Managing Diabetes: Managing Diabetes:

How to help yourself and How to help yourself and your familyyour family

ObjectivesState a difference in Type 1 vs. Type 2

diabetesState 3 ways to prevent diabetesUnderstand the purpose of blood sugar

monitoring

National Diabetes Fact Sheet 23.6 Million people (8% of the U.S. population)

have diabetes57 Million people have pre-diabetes

Risk of death is 2 x that of people similar age without diabetes

Heart disease and stroke account for 65% of those deaths

#1 Cause of adult blindness (20 to 74 year old)#1 Cause of end-stage renal disease#1 Cause of non-traumatic lower limb amputation

Obesity will make today's kids die younger

Life expectancy is decreasing

1 out of 3 children born after 2000 will get diabetes

What will you do to change the course?

The Perfect Storm Hit Hard!

Toxic food environment of :Cheap, fatty foodHighly caloric drinks (soda, juices,

gatorade, energy drinks)Gigantic portionsProcessed, “boxed” foodsPervasive food advertising Sedentary lifestyles

Risk Factors for Diabetes Heredity Age (>45) Race and Ethnicity

(Alaska native, Hispanic-American, Pacific Islander,

African-American)

Gestational diabetes or delivering a baby >9 pounds

Being overweight Sedentary lifestyle Waist CircumferenceAcanthosis Nigricans – darkening of the skin (at folds)

Acanthosis NigricansDevelops mainly from high insulin levelsThis means your body is having to work really

hard to process your blood sugar.This is a sign that you may be at risk for

diabetes

armpit neck

How Does Family History Affect Your Risk of Diabetes?

Type 1 Type 2

Relative w/ diabetes

Your estimated risk

Relative w/ diabetes

Your estimated risk

Mother

Father

Both parents

Sibling

Identical twin

1% - 5%

5% - 15%

10% - 25%

5% - 10%

25% – 50%

Mother

Father

Both parents

Sibling

Identical twin

5% - 20%

5% - 20%

25% - 50%

25% - 50%

60% - 75%

Signs and SymptomsFrequent UrinationExcessive ThirstDry, Itchy SkinWeight Loss/GainBlurred VisionFatigueTingling/Numbness in fingers/toesFrequent Infections or sores that don’t heal

Type 1Autoimmune DiseaseTypically develops in people <30 years oldCan be triggered by virus or traumaBody does not produce insulin, insulin shots

are required.Type 1 is not caused by eating too much

sugar.

Type 2Related to body weight and lifestyleFamily historyCan be controlled with diet/exercise, and/or

oral meds, and/or insulin.Can develop at any age, typically seen at

ages of >45 years old.

Pathophysiology of Type 2 Diabetes

GlucoseGlucose

Cells in the Cells in the Pancreas get Pancreas get

“tired” and have “tired” and have trouble making trouble making

insulininsulin

Sometimes the cells in the body are resistant to insulinSometimes the cells in the body are resistant to insulin

Dinneen SF. Diabet Med. 1997; 14 (Suppl 3): S19-24.

1. You eat food and some turns to glucose (sugar)

2. The sugar goes to the blood vessel

3. The pancreas makes insulin to get the glucose into your cells.

How do we fix it?Sometimes your doctor will give you

medicines to help your pancreas make more insulin or help your cells open up to accept the sugar

Eat smaller amounts of foods that turn to sugar. If you eat less, it’s less sugar to process at one time.

Exercise is a natural medicine! It will help the sugar get out of the blood and into your cells.

Hemoglobin A1CA weighted mean (average) of your last 60-90

days of blood glucoseMeasures how much sugar has attached to

the red blood cells and is reported in % formACE guidelines - <6.5% goal for diabetesADA guidelines - <7% goal for diabetesNormal is ~4-6%

Blood Glucose MonitoringWhen to check

ACE ADA

Fasting or pre-meal

<110mg/dl <130mg/dl

2 hours post- meal

<140mg/dl <180mg/dl

A1C <6.5% <7%

Blood Sugar MonitoringA way for YOU to see if your blood sugar is

under controlCheck before a meal, 2 hours after a meal,

before bed, or when you wake up.If your blood sugars are high, check more

often.

Short Term ComplicationsHypoglycemia

Too much medsMore exercise than normalToo little food to match meds

HyperglycemiaForgot medsStressIllnessToo much food, not enough exercise

Long Term ComplicationsRetionopathy – eye diseaseNephropathy – kidney disease

Heart attacks and StrokeNeuropathy – nerve damage

Sexual ProblemsPain in hands, feet, legsgastroparesis

What can people do to live a healthy life with diabetes?Check blood sugar regularlyExercise regularlyHealthy food choicesTake medications as prescribedSee doctors regularly and get labs checked

Eye, heart, diabetes, internal med, therapistAttend a diabetes education class or

individual sessions with a CDE

Jane Doe

Patient Signature:

TimingEat SOMETHING

within one hour of getting up

Eat about every 4 hours

Smaller, more frequent meals is the key

Time

Blo

od

Su

gar

Smaller portions of food, spread out = smaller rise in

blood sugar

Non-starchy Vegetables(No effect blood sugar)

Grains, Beans & Starchy Vegetables

(100% effect on blood sugar)

Lean Protein(No effect on Blood Sugar)

TOFU

• Serving Size?• Grams of

Total Carbohydrate?

• Number of carbohydrate servings?

MedicationsUnderstand proper times to take themUnderstand side effectsUnderstand the same meds will not work for

a lifetimeAbout half of patients with diabetes type 2

will need insulin at some pointTell your doctor about any natural herbs,

plants, or supplements you use for your health.

DepressionHave you lost interest in things you used to

enjoy?Do you have difficulty making decisions?Have the pleasure and joy have gone out of

your life?Do you feel sad, blue, and unhappy?

Questions???

http://www.anthc.org/anmc/services/diabetes/2010-november-diabetes-month.cfm

Presentation by:Angela Manderfeld, MS, RD, CDE, LD

Diabetes Nutrition ConsultantAlaska Native Tribal Health Consortium

Phone (907) 729-1128Fax (907) 729-1129

 Mailing Address:

Alaska Native Medical Center (DIA)4315 Diplomacy Dr.

Anchorage, AK 99508