Know Your Numbers™ A Guide to BetterDiabetes Management

This material is copyrighted by Bayer HealthCare LLC and is intended solely for use in the “Know Your™” Series educational programs supported by Bayer HealthCare in the United States and Canada. Unauthorized use of this material without the express written consent of Bayer HealthCare, Diabetes Care is forbidden.

© 2007 Bayer HealthCare LLC

How Food is Digested

DiabetesBody lacks insulin or is unable to use insulin effectively

Pancreas Muscle andFat Cells

Cannot ProduceEnough Insulin

Cannot Use Insulin Effectively

Insulin ResistanceRelated Conditions

Complications of Diabetes

Stroke: 2-6x

Heart Disease:

Retinopathy: 25x2-6x Disease:

2-4x25x

End-Stage Kidney Disease:

17x

Foot/LegAmputations:

15-40x

Results from Diabetes Studies

Good Diabetes Management results in� Reduced microvascular disease� Eye disease� Kidney disease� Neuropathy� Neuropathy

� Reduced macrovascular disease� Heart disease� Stroke

United Kingdom Prospective Diabetes Study (UKPDS)

Change in A1C

MicrovascularComplications

1% Decrease in A1C = 25% Decrease in Microvascular Risk

Key Numbers in Diabetes Control

� Daily Blood Glucose� A1C (2-3 month glucose level)

� Lipids (Blood Fats)

� Blood Pressure (Hypertension)

Urine Protein � Urine Protein (Microalbuminuria)

Targets for Glucose Control

ACE ADAFasting/Pre-meal glucose <110 mg/dL 90-130 mg/dL

Post-meal glucose <140 mg/dL <180 mg/dL2-hours after start of meal2-hours after start of meal

A1C <6.5% <7%

American College of Endocrinology (ACE). Consensus statement for glycemic control.Endocrine Pract 2002;8 (Suppl 1); 5-11.American Diabetes Association (ADA). Clinical Practice Recommendations.Diabetes Care. 2007;30 (Suppl 1); S4-S41.

A1C Measures Glucose LevelsOver 2-3 Month Period

A1C and Self-Monitoring Results

LDL HDL Triglyceridescholesterol cholesterol (mg/dL)(mg/dL) (mg/dL)

Lipids <100 >50 women <150

Targets for Lipids, Blood Pressure and Microalbumin

Lipids <100 >50 women <150(Blood Fats) >40 men

Blood Pressure <130/80 mmHg

Microalbumin <30 µg/mg creatinine on a spot sample

American Diabetes Association (ADA). Clinical Practice Recommendations.Diabetes Care. 2007;30 (Suppl 1); S4-S41.American Heart Association, 2003.

Nutrition

� Dietary goals� Maintain good blood glucose control� Achieve and maintain reasonable body weight� Maintain proper nutrition

� Fewer calories require less insulinFewer calories require less insulin� Type of food matters� Carbohydrate digested quickly

� Protein digested somewhat slowly

� Fat digested slowly

Meal Planning Options

� Plate Method

� Food Pyramid

� Exchange System

Carbohydrate Counting

A Variety to Choose From

� Carbohydrate Counting

All meal plans should be individualized

Exercise and Weight Loss

� Improves circulation

� Increases insulin sensitivity

� Increases HDL cholesterol(the good cholesterol)

� Decreases blood pressure, LDL cholesterol� Decreases blood pressure, LDL cholesteroland triglycerides

� Increases energy level

Medications

Insulin Supplements body’s own insulinSecretagogues Pancreas – stimulates insulin

productionMetformin Liver – decreases glucose release

Fat/Muscle – increases insulinsensitivitysensitivity

Sitagliptin Liver – decreases glucose release

Pancreas – stimulates insulin production

Thiazolidinediones Fat/Muscle – increases insulin sensitivity

Alpha-glucosidase Intestine – slows carbohydrate inhibitors metabolism

Action Steps

� Follow your meal plan� Follow your exercise plan� Take your medications as prescribed� Know Your Numbers!Know Your Numbers!� Get all required tests� Monitor your blood glucose frequently

Get All Required Tests

Every visit Weight, blood pressure, andfoot examination

Every 3-6 months A1C – Every 3 months:Initial, poor control, orchanges in therapyA1C – Every 6 months:A1C – Every 6 months:If control is stable

Dental Exam –Every 6 months

Every year Eye examination, lipid levels,microalbumin, andcomprehensive foot exam

Monitor Your Blood Glucose Frequently

� Gain immediate information about how you are doing

� Monitor the effect of changes in lifestyle and medication adjustments

� Relate symptoms of high and low blood glucose with blood glucose test resultsblood glucose test results

7-Day Trends in Blood Glucose LevelsRecommended Testing Pattern

What To Do With Your Numbers

� Meet with your diabetes healthcare provider� Identify any patterns that may need attention� Review all your numbers� Blood Glucose

A1C� A1C� Lipid Levels� Blood Pressure� Microalbuminuria

� Identify missing numbers and arrange to have laboratory test(s) performed

Summary

� Good diabetes control matters!

� Good control involves proper use of lifestyle tools and medications

� Regular and frequent monitoring of all aspects of diabetes is essential to good controldiabetes is essential to good control

� Meet with your healthcare professional regularly to evaluate your treatment program

Know Your Options™ Living an Uncomplicated Life with Diabetes

This material is copyrighted by Bayer HealthCare LLC and is intended solely for use in the “Know Your™” Series educational programs supported by Bayer HealthCare in the United States and Canada. Unauthorized use of this material without the express written consent of Bayer HealthCare, Diabetes Care is forbidden.

© 2007 Bayer HealthCare LLC

As you view the show, make sure to also read the notes underneath each slide because there is a lot of information to keep you healthy in these notes.If you do not see the notes on the bottom of the slides, click on the View tab at the top of the page, and select “notes page”.

If you have any difficulties, call Florey at 748-4501 ext 6410.

Enjoy the show, it is a good one!

Diabetes Complications are Not Inevitable!

� Over the years if you do not control yourblood sugar, complications can occur� Keeping your blood sugar within recommended guidelines can prevent recommended guidelines can prevent and/or reduce complications� Best way to assess control� Must be performed daily to affect control

� Results can be applied to adjustmedications, nutrition and physical activity

� “Know Your Numbers”

Small Vessel Complications

Large Vessel Complications

Eye Disease

� Retinopathy is damage to the back of the eye (retina)

� Usually occurs in people that have diabetes for over 5 years

First signs are blurry vision� First signs are blurry vision

� Glaucoma and Cataracts are seen in people with diabetes

� Need to get an eye exam every year by an Ophthalmologist

Treatment of Eye Disease

� Laser Therapy� Scatter Photocoagulation

� Focal Photocoagulation

� Surgery

Tips to Prevent Eye Problems

� Keep your blood sugar as close to normal as possible� Control your blood pressure� Quit smoking� See your eye specialist � See your eye specialist (Ophthalmologist) once a year� See your doctor immediately if:� Your eyes hurt or become red� Blurred vision or spots� Trouble reading books or signs� Your peripheral vision

(vision on the side) is not the same

Types of Skin Conditions

� Bacterial infections

� Fungal infections

� Dry skin/itching

� Scaly patches or brown spots

Types of Skin Conditions, continued

� Allergic reactions due todiabetes medications

� Xanthomatosis

� Acanthosis Nigricans

Tips for “Good” Skin Care

� Keep your blood sugar under control

� Keep skin clean and dry

� Avoid “hot” baths and showers

Moisturize on a daily basis� Moisturize on a daily basis

� Treat cuts right away

� See a Dermatologist if you have any problems with your skin

Foot Care

� Inadequate foot care can lead to amputation� Foot problems are due to:

Lack of sensation� Lack of sensation

� Poor circulation

� Important to seea Podiatrist on a regular basis

Suggestions for “Good” Foot Care

� Examine feet daily

� Wash and dry feet thoroughly

� Cut toenails straight across

� Avoid self-treatment of corns Avoid self-treatment of corns and calluses

� Wear cotton socks

� Inspect shoes for foreign objects

� See a Podiatrist on a regular basis

Dental Care

� People with diabetes have an increased risk for gum disease and cavity formation� The warning signs of � The warning signs of gum disease are:� Bleeding gums when

you brush or floss

� Red, swollen or tender gums

� Bad breath

� Loose teeth

Types of Dental Conditions

� Oral infections

� Pain when chewing

� Increase in cavities

Fungal infections – Thrush� Fungal infections – Thrush

� Dry mouth

Tips for “Good” Dental Care

� Brushing and flossing are the best way to prevent gum disease

� See your Dentist on a regular basis

� Tell your Dentist you have � Tell your Dentist you have diabetes

� Take your usual medications before your dental visit

� Make sure you are able to get your normal amount of daily calories. Plan ahead

What is Depression?

� Depression comes from a change in

the chemical functioning of the brain

� Depression can be triggered by stress,

difficult life events, environment,difficult life events, environment,

medications

� Depression affects your ability to

function in day to day life

Diabetes and Depression

� Diabetes doubles the risk of being depressed� Depression may be due to stressDepression can lead to:� Depression can lead to:� Poorer physical and

mental functioning� Not following your meal plan

or exercise routine which can lead to weight gain� Not taking your medications

as prescribed

What Causes Depression in Diabetes

� Depression is caused by a number of factors; physical, psychological and genetic� Everyone reacts differently to stressful events. Just finding out you have diabetes can be stressfulcan be stressful� People with diabetes may have depression due to:� Worrying about long term complications� Effect of their diabetes on daily life� Effect of diabetes on their work environment� Remembering the damaging effects of diabetes

on relatives and/or friends

Symptoms of Depression

� People with “true” depression have symptoms that occur almost every day� Symptoms include:� Prolonged sadness/feeling down� Irritability, anger, worry, anxiety� Irritability, anger, worry, anxiety� Tired� Feeling guilty, worthlessness� Weight loss or gain� Trouble sleeping� Thinking about death or suicide

Treatment of Depression in Diabetes

� Important to see a trained mental health professional for counseling

� May need antidepressant medicationsmedications

� Effective treatment of depression has been shown to improve diabetes control

� St. John’s Wort can cause drug interactions

Erectile Dysfunction or Impotence?

� Erectile Dysfunction describes:� Difficulty getting or maintaining an erection

of the penis

� Impotence describes:Impotence describes:� Erectile dysfunction

� Lack of sexual desire

� Inability to reach or experience an orgasm

� Inability to ejaculate sperm during orgasm

Symptoms of Erectile Dysfunction in Men Can Vary

� Complete inability for erection

� Frequent inconsistent ability to achieve erection

� Inability to maintain an erection throughout intercourse

Risk Factors for Erectile Dysfunction in Men

� Physical diseases and disorders

� Surgery or trauma

� Medications� Medications

� Substance abuse

� Stress, anxiety, or depression

� Smoking

Diabetes and Erectile Dysfunction (ED)

� Men with diabetes are 3 times more likely to develop ED than those without diabetes

� ED in patients with diabetes may be a sign of poor blood may be a sign of poor blood sugar control

� By age 60, more than half of all men with diabetes will have experienced ED

� ED is often the first sign of autonomic neuropathy

Diabetes and Erectile Dysfunction (ED)

� ED can be seen at a younger age in men with diabetes

� Male infertility in diabetes is due to both erectile and ejaculatory failureejaculatory failure

� Response to visual stimulation may be decreased

� The quality of the semen may be affected which can lead to infertility

� Improving glycemic control may help

Psychological Component of ED in Men with Diabetes

� Important in over 50% of cases� Diminished self worth

� Fear of failure – patients fear impotence more than blindness impotence more than blindness

� Marital disharmony

� More “stress”

� Decreased libido

� Decrease in sexual arousal

� Couples counseling can be very beneficial

Prevention of Erectile Dysfunction

� Limit or avoid use of all forms of tobacco

� Limit or avoid use of alcohol and other similar drugs

� Exercise regularly� Exercise regularly

� Use methods of stress reduction

� Get enough sleep

� Use effective approaches to deal with anxiety or depression

� See your doctor for regular checkups and medical screening tests

Treatment of Erectile Dysfunction in Men

� Simple change of some lifestyle choices� Review of medication side effects� PsychotherapyMedication therapy� Medication therapy� Oral PDE inhibitors (caution with nitrates!)• Levitra* • Cialis*• Viagra*

� Oral testosterone* Levitra is a registered trademark jointly shared by

Bayer Pharmaceuticals Corporation, GlaxoSmithKline and Schering Corporation.

* Cialis is a trademark of Lilly ICOS LLC.

* Viagra is a registered trademark of Pfizer Inc.

Symptoms of Sexual Dysfunction in Women

Four types of sexual problems observed in women� Desire disorders

Arousal disorders� Arousal disorders

� Orgasmic disorders

� Sexual pain

Risk Factors for Sexual Dysfunction in WomenSome causes of sexual dysfunction� Physical conditions � Diabetes� Arthritis

High blood pressure � High blood pressure � Vaginal Infections

� Hormonal-Estrogen deficiency – Menopause� Psychological – counseling is recommended� Depression� Anxiety� Stress

Treatment of Sexual Dysfunction in Women

� If desire is the problem� Change your usual routine� Muscle relaxation exercises

� If arousal is the problem� If arousal is the problem� Vaginal or estrogen creams� Psychotherapy

� If orgasm is the problem� Extra stimulation

� If pain is the problem� Different positions� Vaginal creams

Stress

� What is stress?� Stress can be acute or chronic� Stress can occur when:• An event produces a strain on

a person a person • A person thinks a situation as

challenging or threatening

� Stress is influenced by the• Individual • Environment

What makes something stressful for you?� What are your major stressors?� Life events

• Negative (traffic, arguing, doctor visits, tests, phone calls, holidays

• Positive (marriage, graduation, birth of • Positive (marriage, graduation, birth of a child, new job)

� Evaluating a stressful situation� Our perspective and perception

changes the way we view stress• Beliefs, values and goals• Change is stress

How does your body react to stress?

� Stress hormones (catecholamines, glucagon, cortisol, and growth hormone)� Symptoms (nervous, sweaty,

palpitations, nausea)

How does stress affect � How does stress affect diabetes and vice versa?� Increase blood glucose

and ketones� Some people actually

have a decrease in blood glucose initially

Coping and Stress Management

� Coping is how each of us respond to a stressful situation� There are certain questions that you need to ask yourself� Strategies and Coping Skills� Different for everyone

� Good strategies – help us to maintain control and feel less tense, relaxed

� Bad strategies – make you feel tired, angry, sick, tense

Important Factors in Coping

� Having enough information� Write down what causes stress and

anxiety in your life

� Feeling in control� Do fewer things better� Do not over commit� Avoid stressful situations

� Having the support of others� Family and friends� Support groups – talk with other

people who have diabetes� Healthcare team – social worker, Psychologist

Schedule Regular Visits With YourHealthcare Team

� Every Day:� Check blood glucose

at home

Every Visit:

� Every Year:� Blood lipid test

� Dilated eye exam

Test for urine protein� Every Visit:� Blood pressure

� Foot exam

� Every 3 months:� A1C

� Weight

� Test for urine protein

� Flu shot and other vaccinations

� Dental checkup

Conclusion

� Managing your blood sugar and keeping it under control can decrease your risk of complications

� Many of the complications of diabetes can be prevented by understanding more about foot, skin and dental care,strategies to cope with stressful situations and making the right lifestyle choices

� Working closely with your healthcare team is crucial

You Can “Live An Uncomplicated Life With Diabetes”