Diabetes Community Expo:

Empowering YouTo Live Well

Provide a high level overview of diabetes head to toe.

Discuss the importance of keeping A1Cs under 8.

Identify ways to prevent long-term complications.

There are no conflicts of interest to disclose.

Objectives and Disclosure

Diabetes self management is key Self motivation “Take home message”

Introduction

Type 1 Diabetes10% of casesInsulin deficiencyAutoimmune related

Type 2 Diabetes90% of casesInsulin resistance

Types of Diabetes

Family History Gestational Diabetes Cardiovascular disease Hypertension Hyperlipidemia Long term use of certain medications such

as steroids or antipsychotics PCOS, acanthosis nigricans

Criteria for Screening

Blurred vision Feeling tired Sores that do not heal Recurrent yeast infections Increased thirst Increased urination May be asymptomatic

Symptoms of Hyperglycemia

Normal Pre-diabetes Diabetes

FBG< 100 md/dL IFG >100-125 mg/dL FBG >126 mg/dL

2 hr PG < 140 mg/dL IGT 2 hr > 140-199 mg/dL

2 hr PG >200mg/dL

A1C < 5.5% A1C 5.8% - 6.4% A1C > 6.5%

Diagnostic Criteria

Finger sticks Pre-meal 2 hours post prandial

Hemoglobin A1C testing Every 3 months if not well controlled Goal <7%

Self monitoring after diagnosis

A1C% 6 7 8 9 10 11 12

Average 126 154 183 212 242 269 298

glucose

Correlation of A1C with average glucose

Yearly Screening

Retinopathy

Maintain blood sugar control Acuity vs Retinal changes or bleeding Dilated eye exam yearly If diagnosed with retinopathy check with

eye specialist regarding exercise restrictions

Retinopathy

Chronic Kidney Disease

Maintain blood sugar control Maintain Normal B/P ( 130/80-140/90 ACE Inhibitor class blood pressure

medication Avoidance of NSAIDS (non-steroidal anti-

inflammatories) Yearly Microalbumin –urine albumin

secretion

Nephropathy

Maintain blood sugar control Daily foot exams Office foot exams during each diabetes visit Avoid injury/exposure Goal is to prevent damage are no therapies

actually proven to reverse damage Symptom control – gabapentin,

PeripheralNeuropathy

Maintain blood sugar control Maintain normal B/P Maintain normal cholesterol profile Aspirin therapy Weight Control Smoking Cessation

Cardiovascular

Healthy Weight – 5-10% reduction Physical Activity – 150 min /week Diet – Low in saturated fats, high in fiber,

carbohydrate controlled Self Monitoring of blood glucose Medication Adherence Immunizations Flu Pneumonia >65 yr Hep B 19-59 yrs of age

Therapeutic Lifestyle Changes

11 types or classes of diabetes medications Know the actions and side effects of each

medication

Insulin Therapy Basal – Long acting Bolus – Quick acting Combination or mixed insulin Vial/syringes, Pre-filled pens, Insulin Pump

Diabetes Medication

CausesMedication Skipping or delaying mealsIncreased activity or exercise

SymptomsShaky & anxiousSweatingHungerFast heartbeatDifficulty concentratingUnconsciousness, seizure, coma, death

Hypoglycemia

15:15 Rule ◦ 15gms of carbohydrates and recheck blood sugar in 15

minutes◦ Correct blood sugar and then eat a snack with proteinPrevent events◦ Know the actions and side effects of medications◦ Test blood sugar more often when adding or

changing medication◦ Carry glucose meter and something to treat ◦ Keep records and watch for trends, report to PCP◦ Test before driving◦ Wear medical alert

Hypoglycemia Treatment

If unable to self treat then assistance will be needed from family or bystander

Have a plan Glucagon injection Call 911 Report any trends and or events to PCP Hypoglycemic unawareness can occur

Hypoglycemic Emergencies

Depression Screening for ages >65 Loss of motivation Non adherence to plan of care Goal Setting Short term goals Long term goals

Emotional Aspects of Diabetes

Patient Family members Health care provider Certified Diabetes Educator Dietitians Counselor Social Worker Pharmacist

Your Diabetes Team

Early diagnosis Lifestyle changes Self management

Conclusion

American Diabetes Association. Standards of Medical Care in diabetes – 2015. Diabetes Care. 2015; 38 (Suppl 1): S1-S93. January 2015

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http://www.ndei.org/patienteducation.aspx

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Resources