1. Better Health. No Hassles. Presented by Elaine Barclay, NP-C Diabetes

2. Better Health. No Hassles. Diabetes What is Diabetes? – Diabetes is a Life Long Disease marked by High Levels of Glucose (Sugar) in the Blood What happens in Food Metabolism? – When food is digested; a sugar called glucose enters the blood stream. Glucose is a source of fuel for the body. The pancreas makes insulin which moves the glucose into muscle, fat, & liver cells, where it is used for fuel – In diabetes the body does not digest glucose because there is not enough insulin or the insulin is not used properly

3. Better Health. No Hassles. In a CDC study; the high category based on this scale started at11 per 1000. In MN. PBG = 25-55/1000

4. Better Health. No Hassles. Diabetes Deaths from diabetes are usually related to chronic complications. It is estimated that > 21 million people have Diabetes Types of diabetes – Type I – starts in childhood or as a young adult. The pancreas does not produce insulin which is needed to use glucose – Type II – the most common form; usually develops in adulthood and is associated with being overweight. The cells do not use insulin properly Gestational Diabetes – develops during pregnancy & usually goes away after pregnancy. These people are at higher risk for developing Type II diabetes. Usually treated with insulin and diet. Pre-Diabetes – develops when blood sugar is high enough to cause changes in the heart and circulatory system. Exercise & diet can lower blood glucose levels and delay or eliminate risk of Type II diabetes

5. Better Health. No Hassles. Risk Factors for Developing Diabetes Being overweight (especially around the waist) Inactive lifestyle > 45 years of age Are African-American, Hispanic-American, Asian or Native American descent Mother, father or siblings have diabetes High blood pressure Abnormal cholesterol Metabolic syndrome: combination of large waist, high triglycerides, low HDL (good cholesterol), High blood pressure & high blood sugar History of gestational diabetes or given birth to a baby weighing > 9 lbs

6. Better Health. No Hassles. Diabetes - Symptoms Frequent urination Blurred vision Excessive thirst or hunger Fatigue Weight loss Other symptoms: increase appetite, skin infections, slow healing wounds, & or tingling & numbness in hands or feet

7. Better Health. No Hassles. Diabetes - Complications Diabetic Retinopathy – Can lead to blindness Diabetic Nephropathy – Kidney disease S&S – protein in urine, fluid retention, high blood pressure, et. Diabetic neuropathy – swelling in affected extremity, loss of sensation & decreased pain Peripheral vascular disease – blockage in blood flow causing leg pain, ulcers & gangrene. Diabetes is the most common condition leading to amputations. Infections that do not heal Heart disease Stroke

8. Better Health. No Hassles. Treatment for Diabetes Type I treatment: Insulin in a shot or pump Type II treatment: take medicine by mouth; some need insulin later on in the disease. For all types of diabetes: Treatment involves making wise food choices, exercising regularly, some take ASA every day, and controlling BP and cholesterol

9. Better Health. No Hassles. Treatment for Diabetes – Prevent Complications Regular Visits to HCP Physicals for those with diabetes include BP check, Check feet for sensation or ulcers, and pulse, and lab tests including HbA1c (should be < 7), Fasting Blood Sugar, Lipids & Urinalysis Eye exam every year Dental exam at least yearly Keep log of blood sugars & share with HCP Always carry a snack high in sugar (lifesavers)

10. Better Health. No Hassles. Diabetes Symptoms of ketoacidosis (blood sugar is too high: increased thirst & urination, nausea, deep & rapid breathing, abdominal pain, sweet smelling breath & loss of consciousness Symptoms of hypoglycemia (blood sugar is too low) or severe insulin reaction: weakness, drowsiness, headache, confusion, dizziness, double vision, lack of coordination, convulsions or unconsciousness

11. Better Health. No Hassles. Who Should be Tested for Diabetes? All persons who are overweight Especially those 45 and > All persons as part of routine exam Any of risk factors: family history, inactive lifestyle, high blood pressure, abnormal cholesterol, metabolic syndrome, history of gestational diabetes or giving birth to baby > 9 lbs, & African- American, Hispanic-American, Asian or Native American descent.

12. Better Health. No Hassles. Diabetes & Glucose Testing Normal Glucose – 74-99 Pre-diabetes – blood glucose is higher than normal, but not diabetic. Fasting glucose 100-125 Diabetes – Fasting glucose > 126

13. Better Health. No Hassles. Steps to Lower Risk of Diabetes Make wise food choices most of the time – lean meats, low fat foods, whole grain foods, fruits & vegetables Become physically active Reach & maintain a reasonable weight Reduce Salt & alcohol Blood Pressure and Cholesterol to be at a healthy level

14. Better Health. No Hassles. Diabetic Diet – Where to start? Easy way - Using a dinner plate; put a line in the middle and then on one side divide it so there is three sections: – In the largest section put non-starchy vegetables such as spinach, green beans, mushrooms, greens, etc. – In one of the smaller sections put starchy foods such as whole grain bread or cereal, rice, pasta, potatoes, peas, low-fat crackers – Include a source of protein such as meat (2-5 ounces) to balance out your meal – select beef trimmed of fat

15. Better Health. No Hassles. Diabetic Diet In the other section put your meat or meat substitute such as chicken or turkey without the fat, fish, shrimp, lean cuts of beef, eggs, or low-fat cheese Add an 8 oz glass of low-fat milk Add a small piece of fruit Breakfast – Keep portions small, Use half of the plate for starchy foods, add fruit in one small part and meat in the other

16. Better Health. No Hassles. Diabetic Diet You can manage blood glucose by counting carbohydrates – A place to start is about 45-60gms carbohydrates/meal What contains carbohydrates? – Starchy foods like bread, cereal, rice, crackers – Fruit & juice – Milk & yogurt What foods contain carbohydrates – Dried beans like pinto beans & soy products – Starchy vegetables like potatoes & corn – Sweets and snack foods like soda, juice drinks, cake, candy & chips

17. Better Health. No Hassles. How Much Carbohydrates are in these Foods? Examples of about 15 grams of carbohydrates – 1 small fruit, ½ cup canned or frozen fruit, 1 slice of bread, ½ cup oatmeal, 1/3 cup pasta or rice, 4-6 crackers, ½ English muffin, ½ cup black beans, ¼ large baked potato, 2/3 cup yogurt, 2 small cookies, ½ cup ice cream, 6 chicken nuggets, ½ cup casserole, 1 cup soup, ¼ serving of medium french fries

18. Better Health. No Hassles. References Healthy Living American Diabetes Association