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DiabetesDiabetes
Making ChangesMaking Changesforfor
SelfSelf--ManagementManagement
Deb Deb BurlageBurlage,RN, CDE,RN, CDE
ObjectivesObjectives
Participants will be able to…..Participants will be able to…..Discuss Basics of DiabetesDiscuss Basics of DiabetesHow to Impact ChangeHow to Impact ChangeApply Concepts to ExerciseApply Concepts to Exercise
EpidemicEpidemic
Approximately 17 Approximately 17 million people in the million people in the US have diabetesUS have diabetes
Another 16 million Another 16 million have a condition now have a condition now known as preknown as pre--diabetesdiabetes
PrevalencePrevalenceThe incidence of The incidence of
diagnosed diabetes has diagnosed diabetes has increased by 61% since increased by 61% since 1990.1990.
0
2
4
6
8
10
12
1990 1998
3-DColumn 1DX_DM
UnDx-DM
Basic Diabetes InformationBasic Diabetes InformationDiabetes Diabetes is a disease in which the body is a disease in which the body does does NotNot produce or properly use insulinproduce or properly use insulin
InsulinInsulin is a hormone that is needed to is a hormone that is needed to convert sugar, starches and other food convert sugar, starches and other food into energy needed for daily lifeinto energy needed for daily life
Cause:Cause: Genetics/EnvironmentGenetics/Environment
Sings and SymptomsSings and Symptoms
Classification of DiabetesClassification of Diabetes
Type 1 diabetes: failure to produce insulinType 1 diabetes: failure to produce insulin
Type 2: results from insulin resistanceType 2: results from insulin resistance
PrePre--diabetes: BS in between normal and diabetes: BS in between normal and highhigh
Gestational Diabetes: affects 4 % of Gestational Diabetes: affects 4 % of pregnant women per yearpregnant women per year
FPG FPG ≥≥ 126 mg/dl**126 mg/dl**
Symptoms of diabetes and a casual Symptoms of diabetes and a casual plasma glucose plasma glucose ≥≥ 200 mg/dl*200 mg/dl*
Current Criteria for Diagnosis of Diabetes
IFG: ≥ 110 mg/IFG: ≥ 110 mg/dLdL and < 126and < 126
IGTIGT
Fasting: Fasting: <126 mg/<126 mg/dLdL
22--h: h: ≥≥140140--<200 mg/<200 mg/dLdL
Criteria for Diagnosis ofPre-diabetes (IFG/IGT)
ComplicationsComplications
Heart DiseaseHeart DiseaseStrokeStrokeHigh Blood PressureHigh Blood PressureBlindnessBlindnessKidney DiseaseKidney DiseaseNervous SystemNervous SystemAmputationsAmputationsDental DiseaseDental Disease
Cost $$$$$$$$$Cost $$$$$$$$$2002: 132 Billion2002: 132 Billion
Per Person:Per Person:–– IndividualsIndividuals with with
diabetes: $13,243 diabetes: $13,243 per yearper year
–– IndividualsIndividualswithout without diabetesdiabetes: : $2,560 per year$2,560 per year
ABCs of DiabetesABCs of Diabetes
Good NewsGood News
Studies have proven: Studies have proven: DCCT/UKSDCCT/UKS
You Can Make A You Can Make A DifferenceDifference
Standards of CareStandards of CareABCsABCs
A A1CA A1CB Blood PressureB Blood PressureC CholesterolC CholesterolD Diabetes Ed/Dental D Diabetes Ed/Dental
Exam/DietExam/DietE Eye Exam/ExerciseE Eye Exam/ExerciseF Foot ExamF Foot ExamG Glucose monitoringG Glucose monitoringH Heart HealthH Heart HealthI Indications forI Indications for
specialtiesspecialtiesK Kidney K Kidney
Recommended GoalsRecommended GoalsGlycemic controlGlycemic control–– A1C <7.0%A1C <7.0%–– Fasting BS 80Fasting BS 80--110mg/dl110mg/dl–– NonNon--fasting <180mg/dlfasting <180mg/dl
Blood Pressure <130/80Blood Pressure <130/80
LipidsLipids–– LDL Cholesterol <100mg/dlLDL Cholesterol <100mg/dl–– Triglycerides <150mg/dlTriglycerides <150mg/dl–– HDL Cholesterol >40mg/dlHDL Cholesterol >40mg/dl
Change Is HARDChange Is HARDKISSKISS
Knowledge: get the Knowledge: get the facts!!!facts!!!Individual: set goals Individual: set goals that are that are yours/understand yours/understand Benefits and BarriersBenefits and BarriersStart with what Start with what motivates YOUmotivates YOUSupport: Health care Support: Health care team/family/friendsteam/family/friends
ExampleExample
ExerciseExercise–– K:K: what do you need to know before you what do you need to know before you
exerciseexercise–– I:I: what works for you (schedules, what works for you (schedules,
limitations)limitations)–– S:S: start with what motivates you (family, start with what motivates you (family,
friends, hobby, travel……………..)friends, hobby, travel……………..)–– S:S: Find a friend or colleague that will Find a friend or colleague that will
motivate you!!!motivate you!!!
Exercise Exercise
Exercise can control blood sugars and lower you risk of heart disease!
Examples of ExerciseExamples of Exercise
Examples of exercise: Examples of exercise: –– Aerobic: Walking, Swimming, Bicycling, Aerobic: Walking, Swimming, Bicycling,
Jogging, and SkatingJogging, and Skating–– Strength: Weight/ResistanceStrength: Weight/Resistance–– Flexibility: Yoga, Tai ChiFlexibility: Yoga, Tai Chi
Three Key Parts To Any Three Key Parts To Any Exercise ProgramExercise Program
–– Frequency:Frequency: Exercise at least 3Exercise at least 3--5 days per 5 days per weekweek
–– Intensity:Intensity: This means how hard you work This means how hard you work during exercise. You should feel like you are during exercise. You should feel like you are working harder than usual but still be able to working harder than usual but still be able to carry on a conversationcarry on a conversation
–– Time:Time: Exercise for at least 20Exercise for at least 20--30 minutes at a 30 minutes at a time (Start out gradual).time (Start out gradual).
Exercise TipsExercise TipsType 1: do not exercise if sugars <70 or Type 1: do not exercise if sugars <70 or >300 or if >300 or if ketonesketones are presentare presentType 2: do not exercise if sugars < 70 or Type 2: do not exercise if sugars < 70 or >350>350Exercise at peak insulin times may cause Exercise at peak insulin times may cause low blood sugarslow blood sugarsExercise can cause low blood sugars Exercise can cause low blood sugars several hours after exerciseseveral hours after exerciseSchedule exercise 45Schedule exercise 45--60 minutes after 60 minutes after eatingeating
GuidelinesGuidelines
–– Always check with your physician before Always check with your physician before beginning any exercise program or if you beginning any exercise program or if you have any complications during exercisehave any complications during exercise
–– Check Blood Sugars before and after exerciseCheck Blood Sugars before and after exercise–– Warm up and cool down Warm up and cool down –– Wear good shoes and check feet after Wear good shoes and check feet after
exercise for any blisters or signs or irritationexercise for any blisters or signs or irritation
Further GuidelinesFurther Guidelines
Keep a daily logKeep a daily logWear Medical IDWear Medical IDDrink plenty of fluidsDrink plenty of fluids
Exercise with a Exercise with a partnerpartnerModify Caloric IntakeModify Caloric IntakeCarry fast acting Carry fast acting sugarsugarDo NOT inject into Do NOT inject into area where exercise area where exercise is involvedis involved
Knowledge (continued)Knowledge (continued)BS Type of Exercise Extra Food NeeBS Type of Exercise Extra Food Neededded
No extra foodNo extra foodNo ExerciseNo Exercise> 300 mg/dl> 300 mg/dl
No extra foodNo extra foodNo extra foodNo extra food15 gms Carb15 gms Carb
Low Low ModerateModerateStrenuousStrenuous
171171--300 mg/dl300 mg/dl
No extra foodNo extra food15 gms Carb15 gms Carb30 gms Carb30 gms Carb
LowLowModerateModerateStrenuousStrenuous
101101--170 mg/dl170 mg/dl
15 gms Carb15 gms Carb30 gms Carb30 gms Carb60 gms Carb60 gms Carb
LowLowModerateModerateStrenuousStrenuous
< 100 mg/dl< 100 mg/dl
Individualize ExerciseIndividualize Exercise
Benefits and Barriers to ExerciseBenefits and Barriers to Exercise
–– Maybe You are not ready to changeMaybe You are not ready to change–– Maybe you are thinking about changeMaybe you are thinking about change–– This is a good time to think about the benefits, This is a good time to think about the benefits,
the barriers, and becoming more physically the barriers, and becoming more physically active!active!
Individualize: ProsIndividualize: Pros--Why do you Why do you want to changewant to change
Physical ReasonsPhysical Reasons
Emotional ReasonsEmotional Reasons
Individual Barriers: What is Individual Barriers: What is Stopping You???Stopping You???
Physical BarriersPhysical Barriers
Emotional BarriersEmotional Barriers
Next StepNext Step
Summarize your findingsSummarize your findings–– ID benefits you are most excited aboutID benefits you are most excited about–– ID barriers you feel strongest aboutID barriers you feel strongest about–– Ask yourself if you are confident and ready to Ask yourself if you are confident and ready to
commit to changecommit to change–– Ask yourself if you are satisfied with status Ask yourself if you are satisfied with status
quoquo–– Are you open to learning more?Are you open to learning more?
Start With What Motivates YouStart With What Motivates You
What is meaningful in your lifeWhat is meaningful in your lifeWhat do you enjoy doingWhat do you enjoy doingWhat are you passionate aboutWhat are you passionate aboutWhat have you always wanted to do?What have you always wanted to do?
So Let’s Get startedSo Let’s Get started
SupportSupport
MultiMulti--disciplinary Teamdisciplinary TeamFamilyFamilyFriendsFriends
Summary for SuccessSummary for Success
KnowledgeKnowledgeIndividualize Individualize StartStartSupportSupport
ConclusionConclusion
Life is not simply holding a good handLife is not simply holding a good handLife is playing poor hand well…….Life is playing poor hand well…….
--Danish SayingDanish Saying
Resources/ReferencesResources/References
American Diabetes Association: American Diabetes Association: www.diabetes.orgwww.diabetes.org
Center for Disease Control: Center for Disease Control: www.cdc.gov/diabeteswww.cdc.gov/diabetes
Clinical Diabetes: Clinical Diabetes: http://clinical.diabetesjournals.http://clinical.diabetesjournals.orgorg
Diabetes is South Dakota:Diabetes is South Dakota:www.www.sddiabetessddiabetes.net.net
The Gift………..The Gift………..
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