,126.
Get the Facts on Fats • Saturated fat: Bacon, butter, sour cream • Unsaturated fat: • Monounsaturated fat - olive oil, canola oil, peanut oil • Polyunsaturated fat - corn oil, safflower oil • Trans fat: unsaturated fats that raise cholesterol ADA. Diabetes A to Z (6th edition). American Diabetes Association, Alexandria, VA. 2010;85.
Let’s Move • Stay healthy • Control blood sugar • Improve heart health • Manage weight • Aim for at least 150 minutes of moderate physical activity each week ADA. Diabetes Care. 2011;34(Suppl 1):S11-S61.
Take 3 Steps to BeMore Active 1 2Recommended Amount of Exercise:At least 2.5 hours/week • Step 1: Talk to your doctor • Step 2: Choose your activity • Step 3: Set a goal 1 ADA. Diabetes Care. 2011;34(Suppl 1):S11-S61. 2ADA. Be active, but how? 2010. http://www.diabetes.org/food-and-fitness/fitness/fitness-management/be-active-but-how.html. Accessed January 4, 2011.