Know Your Options™ Living an Uncomplicated Life with Diabetes

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© 2007 Bayer HealthCare LLC

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Diabetes Complications are Not Inevitable!

� Over the years if you do not control yourblood sugar, complications can occur� Keeping your blood sugar within recommended guidelines can prevent recommended guidelines can prevent and/or reduce complications� Best way to assess control� Must be performed daily to affect control

� Results can be applied to adjustmedications, nutrition and physical activity

� “Know Your Numbers”

Small Vessel Complications

Large Vessel Complications

Eye Disease

� Retinopathy is damage to the back of the eye (retina)

� Usually occurs in people that have diabetes for over 5 years

First signs are blurry vision� First signs are blurry vision

� Glaucoma and Cataracts are seen in people with diabetes

� Need to get an eye exam every year by an Ophthalmologist

Treatment of Eye Disease

� Laser Therapy� Scatter Photocoagulation

� Focal Photocoagulation

� Surgery

Tips to Prevent Eye Problems

� Keep your blood sugar as close to normal as possible� Control your blood pressure� Quit smoking� See your eye specialist � See your eye specialist (Ophthalmologist) once a year� See your doctor immediately if:� Your eyes hurt or become red� Blurred vision or spots� Trouble reading books or signs� Your peripheral vision

(vision on the side) is not the same

Types of Skin Conditions

� Bacterial infections

� Fungal infections

� Dry skin/itching

� Scaly patches or brown spots

Types of Skin Conditions, continued

� Allergic reactions due todiabetes medications

� Xanthomatosis

� Acanthosis Nigricans

Tips for “Good” Skin Care

� Keep your blood sugar under control

� Keep skin clean and dry

� Avoid “hot” baths and showers

Moisturize on a daily basis� Moisturize on a daily basis

� Treat cuts right away

� See a Dermatologist if you have any problems with your skin

Foot Care

� Inadequate foot care can lead to amputation� Foot problems are due to:

Lack of sensation� Lack of sensation

� Poor circulation

� Important to seea Podiatrist on a regular basis

Suggestions for “Good” Foot Care

� Examine feet daily

� Wash and dry feet thoroughly

� Cut toenails straight across

� Avoid self-treatment of corns Avoid self-treatment of corns and calluses

� Wear cotton socks

� Inspect shoes for foreign objects

� See a Podiatrist on a regular basis

Dental Care

� People with diabetes have an increased risk for gum disease and cavity formation� The warning signs of � The warning signs of gum disease are:� Bleeding gums when

you brush or floss

� Red, swollen or tender gums

� Bad breath

� Loose teeth

Types of Dental Conditions

� Oral infections

� Pain when chewing

� Increase in cavities

Fungal infections – Thrush� Fungal infections – Thrush

� Dry mouth

Tips for “Good” Dental Care

� Brushing and flossing are the best way to prevent gum disease

� See your Dentist on a regular basis

� Tell your Dentist you have � Tell your Dentist you have diabetes

� Take your usual medications before your dental visit

� Make sure you are able to get your normal amount of daily calories. Plan ahead

What is Depression?

� Depression comes from a change in

the chemical functioning of the brain

� Depression can be triggered by stress,

difficult life events, environment,difficult life events, environment,

medications

� Depression affects your ability to

function in day to day life

Diabetes and Depression

� Diabetes doubles the risk of being depressed� Depression may be due to stressDepression can lead to:� Depression can lead to:� Poorer physical and

mental functioning� Not following your meal plan

or exercise routine which can lead to weight gain� Not taking your medications

as prescribed

What Causes Depression in Diabetes

� Depression is caused by a number of factors; physical, psychological and genetic� Everyone reacts differently to stressful events. Just finding out you have diabetes can be stressfulcan be stressful� People with diabetes may have depression due to:� Worrying about long term complications� Effect of their diabetes on daily life� Effect of diabetes on their work environment� Remembering the damaging effects of diabetes

on relatives and/or friends

Symptoms of Depression

� People with “true” depression have symptoms that occur almost every day� Symptoms include:� Prolonged sadness/feeling down� Irritability, anger, worry, anxiety� Irritability, anger, worry, anxiety� Tired� Feeling guilty, worthlessness� Weight loss or gain� Trouble sleeping� Thinking about death or suicide

Treatment of Depression in Diabetes

� Important to see a trained mental health professional for counseling

� May need antidepressant medicationsmedications

� Effective treatment of depression has been shown to improve diabetes control

� St. John’s Wort can cause drug interactions

Erectile Dysfunction or Impotence?

� Erectile Dysfunction describes:� Difficulty getting or maintaining an erection

of the penis

� Impotence describes:Impotence describes:� Erectile dysfunction

� Lack of sexual desire

� Inability to reach or experience an orgasm

� Inability to ejaculate sperm during orgasm

Symptoms of Erectile Dysfunction in Men Can Vary

� Complete inability for erection

� Frequent inconsistent ability to achieve erection

� Inability to maintain an erection throughout intercourse

Risk Factors for Erectile Dysfunction in Men

� Physical diseases and disorders

� Surgery or trauma

� Medications� Medications

� Substance abuse

� Stress, anxiety, or depression

� Smoking

Diabetes and Erectile Dysfunction (ED)

� Men with diabetes are 3 times more likely to develop ED than those without diabetes

� ED in patients with diabetes may be a sign of poor blood may be a sign of poor blood sugar control

� By age 60, more than half of all men with diabetes will have experienced ED

� ED is often the first sign of autonomic neuropathy

Diabetes and Erectile Dysfunction (ED)

� ED can be seen at a younger age in men with diabetes

� Male infertility in diabetes is due to both erectile and ejaculatory failureejaculatory failure

� Response to visual stimulation may be decreased

� The quality of the semen may be affected which can lead to infertility

� Improving glycemic control may help

Psychological Component of ED in Men with Diabetes

� Important in over 50% of cases� Diminished self worth

� Fear of failure – patients fear impotence more than blindness impotence more than blindness

� Marital disharmony

� More “stress”

� Decreased libido

� Decrease in sexual arousal

� Couples counseling can be very beneficial

Prevention of Erectile Dysfunction

� Limit or avoid use of all forms of tobacco

� Limit or avoid use of alcohol and other similar drugs

� Exercise regularly� Exercise regularly

� Use methods of stress reduction

� Get enough sleep

� Use effective approaches to deal with anxiety or depression

� See your doctor for regular checkups and medical screening tests

Treatment of Erectile Dysfunction in Men

� Simple change of some lifestyle choices� Review of medication side effects� PsychotherapyMedication therapy� Medication therapy� Oral PDE inhibitors (caution with nitrates!)• Levitra* • Cialis*• Viagra*

� Oral testosterone* Levitra is a registered trademark jointly shared by

Bayer Pharmaceuticals Corporation, GlaxoSmithKline and Schering Corporation.

* Cialis is a trademark of Lilly ICOS LLC.

* Viagra is a registered trademark of Pfizer Inc.

Symptoms of Sexual Dysfunction in Women

Four types of sexual problems observed in women� Desire disorders

Arousal disorders� Arousal disorders

� Orgasmic disorders

� Sexual pain

Risk Factors for Sexual Dysfunction in WomenSome causes of sexual dysfunction� Physical conditions � Diabetes� Arthritis

High blood pressure � High blood pressure � Vaginal Infections

� Hormonal-Estrogen deficiency – Menopause� Psychological – counseling is recommended� Depression� Anxiety� Stress

Treatment of Sexual Dysfunction in Women

� If desire is the problem� Change your usual routine� Muscle relaxation exercises

� If arousal is the problem� If arousal is the problem� Vaginal or estrogen creams� Psychotherapy

� If orgasm is the problem� Extra stimulation

� If pain is the problem� Different positions� Vaginal creams

Stress

� What is stress?� Stress can be acute or chronic� Stress can occur when:• An event produces a strain on

a person a person • A person thinks a situation as

challenging or threatening

� Stress is influenced by the• Individual • Environment

What makes something stressful for you?� What are your major stressors?� Life events

• Negative (traffic, arguing, doctor visits, tests, phone calls, holidays

• Positive (marriage, graduation, birth of • Positive (marriage, graduation, birth of a child, new job)

� Evaluating a stressful situation� Our perspective and perception

changes the way we view stress• Beliefs, values and goals• Change is stress

How does your body react to stress?

� Stress hormones (catecholamines, glucagon, cortisol, and growth hormone)� Symptoms (nervous, sweaty,

palpitations, nausea)

How does stress affect � How does stress affect diabetes and vice versa?� Increase blood glucose

and ketones� Some people actually

have a decrease in blood glucose initially

Coping and Stress Management

� Coping is how each of us respond to a stressful situation� There are certain questions that you need to ask yourself� Strategies and Coping Skills� Different for everyone

� Good strategies – help us to maintain control and feel less tense, relaxed

� Bad strategies – make you feel tired, angry, sick, tense

Important Factors in Coping

� Having enough information� Write down what causes stress and

anxiety in your life

� Feeling in control� Do fewer things better� Do not over commit� Avoid stressful situations

� Having the support of others� Family and friends� Support groups – talk with other

people who have diabetes� Healthcare team – social worker, Psychologist

Schedule Regular Visits With YourHealthcare Team

� Every Day:� Check blood glucose

at home

Every Visit:

� Every Year:� Blood lipid test

� Dilated eye exam

Test for urine protein� Every Visit:� Blood pressure

� Foot exam

� Every 3 months:� A1C

� Weight

� Test for urine protein

� Flu shot and other vaccinations

� Dental checkup

Conclusion

� Managing your blood sugar and keeping it under control can decrease your risk of complications

� Many of the complications of diabetes can be prevented by understanding more about foot, skin and dental care,strategies to cope with stressful situations and making the right lifestyle choices

� Working closely with your healthcare team is crucial

You Can “Live An Uncomplicated Life With Diabetes”