Diabetes Overview. How Food is Digested
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1 Diabetes Overview You are The Teacher, The Coach and the Fan Pathophysiology of Diabetes Complications Know the Numbers Treatment Can Good Control Make a Difference? Can Tight Control Be too Tight? How Food is Digested 1. Food enters stomach 4. Pancreas releases insulin 5. Insulin unlocks receptors 6. Glucose enters cell 2. Food is converted into glucose 3. Glucose enters bloodstream 1
2 Diabetes Body lacks insulin or is unable to use insulin effectively Pancreas Muscle and Fat Cells Cannot Produce Enough Insulin Cannot Use Insulin Effectively Insulin Resistance Related Conditions Type 2 Diabetes Cardiovascular Disease High Blood Fats Insulin Resistance High Blood Pressure Impaired Glucose Tolerance Obesity 2
3 Complications of Diabetes Stroke: 2-6x End-Stage Kidney Disease: 17x Retinopathy: 25x Foot/Leg Amputations: 5x Heart Disease: 2-4x Results from Diabetes Studies Good Diabetes Management results in REDUCED microvascular disease eye disease kidney disease neuropathy REDUCED macrovascular disease heart disease stroke 3
4 United Kingdom Prospective Diabetes Study (UKPDS) Change in A1C - 0.9% Microvascular Complications - 25% % Decrease in A1C = 25% Decrease in Microvascular Risk! Key Numbers in Diabetes Control Daily Blood Glucose A1C (2-3 month glucose levels) Lipids (Blood Fats) Blood Pressure (Hypertension) Urine Protein (Microalbuminuria) 4
5 Targets for Glucose Control Type 1 and Type 2 Diabetes Fasting/Pre-meal glucose Post-meal glucose 2 hr. after start of meal Bedtime glucose mg/dl mg/dl mg/dl A1C 6.5% Adapted from: American Diabetes Association. Clinical Practice Recommendations. Diabetes Care. 2002;25:S33-S49, and American College of Endocrinology: Consensus statement on guidelines for glycemic control. Endocrine Pract 2002;8 (Suppl. 1):5 11. A1C Measures Glucose Levels over 2-3 Month Period Red Blood Cell Glucose High Blood Glucose Normal lblood dglucose 5
6 A1C and Self-Monitoring Results A1C 4% 60 5% 90 6% 120 7% 150 Blood Glucose (mg/dl) 8% 180 9% % % % % 330 Targets for Lipids, Blood Pressure and Microalbumin LDL cholesterol (mg/dl) HDL cholesterol (mg/dl) Triglycerides (mg/dl) Lipids (Blood Fats) <100 >55 women >45 men <150 Blood Pressure <130/80 mmhg Microalbumin <30 mg/g creatinine on a random sample Adapted from: American Diabetes Association. Clinical Practice Recommendations. Diabetes Care. 2002;25:S33-S49. 6
7 Exercise and Weight Loss Improves circulation Increases insulin sensitivity Increases HDL cholesterol (the good cholesterol) Decreases blood pressure and cholesterol Increases energy level Dietary Goals: Nutrition Maintain good blood glucose control Achieve and maintain reasonable body weight Maintain proper nutrition Type of food matters Type of food matters Carbohydrate digested quickly Protein digested somewhat slowly Fat digested slowly 7
8 Medications Insulin Secretagogues Metformin Thiazolidinediones Alpha-glucosidase inhibitors Supplements body s own insulin Pancreas -- stimulates insulin production Liver -- decreases glucose release Fat/Muscle -- increases insulin sensitivity Fat/Muscle -- increases insulin sensitivity Intestine -- slows carbohydrate metabolism Get All Required Tests Every Visit Every 3-6 months Every Year Blood Pressure Foot exam A1C -- Every 3 months: Initial/Poor Control -- Every 6 months: Stable control Eye Examination Lipid Levels Microalbumin 8
9 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 7-Day Trends in Blood Glucose Levels Recommended Testing Pattern Mon Tue Wed Thu Fri Sat Sun Breakfast Lunch Supper Bedtime Pre Post Pre Post Pre Post 9
10 What To Do With Your Numbers Review the numbers: Make sure your patient knows the numbers and what they mean. Blood glucose A1C Cholesterol Blood Pressure Microalbuminuria Use a tracking system in your chart-give your patients their numbers Summary We act as a coach- we educate, support and encourage. The patient needs to be in control of the game plan. Knowledge is power. Every patient, t no matter their education level l or knowledge base, can understand diabetes and be an active player in controlling the disease. 10
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