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Diabetes ABCs

Review Date 8/12D-0549

Contributed by Shawna Gornick-Ilagan, MS, RD, CWPCUpdated by Nutrition411.com staff

Disclaimer• This presentation should not substitute or

replace any medical advice prescribed by your doctor

• This presentation is meant to provide you with general health information to empower you and your family to prevent or manage diabetes

Objectives• What is diabetes?• What are my risks of getting it?• How can I prevent diabetes?• How do I manage diabetes if I get it?• What do the ABCs stand for?

What Is Diabetes?• Diabetes is a condition in which the body is

unable to properly utilize blood sugar

What’s Your Diabetes IQ?

Diabetes IQ Test

1. Every 24 hours:a. More than 1000 adults are diagnosed with

diabetesb. More than 2000 adults are diagnosed with

diabetesc. More than 3000 adults are diagnosed with

diabetesd. More than 4000 adults are diagnosed with

diabetes

2. Every 24 hours:a. About 10 children and adolescents are

diagnosed with type 1 diabetesb. About 20 children and adolescents are

diagnosed with type 1 diabetesc. About 30 children and adolescents are

diagnosed with type 1 diabetesd. About 40 children and adolescents are

diagnosed with type 1 diabetes

Diabetes IQ Test (cont’d)

3. Every 24 hours:a. Two children and adolescents are diagnosed

with type 2 diabetesb. Five children and adolescents are diagnosed

with type 2 diabetesc. Eight children and adolescents are

diagnosed with type 2 diabetesd. Ten children and adolescents are diagnosed

with type 2 diabetes

Diabetes IQ Test (cont’d)

4. Every 24 hours:a. Approximately 50 people die from diabetesb. Approximately 100 people die from diabetesc. Approximately 150 people die from diabetesd. Approximately 200 people die from diabetes

Diabetes IQ Test (cont’d)

5. Every 24 hours:a. 50 people with diabetes have a

nontraumatic lower-limb amputationb. 100 people with diabetes have a

nontraumatic lower-limb amputationc. 150 people with diabetes have a

nontraumatic lower-limb amputationd. 200 people with diabetes have a

nontraumatic lower-limb amputation

Diabetes IQ Test (cont’d)

6. Every 24 hours:a. About 30 people with diabetes develop kidney

failureb. About 60 people with diabetes develop kidney

failurec. About 90 people with diabetes develop kidney

failured. About 130 people with diabetes develop

kidney failure

Diabetes IQ Test (cont’d)

7. Every 24 hours:a. Nearly 5 adults with diabetes go blindb. Nearly 15 adults with diabetes go blindc. Nearly 25 adults with diabetes go blindd. Nearly 50 adults with diabetes go blind

Quiz derived from information found at http://www.cdc.gov/features/livingwithdiabetes/.

Diabetes IQ Test (cont’d)

• The correct answer for all questions— d.• Over the years, high blood glucose

(hyperglycemia) damages nerves and blood vessels, leading to complications such as:– Heart disease– Stroke– Kidney disease– Blindness– Nerve problems– Gum infections– Amputation

Answer Key

• Some people do not have symptoms• Other people have experienced these symptoms:

– Increased thirst– Increased urination– Weight loss without trying– Blurred vision– Increased hunger– Increased fatigue

What Are the Symptoms?

•The three types of diabetes: – Type 1 (juvenile diabetes, insulin dependent:

5%–10%)– Type 2 (adult onset, noninsulin dependent):

90%–95%– Gestational diabetes (diabetes during

pregnancy): 2%–5%•Prediabetes

– Centers for Disease Control and Prevention estimates that 57 million Americans 20+ years of age have prediabetes

Types of Diabetes

Normal Process

Insulin

Diabetes: Type 1

Diabetes: Type 2

Insulin = Fat

Diabetes: Type 2 (Over Time)

Type 1 Diabetes: Risk Factors• Family history of type 1 diabetes: 10%–15%

• Race: White people have a greater risk• Presence of islet cell antibodies in the blood

Prevention• Currently no way to prevent type 1 diabetes• Can prevent or delay the development of

complications, such as:– Vision, kidney, or heart failure– Blood vessel and nerve diseases

• Prevention: Keep blood sugar near normal levels

• Risk factors that you cannot control:– Family history– Age– Race– History of gestational diabetes

• Risk factors that you can control:– Lose weight if overweight– Eat healthy and exercise– Quit smoking– Get treatment if you have prediabetes, high

blood pressure, or high cholesterol

Type 2 Diabetes: Risk Factors (cont’d)

Gestational Diabetes• Stay at a healthy weight and do not gain too

much weight during pregnancy• Exercise regularly to help keep your blood sugar

level within a safe range and to prevent gestational diabetes

Weight Gain During Pregnancy

CategoryWeight Gain

Recommendations

If you began pregnancy at a normal weight

25–35 pounds

If you began pregnancy underweight

28–40 pounds

If you began pregnancy overweight

15–25 pounds

If you are expecting twins

35–45 pounds

How Is It Diagnosed?• Fasting plasma glucose: Must fast for 8 hours or

morePlasma Glucose Results (mg/dL)

Diagnosis

99 or below Normal100–125 Prediabetes 126 or above Diabetes

dL=deciliter, mg=milligram

Glucose Testing Recommendations

• Blood glucose:– During a regular physical– Symptoms suggesting hyperglycemia or

hypoglycemia– During pregnancy– Diabetic

• Starting at age 45 and every 3 years if normal results

Prediabetes

Is prediabetes the same as impaired glucose tolerance or impaired fasting?

Yes. Doctors sometimes refer to this state of elevated blood glucose levels as impaired glucose tolerance or impaired fasting glucose (IGT/IFG), depending on which test was used to detect it.

Source: American Diabetes Association. Prediabetes FAQs. Available at: http://www.diabetes.org/pre-diabetes/faq.jsp. Accessed August 5, 2012.

Prediabetes (cont’d)

Good News•Type 2 diabetes is preventable if you catch it early and make some changes in your lifestyle

85%–90% of Diabetes Is Preventable

Preventable

Diabetes: Type 2 Insulin

Bad News

• Type 2 diabetes is a condition that consumes your:– Time– Money– Energy

How to Prevent Type 2 Diabetes

• Maintain a healthy weight• Increase fruit and vegetable consumption• Increase fiber intake• Decrease fat intake• Exercise• Breastfeed infants:

– 20% less likely to have diabetes and high cholesterol

Tips to Maintain a Healthy Weight

• Do not drink calories• Eat slowly• Stay hydrated• Try the low-fat or nonfat version of foods• Change habits• Eat three meals each day• Focus on fruits and vegetables• Get enough fiber

Tips to Maintain a Healthy Weight (cont’d)

Fruits and vegetables• Canned or frozen• Frozen grapes• Prepackaged • Microwaveable• Low-fat dip• 5 servings/day

Dietary fiber• Beans• Oatmeal• Whole grain

– Pastas– Cereals– Breads

• Adults need 25–35 grams (g)/day; children older than age 3 need their age plus 5 g (minimum recommendation)

Source: Dwyer JT. Dietary fiber for children: how much? Pediatrics. 1995;96:1019-1022.

Exercise Regularly• Exercise regularly to help raise your high-density

lipoprotein (HDL), the good cholesterol, and lower your low-density lipoprotein (LDL), the bad cholesterol

• Aim for 30 minutes of activity or more on most days of the week

Decrease Saturated and Trans Fats

Type of Harmful Fat Food SourceSaturated fat Animal products, such as

meat, poultry, seafood, eggs, dairy products, lard, and butter

Coconut, palm, and other tropical oils

Trans fat Partially hydrogenated vegetable oils

Commercial baked goods, such as crackers, cookies, and cakes

Fried foods, such as doughnuts and French fries

Shortening and margarine

Opt for Healthy Fats

Type of Healthy Fat Food SourceMonounsaturated fat Olive oil, peanut oil, and

canola oil Avocados Nuts and seeds

Polyunsaturated fat Vegetable oils, such as safflower, corn, sunflower, soy, and cottonseed oils

Nuts and seedsOmega-3 fatty acids Fatty cold-water fish, such as

salmon, mackerel, and herring

Flaxseeds and flax oil Walnuts

Know Where to Look• Lose weight—calories• Lower cholesterol—

saturated fats and trans fats

• Manage glucose—total carbohydrate

The Good News• By managing the ABCs of diabetes, people with

diabetes can reduce their risk of heart disease and stroke

A stands for A1cB stands for body mass index (BMI) and blood

pressureC stands for cholesterol

A: Ask About Your A1c• A1c measures average

blood glucose over the last 3 months

• Get your A1c checked at least twice/year

A1c Readin

g

Average Blood Sugar

Level6% 126 mg/dL7% 134 mg/dL8% 183 mg/dL9% 212 mg/dL10% 240 mg/dL11% 269 mg/dL12% 298 mg/dL

Source: American Diabetes Association. Standards of medical care in diabetes–2012. Diabetes Care [serial online]. 2012;35(suppl 1);S11-S63. Available at: http://care.diabetesjournals.org/content/35/Supplement_1/S11.full.pdf+html. Accessed August 5, 2012.

Healthy Plate Format• One fourth of plate

starch• One fourth of plate

meat• One half of plate

nonstarchy vegetables• 8 fluid ounces of

reduced-fat milk• One serving of fruit

Cereal or Grains• 15 g of carbohydrate=one serving• One cereal or grain serving is:

– One slide of bread– One half of a hamburger bun– ¾ cup (C) of unsweetened cereal– ⅓ C cooked pasta– 3 C popcorn– ½ C cooked oatmeal

• 15 g of carbohydrate=one serving• One fruit serving is:

– ⅓ C of fruit juice– ½ C of canned fruit– One small piece of fruit, such as an apple

Fruit

• 15 g of carbohydrate=one serving• One milk or dairy serving is:

– 1 C of milk– 6 ounces of yogurt

Milk or Dairy

Starch or Vegetables• 15 g of carbohydrate=one serving

• One starch or vegetable serving is:– ⅓ C of beans– ½ C of corn or peas– ½ C of mashed potatoes

Quick Reference Chart for Eating With Diabetes

Number of Exchanges/Day for Various Calorie LevelsCalories 1200 1500 1800 2000 2200Starch/bread 5 8 10 11 13Meat 4 5 7 8 8Vegetables 2 3 3 4 4Fruit 3 3 3 3 3Milk 2 2 2 2 2Fat 3 3 3 4 5

Source: University of Maryland Medical Center. Diabetes diet—diabetic exchange lists. Available at: http://www.umm.edu/patiented/articles/what_general_guidelines_heart-healthy_diets_000042_5.htm. Accessed August 5, 2012.

B: BMI• BMI is a number calculated from a person’s

weight and height• Higher BMI values are associated with risk for

health problems• BMI goal=less than 25• More information is available at:

http://www.cdc.gov/healthyweight/assessing/bmi/

BMI(kg/m2) 19 20 21 22 23 24 25 26 27 28 29 30 35 40

Height Normal Weight Increased Risk High Risk58 91 96 100 105 110 115 119 124 129 134 138 143 167 19159 94 99 104 109 114 119 124 128 133 138 143 148 173 19860 97 102 107 112 118 123 128 133 138 143 148 153 179 20461 100 106 111 116 122 127 132 137 143 148 153 158 185 21162 104 109 115 120 126 131 136 142 147 153 158 164 191 21863 107 113 118 124 130 135 141 146 152 158 163 169 197 22564 110 116 122 128 134 140 145 151 157 163 169 174 204 23265 114 120 126 132 138 144 150 156 162 168 174 180 210 24066 118 124 130 136 142 148 155 161 167 173 179 186 216 24767 121 127 134 140 146 153 159 166 172 178 185 191 223 25568 125 131 138 144 151 158 164 171 177 184 190 197 230 26269 128 135 142 149 155 162 169 176 182 189 196 203 236 27070 132 139 146 153 160 167 174 181 188 195 202 207 243 27871 136 143 150 157 165 172 179 186 193 200 208 215 250 28672 140 147 154 162 169 177 184 191 199 206 213 221 258 29473 144 151 159 166 174 182 189 197 204 212 219 227 265 30274 148 155 163 171 179 186 194 202 210 218 225 233 272 31175 152 160 168 176 184 192 200 208 216 224 232 240 279 31976 156 164 172 180 189 197 205 213 221 230 238 246 287 328

B: Beware of Your Blood Pressure• High blood pressure raises your risk for heart

attack, stroke, eye problems, and kidney disease• Get your blood pressure checked at every visit• Target blood pressure=less than 130/80

Key Steps for Lowering Blood Pressure

• Lose weight• Eat more fruits and vegetables• Reduce the amount of salt in diet• Have lower alcohol intake• Quit smoking• Take blood pressure pills, if prescribed:

– Many people require more than one pill

C: Check Your Cholesterol

• Several kinds of blood fats:– Total and LDL (“lousy”) cholesterol—can narrow

or block vessels– HDL (“healthy”) cholesterol—helps remove

cholesterol deposits– Triglycerides—can raise your risk for heart

attack/stroke

Know Your Numbers Value Goals

A1c Less than 7Blood pressure Less than 130/80Total cholesterol

Less than 200

LDL cholesterol Less than 100HDL cholesterol

Greater than 40 (men)Greater than 50 (women)

Triglycerides Less than 150