Diabetes School October 2016

Transcription

1 Diabetes School October 2016

2 Name Change- Why? Shorter Has my name in it Emphasizes a major part of the practice Still see non-research patients

3 Novo Nordisk Lilly sanofi aventis!

4 Thank You to our LucasResearch Staff Ellie Tammie Rebecca Adelle Liz Kelley!

5 Thank You Kerri-NC Aquarium Josh Catherine Tate The Flame - Smoke, Myra, Gerry and Anthony!

6 TURN OFF CELL PHONES Cell phone police are watching If you need to make a call, leave the room Restrooms Break Low blood sugar Copy of presentation on website

7 How did you hear about diabetes school? Brochures Dr. Lucas office Primary Care Offices Pharmacy From a friend or relative From the radio show TV commercial Internet/Website

8 SCHEDULE 8:30-10:00 DIABETES :00-10:30 BREAK 10:30-11:30 WHAT CAN I EAT? 11:30-12:30 THE REST OF THE STORY

9 What is Diabetes?

10 Diabetes is a disease that occurs when your body cannot produce enough insulin and cannot use the insulin well enough to control the amount of glucose (sugar) in your blood. The results is too much sugar in the blood. The sugar sticks to blood vessels throughout the body leading to complications for diabetes.

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16 Types of Diabetes Type 1 Type 2 Gestational Cause Immune system destroys cells that make insulin Insulin resistance wears out the cells that make insulin Insulin resistance is worse during pregnancy How Common? Less than 10% of people with diabetes More than 90% of people with diabetes 5% of pregnancies

17 Diagnosing Diabetes Hemoglobin A1C Fasting Glucose Tolerance Test (at 2 hours) Normal Less than Less than Less than % 100 Diabetes 6.5% or 126 or 200 or greater greater higher Prediabetes %

18 ! WHO IS AT RISK FOR DIABETES? Family history of Type 2 Diabetes Gestational Diabetes Overweight around the waist Medications which increase blood sugar Elevated triglycerides Insulin resistance Pancreatitis or pancreatic surgery!

19 Natural History of Type 2 Diabetes

20 INSULIN RESISTANCE High Insulin levels with normal blood sugars Development of fat around the waist Carbohydrate cravings May have hypoglycemia if delays eating!

21 DELAYED INSULIN RELEASE Elevated blood sugars after eating Insulin is released after sugar has gone up High blood sugar is followed by a low sugar Genetic GLP-1 Deficiency!

22 PREDIABETES Pancreas not able to make enough insulin Blood sugar goes up Fasting blood sugar is After meals, blood sugar is Hemoglobin A1C is % Still insulin resistant!

23 EARLY TYPE 2 DIABETES Fasting blood sugar is 126 or greater After meals, blood sugar is 200 or greater Hemoglobin A1C is 6.5% or greater Pancreas still making insulin Still insulin resistant Still have GLP-1 deficiency!

24 LATE TYPE 2 DIABETES Pancreas is wearing out Oral and injectable non-insulin medications are not controlling blood sugar Insulin is required to control diabetes Still insulin resistant Still may have GLP-1 deficiency!

25 Why Treat Diabetes?

26 Controlling Blood Sugar Makes you feel better Prevents high blood sugar symptoms: excessive thirst, urination dehydration blurred vision yeast infections Prevents long-term complications of diabetes

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

28 WHY DOES DIABETES AFFECT THE FEET? Neuropathy Circulation Delayed healing Infection-bacterial and fungal Unawareness of injury Dry skin

29 PREVENTING FOOT PROBLEMS Inspect feet top and bottom every day Wash feet and dry thoroughly Lotion to help dry skin Do not soak feet Clip toenails straight across Wear socks and comfortable shoes Break in new shoes slowly Do not smoke

30 PREVENTING HEART ATTACKS AND STROKES Control blood sugar Control blood pressure Control cholesterol and triglycerides Stop smoking Exercise Low dose aspirin Do not smoke

31 PREVENTING EYE PROBLEMS Yearly eye exam Treat glaucoma Treat macula edema Protect eyes from sun Control diabetes Control blood pressure Do not smoke

32 PREVENTING KIDNEY PROBLEMS Control diabetes Control blood pressure ACEI or ARB for blood pressure Yearly urine check for albumin Do not smoke

33 PREVENTING NERVE DAMAGE PROBLEMS Control diabetes Control blood pressure Do not smoke Medications which help neuropathy Gabapentin, Lyrica Cymbalta, amitriptyline Capsaicin cream Medications for gastroparesis Medications for erectile dysfunction

34 Clinical Research in Diabetes

35 CLINICAL RESEARCH IN DIABETES! Reasons to participate in diabetes research: Try out new medications prior to approval Concentrate more on your diabetes while in the study Contribute to knowledge about new medications Monitoring supplies, lab work, and medication provided at no charge. Personal attention

36 Stages of Research Ideas Computer modeling Animal Testing: Rats, mice, monkeys Human Testing Phase 1: Safety studies in healthy adults Phase 2: Dose ranging studies in patients Phase 3: Efficacy studies. Comparison with approved medication Phase 4: New indications for an approved medication!

37 CURRENT RESEARCH STUDIES! For those on metformin alone Metformin plus sulfonylureas, DPP-4 Metformin plus Byetta, Victoza or other GLP-1 Type 2 Diabetes with kidney damage Type 2 Diabetes with heart disease Type 1 Diabetes Pediatric Type 1 and Type 2

38 Benefits for Participants! Do you brush and floss your teeth more before a dental visit? Do you dress up for work when the boss is visiting? Participants in Diabetes studies have improved blood sugar control during a study because of constant monitoring and frequent visits to the office. Even if they are not taking the study medication, the diabetes improves from being aware of it. Placebo versus Study Medication. Why do it? It is worth the investment in time to participate to benefit your future health.

39 If you are interested in participating:! Sign up at the research table or at website Call the office and ask to speak to the research staff.! Be put on mailing list for future studies as well.!

40 Goals for the Treatment of Diabetes

41 Key Numbers in Diabetes Daily blood sugar readings Hemoglobin A1C Cholesterol and triglycerides Blood pressure Urine Protein or microalbumin Weight Waist (belly fat) measurement

42 Targets for Glucose Control For Type 1 and Type 2 Fasting/Pre-meal glucose hours after start of meal Bedtime glucose A1C of 6.5% or less No urinary protein

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45 13% 330!! A1C and Self-Monitoring A1C Results! 4% 60 5% 90 6% 120 7% 150 8% 180 Blood Glucose (mg/dl) 9% % % % 300

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47 !!! Targets for Lipids, Blood Pressure and Microalbumin! LIPIDS Blood Pressure Microalbumin! LDL! cholesterol! (mg/dl)!!! <70!!!!!!! HDL! cholesterol! (mg/dl)!! >55 women! >45 men!!! <130/80 mmhg!! Triglycerides! (mg/dl)!! <150!!! <30 mg/g creatinine on a random sample! Adapted from: American Diabetes Association. Clinical Practice Recommendations. Diabetes Care. 2002;25:S33-S49.!

48 Treatment of Diabetes

49 TREATMENT OF TYPE II DIABETES DIET: Total body weight reduction Upper body weight reduction Decrease in waist measurement EXERCISE Improves insulin sensitivity Decreases blood sugar at the time of exercise and up to 24 hours later

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51 Medications for Type 2 Diabetes To increase insulin production (sulfonylureas): Glimepiride, Glipizide, Glyburide To increase insulin production at meals only: Prandin, Starlix To improve pancreatic release of insulin at meals: Byetta, Victoza, Bydureon, Trulicity,Tanzeum, Januvia, Onglyza, Tradjenta, Nesina To improve insulin sensitivity: Metformin, Actos, Avandia To prevent kidney from holding onto sugar: Invokana, Farxiga, Jardiance

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53 GLP-1 secreted upon the ingestion of food

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55 Treatment of Type 1 Diabetes Mimic pancreatic secretion of insulin by long and short acting insulin Coordinating insulin doses to match food intake and activity

56 INSULIN Very long-acting: Tresiba Long-acting: Lantus, Levemir, Toujeo Intermediate: Novolin N, Humulin N, Humulin U-500 Short: Novolin R, Humulin R Rapid: Novolog, Humalog, Apidra Mixed: Novolog 70/30, Humalog 75/25, Humalog 50/50, Humulin 70/30, Novolin 70/30

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60 Insulin Resistance Related Conditions Type 2 Diabetes! Cardiovascular! Disease! High Blood Fats! Insulin! Resistance! High Blood Pressure! Impaired Glucose Tolerance! Obesity!

61 Why Monitor Your Blood Sugar?

62 To understand how the following things affect your blood sugar: Food Activity Medicine Daily life (e.g., illness, stress, drinking alcohol) To help you relate symptoms of high or low blood sugar with the actual results To provide you and your healthcare team with information to analyze and act upon

63 What can cause blood sugars to go up or down?

64 Go up Not taking enough Eating too much food (carbs) Exercising less than usual Physical or emotional stress, illness Go down Taking too much medication Not eating enough when taking certain medications More exercise than usual Alcohol

65 Times to check more often:! When starting a new diabetes medicine When making another change in your treatment plan (food, exercise) When having more highs or lows During times of illness or stress When you are planning a pregnancy or are pregnant

66 Use your tools (logbook, meter, etc.)! Look at 3 days in a row Use a 4-step guide to interpret the numbers: Gather information Look for a pattern Think about possible causes Take action

67 Sample logbook: Bob! Breakfast Lunch Dinner Bedtime! Before After Before After Before After Bedtime Time Time Time Time Time Time Time Day Date Medication Blood Glucose Blood Glucose Medication Blood Glucose Blood Glucose Medication Blood Glucose Blood Glucose Medication Blood Glucose Tue Comments: Additional Blood Glucose: Wed Comments: Additional Blood Glucose: Thur Comments: Additional Blood Glucose:

68 !!! The impact of food! Food has a major impact on blood sugar Check blood sugar before and 1 2 hours after meals Eat about the same size meals each day Have a meal plan that supports carbohydrate guideline Look for patterns of highs and lows and compare to carbs eaten, medications taken, exercise, etc.

69 Sample logbook: Carol! Bedtime! Breakfast Lunch Dinner Before After Before After Before After Bedtime Time Time Time Time Time Time Time Day Date Medication Blood Glucose Blood Glucose Medication Blood Glucose Blood Glucose Medication Blood Glucose Blood Glucose Medication Blood Glucose Tue Comments: Additional Blood Glucose: Wed Comments: Additional Blood Glucose: Thur Comments: Additional Blood Glucose:

70 Clinical Research in Diabetes

71 CLINICAL RESEARCH IN DIABETES! Reasons to participate in diabetes research: Try out new medications prior to approval Concentrate more on your diabetes while in the study Contribute to knowledge about new medications Monitoring supplies, lab work, and medication provided at no charge. Personal attention

72 CURRENT RESEARCH STUDIES! For those on metformin alone Metformin plus sulfonylureas, DPP-4 Metformin plus Byetta, Victoza or other GLP-1 Type 2 Diabetes with kidney damage Type 2 Diabetes with heart disease Type 1 Diabetes Pediatric Type 1 and Type 2

73 If you are interested in participating:! Sign up at the research table or at website Call the office and ask to speak to the research staff.! Be put on mailing list for future studies as well.!

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