1. Provided Courtesy of RD411.com Where health care professionals go for information Diabetes ABCs Review Date 8/09 D-0549 Contributed by Shawna Gornick-Ilagan, MS, RD, CWPC

2. Disclaimer • This presentation should not substitute or replace any medical advice prescribed by your doctor • The presentation is meant to provide you with general health information to empower you and your family to prevent or manage diabetes

3. Objectives • What is diabetes? • What are my risks of getting it? • How can I prevent diabetes? • How do I manage diabetes if I get it? • What do the ABCs stand for?

4. What Is Diabetes • Diabetes is a condition in which the body is unable to properly utilize blood sugar

5. What’s Your Diabetes IQ?

6. Diabetes IQ Test • Every 24 hours: • More than 1000 adults are diagnosed with diabetes • More than 2000 adults are diagnosed with diabetes • More than 3000 adults are diagnosed with diabetes • More than 4000 adults are diagnosed with diabetes

7. Diabetes IQ Test • Every 24 hours: • About 10 children and adolescents are diagnosed with type 1 diabetes • About 20 children and adolescents are diagnosed with type 1 diabetes • About 30 children and adolescents are diagnosed with type 1 diabetes • About 40 children and adolescents are diagnosed with type 1 diabetes

8. Diabetes IQ Test • Every 24 hours: • 2 children and adolescents are diagnosed with type 2 diabetes • 5 children and adolescents are diagnosed with type 2 diabetes • 8 children and adolescents are diagnosed with type 2 diabetes • 10 children and adolescents are diagnosed with type 2 diabetes

9. Diabetes IQ Test • Every 24 hours: • Approximately 50 people die from diabetes • Approximately 100 people die from diabetes • Approximately 150 people die from diabetes • Approximately 200 people die from diabetes

10. Diabetes IQ Test • Every 24 hours: • 50 people with diabetes have a nontraumatic lower-limb amputation • 100 people with diabetes have a nontraumatic lower-limb amputation • 150 people with diabetes have a nontraumatic lower-limb amputation • 200 people with diabetes have a nontraumatic lower-limb amputation

11. Diabetes IQ Test • Every 24 hours: • About 30 people with diabetes develop kidney failure • About 60 people with diabetes develop kidney failure • About 90 people with diabetes develop kidney failure • About 130 people with diabetes develop kidney failure

12. Diabetes IQ Test • Every 24 hours: • Nearly 5 adults with diabetes go blind • Nearly 15 adults with diabetes go blind • Nearly 25 adults with diabetes go blind • Nearly 50 adults with diabetes go blind Quiz derived from information found at http://www.cec.gov/features/livingwithdiabetes/

13. Answer Key • The correct answer for all questions—d. • Over the years, high blood glucose (hyperglycemia) damages nerves and blood vessels, leading to complications such as: • Heart disease • Stroke • Kidney disease • Blindness • Nerve problems • Gum infections • Amputation

14. What Are the Symptoms? • Some people do not have symptoms • Other people have experienced these symptoms: • Increased thirst • Increased urination • Weight loss without trying • Blurred vision • Increased hunger • Increased fatigue

15. Types of Diabetes • The three types of diabetes: • Type 1 (juvenile diabetes, insulin dependent: 5%-10% • Type 2 (adult onset, noninsulin dependent): 90%-95% • Gestational diabetes (diabetes during pregnancy): 2%-5% • Prediabetes • Centers for Disease Control estimates that 57 million Americans age 20+ have prediabetes

16. Normal Process Insulin

17. Diabetes: Type 1

18. Diabetes: Type 2 = Fat Insulin

19. Diabetes: Type 2 (Over Time)

20. Type 1 Diabetes: Risk Factors • Family history of type 1 diabetes: 10%-15% • Race: White people have a greater risk • Presence of islet cell antibodies in the blood • Prevention • Currently no way to prevent type 1 diabetes • Can prevent or delay the development of complications, such as: • Vision, kidney, or heart failure • Blood vessel and nerve diseases • Prevention: Keep blood sugar near normal levels

21. Type 2 Diabetes: Risk Factors • Risk factors that you can not control: • Family history • Age • Race • History of gestational diabetes • Risk factors that you can control: • Lose weight if overweight • Eat healthy and exercise • Quit smoking • Get treatment if you have prediabetes, high blood pressure, or high cholesterol

22. Gestational Diabetes • Stay at a healthy weight and do not gain too much weight during pregnancy • Exercise regularly to help keep your blood sugar level within a safe range and to prevent gestational diabetes

23. Weight Gain During Pregnancy

24. How Is It Diagnosed? • Fasting plasma glucose: Must fast for 8 hours or more dL=deciliter, mg=milligram

25. Glucose Testing Recommendations • Blood glucose: • During a regular physical • Symptoms suggesting hyperglycemia or hypoglycemia • During pregnancy • Diabetic • Starting at age 45 and every 3 years if normal results

26. Prediabetes

27. Prediabetes • Is prediabetes the same as impaired glucose tolerance or impaired fasting? • Yes: Doctors sometimes refer to this state of elevated blood glucose levels as impaired glucose tolerance or impaired fasting glucose (IGT/IFG), depending on which test was used to detect it Source: American Diabetes Association. Frequently asked questions about pre-diabetes. Available at: http://www.diabetes.org/pre-diabetes/faq.jsp. Accessed September 10, 2009.

28. Good News • Type 2 diabetes is preventable if you catch it early and make some changes in your lifestyle

29. 85%-90% of Diabetes Is Preventable Preventable

30. Diabetes: Type 2 Insulin

31. Bad News • Type 2 diabetes is a condition that consumes your: • Time • Money • Energy

32. How to Prevent Type 2 Diabetes • Maintaining a healthy weight • Increasing fruit and vegetable consumption • Increasing fiber intake • Decreasing fat intake • Exercising • Breastfeeding infants • 20% less likely to have diabetes and high cholesterol

33. Tips to Maintain a Healthy Weight • Do not drink calories • Eat slowly • Stay hydrated • Try the low-fat or nonfat version of foods • Change habits • Eat three meals each day • Focus on fruits and vegetables • Get enough fiber

34. Fruits and vegetables Canned or frozen Frozen grapes Prepackaged Microwaveable Low-fat dip 5 servings/day Dietary fiber Beans Oatmeal Whole grain Pastas Cereals Breads Adults need 25-35 grams (g)/day; children older than age 3 need their age plus 5 g (minimum recommendation) Tips to Maintain a Healthy Weight Source: Dwyer JT. Dietary fiber for children: how much? Pediatrics (serial online).1995;96:1019-1022. Available at: http://www.diabetes.org/pre-diabetes/faq.jsp. Accessed September 10, 2009

35. Exercise Regularly • Exercise regularly to help raise your high-density lipoprotein (HDL), the good cholesterol, and lower your low-density lipoprotein (LDL), the bad cholesterol • Aim for 30 minutes of activity or more on most days of the week

36. Decrease Saturated and Trans Fats

37. Opt for Healthy Fats

38. Know Where to Look • Lose weight—calories • Lower cholesterol—saturated and trans fats • Manage glucose—total carbohydrate

39. The Good News… • By managing the ABCs of diabetes, people with diabetes can reduce their risk of heart disease and stroke • A stands for A1c • B stands for body mass index (BMI) and blood pressure • C stands for cholesterol

40. A: Ask About Your A1c • A1c measures average blood glucose over the last 3 months • Get your A1c checked at least twice/year

41. Healthy Plate Format • One fourth plate starch • One fourth plate meat • One half plate nonstarchy vegetables • 8 fluid ounces of reduced-fat milk • One serving of fruit

42. Cereal or Grain • 15 g of carbohydrate=one serving • One cereal or grain serving is: • One slide of bread • One half of a hamburger bun • ¾ cup (C) of unsweetened cereal • ⅓ C cooked pasta • 3 C popcorn • ½ C cooked oatmeal

43. Fruit • 15 g of carbohydrate=one serving • One fruit serving is: • ⅓ C of fruit juice • ½ C of canned fruit • One small piece of fruit, such as an apple

44. Milk or Dairy • 15 g of carbohydrate=one serving • One milk or dairy serving is: • 1 C of milk • 6 ounces of yogurt

45. Starch or Vegetables • 15 g of carbohydrate=one serving • One starch or vegetable serving is: • ⅓ C of beans • ½ C of corn or peas • ½ C of mashed potatoes

46. Quick Reference Chart for Eating With Diabetes Source: University of Maryland Medical Center. Diabetes diet—diabetic exchange lists. Available at: http://www.umm.edu/patiented/articles/what_general_guidelines_heart-healthy_diets_000042_5.htm. Accessed September 10, 2009.

47. B: BMI • BMI is a number calculated from a person’s weight and height • Higher BMI values are associated with risk for health problems • BMI goal=less than 25 • More information at http://www.cdc.gov/healthyweight/assessing/bmi/

49. B: Beware of Your Blood Pressure • High blood pressure raises your risk for heart attack, stroke, eye problems, and kidney disease • Get your blood pressure checked at every visit • Target blood pressure=less than 130/80

50. Key Steps for Lowering Blood Pressure • Lose weight • Eat more fruits and vegetables • Reduce the amount of salt in diet • Lower alcohol intake • Quit smoking • Take blood pressure pills, if prescribed • Many people require more than one pill