DIABETES BASICS: RISK REDUCTION

Linda Kerr, NP, CDE Diabetes Program Director Long Beach Memorial Medical Center

THE BASICS

Diabetes is an insulin problem and not a sugar problem

You have enough insulin, but cant use it well You no longer make insulin

Diabetes is characterized by high levels of sugar in the blood. Managing Diabetes: a lifelong task to keep blood sugar as normal as possible. Left untreated, diabetes can lead to damage of heart, nerves, arteries, eyes, and kidneys.

TRUE OR FALSE
Diabetes

is the #1 cause of adult blindness, kidney failure, and nontraumatic amputation. is a major contributor to Stroke and Heart Disease.

Diabetes

FALSE!

HIGH, UNCONTROLLED BLOOD SUGAR

is the #1 cause of adult blindness, kidney failure,

and non-traumatic amputation

HIGH, UNCONTROLLED BLOOD SUGAR

Is the major contributor to stroke and heart disease.

You may be at risk if:

You have a family history of diabetes You are overweight or obese You are inactive You have high blood pressure (>140/90) You have HDL< 35, Triglycerides > 250 You have a history of gestational diabetes or polycystic ovary disease You are a member of a high risk ethnic population (African American, Hispanic/Latino, American Indian, Pacific Islander, Asian American, etc)

TYPE 1 DIABETES
10% of diabetes Typically onset is < 30 years of age INSULIN DEFICIENCY Sudden onset of symptoms and illness

PRE-DIABETES
Almost

always precedes Type 2 Diabetes A condition where blood sugar is higher than normal, but not yet high enough to be called Diabetes.

TYPE 2 DIABETES
90%

of diabetes Usually onset is > 30-40 years of age INSULIN RESISTANCE Gradual onset of symptoms 80% overweight or obese 20% lean

GESTATIONAL DIABETES
7%

of all pregnancies Screen at 24-28 weeks gestation Certain women are at high risk As much as 50% go on to develop Type 2 diabetes within 5-10 years

Common Tests
{ A1C:

ADA < 7 { BG Targets:

{ Fasting

70 - 130 { 2 hours after eating 100 - 140

{ B/P:

< 130/80 { Cholesterol: -HDL: Men > 45 Women > 55 -LDL: < 100 { Triglycerides: < 150 { Microalbumin: 30 299

DIABETES FACTS

20 million Americans have diabetes (6.9% of population) Growing at an alarming rate probably fueled by obesity Over age 20 8.7% population Over age 60 18.3% have diabetes An additional 30% of adults have pre-diabetes Sixth leading cause of death You either have diabetes or you dont! Borderline diabetes or touch of sugar are incorrect terms. High cholesterol, triglycerides and high blood pressure are also common with diabetes.

DIABETES & LONG BEACH: PERCENT ADULTS (18+ YRS) DX WITH DIABETES
1999 Long Beach 5.6% 2002-2003 8.2% 2005 9.3%

LA County

6.7%

7.2%

8.1%

COMPLICATIONS OF DIABETES

High Blood Glucose can lead to serious health complications, which can affect your: Heart and Blood Vessels Eyes Kidneys Nerves Emotional Health

DIABETES, HEART & STROKE:

WHATS THE CONNECTION?

People with diabetes AND uncontrolled blood sugars are at least twice as likely to have Heart Disease or Stroke and to have these conditions at an earlier age than other people.

According to the National Diabetes Information Clearinghouse (NIDC)

Gender Issues & Blood Vessel Disease

Pre-menopausal women with diabetes lose the natural protection from development of vessel disease. Women with diabetes AND poorly controlled blood sugars are more likely to die after a heart attack, than either diabetic men or non-diabetic women.

Beaser, R. MD et al., Joslins Diabetes Deskbook 2007, p 471.

HEART and BLOOD VESSEL DISEASE

Cardiovascular Disease: The leading cause of diabetesrelated death. People with diabetes are more likely to develop Heart Disease and Stroke due to a variety of risk factors, including: High Cholesterol High Blood Pressure Smoking Obesity Lack of Physical Activity

RISK FACTORS LEADING TO INSULIN RESISTANCE

Insulin Resistance: Condition in which the body does not efficiently use the insulin it makes. High Cholesterol: Associated with insulin resistance (high Triglycerides, low HDL, high LDL) High Blood Pressure: Can greatly aggravate vascular complications. Smoking: Decrease HDL, increase insulin resistance Obesity: Major risk factor for Heart Disease. Has been strongly linked with insulin resistance. Physical Inactivity: Modifiable major risk factor for insulin resistance.

CHOLESTEROL (PLAQUE)
Builds

up on the blood vessel walls and can break off. A condition associated with insulin resistance. Contributes to Arthrosclerosis (fattybuildups in artery walls).

HIGH CHOLESTEROL

High fats in the blood The liver produces fats. Fats also comes from the foods we eat. Egg yolk Red meat Organ meat Shell fish Cheese

CHOLESTEROL GOALS

LDL Cholesterol: L for Lousy

Below 100

HDL Cholesterol: H for Happy

Men: greater than 45 Women: greater than 50

Triglycerides (another type of fat)

Below 150

Measure fasting cholesterol at least annually.

HYPERTENSION

Diagnoses: 2 or more abnormal readings taken on separate days, different times. Abnormal readings: >130 (top number) and/or > 80 (bottom number) Goals: BP < 130 (top number) and < 80 (bottom number) Treatment: Lifestyle therapy Pharmacological

HOW IS DIABETES MANAGED?

Education Healthy Eating Being Active Monitoring Taking Medication Problem Solving Healthy Coping Reducing Risks

SMOKING AND DIABETES

Smoking can increase your risk of diabetes complications. Narrows blood vessels. Decreases blood flow to heart and brain. Lung damage Increased heart rate Increased blood pressure Narrowed blood vessels

SMOKING CESSATION

Nicotine replacement: nicotine gum, patch, nasal spray Pharmacological:

Help to decrease withdrawal symptoms Your doctor will need to prescribe

Resources:
American Heart Association

1-800-242-8721 www.americanheart.org 1-800-586-4872 www.lungusa.org

American Lung Association

TIPS TO QUIT SMOKING

Do things that make it hard to smoke.

Yard work, wash dishes

Go to places where smoking isnt allowed. Avoid situations that tempt you to smoke.
Drinking coffee or alcohol

Find a substitute.
Try hard candy

Dont give up if you smoke a cigarette. Solicit support from family members.

CENTRAL OBESITY
Too

much weight around your waist increases your risk for heart disease, stroke and high blood sugar. Men: greater than 40 inches Women: greater than 35 inches.

ADA Weight Loss Recommendation

Lose

10% of what you weigh right now Result: Improved Blood Sugars, blood pressure & Cholesterol

EAT WELL

Meet with a registered dietitian to devise an eating plan. Increase fiber: whole grain breads, oat meal, beans, fruits, veggies Lower cholesterol: meat, dairy, eggs Reduce saturated fat: meat & butter Reduce Trans fat: commercially made baked goods, fried foods.

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PHYSICAL ACTIVITY

Modifiable major risk factor for insulin resistance and cardiovascular disease. Shown to prevent or delay the onset of Type 2 Diabetes. Shown to reduce Blood Pressure. Helps to reduce risk for Heart Attack and Stroke.

THE FIT PRINCIPLE

Frequency: Try to do most days of the week to

make your heart strong.

Intensity: How hard should you work? If you can

whistle, you can pick up the pace. If you cant talk, you are working too hard. 20 minutes. Then increase the time to as much as 60 minutes, as you are able.

Time: Start with five or ten minutes and work up to

BEFORE STARTING
Be sure to check

with your provider before starting a new activity program, especially if you have:
Heart Disease or Problems with your feet Problems with your eyes

TAKE YOUR MEDICATIONS

Your doctor may suggest one or more medications for your cholesterol, blood pressure or blood sugar. DO NOT stop your medication because your numbers are looking good! Your numbers look good because of the medication.

MONITOR YOUR BLOOD SUGAR

Its a great way to see how you respond to

Food Exercise Medication Stress Illness Weight Loss

CHECK YOUR BLOOD PRESSURE & CHOLESTEROL

Blood pressure should be

checked at every doctor visit.

Get

your cholesterol tested at least once a year.

Diabetes and Depression

Major

depression affects approximately 1 of every 5 patients with diabetes and severely impairs quality of life and all aspects of functioning, including sleep patterns, sexual function, self-care behavior, and metabolic control.
AADE, Core curriculum for diabetes education, 5th ed., p36

Symptoms of Depression

Depressed mood Weight loss Trouble sleeping Feeling agitated or sluggish Loss of energy Diminished interest in ADLs Feeling guilty Recurrent thoughts of death

More Symptoms of Depression

Similar

or identical to symptoms of Hyperglycemia (high blood sugar). be difficult to determine if you are depressed or have high blood sugar.

May

Overcoming Depression

Watch for the warnings: feelings of hopelessness, reduced interest or pleasures in things normally enjoyed. Actions that may help to avoid depression: get a good nights sleep, stay active, spend time with friends each day, volunteer. Speak to your doctor about medication management.

Depression: Giving up the Guilt

You did not give yourselves diabetes. It is not necessary to be perfect in order to reach healthful goals. Get Perspective: give yourselves credit for positive efforts to manage diabetes.

Methods of Coping with Stress

Change your thinking Exercise What you think One of the best influences how you feel ways to reduce Reality assessment stress! On a scale 1-10, how does this issue rate? Relax Music, deep breath, read, laugh, sit on the beach and listen to the waves

Remember.

Learn to Live Life Not to Diabetes! Learn Live Life

Not Diabetes!