ANHYDROSISANHYDROSIS

EXERCISE PREVENTIONEXERCISE PREVENTION

<500 500-1999 >20000

5

10

15

20

25

30

35

40

45

50

Low Risk

High Risk

Helmich, S.P. et al. New England J Medicine 325:147-152, 199Helmich, S.P. et al. New England J Medicine 325:147-152, 199

Inci

den

ce R

ate

s of

typ

e 2

(/ 1

0,0

00

ma

n-ye

ars

Regular Walking Decreases Morbidity Rates by 50% in Diabetics

Regular Walking Decreases Morbidity Rates by 50% in Diabetics

Gregg, E.W., Arch Intern Med 163:1440-1447, 2003Gregg, E.W., Arch Intern Med 163:1440-1447, 2003

0 <1 1-1.9 2-2.9 3-3.9 >40

0.2

0.4

0.6

0.8

1

1.2

Hours Walking per Week

Risk

of A

ll-Ca

use

Mor

talit

y

Pre Post5

6

7

8

9

10

11

12

13

Gly

cosy

late

d H

b (%

)

Boule, N.G. et al JAMA 286:1218-1227, 2001.

Pre Post5

6

7

8

9

10

11

12

13Exercise Groups Control Groups

Pre Post50

60

70

80

90

100

110

Body

Wei

ght (

kg)

Boule, N.G. et al JAMA 286:1218-1227, 2001.

Pre Post50

60

70

80

90

100

110

Exercise Groups Control Groups

INSULIN SENSITIVITYINSULIN SENSITIVITY

Exercise Control0

50

100

150

200

250

300

350

Pre-

Post-

Glu

cose U

pta

ke

(mg

/m2/m

in)*

Landt, et al, Diabetes Care 8:461-465, 1985Wallberg-Henriksson et al., Am J Clinical Nutrition 249:C233-C237, 1985Yki-Jarvinen et al, Diabetes Care 7:520-527, 1984.

SIGNS AND SYMPTOMS OF HYPOGLYCEMIAApathy Sweating Excessive Hunger

Drowsy Fainting Convulsions

Dizziness Fatigue Crying

Hand Tremors Irritability Blurred Vision

Confusion Delusion Double Vision

Headache Slurred Speech Unsteady Gait

Nervousness Poor Coordination

Inability to concentrate Loss of Consciousness

SIGNS AND SYMPTOMS OF HYPOGLYCEMIAApathy Sweating Excessive Hunger

Drowsy Fainting Convulsions

Dizziness Fatigue Crying

Hand Tremors Irritability Blurred Vision

Confusion Delusion Double Vision

Headache Slurred Speech Unsteady Gait

Nervousness Poor Coordination

Inability to concentrate Loss of Consciousness

GOALS OF DIABETIC TREATMENTGOALS OF DIABETIC TREATMENT

• GLUCOSE CONTROL• 80 –100 mg/dl

• 100 - 160 mg/dl

• HbA1C<7%

• PREVENT DIABETIC COMPLICATIONS

• GLUCOSE CONTROL• 80 –100 mg/dl

• 100 - 160 mg/dl

• HbA1C<7%

• PREVENT DIABETIC COMPLICATIONS

HOME BLOOD GLUCOSE MONITORHOME BLOOD GLUCOSE MONITOR

Continuous Glucose Monitoring System.Continuous Glucose Monitoring System.

GLUCOWATCHGLUCOWATCH

URINE TESTSURINE TESTS

• Glucose

• Ketones

• Glucose

• Ketones

HbA1CHbA1C

HEMAGLOBINHEMAGLOBIN

CLINICAL MANAGEMENT GOALSCLINICAL MANAGEMENT GOALS

DIABETIC EXCHANGE DIETDIABETIC EXCHANGE DIET

• FRUIT

• BREADS

• MEATS

• FAT

• MILK

• FRUIT

• BREADS

• MEATS

• FAT

• MILK

BREAKFAST• 2 FRUIT• 3 BREAD• 1 MEAT• 2 FAT• 1 MILK

MID-MORNING• 1 BREAD• ½ Cup MILK

BREAKFAST• 2 FRUIT• 3 BREAD• 1 MEAT• 2 FAT• 1 MILK

MID-MORNING• 1 BREAD• ½ Cup MILK

CARBOHYDRATE COUNTINGCARBOHYDRATE COUNTING15 g CARBOHYDRATES15 g CARBOHYDRATES

STARCHES• ½ Cup Mashed Potatoes• 1 Slice of Bread• 6 crackers• 1/3 cup of Rice• ½ cup of pasta

STARCHES• ½ Cup Mashed Potatoes• 1 Slice of Bread• 6 crackers• 1/3 cup of Rice• ½ cup of pasta

FRUITS• small apple• small orange• ½ banana• ½ cup of canned fruit

FRUITS• small apple• small orange• ½ banana• ½ cup of canned fruit

MILK• 1 cup skim milk

MILK• 1 cup skim milk

CARBOHYDRATE COUNTINGCARBOHYDRATE COUNTING

3 oz Meat

1 Vegetable

3 Carbohydrates

1 Fat

Calorie Free Beverage

3 oz Meat

1 Vegetable

3 Carbohydrates

1 Fat

Calorie Free Beverage

TYPES OF INSULINTYPES OF INSULIN

• RAPID

• SHORT

• REGULAR

• LONG

• ULTRALONG

• RAPID

• SHORT

• REGULAR

• LONG

• ULTRALONG

METHODS TO DELIVER INSULIN

METHODS TO DELIVER INSULIN

METHODS TO DELIVER INSULIN

METHODS TO DELIVER INSULIN

METHODS TO DELIVER INSULIN

INSULIN REGIMINESINSULIN REGIMINES

INSULIN COMBINATIONSINSULIN COMBINATIONS

INSULIN COMBINATIONSINSULIN COMBINATIONS

INSULIN PUMPINSULIN PUMP

ORAL HYPOGLYCEMIC AGENTSORAL HYPOGLYCEMIC AGENTS