© 2005-2011 Canadian Diabetes Association Revised September 5, 2012

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About the Canadian Diabetes Association

Our mission is to lead the fight against diabetes by helping people with diabetes live healthy lives while we work to find a cure.

We deliver our mission by

: • Providing education and services • Advocating on behalf of people with diabetes • Supporting research • Translating research into practical applications

Objectives

At the end of this session, you will: • Understand the seriousness of diabetes • Know who could be part of your healthcare team • Understand the importance of healthy living and blood glucose management • Be able to recognize diabetes related complications and help to prevent or minimize their impact

True or False?

• • • • People with diabetes can eat sweets.

- TRUE

If you take medication or insulin, you can eat anything you want.

- FALSE

You can tell if your blood sugar is too high or too low by how you feel.

- FALSE

Diabetes is a serious disease, like cancer or heart disease.

- TRUE

Diabetes is Serious

– Ketoacidosis – Eye disease – Heart disease – Nerve damage – Kidney disease – Sexual dysfunction – Digestive problems – Dry Skin – Depression – Early death – Amputation

Diabetes Management

• • • • Get to know your healthcare team Schedule regular check-ups to remember your ABCs: • • • A1C Blood Pressure Cholesterol Choose healthy food as part of a balanced meal plan Live an active lifestyle

Your Healthcare Team

• Family Doctor • Diabetes Specialist (Endocrinologist) • Certified Diabetes Educator • Registered Nurse • Registered Dietitian • Pharmacist

Your Healthcare Team

• Foot Care Specialist • Eye Specialist • Social Worker • Dentist • Psychologist • Other medical specialists

You Matter Most

• The most important part of the diabetes healthcare team is you! • Your choices will keep you healthy now and in the future.

Healthy Eating

• Choosing when, what and how much to eat is important to managing your diabetes.

Resources:

Eating Well with Canada’s Food Guide Just the Basics

Your Dietitian

How Much Do I Need?

Fruits and Vegetables

• Banana, apple, carrot, broccoli, salad • Seven to 10 servings per day • 1 serving = • • 1 medium size fruit or vegetable 125 ml (½ cup) chopped fruit or vegetables • • 125 ml (½ cup) juice (100% pure) 250 ml (1 cup) salad

Small Changes

• Eat unpeeled carrots, potatoes and apples.

• Add grated carrots or zucchini to pasta sauce.

• Try a vegetarian meal.

• Try a new fruit or vegetable this week.

Grain Products

• Bread, pasta, rice, pita, cereal • Six to eight servings per day • 1 serving = • 1 slice of bread (35 g) • • ½ small bagel (45 g) or pita 125 ml (½ cup) rice or cooked pasta • An amount the size of your fist

Small Changes

• Add barley, bulgur or brown rice to soup and stews.

• Use bran or whole grain flour in baking.

• Try whole wheat pasta.

• Use whole grain breads.

• Try bran and oat cereals.

Milk and Alternatives

• Milk, cheese, yogurt, fortified soy beverage • Children need two to four servings per day.

• • Teens, pregnant women, and breastfeeding women need three to four servings per day.

• Adults need two to three servings.

Milk and Alternatives

• 1 serving = • 250 ml (1 cup) milk • • • • 2 slices (50 g) processed cheese 50 g (1½ oz) hard cheese 250 ml (1 cup) low-fat soy beverage 175g (3/4 cup) yogurt

Small Changes

• Add milk to soup, pudding and baking.

• Make a vegetable dip with yogurt.

• Try a smoothie made with low-fat milk.

Meat and Alternatives

• Beans, dried peas, lentils, tofu • • • Fish, chicken, eggs, beef Two to three servings per day

Meat and Alternatives

• 1 serving = • 2 eggs • • 175 ml (3/4 cup) beans 175 ml (3/4 cup) tofu • • 30 ml (2 tbsp) peanut butter 75 g (2½ oz) meat, poultry or fish

Small Changes

• Bake, broil, barbecue, poach or stir-fry.

• Try a meatless meal one day a week.

• • Try lentils and rice, quiche, an omelette, bean salad with a pita or a tofu burger.

Fats

• • Limit fat to an amount the size of the tip of your thumb.

• Use cooking spray.

• Try low-fat salad dressing.

Small Changes

• Instead of butter or mayonnaise, try mustard, chutney, or salsa.

• Use herbs to season food.

Don’t Forget Snacks

!

• Snacking can be good for you.

• Make smart choices.

• Stay away from snacks with lots of sugar and fat.

Don’t Forget Snacks!

• Keep lots of healthy snacks on hand.

• Add two or more food groups together.

• Drink more water.

Alcohol

• Alcohol can make some health problems worse.

• Alcohol should be limited to 1-2 drinks per day

True or False?

• • • • You have to be slim to be fit.

- FALSE

Too little exercise is almost as bad for your health as smoking.

- TRUE

Exercise can greatly lessen the risk of getting type 2 diabetes.

- TRUE

You have to exercise for long stretches of time to benefit.

- FALSE

Benefits of Physical Activity

• Better blood glucose management • More energy • Better mood • Lower cholesterol • Weight loss • Maybe less medication

Getting Started

• Start slowly.

• Do something you like.

• Have a support network.

• Set small goals and celebrate when you achieve them.

• Speak to a personal trainer or healthcare professional.

• Maintain a healthy weight.

• Start today!

Plan for Success

• Life can get in the way of regular exercise and making healthy food choices.

• Have a back-up plan.

Oral Diabetes Medications

• • Every person is different and may need different types or combinations of medication to manage their diabetes.

Oral diabetes medication: - Helps the pancreas release more insulin.

- Makes cells more sensitive to insulin - Slows food digestion - Does not contain insulin

Insulin

• Some people need insulin, either alone or with other medication.

• When oral diabetes medication is no longer enough to manage blood glucose levels, insulin may be needed.

• Thousands of Canadians take insulin, and most say it's easier than they expected.

• The most important thing is managing your blood glucose levels.

Medication

• Ask how and when to take your medication.

• Ask about side effects and drugs that interact.

• Wear a MedicAlert® ID.

Blood Glucose Testing

• Talk to your healthcare team about what your target range should be.

• Regularly review your home blood glucose test results with your healthcare professional.

• Work with your healthcare provider to choose a meter that is right for you.

Blood Glucose Levels

• Healthy levels differ from person to person.

• For most people with diabetes, healthy levels are: • • • 4.0 – 7.0 mmol/L before meals 5.0 – 10.0 mmol/L two hours after meals 5.0 – 8.0 mmol/L two hours after meals (if A1C is more than 7%)

A1C

• A1C is the average of your blood glucose levels over the past 120 days.

• Aim for an A1C of 7% or less.

• A lab can test your A1C.

Low Blood Glucose

• • Hypoglycemia = blood glucose that is less than 4 mmol/L When your blood glucose is low you may feel: • – Shaky, weak – Nervous, irritable – Confused – Hungry – Headachy, light headed – Sweaty – Faster heart beat – Numbness or tingling in the tongue or lips Some people have no symptoms at all.

Treating Low Blood Glucose

• • Test your blood glucose.

Even if you can’t check, help yourself by taking: – 3 glucose 5 gram tablets (15 g of carbohydrate) – 15 ml (3 tsp) sugar stirred in water – 175 ml (3/4 cup) juice or regular pop –6 Life Savers® –15 ml (1 Tbsp) honey • • Wait 15 minutes and then test your blood glucose again.

If it is still less than 4.0mmol/L, eat or drink one of the above choices again.

High Blood Glucose (Hyperglycemia)

• • Hyperglycemia is when the amount of blood glucose is higher than your target range (more than 11 mmol/L).

Causes: - Too much food - Too little activity - Not taking your medication and/or insulin - Being sick - Stress

High Blood Glucose

• • When your blood glucose is high, you may: - Need to urinate often - Be unusually thirsty - Feel very tired To treat and prevent high blood glucose, find the cause and fix it if you can.

Sick Day Management

• When you are sick, it is important that you: - Test your blood glucose every two to four hours.

- Take your medication as prescribed.

- Continue taking your insulin. You may need to adjust

your dosage, depending on your blood glucose levels.

- Call a doctor or go to an emergency room if you vomit and/or have diarrhea two times in four hours.

- Eat at regular times or, if you can't eat, drink something like juice or Gatorade®.

- Drink lots of water or sugar-free drinks.

The Flu

• It is recommended that people at high risk of influenza related complications, including all adults and children (aged six months and older) with diabetes, receive an annual influenza vaccine.

• Influenza vaccination can reduce hospitalizations by approximately 40%.

Visiting the Hospital

• Always carry diabetes supplies with you.

• Carry an up-to-date list of all medications and food and drug allergies.

• Wear a MedicAlert ID®.

• Carry emergency contact numbers.

• Tell medical staff you have diabetes.

• Bring a snack in case of long wait times.

Ketone Testing

• Ketones are found: - in your urine - when blood glucose levels are too high • Your doctor can test your ketone levels.

Ketone Testing

• Diabetic ketoacidosis is a serious problem.

• It happens when: - blood glucose and ketone levels are high - you do not control your diabetes - you are sick

Foot Care

• • • High blood glucose can lead to poor blood flow and loss of feeling in the feet.

Even a small cut can be a problem.

Prevent problems by: - checking your feet every day - washing and drying your feet every day - wearing shoes that fit well - visiting your healthcare professional if you suspect a problem

Eye Care

• High blood glucose can damage blood vessels in the retina of the eye.

• There are no early symptoms, so eye check-ups are very important!

Eye Care

• • Type 1 diabetes: - Schedule an eye exam each year for people over 15 years of age who have had type 1 diabetes for five years or more.

Type 2 diabetes: - Have your eyes checked when first diagnosed and every one to two years after.

Preventing Heart Disease

• • • • Also known as cardiovascular disease.

Diabetes is closely linked to high blood pressure and high cholesterol.

- This can lead to angina, stroke, heart attack and heart failure.

80% of people with diabetes die of heart disease.

Prevent it!

Kidneys

• • • Also known as diabetic nephropathy.

- High blood glucose levels can permanently damage the delicate blood vessels of the kidneys, which can lead to kidney infections, kidney damage and end-stage renal failure.

Once the kidneys have been damaged, they cannot be fixed.

Early treatment can slow the way kidney disease progresses, and delay the onset of end-stage renal disease.

Sexual Dysfunction

• • • High blood glucose levels can decrease blood flow and damage nerves that include the sexual organs. For men, it may mean difficulty getting or keeping an erection. For a woman, it may cause: - less vaginal lubrication, leading to discomfort during intercourse - more cases of vaginitis (inflammation of the vagina) - more yeast infections

Dental Care

• What to do: - brush and floss often - visit the dentist often

Digestive Problems

• • High blood glucose can damage the nerves that affect digestion.

Common problems include: • • • Constipation Diarrhea Gastroparesis - About 30% to 50% of all people with diabetes will have some sort of digestive problem.

Digestive Problems

• • What to do: - manage your blood glucose - change your medication - change your diet Talk to your healthcare professional .

Dry Skin (dermatitis)

• • High blood glucose damages small blood vessels and small nerves.

What to do: - Keep the room temperature low - Keep the room more humid - Wear gloves for cleaning - Don’t take hot baths and showers - Use creams and lotions - Check feet often - Drink plenty of sugar-free clear fluids

Depression

• Poor diabetes control can affect the way you feel and the way you cope. • People with diabetes are more likely to develop depression than people without diabetes.

Review

• List some members of the diabetes healthcare team.

• What are the benefits of healthy eating?

• Why is it important to test your blood glucose levels regularly?

• List some diabetes related complications.

• How often should you exercise?

• How can you stay healthy and decrease your risk for developing complications?

Learn more

• To learn more about how to live well with diabetes and how complications may be prevented or delayed, please visit:

www.diabetes.c

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• to find local events and support groups.