1. Preventing Diabetes Complications

2. What is a “complication”? Two problems at the same time A second illness caused by the first one A complication “complicates” the situation!

3. 5 Major Complications Heart Nerves Eyes Brain Kidneys

4. Major Complications #1 &2 Heart disease – High Blood Pressure – High Cholesterol – Heart Attack Stroke – People with diabetes 2-4 times more likely to have stroke

5. How does it happen? High cholesterol more common in diabetes “Good” and “bad” cholesterol – HDL (H= healthy) – LDL (L= lousy) – TG (T= terrible) High “bad” cholesterol (especially TG) + low “good” cholesterol= recipe for heart attack!

6. Know your numbers! What are the ABC’s of diabetes? – A1c Goal is less than 7 Check 2-4 times a year – Blood Pressure Goal is less than 130/80 Check at every clinic visit – Cholesterol Goal is LDL less than 100 and TG less than 150 HDL: women more than 50; men more than 40 Check every 3 months until at goal

7. Most important thing is… Your lifestyle!!! – Low saturated fat, low salt diet – Daily physical activity (30-45 minutes daily or total 150 minutes/week) – Stop smoking – Minimize alcohol – If overweight, try to lose 7-10% of body weight – Check your blood sugar and adjust diet – Stress reduction

8. Let’s Review! What are the ABC’s of diabetes? Your _________ is the most important thing you can do to prevent heart attack or stroke. Which type of cholesterol is “good” and should be high: LDL, HDL, or TG? What is “goal” for A1c: less than 7, 8-9, at least 10?

9. Major Complication #3 Kidney disease – Protein spills into urine – Kidneys cannot get rid of body waste – Kidney failure Diabetes is leading cause of kidney disease! Not reversible, but can be slowed Key is prevention!

10. How does it happen? Diabetes damages blood vessels everywhere in body, including kidneys Conditions that make kidney damage happen sooner: – High blood sugar – Cigarette smoking – High blood pressure – Family history of kidney disease

11. Fight off kidney disease! Control blood sugar (A1c less than 7) Control blood pressure (less than 130/80) Check for protein in urine once a year Make sure your provider has prescribed drugs that protect your kidneys. – ACE-inhibitors (ACE) – ARB (just like ACE but fewer side effects)

12. Major Complication #4 Eye Disease (Retinopathy) – 20% of people with type 2 diabetes have some retinopathy when diagnosed – Leading cause of blindness in US adults aged 20-74 years – 100% of people with type 1 diabetes will have retinopathy after 20 years – Retinopathy only detected by a dilated eye exam

13. How does it happen? High blood sugar damages blood vessels in eye Damaged blood vessels leak fluid that covers “seeing” part of retina Retina cells lack oxygen and die No symptoms until advanced disease

14. Preventing eye disease Control blood sugar (what is goal A1c?) Control blood pressure (what is goal for blood pressure?) Control cholesterol (diet and medicines) Stop smoking Have dilated eye exam every year

15. Let’s Review! What are 2 things that make kidney damage happen earlier? Do ACE-inhibitors and ARBs protect or damage your kidneys? True or false: People can tell when they have retinopathy. Name 2 things that can help prevent retinopathy.

16. Major Complication #5 Nerve Destruction – Called “neuropathy” – 25-50% people with diabetes have it – Worsens when A1c is higher than 9% – Affects more than just feet! – Increases risk for sudden death from heart attack (can’t feel heart pain!)

17. What does it feel like? Sharp, stabbing Prickling, tingling (hurts when sheets touch legs at night) Like pain on sunburned skin when you take a hot shower Affects bowel, bladder, stomach, sex, sleep patterns, balance

18. How does it happen? Starts during pre-diabetes High blood sugar slows speed of nerve message-sending High blood sugar makes swelling around nerves Pain often worse at night Pain can be everywhere- not just feet

19. Preventing nerve destruction Things you can change to prevent it: – Control blood sugar – Control blood pressure – Lower cholesterol – Keep A1c less than 7% – Stop smoking Things that make it worse but can’t be changed: – Getting older – Having diabetes longer

20. Foot Care Check your feet every day Wash daily with mild soap, warm water Do not soak feet Dry carefully between toes Use lotion, not between toes! Wear thick, soft socks without seams Wear good-fitting shoes

21. Foot Care NEVER go barefoot (no, never!!) Cut toenails straight across Don’t sit with crossed legs Wear socks to bed if feet are cold Call your provider for sores on feet

22. And now for a demonstration!