DiabetesDiabetes

Making ChangesMaking Changesforfor

SelfSelf--ManagementManagement

Deb Deb BurlageBurlage,RN, CDE,RN, CDE

ObjectivesObjectives

Participants will be able to…..Participants will be able to…..Discuss Basics of DiabetesDiscuss Basics of DiabetesHow to Impact ChangeHow to Impact ChangeApply Concepts to ExerciseApply Concepts to Exercise

EpidemicEpidemic

Approximately 17 Approximately 17 million people in the million people in the US have diabetesUS have diabetes

Another 16 million Another 16 million have a condition now have a condition now known as preknown as pre--diabetesdiabetes

PrevalencePrevalenceThe incidence of The incidence of

diagnosed diabetes has diagnosed diabetes has increased by 61% since increased by 61% since 1990.1990.

0

2

4

6

8

10

12

1990 1998

3-DColumn 1DX_DM

UnDx-DM

Basic Diabetes InformationBasic Diabetes InformationDiabetes Diabetes is a disease in which the body is a disease in which the body does does NotNot produce or properly use insulinproduce or properly use insulin

InsulinInsulin is a hormone that is needed to is a hormone that is needed to convert sugar, starches and other food convert sugar, starches and other food into energy needed for daily lifeinto energy needed for daily life

Cause:Cause: Genetics/EnvironmentGenetics/Environment

Sings and SymptomsSings and Symptoms

Classification of DiabetesClassification of Diabetes

Type 1 diabetes: failure to produce insulinType 1 diabetes: failure to produce insulin

Type 2: results from insulin resistanceType 2: results from insulin resistance

PrePre--diabetes: BS in between normal and diabetes: BS in between normal and highhigh

Gestational Diabetes: affects 4 % of Gestational Diabetes: affects 4 % of pregnant women per yearpregnant women per year

FPG FPG ≥≥ 126 mg/dl**126 mg/dl**

Symptoms of diabetes and a casual Symptoms of diabetes and a casual plasma glucose plasma glucose ≥≥ 200 mg/dl*200 mg/dl*

Current Criteria for Diagnosis of Diabetes

IFG: ≥ 110 mg/IFG: ≥ 110 mg/dLdL and < 126and < 126

IGTIGT

Fasting: Fasting: <126 mg/<126 mg/dLdL

22--h: h: ≥≥140140--<200 mg/<200 mg/dLdL

Criteria for Diagnosis ofPre-diabetes (IFG/IGT)

ComplicationsComplications

Heart DiseaseHeart DiseaseStrokeStrokeHigh Blood PressureHigh Blood PressureBlindnessBlindnessKidney DiseaseKidney DiseaseNervous SystemNervous SystemAmputationsAmputationsDental DiseaseDental Disease

Cost $$$$$$$$$Cost $$$$$$$$$2002: 132 Billion2002: 132 Billion

Per Person:Per Person:–– IndividualsIndividuals with with

diabetes: $13,243 diabetes: $13,243 per yearper year

–– IndividualsIndividualswithout without diabetesdiabetes: : $2,560 per year$2,560 per year

ABCs of DiabetesABCs of Diabetes

Good NewsGood News

Studies have proven: Studies have proven: DCCT/UKSDCCT/UKS

You Can Make A You Can Make A DifferenceDifference

Standards of CareStandards of CareABCsABCs

A A1CA A1CB Blood PressureB Blood PressureC CholesterolC CholesterolD Diabetes Ed/Dental D Diabetes Ed/Dental

Exam/DietExam/DietE Eye Exam/ExerciseE Eye Exam/ExerciseF Foot ExamF Foot ExamG Glucose monitoringG Glucose monitoringH Heart HealthH Heart HealthI Indications forI Indications for

specialtiesspecialtiesK Kidney K Kidney

Recommended GoalsRecommended GoalsGlycemic controlGlycemic control–– A1C <7.0%A1C <7.0%–– Fasting BS 80Fasting BS 80--110mg/dl110mg/dl–– NonNon--fasting <180mg/dlfasting <180mg/dl

Blood Pressure <130/80Blood Pressure <130/80

LipidsLipids–– LDL Cholesterol <100mg/dlLDL Cholesterol <100mg/dl–– Triglycerides <150mg/dlTriglycerides <150mg/dl–– HDL Cholesterol >40mg/dlHDL Cholesterol >40mg/dl

Change Is HARDChange Is HARDKISSKISS

Knowledge: get the Knowledge: get the facts!!!facts!!!Individual: set goals Individual: set goals that are that are yours/understand yours/understand Benefits and BarriersBenefits and BarriersStart with what Start with what motivates YOUmotivates YOUSupport: Health care Support: Health care team/family/friendsteam/family/friends

ExampleExample

ExerciseExercise–– K:K: what do you need to know before you what do you need to know before you

exerciseexercise–– I:I: what works for you (schedules, what works for you (schedules,

limitations)limitations)–– S:S: start with what motivates you (family, start with what motivates you (family,

friends, hobby, travel……………..)friends, hobby, travel……………..)–– S:S: Find a friend or colleague that will Find a friend or colleague that will

motivate you!!!motivate you!!!

Exercise Exercise

Exercise can control blood sugars and lower you risk of heart disease!

Examples of ExerciseExamples of Exercise

Examples of exercise: Examples of exercise: –– Aerobic: Walking, Swimming, Bicycling, Aerobic: Walking, Swimming, Bicycling,

Jogging, and SkatingJogging, and Skating–– Strength: Weight/ResistanceStrength: Weight/Resistance–– Flexibility: Yoga, Tai ChiFlexibility: Yoga, Tai Chi

Three Key Parts To Any Three Key Parts To Any Exercise ProgramExercise Program

–– Frequency:Frequency: Exercise at least 3Exercise at least 3--5 days per 5 days per weekweek

–– Intensity:Intensity: This means how hard you work This means how hard you work during exercise. You should feel like you are during exercise. You should feel like you are working harder than usual but still be able to working harder than usual but still be able to carry on a conversationcarry on a conversation

–– Time:Time: Exercise for at least 20Exercise for at least 20--30 minutes at a 30 minutes at a time (Start out gradual).time (Start out gradual).

Exercise TipsExercise TipsType 1: do not exercise if sugars <70 or Type 1: do not exercise if sugars <70 or >300 or if >300 or if ketonesketones are presentare presentType 2: do not exercise if sugars < 70 or Type 2: do not exercise if sugars < 70 or >350>350Exercise at peak insulin times may cause Exercise at peak insulin times may cause low blood sugarslow blood sugarsExercise can cause low blood sugars Exercise can cause low blood sugars several hours after exerciseseveral hours after exerciseSchedule exercise 45Schedule exercise 45--60 minutes after 60 minutes after eatingeating

GuidelinesGuidelines

–– Always check with your physician before Always check with your physician before beginning any exercise program or if you beginning any exercise program or if you have any complications during exercisehave any complications during exercise

–– Check Blood Sugars before and after exerciseCheck Blood Sugars before and after exercise–– Warm up and cool down Warm up and cool down –– Wear good shoes and check feet after Wear good shoes and check feet after

exercise for any blisters or signs or irritationexercise for any blisters or signs or irritation

Further GuidelinesFurther Guidelines

Keep a daily logKeep a daily logWear Medical IDWear Medical IDDrink plenty of fluidsDrink plenty of fluids

Exercise with a Exercise with a partnerpartnerModify Caloric IntakeModify Caloric IntakeCarry fast acting Carry fast acting sugarsugarDo NOT inject into Do NOT inject into area where exercise area where exercise is involvedis involved

Knowledge (continued)Knowledge (continued)BS Type of Exercise Extra Food NeeBS Type of Exercise Extra Food Neededded

No extra foodNo extra foodNo ExerciseNo Exercise> 300 mg/dl> 300 mg/dl

No extra foodNo extra foodNo extra foodNo extra food15 gms Carb15 gms Carb

Low Low ModerateModerateStrenuousStrenuous

171171--300 mg/dl300 mg/dl

No extra foodNo extra food15 gms Carb15 gms Carb30 gms Carb30 gms Carb

LowLowModerateModerateStrenuousStrenuous

101101--170 mg/dl170 mg/dl

15 gms Carb15 gms Carb30 gms Carb30 gms Carb60 gms Carb60 gms Carb

LowLowModerateModerateStrenuousStrenuous

< 100 mg/dl< 100 mg/dl

Individualize ExerciseIndividualize Exercise

Benefits and Barriers to ExerciseBenefits and Barriers to Exercise

–– Maybe You are not ready to changeMaybe You are not ready to change–– Maybe you are thinking about changeMaybe you are thinking about change–– This is a good time to think about the benefits, This is a good time to think about the benefits,

the barriers, and becoming more physically the barriers, and becoming more physically active!active!

Individualize: ProsIndividualize: Pros--Why do you Why do you want to changewant to change

Physical ReasonsPhysical Reasons

Emotional ReasonsEmotional Reasons

Individual Barriers: What is Individual Barriers: What is Stopping You???Stopping You???

Physical BarriersPhysical Barriers

Emotional BarriersEmotional Barriers

Next StepNext Step

Summarize your findingsSummarize your findings–– ID benefits you are most excited aboutID benefits you are most excited about–– ID barriers you feel strongest aboutID barriers you feel strongest about–– Ask yourself if you are confident and ready to Ask yourself if you are confident and ready to

commit to changecommit to change–– Ask yourself if you are satisfied with status Ask yourself if you are satisfied with status

quoquo–– Are you open to learning more?Are you open to learning more?

Start With What Motivates YouStart With What Motivates You

What is meaningful in your lifeWhat is meaningful in your lifeWhat do you enjoy doingWhat do you enjoy doingWhat are you passionate aboutWhat are you passionate aboutWhat have you always wanted to do?What have you always wanted to do?

So Let’s Get startedSo Let’s Get started

SupportSupport

MultiMulti--disciplinary Teamdisciplinary TeamFamilyFamilyFriendsFriends

Summary for SuccessSummary for Success

KnowledgeKnowledgeIndividualize Individualize StartStartSupportSupport

ConclusionConclusion

Life is not simply holding a good handLife is not simply holding a good handLife is playing poor hand well…….Life is playing poor hand well…….

--Danish SayingDanish Saying

Resources/ReferencesResources/References

American Diabetes Association: American Diabetes Association: www.diabetes.orgwww.diabetes.org

Center for Disease Control: Center for Disease Control: www.cdc.gov/diabeteswww.cdc.gov/diabetes

Clinical Diabetes: Clinical Diabetes: http://clinical.diabetesjournals.http://clinical.diabetesjournals.orgorg

Diabetes is South Dakota:Diabetes is South Dakota:www.www.sddiabetessddiabetes.net.net

The Gift………..The Gift………..