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Diabetes Community Expo:
Empowering YouTo Live Well
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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
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Diabetes self management is key Self motivation “Take home message”
Introduction
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Type 1 Diabetes10% of casesInsulin deficiencyAutoimmune related
Type 2 Diabetes90% of casesInsulin resistance
Types of Diabetes
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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
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Blurred vision Feeling tired Sores that do not heal Recurrent yeast infections Increased thirst Increased urination May be asymptomatic
Symptoms of Hyperglycemia
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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
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Finger sticks Pre-meal 2 hours post prandial
Hemoglobin A1C testing Every 3 months if not well controlled Goal <7%
Self monitoring after diagnosis
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A1C% 6 7 8 9 10 11 12
Average 126 154 183 212 242 269 298
glucose
Correlation of A1C with average glucose
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Yearly Screening
Retinopathy
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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
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Chronic Kidney Disease
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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
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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
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Maintain blood sugar control Maintain normal B/P Maintain normal cholesterol profile Aspirin therapy Weight Control Smoking Cessation
Cardiovascular
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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
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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
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CausesMedication Skipping or delaying mealsIncreased activity or exercise
SymptomsShaky & anxiousSweatingHungerFast heartbeatDifficulty concentratingUnconsciousness, seizure, coma, death
Hypoglycemia
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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
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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
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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
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Patient Family members Health care provider Certified Diabetes Educator Dietitians Counselor Social Worker Pharmacist
Your Diabetes Team
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Early diagnosis Lifestyle changes Self management
Conclusion
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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