Diabetes ABCsDiabetes ABCs

Provided Courtesy of RD411.comWhere health care professionals go for information

Review Date 8/09 D-0549Contributed by Shawna Gornick-Ilagan, MS, RD, CWPC

Disclaimer

• This presentation should not substitute or replace any medical advice prescribed by your doctor

• The 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

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

Diabetes IQ Test

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

3. Every 24 hours:a. 2 children and adolescents are

diagnosed with type 2 diabetesb. 5 children and adolescents are

diagnosed with type 2 diabetesc. 8 children and adolescents are

diagnosed with type 2 diabetesd. 10 children and adolescents are

diagnosed with type 2 diabetes

Diabetes IQ Test

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

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

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

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.cec.gov/features/livingwithdiabetes/

Answer Key

• 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

What Are the Symptoms?

• 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

Types of Diabetes

• 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 estimates that 57 million Americans age 20+ have prediabetes

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

Type 2 Diabetes: Risk Factors

• Risk factors that you can not 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

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

Category Weight Gain Recommendation

sIf 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 more

Plasma Glucose Results (mg/dL)

Diagnosis

99 or below Normal

100-125 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

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. Frequently asked questions about pre-diabetes. Available at: http://www.diabetes.org/pre-diabetes/faq.jsp. Accessed September 10, 2009.

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

• Maintaining a healthy weight• Increasing fruit and vegetable

consumption• Increasing fiber intake• Decreasing fat intake• Exercising• Breastfeeding 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

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 (serial online). 1995;96:1019-1022. Available at: http://www.diabetes.org/pre-diabetes/faq.jsp. Accessed September 10, 2009

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 seeds

Omega-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 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 A1c

B stands for body mass index (BMI) and blood pressure

C 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

Level

6% 135 mg/dL

7% 170 mg/dL

8% 205 mg/dL

9% 240 mg/dL

10% 275 mg/dL

11% 310 mg/dL

12% 345 mg/dL

Healthy Plate Format

• One fourth plate starch

• One fourth plate meat

• One half plate nonstarchy vegetables

• 8 fluid ounces of reduced-fat milk

• One serving of fruit

Cereal or Grain

• 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

Fruit

• 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

Milk or Dairy

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

– 1 C of milk– 6 ounces of yogurt

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 Levels

Calories 1200 1500 1800 2000 2200Starch/Bread 5 8 10 11 13Meat 4 5 7 8 8Vegetable 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 September 10, 2009.

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 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 96 100 105 110 115 119 124 129 134 138 143 167 191

59 94 99 104 109 114 119 124 128 133 138 143 148 173 198

60 97 102 107 112 118 123 128 133 138 143 148 153 179 204

61 100 106 111 116 122 127 132 137 143 148 153 158 185 211

62 104 109 115 120 126 131 136 142 147 153 158 164 191 218

63 107 113 118 124 130 135 141 146 152 158 163 169 197 225

64 110 116 122 128 134 140 145 151 157 163 169 174 204 232

65 114 120 126 132 138 144 150 156 162 168 174 180 210 240

66 118 124 130 136 142 148 155 161 167 173 179 186 216 247

67 121 127 134 140 146 153 159 166 172 178 185 191 223 255

68 125 131 138 144 151 158 164 171 177 184 190 197 230 262

69 128 135 142 149 155 162 169 176 182 189 196 203 236 270

70 132 139 146 153 160 167 174 181 188 195 202 207 243 278

71 136 143 150 157 165 172 179 186 193 200 208 215 250 286

72 140 147 154 162 169 177 184 191 199 206 213 221 258 294

73 144 151 159 166 174 182 189 197 204 212 219 227 265 302

74 148 155 163 171 179 186 194 202 210 218 225 233 272 311

75 152 160 168 176 184 192 200 208 216 224 232 240 279 319

76 156 164 172 180 189 197 205 213 221 230 238 246 287 328

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• 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 7

Blood pressure Less than 130/80

Total cholesterol

Less than 200

LDL cholesterol Less than 100

HDL cholesterol

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

Triglycerides Less than 150