Top 5 WAYS to beat T2-DIABETES

John Thomas Paruch, MDCombined Internal Medicine & Psychiatry

November 8, 2014

Provide education about basic diabetes concepts

Inspire you to learn, get motivated, and figure out ways to beat diabetes in its tracks

Help you to start and develop a roadmap to living well

Objectives

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The SAFR way to change

#1 – Own your health #2 - Create a roadmap #3 – Incorporate movement #4 – Focus daily on nutrition #5 –Sleep well

Your new plan

 [lou-dzuh] 

A chronic condition characterized by high blood glucose levels (hyperglycemia)

Either a lack of insulin or the body's inability to use insulin efficiently

Develops most often in middle-aged and older adults but can occur in young people

Body does not use insulin properly (insulin resistance)

Often driven by being overweight and obese

What is Diabetes?

At first, the pancreas makes extra insulin to make up for it

But, over time your pancreas is not able to keep up and cannot make enough insulin to keep your blood glucose levels normal

Treated with lifestyle changes, oral and injectable medications, and insulin (injections).

What is Diabetes?

When glucose builds up in the blood instead of going into cells, it can cause two problems:1. Right away, your cells may be starved for energy2. Over time, hyperglycemia will damage many

organs: ◦ eyes (diabetic retinopathy)◦ kidneys (chronic kidney disease/ESRD)◦ nerves (peripheral neuropathy)◦ vasculature (peripheral vascular disease)◦ brain (dementia, stroke)◦ heart (coronary artery disease, arrythmias, heart

attack)

What occurs with hyperglycemia?

Diabetes is a slow and sneaky disease.

True or False

Diabetes is slowly killing your organs.

True or False

Example: Retinopathy vs. A1c

The result of microvascular retinal changes.

Hyperglycemia-induced intramural pericyte death and thickening of the basement membrane lead to incompetence of the vascular walls.

These damages change the formation of the blood-retinal barrier and also make the retinal blood vessels become more permeable

End result is blindness

Diabetic Retinopathy

Diabetic Retinopathy

Target the dysfunctional adipose tissue◦ characterized by adipocyte hypertrophy,

macrophage infiltration, impaired insulin signaling, and insulin resistance.

The result is the release of a host of inflammatory adipokines and excessive amounts of free fatty acids ◦ promote ectopic fat deposition and lipotoxicity in

muscle, liver, and pancreatic beta cells

How can I delay or stop this process?

My doctor should be the one who cares most about my health (and takes control of my health).

True or False

Unfortunately, your doctor is not the one who cares most about your health.

Take control and take charge of your own health.

No one cares about your health as much as you should…

You must assume full and sole responsibility of it.

True or False

Educate yourself about what it means to be healthy

Understand targets for diabetes such as A1c and microalbumin

Learn the terminology Show your interest and ask questions when

you don’t understand Start now and move forward Keep and maintain your own records

#1 – Own your health

What is an “A1c”?

What is a “good” A1c?

Defined as levels of albumin ranging from 30 to 300 mg in a 24-h urine collection

Well-known predictor of poor renal outcomes in patients with type 2 diabetes and in essential hypertension

Shown more recently to be a predictor of cardiovascular outcomes in these populations

What is an “microalbuminuria”?

Albuminuria should not only be measured in all patients with type 2 diabetes and hypertension, but also steps should be taken to suppress albuminuria to prevent future renal and cardiovascular adverse events

Treat with ACE/ARB and titrate up to maximize the beneficial effect on albuminuria

What is an “microalbuminuria”?

If I let it happen, diabetes will damage my body without me knowing it.

True or False

Diabetes will slowly kill the organs and vessels inside your body. The good news is… you can take control of it.

True or False

You must not only aim right but draw your bow with all your might.

Said in 1850…

Develop a plan for addressing your health goals

Figure out what you want out of life: quality, quantity, or both?

Schedule time on a monthly or quarterly basis to evaluate your goals

Get and stay organized Seek out support from others – experts,

non-experts, ones who care

#2 - Create a roadmap

"Whether you think you can or think you can't– you're

right."

Increase the amount of activity that you do throughout the day

Learn to explore the world around you with your feet

Get up and move: walk faster, take the stairs, walk on your lunch break, dance, turn TV time into a workout, talk standing, get face-to-face at work, walking work stations, set an alarm reminder to get up…

#3 – Incorporate movement

“If you can't fly then run, if you can't run then walk, if you can't walk then crawl, but whatever you do you have to keep moving forward.”

Keep moving forward…

Move more often than you sit.“Walk behind the plow”

It’s simple:

I have to lose at least 50 pounds to decrease the burden of the disease (diabetes).

True or False

5-10% weight loss will result in significant improvements in health parameters such as glucose levels (A1c), hypertension, and cholesterol

Health benefits increase as weight loss moves along a scale from modest to substantial, but modest weight loss nonetheless produces clinically significant benefits. 

True or False

Try to learn about the foods you are eating Eat more plants-phytonutrients protect the

body Eat foods that are from the earth, non-

processed Read the labels to look up the words you

don’t recognize. If you don’t know what you’re eating, it’s likely not something that is good for you.

#4 – Focus daily on nutrition

Eating well-balanced meals is an essential part of taking better care of yourself and managing diabetes.

Think about this…

Trans fats

Metabolic improvement often exceeds predictions based on the amount of weight lost.

Why does losing small amounts of weight have so powerful an effect on risk factors?

The seemingly disproportionate health dividends of a 5%-10% weight loss have been attributed to a predominant reduction in visceral fat -- as much as 30% of visceral fat.

Loss of atherogenic and diabetogenic visceral fat improves the metabolic profile as a whole, regardless of the ideal body weight.

Lifestyle change…

This one is relatively new. Our secret. The body's reaction to sleep loss can

resemble insulin resistance, a precursor to diabetes.

Chronic sleep deprivation may lead to elevated levels of the stress hormone, cortisol.

Elevated cortisol may in turn promote insulin resistance, in which the body can't use the hormone insulin properly to help move glucose into cells for energy.

#5 –Sleep well

Sleep loss reduces levels of the hormone leptin, an appetite suppressant, while boosting levels of ghrelin, an appetite stimulant.

May prompt sleep-deprived people to eat more.

Most sleep deprived people don't snack on fruits and vegetables - tend to crave high-carbohydrate foods

Why focus on sleep?

The researchers monitored the blood sugar levels of 11 healthy young men who were allowed only four hours of sleep per night -- from 1 a.m. to 5 a.m. -- for six nights.

After 6 nights of little sleep, the men had higher-than-normal blood sugar levels

The effects went away once the men were back on their normal sleep schedule.

Impaired glucose tolerance There could be dramatic effects even after

only a week.

1999 Lancet study at the University of Chicago

Keep regular bedtime and waking hours Create the Right Sleep Environment

◦ Keep your bedroom cool, quiet, and comfortable.◦ Maintain the temperature between 54 F. to 75 F. ◦ Cut noise with earplugs or "white noise" machines. ◦ Keep the room dark. You can block light with heavy shades or curtains,

or use an eye mask.

A comfortable mattress and pillow make sleep more restful. If your mattress is getting old, consider buying a new one that offers better support.

Keep pets out of your bed. They may wake you if you have allergies or if their movement disturbs you.

Focus on sleep hygiene

Reserve the bedroom for sleep.◦ Ultimately, you're trying to create a mental

association between the bedroom and sleep. ◦ If you lie in bed awake for more than 20 minutes,

get up and do a relaxing activity, such as reading, until you feel sleepy.

◦ Don't lie there staring at your clock. This makes you anxious, and sleep more elusive.

Focus on sleep hygiene

#1 – Own your health #2 - Create a roadmap #3 – Incorporate movement #4 – Focus daily on nutrition #5 –Sleep well

Your new plan

Plan for success, and success will find you. Surround yourself with support: supportive

people, ideas, inspiration, thoughts, intentions – includes people who know your personal mission, philosophy, desires, goals

Find success in the world around you. It is there. Sometimes it’s a matter of having and knowing the plan.

Plan for success

Take up one idea. Make that one idea your life - think of it, dream of it, live on that idea. Let the brain, muscles, nerves, every part of your body, be full of that idea, and just leave every other idea alone. This is the way to success. 

Swami Vivekananda

Step Out Walk to Stop Diabetes American Diabetes Association – St Louis Podcasts – Stitcher MeetUp – example Community Gardens – Gateway greening Inspirational quotes - list

Resources

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to the great and many dedicated staff at Christian Hospital for their commitment to the local community

A special thanks