Your Diabetes Tool Box

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Your Diabetes Tool Box

• Naval Hospital Charleston

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Housekeeping

• Class Time
• Restrooms
• Breaks
• Evaluations

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Introductions

• Instructors
• Participants
• How long have you had diabetes?

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Question...

• What do you need to learn today?...

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Overview

• What is Diabetes
• Sick Days
• Avoid Complications
• Physical Activity
• Medications
• Healthy Eating

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Question...

• What symptoms did you have?

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Review

• ..... How Did Your Symptoms Relate to the Bodys
  Use of Glucose and Insulin?

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What is Diabetes?

• Elevated blood sugar due to insulin deficiency or
  insulin resistance
• Type 1 Diabetes
• Type 2 Diabetes
• Gestational Diabetes

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Pre-Diabetes

• Fasting glucose of 100-125
• Progression to diabetes does not have to be
  inevitable!

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Diabetes Trends Among Adults in the US
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Diabetes and Gestational Diabetes Trends Among
Adults in the U.S., BRFSS 1990
Source Mokdad et al., Diabetes Care
2000231278-83.
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Diabetes and Gestational Diabetes Trends Among
Adults in the U.S., BRFSS 1995-96
Source Mokdad et al., Diabetes Care
2000231278-83.
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Diabetes and Gestational Diabetes Trends Among
Adults in the U.S., BRFSS 2000
Source Mokdad et al., J Am Med Assoc
2001286(10).
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Diabetes Statistics

• Serious Health Problem!!!
• Major Cause of DEATH
• Health Care Dollars

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Obesity Trends Among Adults in the US
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Obesity Trends Among U.S. AdultsBRFSS1990
(BMI ? 30, or 30 lbs overweight for 54 woman)
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Obesity Trends Among U.S. AdultsBRFSS1995
(BMI ? 30, or 30 lbs overweight for 54 woman)
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Obesity Trends Among U.S. AdultsBRFSS2000
(BMI ? 30, or 30 lbs overweight for 54 woman)
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Self Blood Glucose Monitoring

• Know your glucose goals and when/how often to
  check
• Keep a glucose diary and bring with your meter to
  each appointment

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Blood Glucose Targets

• Before Meals 90 - 130 mg/dl
• Bedtime 100 - 140 mg/dl
• How Often Do You Check?

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Why Me?

• Denial / Disbelief
• Fear
• Anger
• Guilt
• Resignation
• ACCEPTANCE

Where Are You?
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Complications

• My mother lost her leg
• My grandfather went blind
• WILL THIS HAPPEN TO ME?

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HgA1c

• Normal 4 - 6
• What is Yours?

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Complications

• Acute
• Blood Vessels

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Acute Low Blood Sugar

• HYPOGLYCEMIA
• Sudden Onset
• Symptoms dizzy, shaky, sweaty,
• tired, hungry, crabby, confused

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Acute Low Blood Sugar

• Frequent Causes
• Too much medicine
• Not Enough Food
• Extra exercise
• Alcohol

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Acute Low Blood Sugar

• 1st Test Blood Sugar
• lt 70 mg/dl
• 15/15 Rule

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Eat 15 Grams Carbohydrates Examples 1 C.
Gatorade 1 C. milk 1/2 C. juice or regular
soda 5 Life Savers 3 large
marshmallows 1 Tbsp.. sugar or honey?Wait 15
Minutes?Repeat
15/15 Rule
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Acute High Blood Sugar

• HYPERGLYCEMIA
• Slow Onset
• Symptoms Headache, Frequency, Vomiting, Tired,
  Stomach Cramps

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Acute High Blood Sugar...

• Frequent Causes
• Not Enough Medicine
• Too Much Food
• Not Enough Exercise
• Sick or Have Infection
• Lots of Stress

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Acute High Blood Sugar

• 1st Test Blood Sugar
• 180 -240 mg/dl Wait
• gt240 mg/dl Call PCM
• Do Not Drive

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High or Low

• Carry a Snack
• Wear Medical ID Jewelry
• Tell a Friend
• Do Not Drive

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Acute Sick Days

• Eat / drink every hour
• - 15 Grams Carbohydrates
• Test blood sugar every 4 - 6 hours
• Continue medications
• Cannot eat longer than one day? ... Call the
  doctor

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Complications

• Acute
• Blood Vessels

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ComplicationsFoot Care

• What kind of shoes to Wear?

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ComplicationsDaily Foot Care

• Wash / Dry / Look
• Clean Socks
• Good Shoes
• Cut Toe Nails Across
• Dont Go Barefoot

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ComplicationsOther Concerns

• Annual Eye Exam
• Annual Dental Exam
• Stop Smoking

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ComplicationsAvoidable Risks

• Remove Excess Weight
• Change Sedentary Lifestyle
• Improve a Poor Diet

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ComplicationsOther Concerns

• Annual Diabetes Education
• Regular Clinic Visits
• Control of Blood Pressure
• Monitoring of Blood Sugar

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Your Best Tools

• MEDICATION
• Physical Activity
• Healthy Eating

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ToolsMedication

• Insulin Add Missing Insulin
• Pills Stimulate Insulin Production or Assist in
  Insulin Uptake

Do You Take Pills or Insulin?
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Your Best Tools

• Medication
• PHYSICAL ACTIVITY
• Healthy Eating

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ToolsPhysical Activity

• Choose something you like
• Wear shoes that fit
• Exercise at least 5 times a week
• Carry a snack

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STOP ... If

• Out of Breath
• Chest Pain
• Pain in Legs or Feet
• Test blood if you feel Hypoglycemic
• Have Fun!

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Daily

• Test blood sugar
• Do Physical Activity
• Eat right
• Wear ID jewelry

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PCM VisitEvery Three Months

• HbA1c
• Blood Pressure
• Weight
• Foot Exam
• Review Glucose Log

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Yearly

• Cholesterol
• Urine
• Eye Exam
• Dental Exam

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Questions So Far?
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Break

• Stand and Stretch

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Your Best Tools

• Medication
• Physical Activity
• HEALTHY EATING

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ToolsHealthy Eating Guidelines
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Goals for Healthy Eating

• lt Glucose Levels
• lt Cholesterol Levels
• Enough Calories
• Prevent/Delay Nutrition-Related Complications
• Improve Overall Health

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Healthy Eating Success...

• Learn about Nutrition
• Improve Eating Habits
• Do Physical Activity
• Maintain Healthy Weight

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Desirable Body Weight

• Females
• 100 Lbs. ....... 1st 5 Ft
• 5 Lbs. . Each Inch

• Males
• 106 Lbs. . 1st 5 Ft
• 6 Lbs. ... Each Inch

Small Frame Subtract 10 Large Frame Add 10
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Daily Nutrition Needs

• Proteins
• Fats
• Carbohydrates

• Sodium
• Fiber
• Water

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Protein

• 10 - 20 Daily Calories
• 4 kcal per gram
• Animal vs. Plant Protein

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Fat

• 20 - 30 Total Calories
• 9 kcal per gram
• Limit lt10 of Fat Calories from Saturated Fat
• lt300 mg/day Cholesterol

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Carbohydrate

• 50 - 70 Daily Calories
• Individual Eating Habits
• Blood Glucose Goals
• Blood Cholesterol Goals
• 4 Kcal per Gram
• Amount More Important Than Source

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Sodium

• lt 2,400 mg/day
• Choose Wisely
• Single Serving - lt400 mg
• Main Dish - gt800 mg

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Fiber

• 20 - 35 Grams Daily
• Decrease Cholesterol
• May Help GI Function
• Increase fiber slowly
• Include adequate fluids

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Water

• gtEight 8 oz glasses daily
• Do not count caffeine beverages
• soda, tea, coffee

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Other Concerns

• Alcohol
• Sugars
• Sweeteners

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Alcohol

• 1 Drink 2 Fat Exchanges
• 7 kcal per gram
• Concerns
• Hypoglycemia
• High Calories
• Possible Drug Interactions
• Increases Triglycerides

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Sugars

• Count as Carbohydrates
• Must Be Eaten Within a Healthy Meal Plan

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Sugars

• By Any Name Is Just As Sweet!
• Sucrose, fructose, honey, corn syrup, molasses,
  fruit juice, dextrose, maltose, mannitol,
  sorbitol, xylitol, hydrogenated starch hydrolyses

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Non-Nutritive Sweeteners

• Examples
• Aspartame Nutrasweet, Equal
• Acesulfame-K Sweet One
• Saccharin Sweet N Low
• Safety Based on Acceptable Daily Intake

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Meal Planning

• Which Meal Planning Method Is Best For Me?
• Will I Be Able To Eat Out?
• Can I Modify My Recipes?

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Meal Planning Methods

• Food Pyramid Guidelines
• Carbohydrate Counting
• Exchange System

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Meal Planning Methods

• Food Pyramid Guide
• Good First Step
• Carbohydrate Counting
• Best for Insulin Dependence

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Meal Planning Methods

• Exchange System
• Groups Similar Foods
• Teaches Portion Control
• Separates Carbohydrates, Fats, Proteins
• Many Cookbooks Available

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Exchange System

• How Many Calories?
• How Many Servings?

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Daily Calories

• 10 Calories / Pound
• Desirable Weight
• Plus
• Sedentary - Add 20
• Moderately Active - Add 40 - 50
• Strenuously Active - Add 70 -100
• Add for growth, weight gain, pregnancy, breast
  feeding
• Subtract for weight loss
• (500 calories/day 1 Lb. loss /
  week)

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Carbohydrates

• Starches
• Fruits
• Milk Milk Products
• Other Carbohydrates
• Vegetables

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Meats

• Very Lean Meats
• Medium Fat Meats
• High Fat Meats
• Meat Substitutes

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Fats

• Monounsaturated
• Polyunsaturated
• Saturated

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Free Foods

• Drinks
• Fruits
• Vegetables
• Seasonings Condiments
• Sweet Substitutes

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Combination Foods

• Casseroles
• Soups
• Pizza

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Fast Foods

• Order On the Side
• Request Reduced or Fat-Free
• Use Free Foods as Fillers
• Watch Portion Size!

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Label Reading

• What are you eating?
• Review Labels

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Other Concerns

• Snacking
• Delay of Meal
• Recipe Modification

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Snacking

• Use to Prevent Dips in Blood Glucose Levels
• Important At Bedtime

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Delay of Meals

• Eat at regular times!
• If delay, snack on 15 grams carbohydrate
• Insulin coordinate meals with insulin peak times

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Recipe Modification

• Check Library or Book Store for Magazines,
  Cookbooks With Exchanges Listed

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Breakfast?

• What did you eat?
• Were you good?
• How can you improve?

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Your Best Tools

• MEDICATION
• EXERCISE
• HEALTHY EATING

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Your Support

• American Diabetes Association
• Internet / Library / Bookstores

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Your Future

• You Are NOT Alone
• Diabetes Can Be Controlled
• You Must Become the EXPERT on Your Disease

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Your Self Management
Set 3 Goals Weekly
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Your Diabetes Tool Box
Evaluations
Thanks for Coming!