Patient’s education about DM,

Nutrition and Excercise

• Diabetes Education:
– self-monitoring of blood glucose
– urine ketone monitoring (type 1 DM)
– insulin administration
– foot and skin care
– diabetes management before, during, and after
exercise
– risk factor–modifying activities
• Nutrition
– Medical nutrition therapy (MNT) - describe the
optimal coordination of caloric intake with other
aspects of diabetes therapy (insulin, exercise,
weight loss)
– Primary prevention measures – directed at
preventing or delaying the onset of type 2 DM in
high-risk individuals by promoting weight
reduction.
• Exercise
– multiple positive benefits: cardiovascular risk
reduction, reduced blood pressure, maintenance
of muscle mass, reduction in body fat, and weight
loss
– recommends 150 min/week (distributed over at
least 3 days) of moderate aerobic physical activity
with no gaps longer than 2 days.
MONITORING THE LEVEL OF GLYCEMIC
CONTROL
• Self-Monitoring of Blood Glucose
– standard of care in diabetes management
• Assessment of Long-Term Glycemic Control
– Measurement of glycated hemoglobin (HbA ) - standard
1c

• In standardized assays, the HbA approximates the following

1c

mean plasma glucose values:

– HbA of 6% = 7.0 mmol/L (126 mg/dL)
1c

– 7% = 8.6 mmol/L (154 mg/dL)

– 8% = 10.2 mmol/L (183 mg/dL)
– 9% = 11.8 mmol/L (212 mg/dL)
– 10% = 13.4 mmol/L (240 mg/dL)
– 11% = 14.9 mmol/L (269 mg/dL)
– 12% = 16.5 mmol/L (298 mg/dL)
• In patients achieving their glycemic goal –
HbA1c at least twice per year
• When glycemic control is inadequate or when
therapy has changed - more frequent testing
(every 3 months)