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Managing Diabetes: Managing Diabetes:
How to help yourself and How to help yourself and your familyyour family
ObjectivesState a difference in Type 1 vs. Type 2
diabetesState 3 ways to prevent diabetesUnderstand the purpose of blood sugar
monitoring
National Diabetes Fact Sheet 23.6 Million people (8% of the U.S. population)
have diabetes57 Million people have pre-diabetes
Risk of death is 2 x that of people similar age without diabetes
Heart disease and stroke account for 65% of those deaths
#1 Cause of adult blindness (20 to 74 year old)#1 Cause of end-stage renal disease#1 Cause of non-traumatic lower limb amputation
Obesity will make today's kids die younger
Life expectancy is decreasing
1 out of 3 children born after 2000 will get diabetes
What will you do to change the course?
The Perfect Storm Hit Hard!
Toxic food environment of :Cheap, fatty foodHighly caloric drinks (soda, juices,
gatorade, energy drinks)Gigantic portionsProcessed, “boxed” foodsPervasive food advertising Sedentary lifestyles
Risk Factors for Diabetes Heredity Age (>45) Race and Ethnicity
(Alaska native, Hispanic-American, Pacific Islander,
African-American)
Gestational diabetes or delivering a baby >9 pounds
Being overweight Sedentary lifestyle Waist CircumferenceAcanthosis Nigricans – darkening of the skin (at folds)
Acanthosis NigricansDevelops mainly from high insulin levelsThis means your body is having to work really
hard to process your blood sugar.This is a sign that you may be at risk for
diabetes
armpit neck
How Does Family History Affect Your Risk of Diabetes?
Type 1 Type 2
Relative w/ diabetes
Your estimated risk
Relative w/ diabetes
Your estimated risk
Mother
Father
Both parents
Sibling
Identical twin
1% - 5%
5% - 15%
10% - 25%
5% - 10%
25% – 50%
Mother
Father
Both parents
Sibling
Identical twin
5% - 20%
5% - 20%
25% - 50%
25% - 50%
60% - 75%
Signs and SymptomsFrequent UrinationExcessive ThirstDry, Itchy SkinWeight Loss/GainBlurred VisionFatigueTingling/Numbness in fingers/toesFrequent Infections or sores that don’t heal
Type 1Autoimmune DiseaseTypically develops in people <30 years oldCan be triggered by virus or traumaBody does not produce insulin, insulin shots
are required.Type 1 is not caused by eating too much
sugar.
Type 2Related to body weight and lifestyleFamily historyCan be controlled with diet/exercise, and/or
oral meds, and/or insulin.Can develop at any age, typically seen at
ages of >45 years old.
Pathophysiology of Type 2 Diabetes
GlucoseGlucose
Cells in the Cells in the Pancreas get Pancreas get
“tired” and have “tired” and have trouble making trouble making
insulininsulin
Sometimes the cells in the body are resistant to insulinSometimes the cells in the body are resistant to insulin
Dinneen SF. Diabet Med. 1997; 14 (Suppl 3): S19-24.
1. You eat food and some turns to glucose (sugar)
2. The sugar goes to the blood vessel
3. The pancreas makes insulin to get the glucose into your cells.
How do we fix it?Sometimes your doctor will give you
medicines to help your pancreas make more insulin or help your cells open up to accept the sugar
Eat smaller amounts of foods that turn to sugar. If you eat less, it’s less sugar to process at one time.
Exercise is a natural medicine! It will help the sugar get out of the blood and into your cells.
Hemoglobin A1CA weighted mean (average) of your last 60-90
days of blood glucoseMeasures how much sugar has attached to
the red blood cells and is reported in % formACE guidelines - <6.5% goal for diabetesADA guidelines - <7% goal for diabetesNormal is ~4-6%
Blood Glucose MonitoringWhen to check
ACE ADA
Fasting or pre-meal
<110mg/dl <130mg/dl
2 hours post- meal
<140mg/dl <180mg/dl
A1C <6.5% <7%
Blood Sugar MonitoringA way for YOU to see if your blood sugar is
under controlCheck before a meal, 2 hours after a meal,
before bed, or when you wake up.If your blood sugars are high, check more
often.
Short Term ComplicationsHypoglycemia
Too much medsMore exercise than normalToo little food to match meds
HyperglycemiaForgot medsStressIllnessToo much food, not enough exercise
Long Term ComplicationsRetionopathy – eye diseaseNephropathy – kidney disease
Heart attacks and StrokeNeuropathy – nerve damage
Sexual ProblemsPain in hands, feet, legsgastroparesis
What can people do to live a healthy life with diabetes?Check blood sugar regularlyExercise regularlyHealthy food choicesTake medications as prescribedSee doctors regularly and get labs checked
Eye, heart, diabetes, internal med, therapistAttend a diabetes education class or
individual sessions with a CDE
Jane Doe
Patient Signature:
TimingEat SOMETHING
within one hour of getting up
Eat about every 4 hours
Smaller, more frequent meals is the key
Time
Blo
od
Su
gar
Smaller portions of food, spread out = smaller rise in
blood sugar
Non-starchy Vegetables(No effect blood sugar)
Grains, Beans & Starchy Vegetables
(100% effect on blood sugar)
Lean Protein(No effect on Blood Sugar)
TOFU
• Serving Size?• Grams of
Total Carbohydrate?
• Number of carbohydrate servings?
MedicationsUnderstand proper times to take themUnderstand side effectsUnderstand the same meds will not work for
a lifetimeAbout half of patients with diabetes type 2
will need insulin at some pointTell your doctor about any natural herbs,
plants, or supplements you use for your health.
DepressionHave you lost interest in things you used to
enjoy?Do you have difficulty making decisions?Have the pleasure and joy have gone out of
your life?Do you feel sad, blue, and unhappy?
Questions???
http://www.anthc.org/anmc/services/diabetes/2010-november-diabetes-month.cfm
Presentation by:Angela Manderfeld, MS, RD, CDE, LD
Diabetes Nutrition ConsultantAlaska Native Tribal Health Consortium
Phone (907) 729-1128Fax (907) 729-1129
Mailing Address:
Alaska Native Medical Center (DIA)4315 Diplomacy Dr.
Anchorage, AK 99508