*Jeremiah 33:6 *'Nevertheless, I will bring health and healing to it; I will heal my people and will let them enjoy abundant peace and security.

Transcription

1 Jeremiah 33:6 Ministry FAITH and HEALTH TEACHING CONNECTION 2 nd Saturdays 10am West Fellowship Hall Brian Mitu, NP, PA-C Nurse Practitioner/Physician Asst. - St. Albert Medical Clinic Eliza Rivera-Mitu, MSN, APRN, FNP-C Professor El Camino College/Compton College/Samuel Merritt University; Cardiac Stress Test Nurse Practitioner St. Albert Medical Clinic Jeremiah 33:6 'Nevertheless, I will bring health and healing to it; I will heal my people and will let them enjoy abundant peace and security. Hosea 4:6 My people are destroyed for lack of knowledge 1

2 To reach people, serve our community and let them know that our Lord Jesus Christ loves them through educating them about their health and how to improve it for God s glory. At the end of each life group session, the participants will be able to: 1. Realize the miracle of life that God has given us by learning about the Anatomy and Physiology of the human body. 2. Gain knowledge about prevention and management of chronic diseases. 3. Prevent chronic diseases through lifestyle change for the glory of God. 2

3 At the end of each life group session, the participants will be able to: 4. Realize that our body is the temple of God, and therefore should be kept holy and clean. 5. Maintain optimum health through total lifestyle change in order to serve God wholly and fully. 6. Educate and enlighten others about the new knowledge that are gained, therefore also spreading the Word of God. Incidence of diabetes is growing rapidly both in the US and worldwide Over 180 million people worldwide are afflicted Prevalence is expected to more than double by year 2030 USA, approximately 21 million are estimated to suffer from diabetes, and is the major cause of morbidity and mortality 3

4 Diabetes is known as starvation in a midst of plenty. It is characterized by an increase of blood glucose by relative or absolute deficiency of insulin, insulin resistance 4

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6 Type 1 (formerly known as insulindependent DM) Type 2 (formerly known as non-insulin dependent DM) Gestational DM Carbohydrate intolerance with onset or 1 st recognition during pregnancy Diabetes due to other causes Medication induced Cause Autoimmune destruction of beta cells Represents 5-10% of diabetics Characteristics Age: less than 20 years old; Onset: Weeks Insulin secretion: falling to none; thus, Insulin is the only treatment Body image: lean Acute complication: Diabetes ketoacidosis Microvascular complications at DX: no Macrovascular complications at DX: uncommon 6

7 Cause Decrease in beta cells activity (insulin deficiency) Insulin resistance ( uptake of insulin by peripheral muscle cells) Increase glucose production by the liver Represents: 90-95% of diabetics Characteristics Age: over 40year old; Onset: gradual ( Takes about 10 years before diagnosis) Insulin secretion: oversecretion for years Body image: overweight or obese Insulin required for treatment: No Acute complication : Hyperosmolar Non-Ketoacidosis Microvascular complication at diagnosis: common Macrovascular complication at diagnosis: common 7

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9 Before eating (Fasting state) blood glucose: Normal Before eating blood glucose: Impaired fasting (borderline diabetic) Before eating blood glucose: > 126 Diabetic Non-fasting blood glucose > 200 plus symptoms diabetic 2 hour Oral glucose tolerance test diabetic Hemoglobin A1C > 6.5 diabetic 9

10 To maintain Blood glucose concentrations with in the normal limits and to prevent the development of long term complications of the disease Microvascular complications Destruction of capillaries in eyes, kidneys, peripheral tissues Macrovascular complications Artherosclerosis of middle to large arteries such as the heart and brain 10

11 Diabetic Retinopathy: It is the leading cause of blindness among U.S. adults. Diabetes can damage the retina; this is the nerve tissue at the back of the eye. This tissue is sensitive to light. And, it sends visual images to the brain. Changes in the tiny blood vessels that send blood here cause eye damage. 11

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13 Diabetic retinopathy stages Nonproliferative Retinopathy (EARLY) Blood vessels of the retina get weak and develop bulges (called microaneurysms ) These may leak blood (hemorrhage), or they may leak fluid into the tissue around the retina Proliferative Retinopathy (Late) New, fragile blood vessels start to grow on the retina and into a jelly-like substance inside the back of the eye These abnormal vessels are prone to rupture and bleed into the back of the eye 13

14 Studies show that keeping blood sugar in control can: Reduce how many people develop eye damage Prevent eye damage from getting worse. If you get eye disease, laser surgery can treat it. And, vision can be preserved if the eye damage is found early. About half of those who do not get treated will become blind in 5 years. But, only 5% who do get treated may become blind. Routine eye exams are key; this is the best way to detect eye damage in its treatable stages. Nephropathy Kidney disease develops in about: 1 out of 3 people with type 1 diabetes 1 out of 5 people with type 2 diabetes. This disease can lead to kidney failure. The number of people who get kidney disease is going down, though. This is because we now know that tight control of blood sugar can help. It cuts the risk of kidney damage in half. And, use of medicine ( ACE inhibitors ) can help stop kidney damage. 14

15 Coronary heart disease Arteries that carry blood to the heart can get narrow which can lead to Chest pain (Angina) or Heart Attack (Myocardial infarction) People who have diabetes are at risk for Coronary Heart Disease. Women who have diabetes are at high risk for heart attacks. The arteries to the heart tend to get wider when you exercise.this increases blood flow to the heart. Other risk factors: Smoking, high blood pressure, high LDL ( bad ) cholesterol, low HDL ( good ) cholesterol 15

16 Stroke People who have diabetes are at risk for stroke. Stroke risk factors that are related to diabetes include: High A1C levels (high blood sugar); Long history of diabetes High blood sugar may raise stroke risk in different ways. It may: Allow cholesterol to build up faster along arteries to the brain, promote blood clots Another risk factor for stroke is high blood pressure. Many people with diabetes have high blood pressure. 16

17 Poor circulation of blood to the feet (called peripheral vascular disease ). Cold feet can be a sign of poor circulation Also, pain in your legs when you walk or exercise. But, that pain stops as soon as you rest. If so, this is a special condition (called intermittent claudication ). Exercise is a good treatment for poor circulation; it helps new blood vessels grow 17

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19 Loss of feeling in the feet (from peripheral neuropathy ). These lead to Amputation. Check for numbness yourself. 19

20 Do you not know that your bodies are temples of the Holy Spirit, who is in you, whom you have received from God? You are not your own; you were bought at a price. Therefore honor God with your bodies. Do you not know that you are God s temple and that God s Spirit dwells in you? If anyone destroys God s temple, God will destroy him. For God s temple is holy, and you are that temple. 20

21 Lifestyle modification: Weight reduction, Exercise, Dietary modification Treat co-morbid condition Medications oral, injectable or Insulin 21

22 1 Corinthians 9:27(NLT) I discipline my body like an athlete, training it to do what it should. Exercise can help you improve your blood sugar control, boost your overall fitness, and reduce your risk of heart disease and stroke. Check your Blood Sugar before exercise Lower than 100. Your blood sugar may be too low to exercise safely. Eat a small snack containing 15 to 30 grams of carbohydrates, such as fruit juice, fruit, crackers or even glucose tablets before you begin your workout. 100 to 250. You're good to go. For most people, this is a safe pre-exercise blood sugar range Types of exercise Walking (split three 10 minute fast walk per day) Walk the dog, Park car at a distance, take the stairs instead of elevator, Yard work w/ push mower Family biking, soccer w/ kids, Swim with family Jogging, Hiking, Dance, elliptical Yoga and Tai chi 22

23 Daniel 1: Please test us for ten days on a diet of vegetables and water, Daniel said. 13 At the end of the ten days, see how we look compared to the other young men who are eating the king s food Know your good carbohydrates (low to medium glycemic Index) 100% stone-ground whole wheat or pumpernickel bread, Whole Wheat pasta/bread, asparagus, cauliflower, Ezekiel bread, Skim milk Apple or Berries: Black, Raspberry, Strawberry, Blue Berry Rolled or steel-cut oatmeal, oat bran, muesli Sweet potato, corn, yam, lima/butter beans, peas, legumes, lentils, SQUASH, Acorn, Butternut, pumpkin Brown, wild or basmati rice, couscous,quinoa, Bulgur, Greek Yogurt Bad carbohydrates (High glycemic index) White bread, bagel, corn flakes, puffed rice, bran flakes, instant oatmeal, flour, sugar Rice pasta, white rice, macaroni and cheese White/Russet potato, pumpkin Pretzels, rice cakes, pop corn, saltine crackers Melon, pineapple, raisins, Bananas, grapes 23

24 Portion and frequency of meals Eat 5 to 6 times per days (small portion) Carbohydrates 3 ounces per meal 4 ounces of protein (Women); 6 ounces of protein (Men) Avoid dairy products A more detailed diet and meal plan will be discussed in weight loss lecture 24

25 Self Blood Glucose Monitoring Before Eating: Two Hours after eating: Less Th 180 Bedtime (Make sure you have light Snack to avoid low blood sugar) A1C Goal Less than 7% if your over 65 years old Less than 6.5% if your less than 65 years old Baby Aspirin (81 mg) for Heart or Stroke prophylaxis Control Blood pressure Take your blood pressure medication regularly, ACE inhibitors ( ends w/ pril ) Lisinopril, benazepril, zestril, etc Blood Pressure goal: Less than 130/80 Control Cholesterol Take your cholesterol medication (ends w/ -statin ) Cholesterol level goal: HDL (good cholesterol) above 45 ; LDL (Bad cholesterol) below70 Triglyceride below 150; Total cholesterol below

26 Bathe your feet daily. Wash carefully with warm water and soap; rinse and dry thoroughly. Make sure you dry completely between the toes. Be careful as you trim your toenails. File straight across. Think about going to see a podiatrist; he or she can do your regular foot care. Do not use products for corn or callus removal; be sure never to try to trim calluses yourself. Try to figure out pressure points that might be causing a callus. Then, be sure to stop that pressure. See a foot doctor for treatment. 26

27 Moisturize feet that are dry. If the skin on your feet is dry, a moisturizing cream will help. But, you should apply it sparingly. Never apply it between the toes. Inspect your feet daily. Be on the lookout for: cuts; red spots, warm spots, or hot spots; calluses or corns; ingrown toenails; change in color; or any other abnormalities. Never go barefoot; always wear shoes to cover your feet. Make sure your shoes fit right. Shoes that are too tight can cause blisters and calluses; Shoes that are too loose can also cause ulcers or blisters as they rub against the foot. Make sure socks aren't rubbing, either. 27

28 PLEASE FILL OUT A CARD TO SUGGEST A TOPIC THAT YOU WOULD LIKE TO DISCUSS IN FUTURE MEETINGS 28

29 Biguanides Glucophage, Fortamet, Glumetza (metformin) Sodium-Glucose co-transporter 2 Inhibitors (SGLT-2 inhibtior) Jardiance (empagliflozin), Farxiga (dapagliflozin), Invokana (canagliflozin) Combination: Invokanamet (canagliflzin/metformin), Glyxambi (empagliflozin/linagliptin), Synjardy (empagliflozin), Xigduo (dapagliflozin/metformin), Qtern (dapagliflozin/saxagliptin) Incretin-Mimetic Agent ( Non-insulin injectables) Byetta (exenatide), Victoza (liraglutide) daily Bydureon BCise (exenatide), Trulicity (dulaglutide) once weekly Dipeptidyl peptidase-4 inhibitors Januvia (sitagliptin), Onglyza (saxagliptin), Tradjenta (linagliptin) 29

30 Secretagogues Sulfonylureas 1st generation:orinase (tolbutamide), Tolinase (tolazamide), Dymelor (acetohexamide), Diabense (chlorpropamide) 2nd generation: Glucotrol (glipizide), Micronase, Diabeta (glyburide), Amaryl (glimepiride) Meglitinide analogs Prandin (repaglinide), Starlix (nateglinide) Insulin Sensitizer Actos (pioglitazone), Avandia (rosiglitazone) Alpha glucosidase Inhibitors Precose (acarbose), Glyset (miglitol) Dopamine Agonist Cycloset, Parlodel (bromocriptine) Bile sequestrants Welchol (colesevelam) 30

31 Rapid Acting Novolog (aspart),humalog (lispro),apidra (glusine) Short Acting Humulin R (human);novolin R (human) Intermediate-Acting Insulin Humulin N (human),novolin N (human),lente iletin II (PORK) Basal Insulin Lantus(glargine);Levemir(detemir) Inhaled Insulin:Exubera (off market) ; Afrezza Glucophage, Fortamet, Glumetza (metformin) How they work: Improve insulin's ability to move sugar into cells (decrease insulin resistance), especially muscle cells. They also prevent the liver from releasing stored sugar (gluconeogenesis and glycogenolysis). Advantage: Weight loss; No risk of low blood sugar (Hypoglycemia) Side Effect: Diarrhea, Abdominal cramps 31

32 Glucophage, Fortamet, Glumetza (metformin) Contraindication You should not take them if you have kidney damage or heart failure Pts receiving radiopaque dyes. Radiopaque dyes often induce temporary Renal Insufficiency Stop metformin hours before procedures in which radiopaque dye will be administered Do not restart metformin for 2-3 days and until normal renal function has been proven Ethanol (Alcohol) Ethanol potentiates the effects of metformin on lactate metabolism Note: Long-term use may interfere with vitamin B12 absorption. Also use in women with PCOS (polycystic ovarian syndrome) 32

33 Jardiance (empagliflozin), Farxiga (dapagliflozin), Invokana (canagliflozin) Combination: Invokanamet,Glyxambi, Synjardy, Xigduo, Qtern How it works: blocks the reabsorption of glucose in the kidney, increase glucose excretion, and lower blood glucose levels 33

34 Side effects Weight loss, excessive urination leading dehydration (Drink plenty of fluids), genital yeast infection ( Meticulous perineal hygiene) Toe amputation with Invokana (canagliflozin) 34

35 Byetta (exenatide), Victoza (liraglutide) daily Bydureon BCise (exenatide), Trulicity (dulaglutide) once weekly How it works: Incretin is a natural hormone comes from L- cells located in the distal ileum and colon in response to ingestion of carbohydrates and fats. Incretin mimetics act like (mimic) the incretins in your body How it works Incretin helps decrease Blood sugar by Enhancing insulin release Suppressing glucagon secretion by the liver, Decreasing glucose output from the liver, Delaying gastric emptying which leads to feeling of fullness, delayed absorption of sugar and fat. As a result Weight loss, Maintaining pancreatic beta cell function Side effects: Nausea, Vomiting, Pancreatitis 35

36 Januvia (sitagliptin), Onglyza (saxagliptin), Tradjenta (linagliptin) How it works Inhibits the enzyme DDP4, which is responsible for the inaction of incretin hormones, such as glucagon-like peptide-1(glp-1) Prolongation of incretin activity results in increase insulin release in response to meals and reduction inappropriate secretion of glucagon Side Effect: Nasopharyngitis, Headache, Pancreatitis 1st generation: Orinase (tolbutamide), Tolinase (tolazamide), Dymelor (acetohexamide), Diabense (chlorpropamide) 2nd generation: Glucotrol (glipizide), Micronase, Diabeta (glyburide), Amaryl (glimepiride) How it works: Promote insulin release from B cells of the pancreas, decrease hepatic glucose production, increase peripheral insulin sensitivity (Do not skip meals) Side Effects: Weight gain, low blood sugar 36

37 Prandin (repaglinide), Starlix (nateglinide) How it works: Same action as sulfonylureas, but has a rapid onset of action and short duration span compared to sulfonylureas Side Effect: Hypoglycemia Note: due to shorter duration,must be taken 3 times per day (which leads to noncompliance) Actos (pioglitazone), Avandia (rosiglitazone) How it works Lowers Blood Glucose by increasing the sensitivity of muscle and fat tissue to insulin, allowing more glucose to enter the cells Inhibit hepatic gluconeogenesis and decrease hepatic glucose output Side Effect Liver toxicity. Stop medicine if Liver function test (LFTs) more than 3x the normal (Check baseline and 6 weeks after initiation) Weight gain due to increase SC fat or fluid retention (can lead to Heart Failure), osteopenia and risk Fracture 37

38 Precose (acarbose), Glyset (miglitol) How it works Block enzymes (pancreatic alpha amylase and GI alpha glucoside hydrolase) that help digest carbohydrates, slowing the rise in blood sugar Side Effect: Flatulence, Diarrhea, Abdominal cramps Contraindication: Inflammatory bowel disease (IBD), Colonic ulceration, Intestinal obstruction Cycloset, Parlodel (bromocriptine) How it works: Increases dopamine receptor activity in the morning, which lowers blood sugar without increasing insulin Not usually prescribed 38

39 Welchol (colesevelam) Used for lowering cholesterol How it works in lowering blood glucose is not known I personally don t prescribe this medication Released by the pancreas in a steady rate unit per hour. Ave units per days Insulin from pancreases different animals (pork, beef) have been used for years; however, due to increased incidence of allergic reaction; biosynthetic human insulin is now the most commonly used 39

40 Types of insulin Rapid acting Short acting (rarely used now) Intermediate acting (rarely used now) Long acting Rapid Acting Novolog (aspart), Humalog (lispro), Apidra (glusine) Onset of action: minutes Peak effect 1-3 hours Duration 6 hours Take less than 15 minutes before meals or immediately after meals Side effect: Hypoglycemia 40

41 Short Acting Humulin R (human); Novolin R (human) Onset: ½- 4hours Peak: 2 ½-5 hours Duration: 5-10hours Side effect: hypoglycemia Intermediate-Acting Insulin Humulin N (human), Novolin N (human), Lente iletin II (PORK) Onset: 1-2 hours Peak: 4-6 hours Duration: 12 hours Side effects: Hypoglycemia Combination insulin Humulin 70/30 or Novolin 70/30; Humalog 75/25; Novolog 70/30 41

42 Basal Insulin Lantus (glargine); Levemir (detemir) Mimics steady pancreatic release of insulin. Onset: 1 hour No Peak Duration: hours Newer kind: Tresiba (degludec); Toujeo (glargine) Basaglar (glargine) Combination: Ryzodeg (70% Tresiba 30% aspart); Xultophy (Tresiba and Victoza);Soliquia (glargine and lixisenatide) Exuber (Rapid acting insulin) This medication was pulled out of the market because of the required medical expense ($$$$$) needed before administration and throughout therapy I personally did not prescribed this medication because of the above reason; Furthermore, its not known about its possible effect on the lungs New version: AFREZZA 42

43 Do not freeze or be heated above 98 F (loss of potency) Store in refrigerator until opened Bottle can be kept at room temperature until gone F Open vial must be discarded in 30 days (not sterile) All insulin except regular, Novolog (aspart), Humalog (lispro), Apidra (glusine) Vial must be rolled in the palms of the hands to warm and resuspend the insulin (lost of potency, clumping, precipitation) Prefilled insulin syringes must be stored in refrigerator and in a vertical position with the needle up. Must be rolled gently between the hands 43