Optimal Life: The Essentials of Diabetes

Optimal Life: The Essentials of Diabetes

Christine Lee, Pharm. D., BCPS

Copyright © 2013 Dr. Christine V. Lee

All rights reserved. No part of this publication may be reproduced, distributed, or transmitted in any form or by any means, or stored in a database or retrieval system, without the prior written permission of the publisher. Optimal Life, OL, and associated logos are trademarks and/or registered trademarks for the use of their respective owners.

ISBN: 978-0-9833372-4-9

ISBN: 9780983337256

Printed in the United States of America

Book Design: www.KarrieRoss.com

Optimal Life Globe Design: Jim Draper www.jimdraper.com

Optimal Life and OL Logo Design: Heide Couch/RHC Design Tech rhcdesigntech.net

A NOTE TO THE READER

The material in this book is meant for informational and educational purposes only; it is not intended to replace the advice of your doctor. Please make sure to discuss all the facts and suggestions presented here with your health care provider to create a plan that is right for you.

DEDICATION

This book is dedicated to my son, Charles, who developed type 1 diabetes in 2004. He has never allowed his diabetes to be an excuse for not accomplishing his dreams and goals. Charles has traveled abroad extensively, is active in sports and mountain climbing and is currently in medical school. He’s given his family the gift of encouragement, telling us all that individually we can do anything if we really want to. Charles once said to me, Mom, don’t worry. Nothing has changed, I just happen to have diabetes. Charles truly lives life to the fullest.

I also dedicate this book to my husband who recognized Charles’ diabetes symptoms before there were irreversible serious consequences, and for the strength he gave Charles when he said, never use your diabetes as an excuse, because the world is wonderful and yours for the taking.

ACKNOWLEDGMENTS

This book could not have been completed without the unwavering support of Sherill Conley Rohde. She spent countless hours reviewing and organizing the text so that nonmedical people could understand it, and coordinated the myriad other details that went into the finished product. As the project blossomed from concept to reality, Sherill’s constant positive feedback and friendship gave me the encouragement to forge ahead; she helped me hold onto the dream that we could do this, and help many individuals with diabetes in doing so.

ABOUT THE AUTHOR

Christine Lee received her Doctor of Pharmacy from the University of the Pacific School of Pharmacy in Stockton, California, and was granted a Bachelor of Science in Clinical Laboratory Science from the University of Nevada, Reno. She is licensed by both the California and Nevada State Boards of Pharmacy. She is also a Board Certified Pharmacotherapy Specialist and a licensed Clinical Laboratory Scientist.

Dr. Lee is the co-founder and Chief Clinical Officer of American Health Care, a health management company that specializes in delivering patient-centric pharmacy benefit, population health and therapy management programs that emphasize clinical excellence. She is also the developer of a proprietary software system that provides virtual medical records, currently in use by hospitals across the country. She is the preceptor for the company’s pharmacy residency program and co-founded the United American Pharmacy Network. She is affiliated with the American College of Managed Care Pharmacy, the American College of Clinical Pharmacy, the American Society of Health System Pharmacists and the Academy of Managed Care Pharmacy.

When not at work, Dr. Lee enjoys the company of her family, maintains her black belt in Taekwondo and loves to run. She is an avid supporter of the Juvenile Diabetes Research Foundation and has served on the boards of several consulting companies, as well as human rights advocacy groups for the mentally disabled.

You can contact the author at info@optimalife.net.

HOW TO USE THIS BOOK

The Optimal Life book is meant to enhance your knowledge of diabetes mellitus (DM) so that you can more fully understand why you need to take control of your diabetes and how to do it. Although there are three main types of diabetes (type 1, type 2, and gestational), only type 1 and type 2 are discussed in this book.

The first three chapters provide in-depth information about the science behind the disease, including why certain complications develop, their symptoms and keys to their prevention, to help you fully understand diabetes. The following chapters focus on medication and diet, which are vital to good diabetes management. A list of resources at the back offers practical information for use right now and suggests other material for further study.

The key to controlling your diabetes is understanding it. So read on and become as knowledgeable as you can.

FOREWORD

My reasons for writing this book are both personal and professional. As a Doctor of Pharmacy and medical consultant with more than 20 years in the health care field, I’ve been involved in diabetes education for most of my professional life, working to convey scientifically-based best practices to a diverse array of medical professionals and individuals with diabetes. Because the complications of diabetes can be so dire and because most of them are actually preventable, it became almost a personal crusade for me to spread this message to as many people as I could. I was passionate about the subject.

Then, in 2003, my 14-year-old son Charles was diagnosed with type 1 diabetes. You can call it coincidence, fate or destiny that my involvement with diabetes became so heartbreakingly personal after spending so many years being professionally involved with it, but I can tell you that this was a defining moment in my life. My otherwise healthy, happy son was suddenly rushed to the hospital with severe hyperglycemia, in very real danger. I’m so grateful to say that he recovered, accepted his diagnosis and is today as an active, energetic medical student who successfully manages his diabetes and enjoys all life has to offer him.

If I was passionate about diabetes education before this event, I was on fire afterward; since that time I’ve devoted hundreds of hours to understanding type 1 and type 2 diabetes. I studied not only the science of diabetes, but also the people I met who had the disease. Almost without exception, the people who were successful in managing their diabetes and avoiding complications were the ones who had become educated on what they needed to know to control the disease. They addressed their diabetes head on, took responsibility for knowing their numbers, constantly asked questions, and did whatever it took to keep their glucose in control. They made education and ownership of their disease their number one priority.

When I looked at the learning tools available to people with diabetes, I realized that the material ranged from oversimplified children’s books to highly academic and scientific discussions of the disease, with not much in between. What I began to envision was one place, a one-stop shop, where all the essential information about diabetes could be gathered – from diagnosis and medication, to testing and insider tips, along with the underlying science – presented in a way that everyone could use to become healthier.

With this in mind, I began work on Optimal Life: The Essentials of Diabetes. The goal of this book is to provide useful health information to the person with diabetes. Early diagnosis and taking an active stance in the early stages of the disease is the best solution to prevent complications and live a healthy life. However, whether you’ve had the disease for a long time or you’re newly diagnosed, this series has valuable information for you.

I believe that good health is the key to living your optimal life. This can be defined a number of ways, but for people with diabetes, I think the most important definition might be knowing that you can have diabetes and live a healthy, active life, doing all the things you want to do – whether that’s mountain climbing, playing with your children, graduating from college, or anything else you can dream of. I believe your optimal life can be achieved by learning how to take care of your diabetes and being proactive about doing so.

The Optimal Life book is meant to enhance your knowledge of diabetes mellitus (DM) so that you can more fully understand why you need to take control of your diabetes and how to do it.

I congratulate you on your decision to read this book and look forward to partnering with you on your journey to good health!

TABLE OF CONTENTS

Note to the Reader

Dedication

Acknowledgments

About the Author

How to Use This Book

Foreword

Chapter 1

What is Diabetes?

Introduction

In-Depth Information

What is Diabetes

Type 1

Type 2

Diagnosing Diabetes

Insulin and Insulin Resistance

Overview of Insulin Resistance

Hyperglycemia

Physical Activity for People with Diabetes

Exercise and Insulin

Exercise and Type 1 Diabetes

Sample Pre-exercise Checklist for People with Type 1

Post-exercise Glucose Levels

Exercise and Type 2 Diabetes

Sample Pre-exercise Checklist for People with Type 2

Summary

Facts At A Glance

Your Three Action Steps

Chapter 2

What is the Next Step?

Introduction

In-Depth Information

The ABCs of Diabetes

A1C

Blood Pressure

Cholesterol

Total Cholesterol

HDL and LDL

Triglycerides

Smoking

Summary

Facts At A Glance

Your Three Action Steps

Chapter 3

How Do I Prevent Complications? – Part 1

Introduction

In-Depth Information

Blood Pressure

What Is High Blood Pressure?

How High Blood Pressure Affects Diabetes

High Blood Pressure and Being Overweight

The Renin-Angiotensin-Aldosterone System Affect on High Blood Pressure

How the RAAS Works

How to Prevent and Control High Blood Pressure

Blood Pressure Medications

How to Get the Most Accurate Blood Pressure Reading

Cholesterol and Cardiovascular Disease

How Does Cholesterol Build Up in Your Body

What are LDL and HDL

Insulin Resistance and Cholesterol

How to Prevent and Control High Cholesterol

Low Blood Sugar/Hypoglycemia

How Glucose Works in Your Body

Why Low Glucose Levels Are Dangerous

What to Do When You’re Low

How to Prevent Hypoglycemia

Summary

Facts At A Glance

Your Three Action Steps

Chapter 4

How Do I Prevent Complications? - Part 2

Introduction

In-Depth Information

Diabetic Nephropathy (Kidney Disease)

Kidney Function

Pathogenesis – How Diabetic Nephropathy Develops

High Blood Sugar

High Blood Pressure

Proteinuria

Symptoms of Chronic Kidney Disease That Lead to Diabetic Nephropathy

Diagnosing Diabetic Nephropathy

Microalbuminuria

Glomerular Filtration Rate (GFR)

Serum Creatinine

When to Begin Testing for Diabetic Nephropathy

Prevention and Treatment

Diabetic Retinopathy (Eye Disease)

What is Diabetic Retinopathy

Pathogenesis – How Diabetic Retinopathy Develops

Symptoms of Diabetic Retinopathy

Diagnosing Diabetic Retinopathy

When to Begin Testing

Prevention and Treatment

Diabetic Neuropathy (Nerve Damage)

Pathogenesis – How Sensory Neuropathy Develops

Symptoms of Sensory Neuropathy

Prevention and Control

Treatment of Sensory Neuropathy

How to Perform Your Tests and Exams

Diabetic Foot Care

ABC MD Foot and Flu

A1C

Blood Pressure

Cholesterol and Creatinine

Microalbuminuria and Dilated Eye Exam

Microalbuminuria

Dilated Eye Examination

Foot Examination

Flu Shot

Summary

Facts At A Glance

Your Three Action Steps

Chapter 5

Medications

Introduction

Fasting Vs. Postprandial Hyperglycemia

General Medication Information

Classes of Diabetes Medications

Biguanide

Insulin Secretagogues: Sulfonylureas/Meglitinides

Thiazolidinedione (TZD)

Insulin

Incretin and Amylin

DPP-4 Inhibitor

Amylin

Summary

Facts At A Glance

Your Three Action Steps

Chapter 6

Insulin

Introduction

Insulin

The Four Classifications of Insulin

Insulin Profiles

Prandial Insulin

Basal Insulin

Prandial Insulin Dosing and the Insulin-to-Carbohydrate Ratio

Correction Factor or Dose Adjustment

Basal Insulin Dosing

Changes in Insulin Dosing

Injecting Insulin

Storing Insulin

Glucagon

Using a Glucagon Kit

Summary

Facts At A Glance

Your Three Action Steps

Chapter 7

Healthy Eating for People with Diabetes

By Kathy Kennedy-Mason, MPH, RD

The Essentials of Diet

Carbohydrates

Protein

Fats

Portions and Portion Control

How to Read a Food Label

Weight Loss

Exercise

Summary

Facts At A Glance

Your Three Action Steps

Afterword

Resources

Glossary

Bibliography

CHAPTER ONE

What is Diabetes?

Introduction

Today we have the advantage of many medical studies that demonstrate how to decrease the complications that have plagued people with diabetes. This literature tells us that the best strategy is one that is multi-focused on controlling blood glucose, blood pressure, cholesterol and protein in the urine, as well as on patient education, diet and exercise, and frequent monitoring to prevent complications. The good news is that these same medical studies provide information on how complications can be prevented or slowed. A person with diabetes does not have to be one of the statistics below.

People with diabetes face the possibility of many complications:

A two- to four-fold increase in risk for coronary heart disease. Coronary disease is the leading cause of death in people with diabetes over the age of 35.

Diabetes is the seventh leading cause of death overall;

Diabetes is the leading cause of chronic kidney disease and failure. Data from the 2005 U.S. Renal Data System documented that 44% of kidney failures occur in people with diabetes.

Nerve damage, called peripheral sensory neuropathy, may affect up to 60% of older people with type 2 diabetes.

Diabetes is the leading cause of blindness among adults 20-74 years of age.

Diabetes causes greater than 60% of all non-traumatic amputations.

75% of adults with diabetes have hypertension. People with diabetes risk increased severity of infections.

The risk of stroke is two to four times higher than people without diabetes.

When glucose is not controlled, the nature of diabetes is to progress to the complications listed above. It’s my firm belief that education about the disease is the first line of defense in understanding the reasons why these complications may develop and how to prevent them.

Many of us have daily routines in life and it’s unlikely that we’ll change those routines unless we’re given a strong enough reason to do so. At the same time, very few of us will intentionally put ourselves in a harmful situation if we actually know of the harm in advance. For example, you probably have a route to work that you drive every day. Imagine that one day, while driving on your usual route, you encountered a big sign indicating a detour because part of the road was washed out in a winter storm. You’d take the detour to work. The detour protected you by giving you important information and