Transcript Slide 1

How things normally work
you eat, your body breaks food down
1 When
into glucose. Glucose is a type of sugar
that is your body’s main source of energy.
page 6
How things normally work
from food is absorbed into the
2 Glucose
bloodstream. Your blood glucose —
the amount of glucose in your
blood — begins to rise.
page 6
How things normally work
As blood glucose rises, the body
3 sends
a signal to the pancreas, which
releases insulin.
page 7
How things normally work
as a key, insulin binds to a place
4 onActing
the cell wall (an insulin receptor),
unlocking the cell so glucose can pass
into it. There, most of the
glucose is used for
energy right away.
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How things normally work
5
page 7
Some glucose is stored
by the liver for later use.
Blood glucose regulation
Blood glucose goes up
and down throughout
the day:
• As your blood glucose
rises (after a meal),
the pancreas
releases insulin.
page 8
Blood glucose regulation
• When your blood
glucose is low
(between meals) your
liver releases glucose.
page 8
Blood glucose regulation
• Without diabetes,
blood glucose levels
stay within normal limits.
page 8
Your blood glucose levels
In a person with
diabetes, levels
tend to run high,
and may vary
dramatically.
In a person
without diabetes,
levels stay within
normal limits.
page 10
Type 1 diabetes
Your pancreas has
stopped — or nearly
stopped making insulin
(insulin deficiency).
Since you’ve suddenly
lost your insulin “keys,”
you have no way to
unlock your body’s
cells and allow
glucose to enter.
page 11
Type 2 diabetes
Your pancreas may not
produce enough insulin
(insulin deficiency).
Your cells don’t use
insulin properly.
The insulin can’t fully
unlock the cells to
allow glucose to enter
page 13
(insulin resistance).
Risk factors for type 2 diabetes
Type 2 is more common in people who:
• Are overweight.
• Are 45 or older.
• Are physically inactive.
• Have a parent or sibling with type 2 diabetes.
• Are African American, Native American,
Hispanic American, or Pacific Islander.
• Have abnormal cholesterol levels.
• Have had gestational diabetes, or given
birth to a baby greater than 9 lbs.
• Have high blood pressure.
page 14
Pre-diabetes
• People with pre-diabetes have blood glucose
levels that are higher than normal, but not high
enough for a diabetes diagnosis.
• Pre-diabetes is a major risk factor for diabetes,
heart disease, and stroke.
• Pre-diabetes can be treated. Studies show that
weight loss and regular exercise can lower blood
glucose levels.
• Studies show that these lifestyle changes can
delay — or even prevent — the onset of
diabetes and other problems.
page 18
Metabolic syndrome
• Metabolic syndrome (also called syndrome x or
insulin resistance syndrome) is also a major risk
factor for diabetes, heart disease, and stroke.
• The National Cholesterol Education Program defines
metabolic syndrome as any 3 of the following:
– Waistline obesity
(>35” for women, >40” for men)
– Triglycerides of 135 mg/dL or greater
– HDL cholesterol (“good cholesterol”)
<50 mg/dL for women, <40 mg/dL for men
– Blood pressure 130/85 mmHg or higher
page 18
– Fasting blood glucose 100 mg/dL or higher
Short-term problems
• In the short-term, undiagnosed or poorly
controlled diabetes can cause:
high blood glucose
(hyperglycemia)
page 92
Short-term problems
• In the short-term, undiagnosed or poorly
controlled diabetes can cause:
low blood glucose
(hypoglycemia)
Both high and low
blood glucose require
immediate action to
prevent serious
problems.
page 94
Long-term problems
In the long-term, poorly
controlled diabetes can cause:
• Damage to blood
vessels — both small
vessel damage and
atherosclerosis
(scarring and hardening
of the arteries)
page 20
Long-term problems
In the long-term, poorly
controlled diabetes can cause:
• Damage to nerves
(neuropathy), which
can cause nerve
signals to stop, slow
down, or be sent at
the wrong time.
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Triple trouble:
Diabetes, high blood pressure, and high cholesterol
By itself, each condition can damage your heart and blood vessels.
If you have all 3 — as many people do — this damage is likely to
happen sooner and progress more quickly.
• High blood pressure: 120/80 or above
• High cholesterol:
– High LDL cholesterol (“bad cholesterol”)
100 mg/dL or higher
– Low LDL cholesterol (“good cholesterol”)
40 mg/dL or lower for men
45 mg/dL or less for women
– High triglycerides: 150 mg/dL or higher
page 21
Complications of diabetes
Over time, damage to blood vessels and
nerves can cause:
•
•
•
•
•
•
Heart disease and stroke
Kidney disease (nephropathy)
Eye disease (retinopathy, glaucoma, cataracts)
Foot and leg problem
Sexual problems
Stomach and intestinal problems
(gastroparesis, enteropathy)
• Problems with skin, teeth, and gums
pages 22-23
Controlling blood glucose, blood pressure, and
cholesterol can lower your risk of complications.
Symptoms of diabetes
Sometimes — but not always — symptoms
are the first clue that you have diabetes.
Common symptoms include:
•
•
•
•
•
•
•
page 26
Fatigue
Intense thirst — and frequent urination
Unusual hunger
Unexplained weight loss
Numbness or tingling in hands and feet
Blurred vision
Frequent infections, or cuts and sores
that are slow to heal
Symptoms may go away once
blood glucose is controlled.
Diagnosing diabetes
HbA1c results
• Diabetes – 6.5% or above
• Pre-diabetes – 5.7% to 6.4%
• Normal - less than 5.7%
Fasting plasma glucose
test (FPG) results
• Diabetes - 126 mg/dL or above
• Pre-diabetes - 125 mg/dL to 100 mg/dL
• Normal - less than 100 mg/dL
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Your goal = control
Diabetes treatment has three main goals:
page 33
Introduction to self-management
Key pieces of diabetes self-management
page 34
The team leader = YOU!
Although you have the biggest responsibility for your
day-to-day care, many other people will help you.
• Primary care provider
(family practice, internist,
nurse practitioner, etc.)
• Physician specialists
(endocrinologist, podiatrist,
ophthamologist)
• Care manager
• Diabetes educators
page 35
• Other health care providers
(pharmacists, exercise
specialists, etc.)
The team leader = YOU!
•
•
•
•
•
Ask questions.
Give feedback.
Be comfortable with your care team.
Trust yourself.
…And don’t be afraid to talk about:
– Money. Diabetes care can get expensive. But there
are ways to make sure finances don’t get in the way.
– Sex. Most people — not just people with diabetes — have
sexual concerns at some point in their lives.
– Technical terms and concepts. Diabetes is complicated!
You might need to ask your care team to better explain the
whats, whys, and how tos of your care.
page 36
What affects blood glucose levels?
Controlling your blood glucose is a balancing act.
As with any balancing act, you
may need to make frequent
adjustments. But you’ll get
better at this over time.
page 41
Blood glucose self testing
page 43
HbA1c: the blood test with a memory
Normal HbA1c is
4% to 5.6%.
People with
diabetes should
aim for an HbA1c
of less than 7%.
Normal: When your
blood glucose levels are
normal, only a small
amount of hemoglobin
gets glycosylated. The
HbA1c level is low.
page 45
With diabetes: If you
have diabetes — and tend
to have a lot of glucose in
your bloodstream — more
of your hemoglobin will be
glycosylated. The HbA1c
level is higher.
HbA1c: the blood test with a memory
Here’s how your HbA1c test results compare with
your average fasting blood glucose test results.
page 46
Medication: Oral medications (pills)
Oral diabetes medications help lower your
blood glucose. Different medications work in
different ways.
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Medication: Oral medications (pills)
Some medications make your cells more receptive
to insulin. Your cells can take in more glucose.
Examples: metformin (Glucophage)
and pioglitazone (Actos)
page 51
Medication: Oral medications (pills)
Some medications slow down the digestion
and absorption of complex carbohydrates.
Your bloodstream is less likely to get overloaded
with glucose after you eat.
Examples: acarbose (Precose)
and miglitol (Glyset)
page 51
Medication: Oral medications (pills)
Some medications decrease the amount of glucose
released by your liver. This helps make sure that
you don’t have more glucose in your bloodstream
than your body can handle at one time.
Examples: metformin (Glucophage)
and pioglitazone (Actos)
page 51
Medication: Oral medications (pills)
Some medications increase the amount of insulin
made by your pancreas. With more insulin available,
more glucose can get into your cells.
Examples: sulfonylurea
(Glucotrol, Amaryl) and miglitinides
(Prandin, Starlix)
page 51
Medication: Oral medications (pills)
Some medications decrease the amount of glucose
released by the liver AND stimulate insulin
production. Your body can achieve a better insulinglucose balance.
Examples: gliptins (Januvia, Onglyza)
page 51
Medication: insulin & other injectables
If you need to take insulin, you’ll
either give yourself injections,
or use an insulin pump.
Some other, non-insulin
medications are
also taken by
injection to
treat diabetes.
page 52-53
Other medications
People with diabetes often need medication for
things besides high blood glucose, such as high
blood pressure and high cholesterol. Common
medications include:
•
•
•
•
•
•
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ACE inhibitors
ARBs (angiotensin II receptor antagonists)
Aspirin
Beta blockers
Diuretics
Statins
How to manage your medications
 Follow ALL parts of your
plan. Medication works
best when combined with
monitoring, meal planning,
and exercise.
 Always take medications
just as your doctor tells
you to.
 Pay attention to how your
medications affect you —
and communicate with
your doctor.
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 Stick to a regular routine
for taking medications.
 Get organized. Have a
system to manage your
medications (pillboxes,
labels, etc.).
 Order more medications
when you’re down to a
2-week supply.
Meal planning
A meal plan is a set of
personalized guidelines
for when to eat, what to eat,
and how much to eat.
A meal plan can help you:
• Establish consistent
eating patterns
• Choose foods wisely
• Control your
portion sizes
page 59
Types of food nutrients
Carbohydrates
Carbohydrates are your
body’s main source of energy.
Found in starchy foods
(like bread, rice and potatoes,
fruits, dairy products,
and vegetables.
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Types of food nutrients
Proteins
Protein in your diet helps
build and repair muscles,
bones, organs, and other
tissues.
Plentiful in fish, poultry,
meat, and eggs.
page 60
Types of food nutrients
Fats
Your body uses fats to
repair cells and help cells
send signals. Fat can also
be stored as a “backup”
energy source.
Plentiful in oils, nuts,
and butters.
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How to establish consistent eating patterns
 Eat meals and snacks at regular
times every day.
 Don’t eat between meals, except for
planned snacks.
 Don’t skip meals.
 Eat about the same amount
of carbohydrate each day.
 Evenly space your carbohydrates
throughout the day.
page 61
How to choose foods wisely
Build a better diet with these 6 basic
nutritional building blocks:
• Eat lots of fruits and vegetables
• Eat more whole grains
• Choose unsaturated fats and oils
• Choose heart-healthy proteins
• Select low-fat dairy products
pages 62-63
• Limit your sodium, sugar, and
alcohol intake
How to control your portion sizes
 Measure or weigh your portions.
 Eat slowly — and stop before you’re full.
 Read the label.
 Develop “hand-eye coordination.”
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Why exercise?
• Exercise lowers blood glucose and improves
your body’s ability to use glucose.
• Exercise helps reverse the resistance to
insulin that comes from being overweight.
• Exercise helps control your blood
pressure and cholesterol.
• Exercise can also make you stronger,
give you more energy, help you cope
better with stress, and lift your mood.
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How to exercise safely
 Monitor your blood glucose before, during,
and after exercise. (Once you see how exercise
affects your blood glucose, you probably won’t
need to check your levels as often.)
 Carry water and a carbohydrate source.
 Carry diabetes identification.
 Warm up and stretch.
 Be consistent from day to day.
 Be careful of your feet.
– Wear clean, smooth socks and
well-fitting shoes while you exercise.
– Make sure your shoes fit well.
– Check for blisters or sore spots afterward.
pages 70-71
Balancing activity and food
Once you settle into an exercise
routine, you probably won’t have
much trouble maintaining healthy
blood glucose levels during and
after exercise.
But some people may continue to
find it tricky, particularly if they take
insulin. In this case, follow these
additional guidelines.
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Staying motivated for exercise
• Consider your interests.
• Schedule it.
• Find an exercise buddy.
• Set short-term and
long-term goals.
• Track your progress.
Remember, nobody finds time
for exercise. You have to make it.
page 73
Getting regular medical care
Schedule for routine
medical care for
people with diabetes
page 76
Maintain a healthy weight
If you’re overweight, losing weight is one of
the single greatest steps you can take to
control your diabetes.
For a safe, permanent weight loss, ask your
care team to create a program just for you.
A good weight loss program will include:
• Consistent exercise and activity.
• A restricted-calorie meal plan.
• Goals and supervision for a gradual,
permanent weight loss.
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How to begin changing your “heavyweight habits”
 In addition to regular exercise, be more
active all day long, wherever you are.
 Beware of “unconscious eating.” Eating
while watching TV, snacking in the car, etc.
 Watch out for “emotional eating.” Relying
on food to ease boredom, loneliness, stress,
or anger.
 Be extra aware of portion sizes.
 Lead yourself out of temptation.
Don’t keep your “trigger foods” on hand.
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 Write it down. Write down what you eat
throughout the day.
Care for your feet
 Wash your feet every day.
 Avoid temperature extremes.
 Prevent and treat dry skin.
 Don’t use sharp tools or
harsh chemicals on
your feet.
page 80
Care for your feet
 Keep your toenails trimmed
straight across.
 Be “shoe smart”:
• Always wear comfortable shoes
or slippers, with socks.
• Avoid open-toed shoes or flip flops.
• Buy comfortable shoes, and break
in new shoes gradually.
• Inspect the inside of your shoes for
rough or sharp areas.
• If you have trouble, consider getting
custom shoes.
page 81
Manage stress
Take the stress test
Although some of the
behaviors and changes
listed at right come from your
diabetes or another health
problem, they’re often
symptoms of stress.
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• Sleeping too little or too much
• Nightmares or poor sleep
• Nervous habits like nail-biting
or foot tapping
• Eating too much or too quickly
• Decreased sex drive
• Teeth grinding
• Irritability or impatience
• Migraine or tension headaches
• Muscle tension
• Shallow breathing or sighing
• Racing heart
• Upset stomach
Depression and “burnout”
What you may feel
Even if you’ve adapted well to
having diabetes, negative feelings
may crop up from time to time.
•
•
•
•
page 86
Denial
Fear or anxiety
Anger or self-pity
Sadness
Depression and “burnout”
When you may feel it
Often there seems to be
no “good reason” for your
mood. But sometimes
you’re responding to
specific events in your life.
page 86
Depression and “burnout”
When you may feel it
Common times for negative feelings to appear —
or re-appear — are:
• At the time of your diagnosis.
• After your first episode of low or high blood glucose.
• If you’re pregnant or thinking about starting a family.
• If you have recurrent infections.
• When your self-management plan changes.
• If long-term complications appear.
page 86
How to cope with negative emotions
 Recognize when your emotions may be harmful —
and when you should seek help.
 Seek out support from a counselor, diabetes support
group, or others.
 Keep up with your care — and make adjustments
as necessary.
 Deal with your stress. Stress can make a
dark mood even darker.
 Be kind to yourself — and set realistic goals.
Everyone feels down from time to time. But don’t let
your feelings interfere with your daily self-care — or
with your ability to live a full, satisfying life.
page 86
How to care for yourself when you’re sick
 Monitor blood glucose levels.
 Maintain your meal plan.
 Test for ketones if necessary.
 Drink plenty of caffeine-free
fluids.
 Continue to take your diabetes
medications as prescribed —
unless you’re told otherwise.
 Take non-diabetes medications carefully
(watching how it may affect your blood glucose).
page 91
High blood glucose (hyperglycemia): how to care for yourself
 Recognize symptoms of hyperglycemia —
and ketoacidosis.
…but don’t rely on
symptoms! Monitor
your blood glucose.
page 93
High blood glucose (hyperglycemia): how to care for yourself
 Test for ketones if necessary.
– Type 1: test every 4 hours
– Type 2: test if your blood glucose is over 250 mg/dL
 If you need to, get back on your
self-management plan.
 Look for a cause for your rising blood glucose,
and make adjustments as necessary.
page 93
Low blood glucose (hypoglycemia): how to care for yourself
 Recognize symptoms of hypoglycemia
– Shakiness or dizziness
– Sweating
– Hunger
– Headache
…but don’t rely on
symptoms! Monitor
your blood glucose.
– Pale skin color
– Sudden moodiness or behavior changes:
nervousness, irritability, or crying for no apparent reason
– Clumsy or jerky movements
– Difficulty paying attention, or confusion
– Tingling sensations around the mouth
– Fainting or seizure
page 96
Low blood glucose (hypoglycemia): how to care for yourself
 Eat or drink 15 grams of fast-acting,
low-fat carbohydrate right away.
Quick energy sources
The following items are
quick energy sources that
contain about 15 grams
of carbohydrate:
• ½ cup juice or regular soda
(not diet soda)
• 4 teaspoons of sugar
• 2 tablespoons raisins
• 4 to 5 saltine crackers
• 3 to 5 pieces hard candy
• 1 cup skim milk
• 1 piece bread
• 1 fruit roll-up
• 3 to 4 glucose tablets, or 1 tube glucose gel
• 11 jellybeans
page 96
• 8 Lifesavers candies
(not sugar-free)
Low blood glucose (hypoglycemia): how to care for yourself
 Check your blood glucose 15 minutes
after you eat. If it’s still below 70, eat another
15 grams of carbohydrate. Repeat this until
your blood glucose is over 70 or until your
symptoms go away.
page 96
Low blood glucose (hypoglycemia): how to care for yourself
 Tell someone around you
that you have low blood
glucose — if you can.
 Once your blood glucose
is back to normal, get
back on your management
plan, and look for causes.
pages 96-97
Diabetes education in your area
Online
www.intermountainhealthcare.org/diabetes
Contact a diabetes educator, locate a class, and
learn more about diabetes and how to manage it.
By Phone
Call Intermountain's Primary Care Clinical Program
From Monday to Friday during normal business hours,
call for help locating a diabetes educator near you:
(801) 442-2990
Call SelectHealth Member Services
If you have SelectHealth insurance, you can call either
of these phone numbers to locate a diabetes educator:
in Salt Lake (801) 442-5038
page 106
toll free (800) 538-5038
Also from Intermountain…
The materials shown
here — and many
others — are available
from your healthcare
provider, or online at
www.intermountain
healthcare.org
Carb Counselor
Count carbohydrates as part
of your diabetes meal plan
www.intermountainhealthcare.org/
diabetes
The Weigh to Health and
The Habit Tracker
Manage your weight
www.intermountainhealthcare.org/
weight
Diabetes Care Card
Stay on track with regular
medical care
www.intermountainhealthcare.org/
diabetes
Quitting Tobacco:
your journey to freedom
(in English and Spanish)
Stop using tobacco
www.intermountainhealthcare.org/
prevention
Pre-Diabetes: act now
to protect your health
Learn about pre-diabetes
www.intermountainhealthcare.org/
diabetes
BP Basics and the BP Tracker
Manage your blood pressure
www.intermountainhealthcare.org/
bp
page 106
Healthy Choices for Families:
nutrition and activity
Help your family be healthier
www.intermountainhealthcare.org/
weight
Organizations and websites
Intermountain Healthcare
National Diabetes
www.intermountainhealthcare.org/diabetes
Education Program
One Diabetes Way
Bethesda, MD 20814
www.ndep.nih.gov
also, for SelectHealth members:
SelectHealth Diabetes
Management Program
Phone: 1.800.442.5305
National Diabetes Information Clearinghouse
Diabetes Exercise and
Sports Association
1 Information Way
Bethesda, MD 20892
Phone: 1.800.860.8747
www.diabetes.niddk.nih.gov
8001 Montcastle Drive
Nashville, TN 37221
www.diabetes-exercise.org
Juvenile Diabetes
American Diabetes Association
Research Foundation
120 Wall Street
New York, NY 10005
www.jdf.org
ATTN: National Call Center
1701 North Beauregard Street
Alexandria, VA 22311
Phone: 1.800.DIABETES
(1.800.342.2383)
www.diabetes.org
American Dietetic Association
page 107
120 South Riverside Plaza,
Suite 2000
Chicago, Illinois 60606
Phone: 1.800.877.1600
www.eatright.org
Joslin Diabetes Center
One Joslin Place
Boston, MA 02215
www.joslin.org
When to call your healthcare provider
 You’re sick and…
– You’ve been sick or had a fever for a couple of days and aren’t
getting better.
Call your
healthcare
provider for
advice or an
appointment
– You’ve been vomiting or having diarrhea for more than 6 hours.
– You have a fever higher than 101.5 or a fever that lasts for
more than 24 hours.
– You have a fasting blood glucose of 240 mg/dL or higher for
more than 24 hours.
– You have moderate to large amounts of ketones in your urine.
If you can’t reach your health care provider, or if you have large
amounts of ketones in your urine, get emergency care.
– You begin to notice problems like confusion or dehydration
(symptoms of dehydration include a decrease in urine output,
dry mouth and skin, and dry sunken eyes).
page 110
– You aren’t sure what to do to take care of yourself.
When to call your healthcare provider
 You have hyperglycemia and…
– You can’t control your hyperglycemia, in spite
of taking action to correct it.
Call your
healthcare
provider for
advice or an
appointment
– You have 2-3 readings in a row with results of
240 mg/dL or higher.
– You have more than 2 unexplained episodes
of hyperglycemia in a week.
– You have repeated high glucose readings during
a particular time of day.
– You have moderate to large amounts of ketones
in your urine. If you can’t reach your health care
provider, or if you have large amounts of ketones
in your urine, get emergency care.
page 110
When to call your healthcare provider
 You have hypoglycemia and…
– You can’t control your hypoglycemia, in spite of
taking action to correct it.
Call your
healthcare
provider for
advice or an
appointment
– You have 2-3 readings in a row with results of
70 mg/dL or less.
– You have more than 2 unexplained episodes of
hypoglycemia in a week.
– You have repeated low glucose readings during
a particular time of day.
page 110
Get emergency care (call 911)
 If you have symptoms of ketoacidosis:
– Large amounts of ketones in your urine
– A fruity odor on the breath
– Extreme thirst or hunger
– Nausea/vomiting
– Extreme drowsiness
– Stomach pain
– Body aches
 If you think you may pass out:
– You feel lightheaded or dizzy
– You feel yourself “fading” in and out of alertness
page 110