What You Need To Know About Diabetes and Diabetes Prevention

1
What You Need To Know About Diabetes and
Diabetes Prevention

• Roger Chene MPH,RD
• Area Health Promotion Specialist
• California Diabetes Program

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Welcome

• California Diabetes Program
• Introductions
• Who are we?
• Purpose of today
• Agenda

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California Diabetes Program

• Within the California Department of Health
  Services
• The mission of the California Diabetes Program is
  to prevent diabetes and its complications in
  Californias diverse communities
• Funded primarily by Centers for Disease Control
  and Prevention (CDC)
• Collaborates with local, state and national
  organizations to accomplish goals

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California Diabetes Program Focus Areas

• Health Systems
• Communications
• Community Health Interventions
• Surveillance
• Public Policy

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Expectations

• What are your hopes for todays training?
• What would you like to take with you?

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Purpose

• To provide you with basic
• diabetes knowledge to better help you care for
• persons with or at risk for diabetes.

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Agenda

• What is diabetes?
• Types of diabetes
• Risk factors
• Signs symptoms
• Diabetes complications
• How to manage diabetes
• Diabetes prevention
• Diabetes resources
• Brainstorm Action for diabetes prevention

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The Basics of Diabetes
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Diabetes is...

• Serious - Chronic condition, there is currently
  no cure. More children now diagnosed with Type 2
  diabetes.
• Common There are now almost 21 million people
  in the U.S. with diabetes.
• Preventable - modest changes in lifestyle can
  prevent diabetes and complications
• Controllable - take charge of your diabetes
• Source National Diabetes Fact Sheet, Centers for
  Disease Control and Prevention, 2005

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Diabetes is Costly

• Cost of Diabetes in the United States, 2002
• Total (direct and indirect) 132 billion
• Direct medical costs 92 billion
• Indirect costs (disability, work loss, premature
  death) 40 billion
• Average annual health care costs for a person
  with diabetes 13,243
• Average annual health care costs for a person
  without diabetes 2,560
• California Department of Health Services
  estimates 13 billion is spent annually
• Source National Diabetes Fact Sheet, Centers for
  Disease Control and Prevention, 2005

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Who has Diabetes?

• Nationwide 7.0 of the population has diabetes
• Diagnosed 15.0 million people
• Undiagnosed 6.2 million people
• 1.5 million new cases in people 20 years and
  older in 2005.
• Diabetes disproportionately burdens ethnic and
  older populations
• Source National Diabetes Fact Sheet, Centers for
  Disease Control and Prevention, 2005

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Who has Diabetes?

• In California, approximately 2 million people
  have diabetes
• For every 2 people who have been diagnosed with
  diabetes, there is 1 who has diabetes and doesn't
  know it
• (Add local or audience specific information)

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Who has Diabetes?

• American Indians
• American Indians and Alaska Natives are 2.3 times
  as likely to have diabetes than non-Hispanic
  whites of similar age
• African Americans
• 13.3 percent of African Americans aged 20 years
  or older have diabetes.
• African Americans are 1.8 times as likely to have
  diabetes than whites of a similar age
• Source National Diabetes Fact Sheet, Centers for
  Disease Control and Prevention, 2005

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Who has Diabetes?

• Hispanics
• 9.5 of Hispanics aged 20 years or older have
  diabetes.
• Hispanic Americans are 1.7 times more likely to
  have diabetes than whites of similar age
• Asian Americans
• Limited data, at increased risk for developing
  type 2 diabetes compared with whites.
• Show higher rates of pre-diabetes than whites.
• In California, Asians are 1.5 times as likely to
  have diabetes as whites
• Source National Diabetes Fact Sheet, Centers for
  Disease Control and Prevention, 2005

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Diabetes A Growing Epidemic

• New evidence shows that 1 in 3 Americans born in
  2000 will develop diabetes sometime during their
  lifetime
• 2 of 5 African Americans and Hispanics
• 1 of 2 Hispanic Females
• Julie Louise Gerberding, MD, MPHDirector,
  Centers for Disease Control and Prevention, and
  Administrator, ATSDR. Diabetes Disabling,
  Deadly and on the Rise. Revised May 2005

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The Growing Epidemic
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What is Diabetes?

• A condition where the body does not make or
  properly use insulin
• Identified by high levels of blood glucose
  diagnosed by your primary care provider
• Fasting blood glucose 126 mg/dl
• Random blood glucose gt 200 mg/dl
• Blood glucose gt 200 mg/dl at 2 hours using a 75
  gram oral glucose tolerance test

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Blood Glucose Insulin

• After eating, much of the food we eat is turned
  into blood glucose (blood sugar).
• Insulin acts as a key that allows glucose to
  enter the bodys cells to be used as energy.
• Blood glucose is the bodys main source of
  energy.

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What happens in your body?
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Types of Diabetes

• Type 1
• The body produces little or no insulin
• Must take insulin
• Usually occurs in children and young adults
• About 10 of people with diabetes have Type 1

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Types of Diabetes

• Type 2
• The body becomes resistant to its own insulin
• The insulin production in the body varies
• Several methods of blood glucose control (diet
  and exercise, oral medication, insulin)
• 90 of people with diabetes have type 2
• Usually diagnosed in adults, but growing rate
  of children now developing type 2 diabetes

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Gestational Diabetes

• Gestational Diabetes is any degree of high blood
  glucose found during pregnancy
• Women who have had gestational diabetes have a
  20 to 50 percent chance of developing type 2
  diabetes within 5 to 10 years

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Other Types of Diabetes

• Not common may be triggered by illness, surgery,
  drugs, genetic syndromes, malnutrition or
  infection

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Pre-diabetes

• Pre-diabetes is a higher than normal blood
  glucose but not high enough for a diagnosis of
  diabetes
• People with Pre-diabetes are at an increased risk
  of developing diabetes

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Pre-diabetes or Diabetes?
Fasting Plasma Glucose Test
Less Than 100 mg/dl Normal
100-125 mg/dl Pre-Diabetes
126 mg/dl or higher Diabetes
Oral Glucose Tolerance Test
Less than 140 mg/dl Normal
140-199 mg/dl Pre-Diabetes
200 mg/dl or Higher Diabetes
If you are over age 45, get tested! If you are
overweight or in a high risk group get tested
earlier.
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Diabetes Risk Factors

• Age
• Race or ethnic background
• Obese or overweight
• Family history/history of gestational diabetes
• Lack of activity or exercise
• High blood pressure
• High cholesterol

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High Risk Ethnic Populations

• American Indians/Alaska Natives
• African Americans
• Hispanics/Latinos
• Asian Americans
• Pacific Islanders

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Signs and Symptoms of Diabetes

• Increased thirst
• Increased urination
• Increased fatigue
• Weight loss
• Nausea/vomiting/abdominal pain
• Blurred vision
• Increased infections
• Cuts and sores that do not heal
• Those with type 2 may have no symptoms

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Short term Complications of Diabetes

• Hypoglycemia Low blood sugar caused by too
  little food, too much insulin or diabetes
  medicine or extra activity. Needs to be treated
  quickly and appropriately
• Hyperglycemia High blood sugar caused by too
  much food, too little insulin or diabetes
  medicine, illness or stress
• See health care provider to discuss therapy if
  having frequent episodes
• Source NIDDK

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Longterm Complications of Diabetes

• Kidney Disease/ Nephropathydamage to blood
  vessels in the kidneys causing kidney failure
• Eye Disease/ Retinopathy damage to vessels in
  back of the eye leading to blindness
• Heart and Blood Vessels causes narrowing of the
  arteries and increases the risk of a heart attack
  or stroke
• Nerve Disease/ Neuropathy nerve damage
  throughout the body. Causes numbness, pain, and
  weakness in the hands, arms, feet, and legs

Sources AADE, CDC and NIDDK
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Source AADE
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CardiovascularComplications

• Risk of Coronary Heart Disease in persons with
  diabetes is 2 - 4 times higher
• Probability of death from first Coronary Heart
  Disease event in patients with type 2 diabetes is
  higher than for patients without diabetes

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Diabetes Smoking

• Smoking increases insulin resistance
• Smoking one cigarette reduces your bodies ability
  to use insulin by 15 percent
• Negatively impacts diabetes control
• Increases diabetes-related complications
• Such as vascular disease, nephropathy,
  retinopathy, and neuropathy
• Increased risk for heart attack
• Even if complications are treated they are more
  likely to progress
• See Fact Sheets

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Diabetes Smoking

• Smoking prevalence was 15.4 of adults in
  California in 20041
• 2 million people in California have diabetes
• 17.9 are smokers 3
• In 1999, nearly one in five deaths in California
  could be attributed to smoking. This loss
  translates to
• 5.7 billion in lost productivity
• 12.4 years lost in death.2
• 1. California Adult Tobacco Survey 2004.
• 2. The Cost of Smoking in California,1999,
  Sacramento, CA, CDHS 2002.
• 3. 2003 Behavioral Risk Factor Surveillance
  Survey

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Managing Diabetes

• The key to managing diabetes is to balance blood
• glucose, blood pressure and cholesterol as near
  to
• normal as possible. This helps to
• Prevent symptoms
• Reduce risk of complications
• Improve health overall

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Managing Diabetes

• Diabetes is best managed by
• Healthy Eating Individualized meal plan
• Physical Activity
• Taking medications as prescribed
• Receiving appropriate medical care health
  education
• Community resources and support

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Other Things That Influence Diabetes Control

• Depression
• Stress
• Finances
• Family support
• Workplace support

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Healthy Eating

• A variety of foods
• High fiber, fresh fruits, vegetables and whole
  grains, low fat dairy
• Low in total fat, saturated fat and trans fats
• Moderate in calories
• Regularly scheduled meals and snacks
• Portion control
• Adequate fluid intake six 8 oz. glasses of
  water a day

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Nutrition Labels

• Read the food label to look for
• Portion/serving size
• Fat content
• Carbohydrate content
• Ingredient list
• Sugar free does not mean carbohydrate free or fat
  free
• Use the food label information to help make
  healthy food choices and work favorite foods into
  a healthy meal plan

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Carbohydrates

• Grains, fruits, vegetables and low and non fat
  milk are healthy foods
• Provide energy for everyday activities
• Provide vitamins, minerals and fiber
• Important for people with diabetes
• The balance of carbohydrate intake and insulin
  action determines how much blood sugar rises
  after meals
• Portion control is key!

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Portion Sizes Equaling 15 Grams of Carbohydrate
or 1 Carbohydrate Serving
1 slice of bread 8 oz of milk 4 oz juice 1/3 cup
baked beans 3/4 cup cereal 1/3 cup rice 17
grapes 1/2 English muffin 1/2 cup mashed
potatoes 3 graham crackers 6 saltine crackers 6
vanilla wafers
1/2 grapefruit 1/2 banana 1 kiwi 1 small orange 8
animal crackers 1/2 cup canned fruits 2 Tbsp
raisins 1 1/4 cup strawberries 1 1/4 cup
watermelon 1/2 cup sugar free ice-cream 3/4 cup
low-fat yogurt
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Portion Size in Your Hand!

• 1 palm 3 oz a deck of cards
• 1 fist 1 cup
• 1 handful 1/2 oz
• 1 thumb 1 oz
• 1 thumb tip 1 teaspoon

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Planning Shopping Tips

• Planning
• - take some time to think about meals
• - keep a good stock of basics on hand
• - buy and keep mostly healthy foods
• Shopping
• - healthiest foods around the sides of the
• market
• - shop with a list and when least crowded
• - dont shop when you are hungry
• - read food labels

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Eating Out Tips

• Ask about whats in a dish or what the serving
  size is
• Try to eat the same portions you would eat at
  home
• Eat slowly
• Ask for salad dressings, gravy, sauces on the
  side
• Avoid fried foods
• Ask for substitutions
• Ask for low calorie items even if not on menu

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Fast Food Tips

• Balance intake with healthy food choices
• Watch out for jumbo, giant, deluxe, super size
• Choose grilled or broiled sandwiches
• Order items plain, without toppings, sauces or
  mayonnaise
• Go for salads, but watch out for high fat
  toppings and dressings
• Be alert for traps fat free muffins may have
  plenty of sugar, skinless fried chicken has
  almost the same amount of fat as the regular kind

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The New Food Guide Pyramid

• Old Pyramid

• New Pyramid

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Mypyramid.gov

• Tour MyPyramidTour the Mypyramid.gov
  animated tool Mini-Poster DownloadView and
  download the MyPyramid mini-poster to learn the
  basics about eating healthy and physical
  activity. Inside The PyramidExplore the
  pyramid to learn about the Food groups and to see
  how much physical activity you should be getting.
  Tips ResourcesLearn how to make
  MyPyramid work for you. Find a wealth of ideas
  that can help you get started toward a healthy
  diet. There are tips for each food group,
  physical activity, eating out, a sample menu, and
  more...

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Physical Activity

• A physical activity program should include
  body strengthening, flexibility, and endurance
  activities
• Physical activity includes anything that gets you
  moving, such as brisk walking, dancing, or
  working in the yard
• You can earn the benefits of being physically
  active without going to a gym, playing sports, or
  using fancy equipment

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Benefits of Physical Activity For People with
Diabetes

• Can lower blood glucose
• Increases insulin sensitivity
• Helps to lower blood pressure and cholesterol

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More Benefits of Physical Activity

• Increases muscular strength and flexibility
• Promotes long-term weight control
• Can play a role in reducing stress and enhancing
  psychological well-being

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Be Active Safely

• Physical exam to assess presence of complications
  and obtain MD approval
• Hypoglycemia/ hyperglycemia prevention and
  treatment
• Fluid intake
• Modify physical activity if complications are
  present
• Foot care

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Physical Activity Program

• Frequency How often
• Most, if not all, days of the week
• Intensity How hard
• Low to moderate intensity physical activity( like
  brisk walking) is recommended
• Duration How long
• If just starting out a 10-15 min/session is good.
  Increase to at least 30 minutes. Physical
  activity can be divided into three 10 min
  sessions.
• Up to 90 minutes a day may be needed to control
  weight
• Mode What kind of activity
• Aerobic activity such as brisk walking, cycling,
  swimming.
• Strengthening and resistance
• Always include warm-up and cool down,

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Physical Activity Ideas

• A brisk walk
• Dancing
• Aerobics class
• Swimming
• Walk instead of drive, whenever possible
• Work in the garden, rake leaves, do some
  housework
• Look for activity opportunities like
• Taking the stairs
• Park at the far end of the shopping center lot
  and walk to the store

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Medications as Prescribed

• Pills and insulin are used to manage diabetes
• Medications work by different means
• - stimulate the pancreas to make more insulin
• - shut off the livers excess production of
  glucose
• - increase the bodys sensitivity to insulin
• - slows absorption of carbohydrates in the
  intestines
• Different medications should be taken
• at different times

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Appropriate Diabetes Care The Basics

• Blood sugar records every visit
• Blood pressure every visit
• Weight every visit
• Foot exam every visit
• A1C every three months
• Microalbuminuria every year
• Dilated eye exam every year
• Cholesterol, HDL, LDL, triglycerides every year
• Flu shots every year
• Pneumonia vaccine at least once

Take Charge!!
with the
Diabetes Health Record
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Diabetes Prevention

• What can you do to prevent diabetes?
• Diabetes Prevention Program research study found
  that type 2 diabetes can be delayed or prevented
  in persons at risk
• How?
• Through moderate lifestyle changes
• 5 to 7 percent reduction in body weight
• Regular physical activity (30 minutes a day)
• This study was especially successful for people
  over age 60

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Small Steps, Big Rewards

• Move More
• Eat Healthier
• Start Your Game Plan for Preventing Diabetes
• Modeling for others

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Whats your Game Plan?

• Make a plan to change behavior
• Decide what you want to do and when to do it
• Think about what might prevent you from reaching
  your goals
• Find support (family, friends)
• Decide how you will be rewarded when you do what
  you have planned

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Diabetes Resources

• California Diabetes Program
• Basic Guidelines for Diabetes Care
• Diabetes Health Record Card
• National State Resources
• NDEP, CDC and NIDDK
• American Diabetes Association
• Other state programs
• What are Your Local Resources?

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Smoking CessationDiabetes and Smoking

• California Smokers Helpline
• 1-800- NO BUTTS
• http//www.californiasmokershelpline.org/
• Be Proactive Provider Tool Kit available at
  www.caldiabetes.org
• Helpline Free Services
• one-on-one confidential counseling,
• self-help materials
• Referrals

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Brainstorm

• What can you do to improve care for persons
  living with diabetes or at risk for diabetes?

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Conclusion

• What is something new you learned today?
• How can you apply what you learned today in your
  daily work ?
• Did we meet your expectations?
• What more would you like learn about diabetes?