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ANHYDROSISANHYDROSIS
EXERCISE PREVENTIONEXERCISE PREVENTION
<500 500-1999 >20000
5
10
15
20
25
30
35
40
45
50
Low Risk
High Risk
Helmich, S.P. et al. New England J Medicine 325:147-152, 199Helmich, S.P. et al. New England J Medicine 325:147-152, 199
Inci
den
ce R
ate
s of
typ
e 2
(/ 1
0,0
00
ma
n-ye
ars
Regular Walking Decreases Morbidity Rates by 50% in Diabetics
Regular Walking Decreases Morbidity Rates by 50% in Diabetics
Gregg, E.W., Arch Intern Med 163:1440-1447, 2003Gregg, E.W., Arch Intern Med 163:1440-1447, 2003
0 <1 1-1.9 2-2.9 3-3.9 >40
0.2
0.4
0.6
0.8
1
1.2
Hours Walking per Week
Risk
of A
ll-Ca
use
Mor
talit
y
Pre Post5
6
7
8
9
10
11
12
13
Gly
cosy
late
d H
b (%
)
Boule, N.G. et al JAMA 286:1218-1227, 2001.
Pre Post5
6
7
8
9
10
11
12
13Exercise Groups Control Groups
Pre Post50
60
70
80
90
100
110
Body
Wei
ght (
kg)
Boule, N.G. et al JAMA 286:1218-1227, 2001.
Pre Post50
60
70
80
90
100
110
Exercise Groups Control Groups
INSULIN SENSITIVITYINSULIN SENSITIVITY
Exercise Control0
50
100
150
200
250
300
350
Pre-
Post-
Glu
cose U
pta
ke
(mg
/m2/m
in)*
Landt, et al, Diabetes Care 8:461-465, 1985Wallberg-Henriksson et al., Am J Clinical Nutrition 249:C233-C237, 1985Yki-Jarvinen et al, Diabetes Care 7:520-527, 1984.
SIGNS AND SYMPTOMS OF HYPOGLYCEMIAApathy Sweating Excessive Hunger
Drowsy Fainting Convulsions
Dizziness Fatigue Crying
Hand Tremors Irritability Blurred Vision
Confusion Delusion Double Vision
Headache Slurred Speech Unsteady Gait
Nervousness Poor Coordination
Inability to concentrate Loss of Consciousness
SIGNS AND SYMPTOMS OF HYPOGLYCEMIAApathy Sweating Excessive Hunger
Drowsy Fainting Convulsions
Dizziness Fatigue Crying
Hand Tremors Irritability Blurred Vision
Confusion Delusion Double Vision
Headache Slurred Speech Unsteady Gait
Nervousness Poor Coordination
Inability to concentrate Loss of Consciousness
GOALS OF DIABETIC TREATMENTGOALS OF DIABETIC TREATMENT
• GLUCOSE CONTROL• 80 –100 mg/dl
• 100 - 160 mg/dl
• HbA1C<7%
• PREVENT DIABETIC COMPLICATIONS
• GLUCOSE CONTROL• 80 –100 mg/dl
• 100 - 160 mg/dl
• HbA1C<7%
• PREVENT DIABETIC COMPLICATIONS
HOME BLOOD GLUCOSE MONITORHOME BLOOD GLUCOSE MONITOR
Continuous Glucose Monitoring System.Continuous Glucose Monitoring System.
GLUCOWATCHGLUCOWATCH
URINE TESTSURINE TESTS
• Glucose
• Ketones
• Glucose
• Ketones
HbA1CHbA1C
HEMAGLOBINHEMAGLOBIN
CLINICAL MANAGEMENT GOALSCLINICAL MANAGEMENT GOALS
DIABETIC EXCHANGE DIETDIABETIC EXCHANGE DIET
• FRUIT
• BREADS
• MEATS
• FAT
• MILK
• FRUIT
• BREADS
• MEATS
• FAT
• MILK
BREAKFAST• 2 FRUIT• 3 BREAD• 1 MEAT• 2 FAT• 1 MILK
MID-MORNING• 1 BREAD• ½ Cup MILK
BREAKFAST• 2 FRUIT• 3 BREAD• 1 MEAT• 2 FAT• 1 MILK
MID-MORNING• 1 BREAD• ½ Cup MILK
CARBOHYDRATE COUNTINGCARBOHYDRATE COUNTING15 g CARBOHYDRATES15 g CARBOHYDRATES
STARCHES• ½ Cup Mashed Potatoes• 1 Slice of Bread• 6 crackers• 1/3 cup of Rice• ½ cup of pasta
STARCHES• ½ Cup Mashed Potatoes• 1 Slice of Bread• 6 crackers• 1/3 cup of Rice• ½ cup of pasta
FRUITS• small apple• small orange• ½ banana• ½ cup of canned fruit
FRUITS• small apple• small orange• ½ banana• ½ cup of canned fruit
MILK• 1 cup skim milk
MILK• 1 cup skim milk
CARBOHYDRATE COUNTINGCARBOHYDRATE COUNTING
3 oz Meat
1 Vegetable
3 Carbohydrates
1 Fat
Calorie Free Beverage
3 oz Meat
1 Vegetable
3 Carbohydrates
1 Fat
Calorie Free Beverage
TYPES OF INSULINTYPES OF INSULIN
• RAPID
• SHORT
• REGULAR
• LONG
• ULTRALONG
• RAPID
• SHORT
• REGULAR
• LONG
• ULTRALONG
METHODS TO DELIVER INSULIN
METHODS TO DELIVER INSULIN
METHODS TO DELIVER INSULIN
METHODS TO DELIVER INSULIN
METHODS TO DELIVER INSULIN
INSULIN REGIMINESINSULIN REGIMINES
INSULIN COMBINATIONSINSULIN COMBINATIONS
INSULIN COMBINATIONSINSULIN COMBINATIONS
INSULIN PUMPINSULIN PUMP
ORAL HYPOGLYCEMIC AGENTSORAL HYPOGLYCEMIC AGENTS