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Open Mic: Cara Harris NP,CDE Certified Diabetes

EducatorWellness Services

The OSU Health PlanMarch 2012

• Overview of Diabetes • Treatments• Prevention• Nutrition• Exercise • Resources • Questions

Diabetes Around the World

The number of people with diabetes worldwide is expected to increase alarmingly in the coming decades

This increase is projected to occur as a result of:• Population ageing• Unhealthy diet• Obesity• Sedentary lifestyle• Socio-economic realities• Urbanization, and economic development

2008

Obesity and Diabetes Trends in the USObesity and Diabetes Trends in the US

Obesity (BMI ≥30 kg/m2)

Diabetes

1994

1994

2000

2000

No Data <14.0% 14.0-17.9% 18.0-21.9% 22.0-25.9% >26.0%

No Data <4.5% 4.5-5.9% 6.0-7.4% 7.5-8.9% >9.0%

CDC’s Division of Diabetes Translation. National Diabetes Surveillance System available at http://www.cdc.gov/diabetes/statistics

2008

Types of DiabetesType 1: insulin required for survival due to lack of insulin

produced by the body – 10%

Type 2: most common form of diabetes • Occurs when the body cannot properly use the insulin that

is produced - or• Insulin that is produced is not enough to properly handle

bodies needs -90%

• Gestational: Can occur in pregnant women who do not already have diabetes

http://professional.diabetes.org/UserFiles/Insulin_The%20Movie.wmv 

INSULINThe Movie

Target Blood Glucose/A1C Level

American Diabetes Association 2011American Association of Clinical Endocrinologists 2011

INDIVIDUALIZE

10

ADA mg/dL AACE mg/dL

Pre-meal 70-130 <110Post-meal < 180 <140A1C <7 % <6.5HS 100-140Inpatient 140-180

Criteria for Diagnosis of Diabetes

Prediabetes2

(IFG or IGT)Impaired Fasting Glucose

1ADA. Diabetes Care. 2007;30(suppl 1)/2011 suppl 34

•IFG: FPG 100 and<125 mg/dL•IGT: 2-hr PG† 140 and <200 mg/dL

•FPG 126 mg/dL•2-hr PG† 200 mg/dL •Symptoms ofdiabetes and casualPG concentration

200 mg/dL

Diabetes*Normoglycemia

•FPG <100 mg/dL

•2-hr PG† <140 mg/dL

All PG values in mg/dL= Plasma Glucose*Diagnosis of diabetes must be confirmed on subsequent day by measuring FPG, 2-hr PG, or random PG (if symptoms present). FPG test commonly used because of ease of administration, convenience, acceptability to patients, and lower cost. Fasting=no caloric intake for 8 hr †This test requires glucose load containing equivalent of 75 g anhydrous glucose dissolved in water

•HbA1c >6.5%

Diabetes Risk Factors

• Older age• Being overweight• Family history of diabetes• Lack of physical exercise

Everyone should be aware of the risk factors for Type 2 Diabetes

•Prior history of gestational diabetes

•Race/ethnicity•Stress

Worse abdominalWaist fat

Counting the Costs

The costs add up:• Direct costs to diabetics and their families• Direct costs to healthcare sector• Indirect costs to society• Psychosocial costs

III.2

Preventing DiabetesFocus on Risk Factors

• Not modifiable– Genetic factors– Family history

• Modifiable– Hyperglycemia– Hypertension– Dyslipidemia– Smoking– Obesity– Physical inactivity

What can you do to prevent Diabetes

• Be More Active– Watch Less

TV/Video– Get up and move– 10,000 steps/day

• Eat a balanced Diet– Fresh fruits and

veggies- Include

carbohydrates, protein and fat

- Not recommended to cut out food groups

HEALTHY EATINGDIET AND NUTRITION

Size does make a difference!

Since carbohydrates raise blood glucose the most …

… that’s what we focus on most with Diabetic patients

Dietary Components6 FOOD GROUPS• Starches• Fruits• Milk• Vegetables• Meats• Fats and Sweets

NUTRIENTS• Macronutrients

(contain calories)– Carbohydrates– Protein– Fat

• Micronutrients– Vitamins– Minerals

• Alcohol

Examples of Carbohydrates• Starches, Cereals & Grains

– Breads, pasta, rice • Starchy Vegetables

– Beans, legumes, potatoes, corn, peas• Fruits & Fruit Juices

– Dried fruits, fresh fruits• Dairy

– Milk, yogurt, soy milk• Sweets & Snacks (smile)

– Ice cream, cake, cookies, crackers, chips– soda, sugar drinks

6 FOOD GROUPSStarches

FruitsMilk

VegetablesMeats

Fats and Sweets

What can I eat if I have diabetes?• Eat lots of vegetables and fruits.

-Try picking from the rainbow of colors available to maximize variety. • Eat non-starchy vegetables

– spinach, carrots, broccoli, green beans vs. corn, potatoes. • Choose whole grain foods over processed grain products.

– brown rice or whole wheat spaghetti. . • Include fish in meals 2-3 times a week. • Choose lean meats

– beef and pork "loin". Remove the skin from chicken and turkey. • Choose non-fat dairy

– skim milk, non-fat yogurt and non-fat cheese. • Choose liquid oils for cooking

– instead of solid fats (high in saturated and trans fats)– Remember that fats are high in calories. If you're trying to lose

weight, watch your portion sizes of added fats.

KEY MESSAGEMeal Plan for Diabetics• Carbohydrates raise blood sugar most• Eat 3 balanced meals per day• Avoid skipping meals• Moderation – Avoid seconds• Use a small plate• Steam vs. Fry• Choose diet drinks or water• Encourage not to snack• Keep sugar and added fats to a

minimum

PHYSICAL ACTIVITYEXERCISE

Diabetes and Lifestyle

Lifestyle changes can mean the difference between developing diabetes or not

• Sedentary living, unhealthy dietary patterns, obesity, lack of exercise and socio-economic pressures all contribute to the development of diabetes

• Make a commitment to a healthy lifestyle and you will not only reduce the risk of developing type 2 diabetes, but will also enjoy a much better quality of life!

Exercise Recommendations for general public:Exercise Recommendations for general public:

All adults should accumulate at least 30 minutes of at least moderate intensity physical activity each day

Equivalent to walking about 1.5 miles at a pace of 3-4 mph (brisk walk)

More exercise and perhaps more strenuous exercise may produce additional health benefits

Resistance and flexibility exercises provides health benefits

• Flexibility training (stretching) may be included as part of a PA program, although it should not substitute for other training. – Older adults – increasing joint range of motion (ROM) – reducing risk of injury

• At least twice weekly on nonconsecutive days – Ideally three times a week

• as part of a PA program for individuals with T2DM

• 30 - 60 minutes

• Minimally include 5-10 exercises – major muscle groups (upper & lower body, with

regular aerobic activities.

1. Scheduled physical activity a. Walking, treadmill, jogging, walking dog b. Swimming, biking, volleyball c. Resistant training and stretching

2. Lifestyle physical activity a. Walk more stairs at work, walking for

errands, parking farther away in parking lots

b. Housework, gardening

DiabetesSummary and

Resources

•A healthy lifestyle means combining a balanced diet with regular physical activity for good blood glucose control

•Everyone with diabetes has the potential to lead a normal and active life by learning to manage their condition

A healthy lifestyle, like everything else in diabetes, is essentially about balance

III.16

Diabetes and Lifestyle

RESOURCESOSUMC DRC EDUCATION CLASSES• Group & individual education for Type 1 diabetes, Type 2

diabetes, and pre-diabetes.• Diabetes Technology Classes on insulin pumps and continuous

glucose monitors.• To attend a diabetes class call (614) 292-3800

RESEARCH STUDIES• The Diabetes Research Center is actively recruiting for the

following studies/trials: • TECOS Study: age 50 or older, diagnosis of type 2 diabetes and

heart disease

• SPRINT Trial: age 50 or older, diagnosis of high blood pressure, no stroke or diabetes.

• To see if you qualify for a research study call 1-(800)-678-6156

RESOURCESSUPPORT GROUP• Meetings are held every third Tuesday of the

month from 6:00-7:00pm.• Located at Care Point East, Diabetes Research

Center, 543 Taylor Ave, Room 3053.

WEB-BASED COMMUNICATION• Like our Facebook Page! “Diabetes Research

Center at Ohio State”• Learn more at

www.diabetesresearch.osu.edu/patientcare/classes/index.com

OTHER RESOURCES• The Learn Program for Weight Management and

Nutrition• Ohio State’s Center for Wellness and Prevention is

offering group personal training sessions • Cardiac or Pulmonary Rehab Programs• Referral Questions 293-5123• Updated physician referral guides:

medicalcenter.osu.edu/referringphysicians • Or guides from Physician Relations 293-4326

Thank you, Thank you very much

Cara Harris NP,CDECara.Harris@osumc.edu

Call (614)292-4700 TODAY to learn more

about Care Coordination or Health

Coaching!