Understanding Diabetes
And Your Risk
Presented by:
Sheryl Bartholow, FNP-BC
Family Medicine

Important Notice
The information contained in this document is for informational purposes only. It is not intended to diagnose or treat specific patients and should not be used as a substitute for the medical care and advice of your health care provider. In addition, this document may contain references to specific products and/or medications. Such references, whether by brand name or generically, are provided for informational purposes only and do constitute endorsement, recommendation, or approval by GRHS or its medical providers. Always consult a medical professional if you have concerns regarding your health. If you are experiencing a medical emergency, dial 911. Some images have been removed from the original presentation due to copyright or other considerations.

3 Main Points
 How can you decrease your risk of  What is the difference between diabetes and pre-diabetes?  What can you expect if you develop either condition?

Risk factors for diabetes
 Over 40 years old  Overweight  Family history  Diabetes during pregnancy  Baby over 9 lbs.  Stress of illness or injury  Elevated blood pressure  Sedentary Lifestyle  Some minorities

How to decrease risk of Diabetes
 Stay at a healthy weight -BMI 19-25  Eat well: healthy fats, lean proteins, lots of fruits and vegetables, low-fat dairy  Be active: preferably 30 minutes at least 3  With these steps, you can stay healthier longer and lower your risk of diabetes.  From the ADA web page,

 When fasting blood sugar is between 100-  When HgbA1c is between 5.7-6.4  When oral glucose tolerance test shows blood sugar between 140-199 Pre-diabetes cont.
 Sometimes occurs with symptoms of  Many times it has no symptoms  Always occurs before type II diabetes, but diabetes doesn't always have to follow it Pre-diabetes cont.
 Losing 7% of body weight (15# for someone who's 200#) can lower risk of Type II diabetes being diagnosed  Exercising 30 minutes 5 times weekly can decrease risk of diabetes diagnosis  With pre-diabetes it is important to be checked for Type II diabetes every 1-2 years Signs and Symptoms of Diabetes
 Tired  Dry itchy skin  Numbness or tingling in hands or feet  Increased urination  Problems with sexual function  Slow healing  Increased thirst  Unexplained weight loss What can you expect if you develop
5 main points for Controlling
Type II Diabetes
 Blood Glucose testing
 Diet
 Exercise
 Medications
 Visits with Health Care providers
Overview of Diabetes
 24 Million people with diabetes in USA  3 types of diabetes  Type 1 (auto-immune, NO insulin)  Type 2 (insulin resistance & insulin deficiency)  Gestational (pregnancy hormones= I.R.)  "Pre-diabetes" (also has risk factors) Target Glucoses for Diabetics
 70-120 mg/dL premeal  Less than 160 mg/dL (2 hours post prandial)  A rise of less than 40 (2 hours post prandial) if on Rapid acting insulin (Humalog, Novolog, or Aspart) Blood Glucose Testing
ALL people with diabetes should test
 If no meds or pills  test BG 3 x/day (minimum 2-3 days per week)  If on insulin  prefer 4 x/day  test as often as Health Care Provider or educator asks you to The Natural History of Type 2 Diabetes
Post Meal Glucose
Fasting Glucose
Insulin Resistance
Functi 100
Insulin Level
At risk for Diabetes
Beta cell failure
Years of Diabetes
Abnormal Glucose Metabolism
Glucose Metabolism
Peripheral tissues (Muscle and Fat) Improper regulation of (Type 1 and Type 2) Relative Insulin deficiency (Type 2) or no insulin (Type 1) What is Type II?
 Beta cells struggling to produce enough insulin to overcome insulin resistance. Complications from high blood glucose
 Retinopathy-diabetes affects eyes  Neuropathy- nerve cells swell and scar  Nephropathy-diabetes affects kidneys  Cardiovascular- higher risk of heart disease, especially with abnormal cholesterol, high blood pressure, smoking Carbohydrate Counting
 What is a carbohydrate?  Carbohydrate raises blood sugar  Examples of carbohydrates (CHO)  Bread, starch, milk, fruit, sweets  15 Gms of CHO = 1 choice  Recommend from 3(-5) choices per meal What is a Carbohydrate?
 Any food that turns to sugar after it is eaten is considered a carbohydrate  Starches and grains - Bread, potatoes, pasta,  Fruits and fruit juices  Milk and yogurt  Sweets What foods are not considered

 Most vegetables  Meats and meat substitutes  Fats Exercise and Diabetes
 Primarily applies to Type II  In Type I, an individualized approach with health care provider/educator is usually needed  Important to start moving more -stairs, parking further away from destination, going for a walk  Start slow or increase current exercise Exercise cont.
 Find times that work into your schedule so you can be consistent  Check blood sugar before and after vigorous exercise, especially when beginning program  Carry fast acting carbohydrate (juice, glucose tabs) with you during vigorous exercise Medications
 Discuss medication options with Health  Insulin –always in Type I, sometimes in Type II, esp. when disease present longer  Sulfonylureas –glipizide (Glucotrol), glimepiride (Amaryl), glyburide-stimulate pancreas to release more insulin  Biguanides –metformin (Glucophage)- decreases amount of glucose made by liver Medications cont.
 Meglitinides –repaglinide (Prandin), nateglinide (Starlix)-stimulate pancrease to secrete more insulin  Thiazolidinediones –rosiglitazone (Avandia), pioglitazone (Actos)-help insulin work better in muscle and fat and decrease glucose from liver  DPP-4 inhibitors -the "gliptins" like Januvia and Onglyza-prevents breakdown of GLP-1 in body, which regulates blood glucose Medications cont.
 SGLT2 inhibitors- Invokana and Farxiga-let excess glucose pass out of body into urine  Alpha-glucosidase inhibitors –acarbose (Precose), meglitol (Glyset)-blocks the breakdown of starches and slows breakdown of sugars  Bile acid sequestrants - colesevelam(Welchol)-binds with bile acids in digestive system, lowers cholesterol and blood glucose Medications cont.
 GLP-1 Receptor Agonists - exenatide (Byetta), liraglutide (Victoza), pramlintide (Symlin) –normalize blood glucose, makes you feel full longer and helps insulin in your body work better. Many lose weight. It is injectable.  New once weekly versions- dulaglutide (Trulicity), albiglutide (Tanzeum), exenatide (Bydureon) How often do I need to see my
health care provider?
 EVERY 3 MONTHS!!  Visit to include:  HgbA1c  Foot check  Annual visit to include:  Comprehensive foot exam  Lipid profile  Urine screening for protein  Stress test (every 5 years) What should I bring?
 LOG BOOK!!  Log book should include:  Blood sugars with dates & relationship to  Exercise  Medications (esp. if on insulin)  Results of previous test results (ie. HgbA1c, lipids, urine screening for protein, etc.)  Any questions for provider written down ABC's of Self-Management
 (Hemoglobin) A1c  <7% (as close to 6% as can get)  Blood Pressure < 130/80  Cholesterol (LDL<100)  Blood glucose (BG) control is  BG testing improves BG  See your physician every 3  Bring your LOG BOOK!!  Remember your A, B, C's! Questions?


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