Diabetes Survival Camp –Diabetes Survival Camp –Session 2Session 2

You can strive and You can strive and thrive with diabetesthrive with diabetes

WelcomeWelcome

Survival Camp TopicsSurvival Camp TopicsTraining 2Training 2

Calibrate your Diabetes CompassCalibrate your Diabetes Compass Boots are made for Walking!Boots are made for Walking! Medications and InsulinMedications and Insulin

Diabetes ABC’sDiabetes ABC’s

AA 1c 1c

BB lood Pressure lood Pressure

CC holesterol holesterol

A1C Blood TestA1C Blood Test

A1c and Mean Plasma GlucoseA1c and Mean Plasma Glucose

A1c (%)A1c (%) Mean Plasma GlucoseMean Plasma Glucose66 12612677 15415488 18318399 2122121010 2402401111 259259

1212 345345

American Diabetes Association 2008American Diabetes Association 2008

Know Your Know Your Check every 3 - 6 monthsCheck every 3 - 6 months

A1cA1cLess than 7%Less than 7%

Glucose Goals – Glucose Goals – How do we Get there?How do we Get there?

TestTest Pre-meal blood sugarPre-meal blood sugar 1-2 hours after meal blood sugar1-2 hours after meal blood sugar

Goal Goal 70 – 13070 – 130 Less than 180Less than 180

• Healthy Eating

• Exercise

• Medication / Insulin

• Monitoring

Keep Your Blood Keep Your Blood Pressure In CheckPressure In Check

UKPDS Blood Pressure FindingsUKPDS Blood Pressure Findings

By controlling your blood By controlling your blood pressure you reduce your risk pressure you reduce your risk of:of:Heart failure (56%)Heart failure (56%)Stroke (44%)Stroke (44%)Death from diabetes (32%)Death from diabetes (32%)

Blood Pressure Blood Pressure GoalGoal

Less than Less than

140 / 80 140 / 80

(check each (check each office visitoffice visit))

Blood Fat (Cholesterol Blood Fat (Cholesterol Goals)Goals)

Cholesterol Levels: Cholesterol Levels:

Check once a yearCheck once a year LDL (lousy cholesterol) less than 100LDL (lousy cholesterol) less than 100

Less than 70 with heart diseaseLess than 70 with heart disease HDL (happy cholesterol) more than 40HDL (happy cholesterol) more than 40 Triglycerides (bad fat) less than 150Triglycerides (bad fat) less than 150

Diabetes ABC’sDiabetes ABC’s

AA 1c 1c (less than 7%)(less than 7%)

BB lood Pressure lood Pressure (140/80)(140/80)

CC holesterol holesterol (LDL <100, HDL > 40, Trig < 150)(LDL <100, HDL > 40, Trig < 150)

How are you Kidneys How are you Kidneys Working?Working?

CreatinineCreatinine - a simple blood test to - a simple blood test to check your kidneys. Normal is less check your kidneys. Normal is less than 1.5.than 1.5.

GFR- Glomerular Filtration RateGFR- Glomerular Filtration Rate – – how well your kidneys are working. how well your kidneys are working. Goal is more than 60Goal is more than 60 Talk to your doctor if less than 60Talk to your doctor if less than 60

Flu Shot and Pneumonia Flu Shot and Pneumonia VaccineVaccine

If you have diabetes, you are If you have diabetes, you are more likely to get the flu.more likely to get the flu.

Sign up for your flu shot in Sign up for your flu shot in September.September.

Ask your doctor if you should Ask your doctor if you should also get a pneumonia also get a pneumonia vaccine.vaccine.

Dental CareDental Care

mouth infections more mouth infections more commoncommon

flushing, brushing, flushing, brushing, regular check-ups regular check-ups important!important!

See your dentist at See your dentist at least every 6 months.least every 6 months.

Schedule Regular Schedule Regular Visits with Diabetes Visits with Diabetes

Care ProvidersCare Providers

Mr. Jones -What Should We Mr. Jones -What Should We Do?Do?

64 yr old with type 2 with 64 yr old with type 2 with heart problemsheart problems

Labs:Labs: A1c 9.3%A1c 9.3% HDL 41mg/dlHDL 41mg/dl LDL 156 mg/dlLDL 156 mg/dl Triglyceride 260mg/dlTriglyceride 260mg/dl Last eye exam, 1992 Last eye exam, 1992 B/P 142/92B/P 142/92

Self-Care SkillsSelf-Care Skills Walks dog around Walks dog around

block 3 x’s a weekblock 3 x’s a week Bowls every FridayBowls every Friday 3 bottles of beer 3 bottles of beer

dailydaily Widowed, so usually Widowed, so usually

eats outeats out 15 lbs overweight15 lbs overweight

You Can Survive and Thrive You Can Survive and Thrive with Diabeteswith Diabetes

StepsSteps A1c less than 7%A1c less than 7% Get blood pressure to goalGet blood pressure to goal Get lipids to goalGet lipids to goal Get activeGet active Stop SmokingStop Smoking Partner with your health care teamPartner with your health care team Attend our support groupAttend our support group

Adopt a Healthy Adopt a Healthy LifestyleLifestyle

Boots are Boots are Made for Made for WalkingWalking

Good News About Physical Good News About Physical ActivityActivity

Physical Activity: Keep It Physical Activity: Keep It FunFun

Activity Activity PyramidPyramid

Success with ExerciseSuccess with Exercise

What kind of activities count as exercise?What kind of activities count as exercise?What are some barriers to exercise?What are some barriers to exercise?How do you succeed with exercise?How do you succeed with exercise?

Set a Realistic Set a Realistic Exercise GoalExercise Goal

Set a realistic starting goal for YOUSet a realistic starting goal for YOU3 ten minute segments a day3 ten minute segments a dayLong term goal – 30 min’s, 5 days a Long term goal – 30 min’s, 5 days a

weekweekStart slow, increase gradually, listen Start slow, increase gradually, listen

to your body, do not overdo to your body, do not overdo Drink water before, during and afterDrink water before, during and after

Physical Activity Can Lead to Physical Activity Can Lead to Low Blood Glucose Low Blood Glucose

(Hypoglycemia)(Hypoglycemia)

Tips for Safe Physical Tips for Safe Physical ActivityActivity

Exercising SafelyExercising Safely

Let someone know your routeLet someone know your routeTalk/Walk TestTalk/Walk TestEffects of exercise/activity can last 24-48 Effects of exercise/activity can last 24-48

hourshoursKeep in contact with your doctor for Keep in contact with your doctor for

medication changes (blood sugars may medication changes (blood sugars may decrease)decrease)

Exercise is RestorativeExercise is Restorative

Regular physical Regular physical activity reduces activity reduces your risk of many your risk of many chronic diseases chronic diseases and improves your and improves your overall quality of overall quality of life.life.

Medications andMedications andInsulinInsulin

Your survival tools.Your survival tools.

MedicationsMedications

Oral Diabetes Agents:Oral Diabetes Agents:

Diabetes medications can be used Diabetes medications can be used by themselves, with other by themselves, with other medications or with insulinmedications or with insulin

Using different types of Using different types of medications together may work medications together may work better. better.

Most lower A1c 0.5 - 1.5% Most lower A1c 0.5 - 1.5%

Most Common Medications Most Common Medications for Type 2 for Type 2

1. Increase insulin release from pancreas1. Increase insulin release from pancreas

2. Decrease sugar release from liver2. Decrease sugar release from liver

3. Make your own insulin work better3. Make your own insulin work better

4. Makes you feel fuller4. Makes you feel fuller

5. Tell your kidneys to release sugar 5. Tell your kidneys to release sugar

Oral Medications Oral Medications for Type 2 for Type 2 Diabetes: Diabetes:

SulfonylureasSulfonylureas

Oral Medications Oral Medications for Type 2 for Type 2 Diabetes: Diabetes:

BiguanidesBiguanides

Oral Medications Oral Medications for Type 2 for Type 2

Diabetes: Insulin Diabetes: Insulin SensitizersSensitizers

Human Gut HormonesHuman Gut Hormones

Liverreduces glucose

production

Brain

promotes satiety and reduction of appetite

Stomach slows emptying

Beta cellstimulates insulin secretion

Alpha cellblocks glucagon secretion

Diabetes = 50% Less Gut Diabetes = 50% Less Gut HormoneHormone

Protect what you do Protect what you do havehave

JanuviaJanuviaOnglyzaOnglyzaTradjentaTradjentaNesinaNesina

Inject Synthetic Gut Inject Synthetic Gut HormoneHormone

ByettaByettaVictoza Victoza BydureonBydureon

5. New Diabetes 5. New Diabetes Medications that make you Medications that make you

feel “fuller”feel “fuller”Incretin MimeticsIncretin Mimetics

Exenatide (Byetta)Exenatide (Byetta) Liraglutide (Victoza)Liraglutide (Victoza)

DPP-4 InhibitorDPP-4 Inhibitor Januvia (sitagliptin)Januvia (sitagliptin) Onglyza (saxagliptin)Onglyza (saxagliptin)

AmylinomimeticsAmylinomimetics Pramlintide (Symlin)Pramlintide (Symlin)

Gut Hormone Replacement Gut Hormone Replacement Exenatide and LiraglutideExenatide and Liraglutide

Most common side effectsMost common side effects Nausea, vomiting, diarrhea, dizziness, Nausea, vomiting, diarrhea, dizziness,

headache, feeling jittery, and acid headache, feeling jittery, and acid stomachstomach

Nausea is most common when first Nausea is most common when first starting but decreases over time in most starting but decreases over time in most patientspatients

Reduced appetiteReduced appetite Report any abdominal painReport any abdominal pain

DPP-IV Inhibitors – DPP-IV Inhibitors – Januvia and OnglyzaJanuvia and Onglyza

Januvia (sitagliptin)Januvia (sitagliptin)Onglyza (saxagliptin)Onglyza (saxagliptin)

Lowers blood glucoses by increasing amount Lowers blood glucoses by increasing amount of gut hormone in your systemof gut hormone in your system

Januvia dose is 100 mg a dayJanuvia dose is 100 mg a day Onglyza dose is up to 5 mg a dayOnglyza dose is up to 5 mg a day Side effects: Can cause headache and flu like Side effects: Can cause headache and flu like

symptoms. Take lower dose if have kidney symptoms. Take lower dose if have kidney problemsproblems

Right Medication for YouRight Medication for You

Work with your health care team to Work with your health care team to determine which medications and/or determine which medications and/or combinations of medications are right for combinations of medications are right for you.you.

Consider:Consider: Blood sugar effectBlood sugar effect Other side effectsOther side effects Ease of use for YOUEase of use for YOU

Diabetes Diabetes MedicationsMedications

Invention of Insulin 1921Invention of Insulin 1921

The first stills used to make insulin (early-mid 1920's).

InsulinInsulin(µU/mL)(µU/mL)

GlucoseGlucose(mg/dL)(mg/dL)

Physiologic Insulin Secretion: Physiologic Insulin Secretion: 24-Hour Profile 24-Hour Profile

150150

100100

5050

0077 88 99 1010 1111 1212 11 22 33 44 55 66 77 88 99

A.M.A.M. P.M.P.M.

Basal GlucoseBasal Glucose

TimeTime of Dayof Day

5050

2525

00 Basal InsulinBasal Insulin

Breakfast Lunch DinnerBreakfast Lunch Dinner

Meal InsulinMeal Insulin

Meal GlucoseMeal Glucose

Insulin Action CategoriesInsulin Action CategoriesBolus: lowers after meal glucose levels

Rapid Acting Rapid Acting Aspart, Lispro, GlulisineAspart, Lispro, Glulisine

Short ActingShort Acting RegularRegular

Basal: controls glucose between meals, hs Intermediate Intermediate

NPHNPH Long Acting Long Acting

Detemir (Levemir)Detemir (Levemir) Glargine (Lantus)Glargine (Lantus)

Insulin Injection Insulin Injection SitesSites

Insulin Needles and PensInsulin Needles and Pens

Care for Insulin and Care for Insulin and NeedlesNeedles

Safe Disposal of Syringes Safe Disposal of Syringes and Lancetsand LancetsTake to Hazardous Waste Collection SiteTake to Hazardous Waste Collection Site

In ParadiseIn Paradise - 920 American Way (near Clark Rd.) - 920 American Way (near Clark Rd.)

Monday- Friday, Hours-8am – 5pm. Phone 876-Monday- Friday, Hours-8am – 5pm. Phone 876-3340 3340

In ChicoIn Chico - 1101 Marauder Street (near the airport) - 1101 Marauder Street (near the airport)

Hours – 9am – 1pm on Friday and 9-4pm on Hours – 9am – 1pm on Friday and 9-4pm on Saturday Saturday

More info - Call (866) 429-2288 More info - Call (866) 429-2288

Or Get BD Safe ClipOr Get BD Safe Clip