kōkua kalihi valley comprehensive family services the ulu ...€¦ · type 2 diabetes most common...
TRANSCRIPT
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Made possible by: Kōkua Kalihi Valley Comprehensive Family Services
& the ‘Ulu Network
Developed by Sheryl R Yoshimura, RD
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Topics covered:
Overview of Diabetes Diabetes Goals
Diabetes Self-management
Problem Solving Goal Setting &
Action Planning
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Thoughts and Feelings about Diabetes What have you heard about diabetes?
How did you feel when you were first diagnosed with diabetes?
Were you surprised to learn you had diabetes? Why/Why not?
What types of diabetes have you heard about?
What concerns do you have?
What’s the most difficult thing for you?
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Risk Factors for Developing Type 2 Diabetes Pre-diabetes
A1c: 5.7-6.4 Fasting Blood sugar: 100-125
Metabolic Syndrome Obesity, particularly around your
waist (having an "apple shape") Insulin Resistance (next slide) Low HDL High Triglycerides High blood pressure
Polycystic Ovarian Syndrome (PCOS)
Overweight or obese (BMI>25 or BMI >23—Asians)
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Most often, acanthosis nigricans affects your armpits, groin and neck.
Acanthosis Nigricans (Insulin Resistance)
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Risk Factors for Developing Type 2 Diabetes
Sedentary lifestyle
Stressful lifestyle
Age over 45 years
History of gestational diabetes
Delivering over 9 lbs baby
Ethnicity (Native Hawaiians, Pacific Islanders, Filipinos, Japanese)
Family history of diabetes
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Symptoms of Diabetes
Sometimes NO symptoms at all
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Diabetes - Defined Diabetes is a chronic
disease marked by high levels of blood glucose (sugar) due to your body not having enough insulin or your body is not using the insulin properly or both.
Insulin – hormone
produced by the pancreas
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How Insulin is related to blood sugar?
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Insulin Action
1. Food enters stomach 5. Receptors
unlocked by Insulin
4. Pancreas releases insulin
2. Food is converted into glucose
3. Glucose enters bloodstream
6. Glucose enters cell
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What happens if you have diabetes?
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Insulin Action in Diabetes
1. Food enters stomach
5. Receptors unlocked by Insulin
4. Pancreas releases insulin
2. Food is converted into glucose
3. Glucose enters bloodstream
6. Glucose cannot enter cell
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Skipping meals can make your blood sugar go up!
Blood glucose is the same as blood sugar!
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Diabetes is a lifelong condition! Total: 25.8 million children and adults
in the United States—8.3% of the population—have diabetes. Diagnosed: 18.8 million people
Undiagnosed: 7.0 million people
Prediabetes: 79 million people*
2010 data
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More facts on diabetes Over 100 thousand people in Hawai‘i have
diabetes today. Asian Americans & Pacific Islanders have some
of the highest risks for developing diabetes.
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Types of Diabetes
1. Type 1 Diabetes
2. Type 2 Diabetes Pre-diabetes
3. Gestational Diabetes
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19
The body does NOT produce insulin
Requires insulin injections
Type 1 Diabetes Usually diagnosed in
children and young adults
Autoimmune Disease Genetic Environment
National Institutes of Health, 2001 & National Diabetes Fact Sheet, 2007
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20
Type 2 Diabetes Most common
form of diabetes Accounts for 90% -
95% of all diagnosed cases of diabetes
The body does not produce enough insulin OR the cells ignore the insulin
National Institutes of Health, 2001 & National Diabetes Fact Sheet, 2007
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Pre-Diabetes
Aka “borderline” diabetes, IFG or IGT
Insulin resistance
100 mg/dl ≥ blood sugar > 125 mg/dl1
Lifestyle changes
Type 2 diabetes is still preventable
TAKE ACTION BEFORE DAMAGE IS DONE!!!
1 American Diabetes Association, www.diabetes.org
* Numbers for fasting glucose test*
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Gestational Diabetes
Develops during pregnancy Develops in 7% of all
pregnancies Diagnosed between 24 – 28
weeks Increased risk for type 2 diabetes
5% to 10% diagnosed within 1st year after pregnancy
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Why is having control of your diabetes so important?
To prevent symptoms of high & low blood sugar,
which lead to chronic & acute complications.
To prevent infections & illness
To decrease the risks of complications to blood & nerves
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Hyperglycemia (high blood sugar) Symptoms
Blurred vision
Drowsiness
Frequent urination & decreased wound healing
Extreme thirst
Dry, itchy
skin
Hunger
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Hypoglycemia (low blood sugar) Symptoms
Shaking Sweating Anxious Dizziness Hunger
Impaired vision
Weakness Fatigue
Headache Irritable Fast heartbeat
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Complications of Uncontrolled Diabetes Blindness & Stroke & Mental health Teeth & Gum Disease
Heart Disease
Kidney Disease
Sexual Dysfunction
Nerve Problems
Feet & Skin Problems
Blood Vessel Problems
Gastroparesis
• Death
• Amputations
• Kidney disease
• Infections
• Nerve damage
• Eye disease
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Complications of Uncontrolled Diabetes
Gastroparesis
Signs and symptoms: •Vomiting •Nausea •A feeling of fullness after eating just a few bites •Abdominal bloating •Heartburn or gastroesophageal reflux •Changes in blood sugar levels •Lack of appetite •Weight loss and malnutrition
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Common wrong ideas about diabetes:
Diabetes is curable. Diabetes is ONLY a problem if you feel bad or
sick.
There is nothing you can do about having diabetes.
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Taking care of your diabetes Blood Sugar Goals
Before Meals: 70 to 130
2 hours after starting a meal: Less than 180
Hemoglobin A1c: <7
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Taking care of your diabetes Goals
Blood Pressure: less than 130/80
HDL Cholesterol (good cholesterol) Over 60
LDL Cholesterol: less than 70
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Goals of diabetes control Keep a Healthy/Positive Attitude
If you smoke or drink alcohol:
QUIT!!! Healthy Eating. . .
Well-balanced meals No skipping meals Portion control
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Goals of diabetes control Exercise regularly. . .
helps Insulin to do its job
helps with weight loss/weight control
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Goals of diabetes control Take Medications as prescribed
DO NOT miss appointments with your doctor, nutritionist, and other health care providers.
Make sure you come to class
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Goals of diabetes control
Take care of your: Feet & Skin Wear covered shoes Check for cuts daily Keep your skin soft &
smooth
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Goals of diabetes control
Take care of your: Teeth/gums Dental check ups every 6
months. Tell your dentist that you
have diabetes
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Goals of diabetes control Take care of your: Eyes Maintain normal to
acceptable blood glucose control & normal blood pressure
See your Ophthalmologist once a year for dilated eye exam.
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Goals of diabetes control Take your flu shots every year
Take your Pneumonia vaccine
Check microalbumin yearly to
check for small amount of protein in your urine.
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Topics covered:
Overview of Diabetes Diabetes Goals
Diabetes Self-management
Problem Solving Goal Setting &
Action Planning
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Patient
Physicians Nurse Practitioners
Dietitians Physician’s Assistants
Nurses
Pharmacists Behavioral Health Specialists
Case managers
Exercise Physiologists
Medical Assistants Community Health Worker
Family/Work/Friends/Church
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Managing Diabetes is not easy….but it’s worth it!
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Self-Management Tasks
Take care of your health problem Do your normal activities Manage your emotional changes
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PROBLEM SOLVING This self-care behavior focuses on the
“what ifs”— Hypoglycemia (low blood sugar) Hyperglycemia (high blood sugar) Sick day management Travel management
Do you know what to do if you have low
blood sugar? How about high blood sugar?
How do you know if you have low or high blood sugar? What are the signs and symptoms?
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Problem-Solving Steps 1. Identify the problem 2. List ideas to solve the problem 3. Select one method to try 4. Assess the results
5. Substitute another idea 6. Use other resources/Make another list 7. Accept that the problem may not be solvable now.
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Problem-Solving Activity 1. Identify the problem “I forget to take my medications”
2. List ideas to solve the problem 1. Idea A 2. Idea B 3. Idea C
3. Select one method to try 4. Assess the results
5. Substitute another idea 6. Use other resources/Make another list 7. Accept that the problem may not be solvable now.
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Goal Setting One of the most important self-management
SKILLS.
Generally too big to work on all at once; they can be overwhelming.
To achieve a goal, it needs to be broken down into small, more doable steps.
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SMART Goal Setting Specific – Measurable –
Attainable –
Realistic –
Timeline –
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SMART Goal Setting Activity
How is this goal specific? How is it measurable? How do you know if it’s attainable & realistic? Is there a timeline?
Problem: Skipping breakfast everyday Goal: Starting Monday, I will eat breakfast at least 3 times a week
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Choose your Goal Suggested goal might be:
1. Reduce portion size
2. Exercise more often
3. Follow monitoring schedule
4. Miss fewer medications
5. Plan problem situation treatment
6. Get support from family/friends
7. Stop smoking
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One of the most important self-management tools!
Turn your options into short-term plans (weekly)
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Parts of an Action Plan 1. Something YOU want to do 2. Achievable 3. Action-specific 4. Make a specific plan
1. What? 2. How much 3. When? 4. How often
5. On a scale of 0-10 (0 = not at all; 10 = very) Confidence level of 7 or more
1. How convinced are you that it’s important to make this change?
2. How confident are you that you can make this change?
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Action Plan Activity 1. Something YOU want to do 2. Achievable 3. Action-specific 4. Make a specific plan
1. What? 2. How much 3. When? 4. How often
5. Confidence level of 7 or more. On a scale of 0-10 (0 = not at all; 10 = very)
1. How convinced are you that it’s important to make this change?
2. How confident are you that you can make this change?
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One last note….
Not all goals are achievable
Don’t dwell too much on what you cannot do
Focus on the things you CAN do!
See yourself successful!
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Set up for Nutrition Moment