provide a high level overview of diabetes head to toe. discuss the importance of keeping a1cs under...
TRANSCRIPT
Diabetes Community Expo:
Empowering YouTo Live Well
Provide a high level overview of diabetes head to toe.
Discuss the importance of keeping A1Cs under 8.
Identify ways to prevent long-term complications.
There are no conflicts of interest to disclose.
Objectives and Disclosure
Diabetes self management is key Self motivation “Take home message”
Introduction
Type 1 Diabetes10% of casesInsulin deficiencyAutoimmune related
Type 2 Diabetes90% of casesInsulin resistance
Types of Diabetes
Family History Gestational Diabetes Cardiovascular disease Hypertension Hyperlipidemia Long term use of certain medications such
as steroids or antipsychotics PCOS, acanthosis nigricans
Criteria for Screening
Blurred vision Feeling tired Sores that do not heal Recurrent yeast infections Increased thirst Increased urination May be asymptomatic
Symptoms of Hyperglycemia
Normal Pre-diabetes Diabetes
FBG< 100 md/dL IFG >100-125 mg/dL FBG >126 mg/dL
2 hr PG < 140 mg/dL IGT 2 hr > 140-199 mg/dL
2 hr PG >200mg/dL
A1C < 5.5% A1C 5.8% - 6.4% A1C > 6.5%
Diagnostic Criteria
Finger sticks Pre-meal 2 hours post prandial
Hemoglobin A1C testing Every 3 months if not well controlled Goal <7%
Self monitoring after diagnosis
A1C% 6 7 8 9 10 11 12
Average 126 154 183 212 242 269 298
glucose
Correlation of A1C with average glucose
Yearly Screening
Retinopathy
Maintain blood sugar control Acuity vs Retinal changes or bleeding Dilated eye exam yearly If diagnosed with retinopathy check with
eye specialist regarding exercise restrictions
Retinopathy
Chronic Kidney Disease
Maintain blood sugar control Maintain Normal B/P ( 130/80-140/90 ACE Inhibitor class blood pressure
medication Avoidance of NSAIDS (non-steroidal anti-
inflammatories) Yearly Microalbumin –urine albumin
secretion
Nephropathy
Maintain blood sugar control Daily foot exams Office foot exams during each diabetes visit Avoid injury/exposure Goal is to prevent damage are no therapies
actually proven to reverse damage Symptom control – gabapentin,
PeripheralNeuropathy
Maintain blood sugar control Maintain normal B/P Maintain normal cholesterol profile Aspirin therapy Weight Control Smoking Cessation
Cardiovascular
Healthy Weight – 5-10% reduction Physical Activity – 150 min /week Diet – Low in saturated fats, high in fiber,
carbohydrate controlled Self Monitoring of blood glucose Medication Adherence Immunizations Flu Pneumonia >65 yr Hep B 19-59 yrs of age
Therapeutic Lifestyle Changes
11 types or classes of diabetes medications Know the actions and side effects of each
medication
Insulin Therapy Basal – Long acting Bolus – Quick acting Combination or mixed insulin Vial/syringes, Pre-filled pens, Insulin Pump
Diabetes Medication
CausesMedication Skipping or delaying mealsIncreased activity or exercise
SymptomsShaky & anxiousSweatingHungerFast heartbeatDifficulty concentratingUnconsciousness, seizure, coma, death
Hypoglycemia
15:15 Rule ◦ 15gms of carbohydrates and recheck blood sugar in 15
minutes◦ Correct blood sugar and then eat a snack with proteinPrevent events◦ Know the actions and side effects of medications◦ Test blood sugar more often when adding or
changing medication◦ Carry glucose meter and something to treat ◦ Keep records and watch for trends, report to PCP◦ Test before driving◦ Wear medical alert
Hypoglycemia Treatment
If unable to self treat then assistance will be needed from family or bystander
Have a plan Glucagon injection Call 911 Report any trends and or events to PCP Hypoglycemic unawareness can occur
Hypoglycemic Emergencies
Depression Screening for ages >65 Loss of motivation Non adherence to plan of care Goal Setting Short term goals Long term goals
Emotional Aspects of Diabetes
Patient Family members Health care provider Certified Diabetes Educator Dietitians Counselor Social Worker Pharmacist
Your Diabetes Team
Early diagnosis Lifestyle changes Self management
Conclusion
American Diabetes Association. Standards of Medical Care in diabetes – 2015. Diabetes Care. 2015; 38 (Suppl 1): S1-S93. January 2015
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http://www.ndei.org/patienteducation.aspx
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Resources