1 / 40

Strike The Spike

kelli
Télécharger la présentation

Strike The Spike

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

    1. Strike The Spike! Strategies for Combatting After-Meal Highs Gary Scheiner MS, CDE

    2. Overview Definitions Risks Detection Management

    3. After-Meal Peaks Defined The net rise that occurs from before eating to the highest point after eating. ADA Goal: <180 mg/dl 1-2 hrs after start of meal DCCT Goals: <180 mg/dl 2 hrs after meal European Diabetes Policy Grp: <165 (to prevent complications)

    4. After-Meal Goals for Children Under 5 Years: <250 @ 1 hr. post-meal (<120 pt. Rise) 5-11 Years: <225 @ 1 hr. post-meal (<100 pt. Rise) 12 Years + < 200 @ 1 hr. post-meal (<80 pt. Rise)

    5. After-Meal Peaks: Reality for children

    6. After-Meal Peaks: Reality in Children

    7. After-Meal Highs: Immediate Problems Tiredness Difficulty Concentrating Impaired Athletic Performance Decreased desire to move Mood Shifts Enhanced Hunger

    8. Long-Term Problems

    9. Long-Term Problems (contd)

    10. Long-Term Problems (contd)

    13. Measurement of After-Meal Peaks SMBG Capillary (finger) test After completion of meal Check BG 1 Hr PP (or) every 15, 20 or 30 min until 2 consecutive BG drops occur No addl. Food/insulin until test is completed

    14. Meter Test Example

    15. Meter Test Example Time pp BG Value Premeal 135 :20 155 :40 168 1:00 214 1:20 222 1:40 175 2:00 141

    16. Measurement of After-Meal Peaks CGMS (Medtronic) Worn for 72 hrs (or more), then data is downloaded Meals should be entered as events while wearing Calculates 1 & 3-hr post-meal averages

    17. Measurement of After-Meal Peaks Real-Time Continuous Glucose Monitors Allow tracking of post-meal trends Produce BG estimates every 5 minutes

    18. CGMS Case Study

    19. CGMS Case Study

    20. CGMS Case Studies

    21. After-Meal Spike Reduction Lifestyle Approaches Medicinal Approaches

    22. Glycemic Index All carbs (except fiber) convert to blood glucose eventually G.I. Reflects the magnitude of blood glucose rise for the first 2 hours following ingestion G.I. Number is % or rise relative to pure glucose (100% of glucose is in bloodstream within 2 hours)

    23. Glycemic Index (contd.) Example: Spaghetti GI = 37 Only 37% of spaghettis carbs turn into blood glucose in the first 2 hours. The rest will convert to blood glucose over the next several hours.

    24. Glycemic Index (contd)

    25. Glycemic Index (contd) Use of Glycemic Index Lower GI foods digest & convert to glucose more slowly High-fiber slower than low Hi-fat slower than low Solids slower than liquids Cold foods slower than hot Type of sugar/starch affects GI

    26. Glycemic Index (contd.)

    27. Examples: Use of GI

    28. Choice of Bolus Insulin

    29. Timing of Bolus Insulin

    30. Timing of Bolus Insulin

    31. Does Timing Matter?

    32. Does Timing Matter? Bolus w/meal Bolus pre-meal

    33. Choice of Insulin Program

    34. Injectible Symlin (Amylin Pharmaceuticals)

    35. Injectible Symlin (Amylin Pharmaceuticals)

    36. Physical Activity Intervention

    37. Examples: After-Meal/Snack Activity Walking Pets Household Chores Planned Exercise Yard Work Gym Class??? Shooting Hoops Dancing Bowling Mini Golf Skating

    38. Examples: After-Meal/Snack Activity

    39. Summary

    40. For More Information: Gary Scheiner MS, CDE Integrated Diabetes Services 877-735-3648 (877-SELF-MGT) Website: www.integrateddiabetes.com E-mail: gary@integrateddiabetes.com

More Related