Know Your Numbers. A Guide to Better Diabetes Management

Transcription

1 Know Your Numbers A Guide to Better Diabetes Management This material is copyrighted by Bayer HealthCare LLC and is intended solely for use in the Know Your Series educational programs supported by Bayer HealthCare in the United States and Canada. Unauthorized use of this material without the express written consent of Bayer HealthCare, Diabetes Care is forbidden Bayer HealthCare LLC

2 How Food is Digested

3 Diabetes Body lacks insulin or is unable to use insulin effectively Pancreas Muscle and Fat Cells Cannot Produce Enough Insulin Cannot Use Insulin Effectively

4 Insulin Resistance Related Conditions

5 Complications of Diabetes Stroke: Heart 2-6x Disease: 2-4x Retinopathy: 25x End-Stage Kidney Disease: 17x Foot/Leg Amputations: 15-40x

6 Results from Diabetes Studies Good Diabetes Management results in Reduced microvascular disease Eye disease Kidney disease Neuropathy Reduced macrovascular disease Heart disease Stroke

7 United Kingdom Prospective Diabetes Study (UKPDS) Change in A1C Microvascular Complications 1% Decrease in A1C = 25% Decrease in Microvascular Risk

8 Key Numbers in Diabetes Control Daily Blood Glucose A1C (2-3 month glucose level) Lipids (Blood Fats) Blood Pressure (Hypertension) Urine Protein (Microalbuminuria)

9 Targets for Glucose Control ACE ADA Fasting/Pre-meal glucose <110 mg/dl mg/dl Post-meal glucose <140 mg/dl <180 mg/dl 2-hours after start of meal A1C <6.5% <7% American College of Endocrinology (ACE). Consensus statement for glycemic control. Endocrine Pract 2002;8 (Suppl 1); American Diabetes Association (ADA). Clinical Practice Recommendations. Diabetes Care. 2007;30 (Suppl 1); S4-S41.

10 A1C Measures Glucose Levels Over 2-3 Month Period

11 A1C and Self-Monitoring Results

12 Targets for Lipids, Blood Pressure and Microalbumin LDL HDL Triglycerides cholesterol cholesterol (mg/dl) (mg/dl) (mg/dl) Lipids <100 >50 women <150 (Blood Fats) >40 men Blood Pressure Microalbumin <130/80 mmhg <30 µg/mg creatinine on a spot sample American Diabetes Association (ADA). Clinical Practice Recommendations. Diabetes Care. 2007;30 (Suppl 1); S4-S41. American Heart Association, 2003.

13 Nutrition Dietary goals Maintain good blood glucose control Achieve and maintain reasonable body weight Maintain proper nutrition Fewer calories require less insulin Type of food matters Carbohydrate Protein Fat digested quickly digested somewhat slowly digested slowly

14 Meal Planning Options A Variety to Choose From Plate Method Food Pyramid Exchange System Carbohydrate Counting All meal plans should be individualized

15 Exercise and Weight Loss Improves circulation Increases insulin sensitivity Increases HDL cholesterol (the good cholesterol) Decreases blood pressure, LDL cholesterol and triglycerides Increases energy level

16 Medications Insulin Secretagogues Metformin Sitagliptin Thiazolidinediones Alpha-glucosidase inhibitors Supplements body s own insulin Pancreas stimulates insulin production Liver decreases glucose release Fat/Muscle increases insulin sensitivity Liver decreases glucose release Pancreas stimulates insulin production Fat/Muscle increases insulin sensitivity Intestine slows carbohydrate metabolism

17 Action Steps Follow your meal plan Follow your exercise plan Take your medications as prescribed Know Your Numbers! Get all required tests Monitor your blood glucose frequently

18 Get All Required Tests Every visit Every 3-6 months Every year Weight, blood pressure, and foot examination A1C Every 3 months: Initial, poor control, or changes in therapy A1C Every 6 months: If control is stable Dental Exam Every 6 months Eye examination, lipid levels, microalbumin, and comprehensive foot exam

19 Monitor Your Blood Glucose Frequently Gain immediate information about how you are doing Monitor the effect of changes in lifestyle and medication adjustments Relate symptoms of high and low blood glucose with blood glucose test results

20 7-Day Trends in Blood Glucose Levels Recommended Testing Pattern

21 What To Do With Your Numbers Meet with your diabetes healthcare provider Identify any patterns that may need attention Review all your numbers Blood Glucose A1C Lipid Levels Blood Pressure Microalbuminuria Identify missing numbers and arrange to have laboratory test(s) performed

22 Summary Good diabetes control matters! Good control involves proper use of lifestyle tools and medications Regular and frequent monitoring of all aspects of diabetes is essential to good control Meet with your healthcare professional regularly to evaluate your treatment program

23 Know Your Options Living an Uncomplicated Life with Diabetes This material is copyrighted by Bayer HealthCare LLC and is intended solely for use in the Know Your Series educational programs supported by Bayer HealthCare in the United States and Canada. Unauthorized use of this material without the express written consent of Bayer HealthCare, Diabetes Care is forbidden Bayer HealthCare LLC

24 As you view the show, make sure to also read the notes underneath each slide because there is a lot of information to keep you healthy in these notes. If you do not see the notes on the bottom of the slides, click on the View tab at the top of the page, and select notes page. If you have any difficulties, call Florey at ext Enjoy the show, it is a good one!

25 Diabetes Complications are Not Inevitable! Over the years if you do not control your blood sugar, complications can occur Keeping your blood sugar within recommended guidelines can prevent and/or reduce complications Best way to assess control Must be performed daily to affect control Results can be applied to adjust medications, nutrition and physical activity Know Your Numbers

26 Small Vessel Complications

27 Large Vessel Complications

28 Eye Disease Retinopathy is damage to the back of the eye (retina) Usually occurs in people that have diabetes for over 5 years First signs are blurry vision Glaucoma and Cataracts are seen in people with diabetes Need to get an eye exam every year by an Ophthalmologist

29 Treatment of Eye Disease Laser Therapy Scatter Photocoagulation Focal Photocoagulation Surgery

30 Tips to Prevent Eye Problems Keep your blood sugar as close to normal as possible Control your blood pressure Quit smoking See your eye specialist (Ophthalmologist) once a year See your doctor immediately if: Your eyes hurt or become red Blurred vision or spots Trouble reading books or signs Your peripheral vision (vision on the side) is not the same

31 Types of Skin Conditions Bacterial infections Fungal infections Dry skin/itching Scaly patches or brown spots

32 Types of Skin Conditions, continued Allergic reactions due to diabetes medications Xanthomatosis Acanthosis Nigricans

33 Tips for Good Skin Care Keep your blood sugar under control Keep skin clean and dry Avoid hot baths and showers Moisturize on a daily basis Treat cuts right away See a Dermatologist if you have any problems with your skin

34 Foot Care Inadequate foot care can lead to amputation Foot problems are due to: Lack of sensation Poor circulation Important to see a Podiatrist on a regular basis

35 Suggestions for Good Foot Care Examine feet daily Wash and dry feet thoroughly Cut toenails straight across Avoid self-treatment of corns and calluses Wear cotton socks Inspect shoes for foreign objects See a Podiatrist on a regular basis

36 Dental Care People with diabetes have an increased risk for gum disease and cavity formation The warning signs of gum disease are: Bleeding gums when you brush or floss Red, swollen or tender gums Bad breath Loose teeth

37 Types of Dental Conditions Oral infections Pain when chewing Increase in cavities Fungal infections Thrush Dry mouth

38 Tips for Good Dental Care Brushing and flossing are the best way to prevent gum disease See your Dentist on a regular basis Tell your Dentist you have diabetes Take your usual medications before your dental visit Make sure you are able to get your normal amount of daily calories. Plan ahead

39 What is Depression? Depression comes from a change in the chemical functioning of the brain Depression can be triggered by stress, difficult life events, environment, medications Depression affects your ability to function in day to day life

40 Diabetes and Depression Diabetes doubles the risk of being depressed Depression may be due to stress Depression can lead to: Poorer physical and mental functioning Not following your meal plan or exercise routine which can lead to weight gain Not taking your medications as prescribed

41 What Causes Depression in Diabetes Depression is caused by a number of factors; physical, psychological and genetic Everyone reacts differently to stressful events. Just finding out you have diabetes can be stressful People with diabetes may have depression due to: Worrying about long term complications Effect of their diabetes on daily life Effect of diabetes on their work environment Remembering the damaging effects of diabetes on relatives and/or friends

42 Symptoms of Depression People with true depression have symptoms that occur almost every day Symptoms include: Prolonged sadness/feeling down Irritability, anger, worry, anxiety Tired Feeling guilty, worthlessness Weight loss or gain Trouble sleeping Thinking about death or suicide

43 Treatment of Depression in Diabetes Important to see a trained mental health professional for counseling May need antidepressant medications Effective treatment of depression has been shown to improve diabetes control St. John s Wort can cause drug interactions

44 Erectile Dysfunction or Impotence? Erectile Dysfunction describes: Difficulty getting or maintaining an erection of the penis Impotence describes: Erectile dysfunction Lack of sexual desire Inability to reach or experience an orgasm Inability to ejaculate sperm during orgasm

45 Symptoms of Erectile Dysfunction in Men Can Vary Complete inability for erection Frequent inconsistent ability to achieve erection Inability to maintain an erection throughout intercourse

46 Risk Factors for Erectile Dysfunction in Men Physical diseases and disorders Surgery or trauma Medications Substance abuse Stress, anxiety, or depression Smoking

47 Diabetes and Erectile Dysfunction (ED) Men with diabetes are 3 times more likely to develop ED than those without diabetes ED in patients with diabetes may be a sign of poor blood sugar control By age 60, more than half of all men with diabetes will have experienced ED ED is often the first sign of autonomic neuropathy

48 Diabetes and Erectile Dysfunction (ED) ED can be seen at a younger age in men with diabetes Male infertility in diabetes is due to both erectile and ejaculatory failure Response to visual stimulation may be decreased The quality of the semen may be affected which can lead to infertility Improving glycemic control may help

49 Psychological Component of ED in Men with Diabetes Important in over 50% of cases Diminished self worth Fear of failure patients fear impotence more than blindness Marital disharmony More stress Decreased libido Decrease in sexual arousal Couples counseling can be very beneficial

50 Prevention of Erectile Dysfunction Limit or avoid use of all forms of tobacco Limit or avoid use of alcohol and other similar drugs Exercise regularly Use methods of stress reduction Get enough sleep Use effective approaches to deal with anxiety or depression See your doctor for regular checkups and medical screening tests

51 Treatment of Erectile Dysfunction in Men Simple change of some lifestyle choices Review of medication side effects Psychotherapy Medication therapy Oral PDE inhibitors (caution with nitrates!) Levitra* Cialis* Viagra* Oral testosterone * Levitra is a registered trademark jointly shared by Bayer Pharmaceuticals Corporation, GlaxoSmithKline and Schering Corporation. * Cialis is a trademark of Lilly ICOS LLC. * Viagra is a registered trademark of Pfizer Inc.

52 Symptoms of Sexual Dysfunction in Women Four types of sexual problems observed in women Desire disorders Arousal disorders Orgasmic disorders Sexual pain

53 Risk Factors for Sexual Dysfunction in Women Some causes of sexual dysfunction Physical conditions Diabetes Arthritis High blood pressure Vaginal Infections Hormonal-Estrogen deficiency Menopause Psychological counseling is recommended Depression Anxiety Stress

54 Treatment of Sexual Dysfunction in Women If desire is the problem Change your usual routine Muscle relaxation exercises If arousal is the problem Vaginal or estrogen creams Psychotherapy If orgasm is the problem Extra stimulation If pain is the problem Different positions Vaginal creams

55 Stress What is stress? Stress can be acute or chronic Stress can occur when: An event produces a strain on a person A person thinks a situation as challenging or threatening Stress is influenced by the Individual Environment

56 What makes something stressful for you? What are your major stressors? Life events Negative (traffic, arguing, doctor visits, tests, phone calls, holidays Positive (marriage, graduation, birth of a child, new job) Evaluating a stressful situation Our perspective and perception changes the way we view stress Beliefs, values and goals Change is stress

57 How does your body react to stress? Stress hormones (catecholamines, glucagon, cortisol, and growth hormone) Symptoms (nervous, sweaty, palpitations, nausea) How does stress affect diabetes and vice versa? Increase blood glucose and ketones Some people actually have a decrease in blood glucose initially

58 Coping and Stress Management Coping is how each of us respond to a stressful situation There are certain questions that you need to ask yourself Strategies and Coping Skills Different for everyone Good strategies help us to maintain control and feel less tense, relaxed Bad strategies make you feel tired, angry, sick, tense

59 Important Factors in Coping Having enough information Write down what causes stress and anxiety in your life Feeling in control Do fewer things better Do not over commit Avoid stressful situations Having the support of others Family and friends Support groups talk with other people who have diabetes Healthcare team social worker, Psychologist

60 Schedule Regular Visits With Your Healthcare Team Every Day: Check blood glucose at home Every Visit: Blood pressure Foot exam Every 3 months: A1C Weight Every Year: Blood lipid test Dilated eye exam Test for urine protein Flu shot and other vaccinations Dental checkup

61 Conclusion Managing your blood sugar and keeping it under control can decrease your risk of complications Many of the complications of diabetes can be prevented by understanding more about foot, skin and dental care, strategies to cope with stressful situations and making the right lifestyle choices Working closely with your healthcare team is crucial You Can Live An Uncomplicated Life With Diabetes