Diabetes School April 2016 - Amazon S3 · 2017-09-08 · • Control diabetes • Control blood...

Diabetes School April 2016

Thank You to our Sponsors

Novo Nordisk Lilly

sanofi aventis Astra Zeneca

!

Thank You to our Staff • Liz • Hillery • Brooke N. • Brooke K. • Katie • Ellie

!

Announcements

• TURN OFF CELL PHONES • Cell phone police are watching • If you need to make a call, leave the room • Restrooms • Break • Low blood sugar • Copy of presentation, e-mail [email protected] !

How did you hear about diabetes school?!

Brochures!•  Dr. Lucas office!•  Primary Care Offices!•  Pharmacy!

From a friend or relative!From the radio show!TV commercial!Internet/Website!

SCHEDULE 8:30-10:00 DIABETES 101 10:00-10:30 BREAK 10:30-11:30 WHAT CAN I EAT? 11:30-12:00 THE REST OF THE STORY

What is Diabetes?

Diabetes is a disease that occurs when your body cannot produce enough insulin and cannot use the insulin well enough to control the amount of glucose (sugar) in

your blood. The results is too much sugar in the blood. The sugar sticks to blood vessels throughout the body leading to

complications for diabetes.

Cause How Common?

Type 1 Immune system destroys cells that

make insulin

Less than 10% of people with

diabetes

Type 2 Insulin resistance wears out the cells that make

insulin

More than 90% of people with

diabetes

Gestational Insulin resistance is worse during pregnancy

5% of pregnancies

Types of Diabetes

Hemoglobin A1C Fasting Glucose Tolerance Test (at 2 hours)

Normal Less than 5.6%

Less than 100

Less than 140

Diabetes 6.5% or greater

126 or higher

200 or greater

Pre-diabetes

5.7-6.4% 100-125 140-199

Diagnosing Diabetes

WHO IS AT RISK FOR DIABETES?

• Family history of Type 2 Diabetes • Gestational Diabetes

• Overweight around the waist • Medications which increase blood sugar

• Elevated triglycerides • Insulin resistance

• Pancreatitis or pancreatic surgery !!

Natural History of Type 2 Diabetes

INSULIN RESISTANCE

• High Insulin levels with normal blood sugars • Development of fat around the waist

• Carbohydrate cravings • May have hypoglycemia if delays eating

!

DELAYED INSULIN RELEASE

• Elevated blood sugars after eating • Insulin is released after sugar has gone up

• High blood sugar is followed by low • Genetic GLP-1 Deficency

!

PREDIABETES

• Pancreas not able to make enough insulin • Blood sugar goes up

• Fasting blood sugar is 100-125 • After meals, blood sugar is 140-199

• Hemoglobin A1C is 5.7-6.4% • Still insulin resistant

!

EARLY TYPE 2 DIABETES

• Fasting blood sugar is 126 or greater • After meals, blood sugar is 200 or greater

• Hemoglobin A1C is 6.5% or greater • Pancreas still making insulin

• Still insulin resistant • Still have GLP-1 deficiency

!

LATE TYPE 2 DIABETES

• Pancreas is wearing out • Oral and injectable non-insulin medications are not

controlling blood sugar • Insulin is required to control diabetes

• Still insulin resistant • Still have GLP-1 deficiency

!

Why Treat Diabetes?

Controlling Blood Sugar

• Makes you feel better • Prevents high blood sugar symptoms such as excessive thirst, urination, blurred vision, yeast

infections • Prevents long-term complications of diabetes

Retinopathy: 25x

End-Stage

Kidney Disease:

17x

Heart Disease: 2-4x

Foot/Leg Amputations:

5x

Stroke: 2-6x

Complications of Diabetes

WHY DOES DIABETES AFFECT THE FEET?

• Neuropathy

• Circulation

• Delayed healing

•  Infection-bacterial and fungal

• Unawareness of injury

• Dry skin

PREVENTING FOOT PROBLEMS

• Inspect feet top and bottom every day

• Wash feet and dry thoroughly

• Lotion to help dry skin

•  Do not soak feet

• Clip toenails straight across

• Wear socks and comfortable shoes

• Break in new shoes slowly

• Do not smoke

PREVENTING HEART ATTACKS AND STROKES

• Control blood sugar

• Control blood pressure

• Control cholesterol and triglycerides

•  Stop smoking

• Exercise

• Low dose aspirin

• Do not smoke

PREVENTING EYE PROBLEMS

• Yearly eye exam

• Treat glaucoma

• Treat macula edema

•  Protect eyes from sun

•  Control diabetes

•  Control blood pressure

•  Do not smoke

PREVENTING KIDNEY PROBLEMS



•  ACEI or ARB for blood pressure

•  Yearly urine check for albumin

•  Do not smoke

PREVENTING NERVE DAMAGE PROBLEMS



•  Do not smoke

• Medications which help neuropathy •  Gabapentin, Lyrica •  Cymbalta, amitriptyline •  Capsaicin cream •  Medications for gastroparesis •  Medications for erectile dysfunction

Goals for treatment of diabetes

Key Numbers in Diabetes

• Daily blood sugar readings

• Hemoglobin A1C

• Cholesterol and triglycerides

•  Blood pressure

• Urine Protein or microalbumin

• Weight

• Waist (belly fat) measurement

Targets for Glucose Control

• For Type 1 and Type 2

• Fasting/Pre-meal glucose 80-110

• 2 hours after start of meal 100-140

•  Bedtime glucose 100-140

• A1C of 6.5% or less

• No urinary protein

8% 180

9% 210 10% 240

11% 270 12% 300

13% 330 !!

4% 60 5% 90

6% 120

A1C Blood Glucose (mg/dl)

A1C and Self-Monitoring Results!

7% 150

Targets for Lipids, Blood Pressure and Microalbumin!!

LDL !cholesterol!

(mg/dL)!!!

<70!!!!!!!!

! !

Triglycerides!(mg/dL)!

!

<150!!!

!HDL !

cholesterol!(mg/dL)!

! >55 women!

>45 men!!!

<130/80 mmHg!

<30 mg/g creatinine on a random sample!

Adapted from: American Diabetes Association. Clinical Practice Recommendations. Diabetes Care. 2002;25:S33-S49. !

LIPIDS

Blood Pressure

Microalbumin

Treatment of Diabetes

TREATMENT OF TYPE II DIABETES

DIET:

Total body weight reduction

Upper body weight reduction

Decrease in waist: hip ratio

EXERCISE

Improves insulin sensitivity

Decreases blood sugar at the time of exercise and up to 24 hours later

• To increase insulin production: Glimepiride, Glipizide, Glyburide • To increase insulin production at meals only: Prandin, Starlix • To improve pancreatic release of insulin at meals: Byetta, Victoza, Bydureon, Trulicity,Tanzeum, Januvia, Onglyza, Tradjenta, Nesina • To improve insulin sensitivity: Metformin, Actos, Avandia • To prevent kidney from holding on to sugar: Invokana, Farxiga, Jardiance • To delay absorption of carbohydrates: Precose

Medications for Type 2 Diabetes

GLP-1 secreted upon the ingestion of food

Treatment of Type 1 Diabetes

• Mimic pancreatic secretion of insulin by long and short acting insulin

• Coordinating insulin doses to match food intake and activity

INSULIN •  Very long-acting: Tresiba

•  Long-acting: Lantus, Levemir, Toujeo

•  Intermediate: Novolin N, Humulin N, Humulin U-500

•  Short: Novolin R, Humulin R

•  Rapid: Novolog, Humalog, Apidra

•  Mixed: Novolog 70/30, Humalog 75/25, Humalog 50/50, Humulin 70/30, Novolin 70/30

Clinical Research in Diabetes

CLINICAL RESEARCH IN DIABETES!

Reasons to participate in diabetes research:

Try out new medications prior to approval

Concentrate more on your diabetes while in the study

Contribute to knowledge about new medications

Monitoring supplies, lab work, and medication provided at no charge.

Personal attention

Stages of Research •  Ideas

•  Computer modeling

•  Animal Testing: Rats, mice, monkeys

•  Human Testing

•  Phase 1: Safety studies in healthy adults

•  Phase 2: Dose ranging studies in patients

•  Phase 3: Efficacy studies. Comparison with approved medication

•  Phase 4: New indications for an approved medication

!

CURRENT RESEARCH STUDIES!

• For those on metformin alone • Metformin plus Invokana, Farxiga or Jardiance • Metformin plus Byetta, Victoza or other GLP-1 • For those on 0-1 oral medication for diabetes

• Type 1 or 2 Diabetes with kidney damage (excessive protein in the urine)

• Type 2 Diabetes with heart disease • Type 1 Diabetes

Benefits for Participants !

• Do you brush and floss your teeth more before a dental visit? • Do you dress up for work when the boss is visiting?

• Participants in Diabetes studies have improved blood sugar control during a study because of constant monitoring and

frequent visits to the office.

• Even if they are not taking the study medication, the diabetes improves from being aware of it.

• Placebo versus Study Medication. Why do it? • It is worth the investment in time to participate to benefit your

future health.

If you are interested in participating: !

• Sign up at the research table or at website www.beachdoctor.com!

• Send us an e-mail at beachdoctor.com!• Call the office and ask to speak to the research staff.!

• Be put on emailing list for future studies as well.!

Other medications

Medications that Elevate Blood Sugar !

• Prednisone, Medrol, Cortisone shots!• Major Tranquilizers: Zyprexa, Risperdal, Seroquel!• Niacin!• For Prednisone, may need to double usual insulin supplements!• If on oral agents, may need insulin!

Medications which affect diabetic complications!• Non-steroidal anti-inflammatories (arthritis medications)!• Examples: Motrin, Advil, Naprosyn, Aleve, Indocin, Relafen, Celebrex !• May worsen diabetic nephropathy!• May raise BP!• May cause swelling!

Cardiovascular !Disease!

Type 2 Diabetes!

High Blood Pressure!

Obesity!High Blood Fats!

Impaired Glucose Tolerance!

Insulin Resistance Related Conditions

Insulin!Resistance!

Why monitor your blood sugar?

•  To understand how the following things affect your blood sugar (glucose):

• Food • Activity

• Medicine • Daily life (e.g., illness, stress, drinking alcohol)

•  To help you relate symptoms of high or low blood sugar with the actual results

•  To provide you and your healthcare team with information to analyze and act upon

What can cause blood sugar to

go up or down?

Go up…!

•  Not taking enough or any medication!

•  Eating too much food (carbs)!

•  Exercising less than usual!

•  Physical or emotional stress, illness!

Go down…!

•  Taking too much diabetes medication!

•  Not eating enough when taking certain medications!

•  More exercise than usual!

•  Alcohol!

Times to check more often:!•  When starting a new diabetes

medicine

•  When making another change in your treatment plan (food, exercise)

•  When having more highs or lows

•  During times of illness or stress

•  When you are planning a pregnancy or are pregnant

Use your tools (logbook, meter, etc.)!

Look at 3 days in a row

Use a 4-step guide to interpret the numbers:

•  Gather information

•  Look for a pattern

•  Think about possible causes

•  Take action

Breakfast Lunch Dinner

Day Date Medication

Before After

Medication

Before After

Medication

Before After

Medication

Bedtime

Time

Blood Glucose

Time

Blood Glucose

Time

Blood Glucose

Time

Blood Glucose

Time

Blood Glucose

Time

Blood Glucose

Time

Blood Glucose

Tue. 109 120 215 110

Comments: Additional Blood Glucose:

Wed. 121 96 190 135


Thur. 107 119 236 153


Sample logbook: Bob!

Bedtime!

The impact of food!!•  Food has a major impact on blood sugar

•  Check blood sugar before and 1–2 hours after meals

•  Eat about the same size meals each day

•  Have a meal plan that supports carbohydrate guidelines

•  Look for patterns of highs and lows and compare to carbs eaten, medications taken, exercise, etc.

!

Breakfast Lunch Dinner

Day Date Medication

Before After

Medication

Before After

Medication

Before After

Medication

Bedtime

Time

Blood Glucose

Time

Blood Glucose

Time

Blood Glucose

Time

Blood Glucose

Time

Blood Glucose

Time

Blood Glucose

Time

Blood Glucose

Tue. 105 140 120 200 128 170


Wed. 100 150 130 210 132 174


Thur. 110 152 126 204 124 172


Sample logbook: Carol! Bedtime!

You are in control

By reviewing your blood sugar for patterns and using the event markers in your meter, you can find out what’s

affecting your glucose numbers.

Share this information with your diabetes care provider so together you can make better treatment changes that help

you manage your diabetes, feel better and enjoy life!

Clinical Research in Diabetes

CLINICAL RESEARCH IN DIABETES!

Reasons to participate in diabetes research:

Try out new medications prior to approval

Concentrate more on your diabetes while in the study

Contribute to knowledge about new medications

Monitoring supplies, lab work, and medication provided at no charge.

Personal attention

CURRENT RESEARCH STUDIES!

• For those on metformin alone • Metformin plus Invokana, Farxiga or Jardiance • Metformin plus Byetta, Victoza or other GLP-1 • For those on 0-1 oral medication for diabetes

• Type 1 or 2 Diabetes with kidney damage (excessive protein in the urine)

• Type 2 Diabetes with heart disease • Type 1 Diabetes

If you are interested in participating: !

• Sign up at the research table or at website www.beachdoctor.com!

• Send us an e-mail at beachdoctor.com!• Call the office and ask to speak to the research staff.!

• Be put on mailing list for future studies as well.!

Diabetes School April 2016 - Amazon S3 · 2017-09-08 · • Control diabetes • Control blood...

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Transcript of Diabetes School April 2016 - Amazon S3 · 2017-09-08 · • Control diabetes • Control blood...