four steps to control diabetes

4 Steps to Control Diabetes for Life

Beverly ThomassianBeverly Thomassian

Diabetes Nurse for a really long timeDiabetes Nurse for a really long time

Goals for Tonight

The state of diabetes The state of diabetes

What is diabetes?What is diabetes?If you have pre diabetes or diabetes, If you have pre diabetes or diabetes, what can you do to increase your what can you do to increase your healthspan?healthspan?Getting the most out of your doctor or Getting the most out of your doctor or provider visit.provider visit.

Step 1Learn about Learn about DiabetesDiabetes

C D C A n n o u n c e s

1 in 3 Americans 1 in 3 Americans may have may have Diabetes by Diabetes by

20502050Boyle, Thompson, Barker, Williamson Boyle, Thompson, Barker, Williamson

2010, Oct 22:8(1)292010, Oct 22:8(1)29

www.pophealthmetrics.cowww.pophealthmetrics.comm

Diabetes in America 201126 > 26 > 2828 million or 8% > million or 8% > 8.3%8.3%79 million have pre diabetes79 million have pre diabetes

New cases increased New cases increased 90%90% in past 10 years. in past 10 years. 4.8 per 1,000 people during 1995-1997 to 4.8 per 1,000 people during 1995-1997 to

9.1 per 1,000 in 2005-2007 in 33 states.9.1 per 1,000 in 2005-2007 in 33 states. CDC 2011CDC 2011

• 34% BMI 30 +, 34% BMI 25-2934% BMI 30 +, 34% BMI 25-29• We burn 100 cals less a day at workWe burn 100 cals less a day at work• 1/3 of all overwt people don’t get diabetes1/3 of all overwt people don’t get diabetes

Diabetes 2 - Who is at Risk? (ADA Clinical Practice Guidelines)

Testing should be considered in all adults Testing should be considered in all adults who are overweight (BMI who are overweight (BMI ≥≥ 25) and have 25) and have additional additional risk factorsrisk factors::

First-degree relative w/ diabetesFirst-degree relative w/ diabetesMember of a high-risk ethnic Member of a high-risk ethnic populationpopulationHabitual physical inactivityHabitual physical inactivityPreDiabetes PreDiabetes History of heart diseaseHistory of heart disease

Diabetes 2 - Who is at Risk? (ADA Clinical Practice Guidelines)

Risk factors cont’dRisk factors cont’d

HTN - BP > 140/90HTN - BP > 140/90HDL < 35 or triglycerides > 250HDL < 35 or triglycerides > 250baby >9 lb or history of Gestational baby >9 lb or history of Gestational Diabetes Mellitus (GDMDiabetes Mellitus (GDMPolycystic ovary syndrome (PCOS)Polycystic ovary syndrome (PCOS)Other conditions assoc w/ insulin resistance:Other conditions assoc w/ insulin resistance:

Severe obesity, acanthosis nigricans (AN)Severe obesity, acanthosis nigricans (AN)

Natural History of Diabetes

Development of type 2 diabetes happens over years or decades

Yes! NO

Can we stop the progression?

Insulin Resistance ➪Pre Diabetes ➪

Diabetes ➪ and what about

cardiovascular risk factors?

Preventing Pre Diabetes

Can Type 2 be Prevented in Older Adults?

Overall, 9 of 10 new Overall, 9 of 10 new cases of diabetes cases of diabetes attributableattributable to these to these 5 lifestyle factors.5 lifestyle factors.

89% risk reduction 89% risk reduction when all at goal.when all at goal.

35% rel risk reduction 35% rel risk reduction for each additionalfor each additional

• Physical activity (30 mins a day)• Dietary score (higher fiber intake, low saturated fat and trans-fat, lower mean

glycemic index)• Not Smoking• Alcohol use (up to 2 drinks a day); • BMI <25 and waist circumference

Dariush Mozaffarian, MD, Arch Intern Med. 2009;169(8):798-807.

The Good News About Diabetes

Step 2Know your Know your ABC’sABC’s

Why bother? Blood sugars matter!

Every 1 point drop in AEvery 1 point drop in A11c causes a c causes a 35% decrease in diabetes problems35% decrease in diabetes problemsInsulin and pills work equally wellInsulin and pills work equally wellKeep your pancreas happy. Keep your pancreas happy. It’s worth it!It’s worth it!

A1C Blood Test

A1c and Estimated Avg Glucose (eAG) 2008

A1c (%)A1c (%) eAGeAG55 97 97

66 12612677 15415488 18318399 2122121010 2402401111 269269

1212 298298

eAG = 28.7 x A1c-46.7 ~ 29 pts per 1%eAG = 28.7 x A1c-46.7 ~ 29 pts per 1%Translating the A1c Assay Into Estimated Average Glucose Values – ADAG StudyTranslating the A1c Assay Into Estimated Average Glucose Values – ADAG Study

Diabetes Care: 31, #8, August 2008Diabetes Care: 31, #8, August 2008

Order teaching tool kit free at diabetes.org

Know Your Check every 3 - 6 months

A1cA1c

Glucose Goals Targets are individualized

Before meals: 70 - 130Before meals: 70 - 130

1-2 hr after meal: less than 1801-2 hr after meal: less than 180**for nonpregnant adultsfor nonpregnant adults

Keep Your Blood Pressure In Check

UKPDS Blood Pressure Findings

By controlling your blood pressure By controlling your blood pressure you reduce your risk of: you reduce your risk of:

Heart failure (56%)Heart failure (56%)Stroke (44%)Stroke (44%)Death from diabetes (32%)Death from diabetes (32%)

Blood Pressure Goal

Less than Less than 130 / 80 130 / 80

(check each (check each office visitoffice visit))

Blood Fat (Cholesterol Goals)

Cholesterol Levels: Cholesterol Levels: Check once a yearCheck once a year

HDL (happy cholesterol) more than 40HDL (happy cholesterol) more than 40 LDL (lousy cholesterol) less than 100LDL (lousy cholesterol) less than 100Triglycerides (bad fat) less than 150Triglycerides (bad fat) less than 150

Diabetes ABC’s

AA 1c 1c

BB lood Pressure lood Pressure

CC holesterol holesterol

ABCs of Diabetes – AA1c less than 7% (avg 3 month BG)1c less than 7% (avg 3 month BG)

Pre-meal BG 70-130Pre-meal BG 70-130Post meal BG <180Post meal BG <180

BBlood Pressure < 130/80lood Pressure < 130/80

CCholesterol holesterol HDL >40HDL >40LDL <100 (if CHD, <70)LDL <100 (if CHD, <70)Triglyceride < 150Triglyceride < 150

Your Diabetes Care Team

Getting the Most out of your Doctor visit

Write down your numbers in the Write down your numbers in the back of this book –keep trackback of this book –keep trackBring your blood sugar log book Bring your blood sugar log book to each visit. Circle levels you to each visit. Circle levels you want to discuss.want to discuss.Jot down important topics to Jot down important topics to discussdiscuss

Bring someone if you have Bring someone if you have trouble remembering everything.trouble remembering everything.

Getting the Most out of your Doctor visit

Keep log of your current Keep log of your current medications on your person.medications on your person.While waiting take off While waiting take off shoes/socks.shoes/socks.

Work with the team to Work with the team to make one goal to work on make one goal to work on until next visit.until next visit.

Step 3Manage your DiabetesManage your Diabetes

Goal Ideas Eat healthier foodsEat healthier foods

Eat 3 oz portions of lean meat / fishEat 3 oz portions of lean meat / fishEat foods that have less fat and saltEat foods that have less fat and saltEat foods with more fiberEat foods with more fiber

USDA Food Pyramidwww.myplate.gov

Balancing CaloriesBalancing Calories • Enjoy your food, but eat less. Enjoy your food, but eat less. • Avoid oversized portions. Avoid oversized portions.

Foods to IncreaseFoods to Increase Make half your plate fruits and vegetables. Make half your plate fruits and vegetables. Make at least half your grains whole grains. Make at least half your grains whole grains. Switch to fat-free or low-fat (1%) milk. Switch to fat-free or low-fat (1%) milk.

Foods to ReduceFoods to Reduce Compare sodium in foods like soup, bread, and Compare sodium in foods like soup, bread, and frozen meals ― and choose the foods with lower frozen meals ― and choose the foods with lower numbers. numbers.

Drink water instead of sugary drinks.Drink water instead of sugary drinks.

Foods that do not raise blood sugar

o VegetablesVegetableso MeatMeato FatFato ““Free” foodsFree” foods

Don’t limit the Vegetables o Non-starchy vegetable categoryNon-starchy vegetable categoryo Contains about 5 gm carb per servingContains about 5 gm carb per serving

o But much of the carb comes from fiberBut much of the carb comes from fiber

Not digestedNot digested

Has minimal affect blood sugar*Has minimal affect blood sugar*

Helps to keep us fullHelps to keep us full

Aim for 25-35 gm fiber dailyAim for 25-35 gm fiber daily

Go Lean with Proteino Choose lean proteinChoose lean protein

Poultry, fish, egg, lean beefPoultry, fish, egg, lean beefPlant sources- beans, lentils, nutsPlant sources- beans, lentils, nutsLow fat cheese- cottage cheese, mozzarella Low fat cheese- cottage cheese, mozzarella cheesecheese

o Limit high fat proteinLimit high fat proteinBacon & sausageBacon & sausageHigh fat cuts of beefHigh fat cuts of beefWhole milk cheeseWhole milk cheese

o Serving sizeServing sizeo 1 oz = ¼ cup1 oz = ¼ cupo 3 oz = deck of cards3 oz = deck of cards

Fats- Aim for heart healtho MonounsaturatedMonounsaturated

o Olive & canola oilsOlive & canola oilso NutsNutso AvocadoAvocado

o PolyunsaturatedPolyunsaturatedveg oils: canola, corn, veg oils: canola, corn,

walnut, safflower, walnut, safflower, soybeansoybean

Saturated fatsSaturated fats ( (LIMITLIMIT))o SolidSolido Animal Animal o Tropical (palm, coconut)Tropical (palm, coconut)o Trans fats (deep fried)Trans fats (deep fried)

Serving sizesServing sizeso 1 tsp butter, margarine, 1 tsp butter, margarine,

oil, mayonnaiseoil, mayonnaiseo 1 Tbsp salad dressing, 1 Tbsp salad dressing,

cream cheese, seedscream cheese, seedso 2 Tbsp avocado, cream, 2 Tbsp avocado, cream,

sour creamsour creamo 1 slice bacon1 slice bacon

Goal Ideas – Get more activeGet more active

Ask for help if you feel downAsk for help if you feel downLearn to cope with stressLearn to cope with stressStop smokingStop smoking

Check your feet everydayCheck your feet everyday

Other stuff to do…Brush and floss dailyBrush and floss daily

Check your blood glucose Check your blood glucose Check your blood pressureCheck your blood pressureReport changes in eyesight right away.Report changes in eyesight right away.

Step 4Get Routine CareGet Routine Care

Schedule Regular Visits with Diabetes Care

Providers

Which Famous Person with Type 2 Diabetes?

“Too much of a good thing is wonderful?”

Mae West - lived into her 80’s

Thank You!