1. What is Sugar? Sugar or glucose, is our bodies main source of energy. Normally, after you eat, your sugar in your blood stream begins to rise. When your blood sugar rises, it sends a message to your pancreas to release insulin. Insulin is what takes the sugar from your blood stream to each cell for energy.

3. Sugar continued.. If your sugar is not able to reach each cell, it will continue to build up in the bloodstream, causing damage. Too much sugar in the bloodstream is like shards of glass in your arteries. It causes damage to the arteries, leading to complications.

5. What is Diabetes?

6. Diabetes Diabetes is diagnosed when your body is not able to get rid of extra sugar in your bloodstream. There are two types: – Type 1 (juvenile, early onset, insulin dependent) – Type 2 (non insulin dependent, later onset)

7. Is Diabetes Common? Diagnosed: 18.8 million people Undiagnosed: 7.0 million people Prediabetes: 79 million people

8. Diabetes Source: 2005–2008 National Health and Nutrition Examination Survey.

9. Is Diabetes Serious? Morbidity and Mortality In 2007, diabetes was listed as the underlying cause or contributing factor on death certificates of 231,404 deaths. Is the 7 th leading cause of death in the US Diabetes causes more deaths a year than breast cancer and AIDS combined. Two out of three people with diabetes die from heart disease or stroke.

10. Why is Diabetes so Serious? Heart disease and stroke In 2004, heart disease was noted on 68% of diabetes- related death certificates among people aged 65 years or older. In 2004, stroke was noted on 16% of diabetes-related death certificates among people aged 65 years or older. Adults with diabetes have heart disease death rates about 2 to 4 times higher than adults without diabetes. The risk for stroke is 2 to 4 times higher among people with diabetes.

11. Why is Diabetes so Serious? Blindness Diabetes is the leading cause of new cases of blindness among adults aged 20–74 years. In 2005-2008, 4.2 million (28.5%) people with diabetes aged 40 years or older had diabetic retinopathy, and of these, almost 0.7 million (4.4% of those with diabetes) had advanced diabetic retinopathy that could lead to severe vision loss. Kidney disease Diabetes is the leading cause of kidney failure, accounting for 44% of new cases in 2008. In 2008, 48,374 people with diabetes began treatment for end-stage kidney disease in the United States. In 2008, a total of 202,290 people with end-stage kidney disease due to diabetes were living on chronic dialysis or with a kidney transplant in the United States.

12. Diabetic Blindness

13. Why is Diabetes so Serious? Nervous system disease (Neuropathy) About 60% to 70% of people with diabetes have mild to severe forms of nervous system damage. Amputation More than 60% of nontraumatic lower-limb amputations occur in people with diabetes. In 2006, about 65,700 nontraumatic lower-limb amputations were performed in people with diabetes

14. True or False? Eating too much sugar causes diabetes?

15. Answer: FALSE! Type 1 diabetes is caused by genetics and unknown factors that trigger the onset of the disease; type 2 diabetes is caused by genetics and lifestyle factors. Being overweight does increase your risk for developing type 2 diabetes, and a diet high in calories, whether from sugar or from fat, can contribute to weight gain. If you have a history of diabetes in your family, eating a healthy meal plan and regular exercise are recommended to manage your weight.

16. Type 2 Diabetes Chronic condition Pancreas is not making enough insulin Insulin is not used well by the body Not caused by eating too many sweets Does not go away

17. Risk Factors Overweight Inactive Over 40 Strong family history High risk population Race

18. What Causes Diabetes? Cause is unknown Many factors may lead to diabetes

19. Symptoms of diabetes Thirst Frequent urination Fatigue Dry skin Blurry vision Change in weight Hunger, change in appetite

21. Type 1 diabetes Usually children under 20 Rapid onset with symptoms Autoimmune disorder, makes antibodies against own insulin Little on no family history Boys = girls Requires insulin for life

22. Type 2 diabetes 1 out of 20 adults over 40 Overweight, inactive Strong family history Slow onset, often without symptoms Usually occurs after 40, but occurring in children now Diet, medicine and exercise

23. Normal blood sugar Fasting 65 – 99 mg/dl Non – fasting 65 – 140 mg/dl

24. Pre - diabetes Fasting 100 – 125 mg/dl Non – fasting 140 – 199 mg/dl

25. Diagnosis of diabetes Fasting blood sugar above 126 mg/dl Non – fasting blood sugar above 200 mg/dl

26. A1C glycohemoglobin Measurement of the average blood sugars over a 90 day period “3 month test” Should be done routinely every 3 to 4 months

28. Diabetes management Diet Exercise Medicine Blood sugar testing

29. Diet A healthy meal plan for people with diabetes is generally the same as a healthy diet for anyone – low in fat (especially saturated and trans fat), moderate in salt and sugar, with meals based on whole grain foods, vegetables and fruit. Diabetic and “dietetic” foods generally offer no special benefit. Most of them still raise blood glucose levels, are usually more expensive, and can also have a laxative effect if they contain sugar alcohols.

30. True or False? People with diabetes can't eat sweets or chocolate?

31. Answer FALSE! If eaten as part of a healthy meal plan, or combined with exercise, sweets and desserts can be eaten by people with diabetes. They are no more “off limits” to people with diabetes than they are to people without diabetes.

32. Diet Although there are no “off-limit” foods, it is important to develop a meal plan with your doctor or dietician. You should aim for consistency in regards to carbohydrates. Goal is 30-45 grams of carbs per meal to keep sugar levels consistent.

34. Exercise People with pre-diabetes, diabetes, or the general adult public should aim for a minimum of 30 minutes most days. Walking, gardening, doing yard work, swimming, or cleaning house will all work to meet this goal. Anything that increases your heart rate and causes you to break a light sweat. You won’t go from zero to thirty or sixty (minutes), in a day or week. Take one step at a time. Slowly build up to your goal. A comprehensive physical activity routine includes three kinds of activities: – Aerobic Exercise – Strength Training – Flexibility Exercises

35. Medicine Many people only need to take pills. Talk to your doctor regarding medications Some people require insulin injections. – Very small needle – Very important to have sugar levels under control

36. Testing Your doctor will tell you how often you should check your sugar. Usually, it is anywhere from once a day to six times a day. Your doctor should give you a prescription for a – Glucose meter – Strips – Lancets (needles) It is important to check your sugars regularly and record them!

37. Glucose Testing

38. Other Tests Hemoglobin A1c test: Get this test at least twice a year. It checks your average blood sugar over the past two to three months. Blood lipid (fats) test: A blood test of cholesterol and triglycerides. Once a year Kidney function tests: Get a urine test that checks for protein in urine at least once a year. Get a blood test for creatinine, a waste product, at least once a year. These tests screen for kidney problems. Blood pressure: Get your blood pressure checked at every medical appointment. Dilated eye exam: See an eye care professional once a year for a complete eye exam. Foot exam: At every medical appointment, get your feet's nerves and blood circulation.

39. Thank you!