Diabetes

1. Diabetes What Does it Mean for Me? Leader Diabetes Initiative 2005

2. What is Diabetes? • People with diabetes have high blood sugar levels. This is because their pancreas doesn’t make enough insulin, or their cells don’t respond to the insulin normally (insulin resistance), or both. • The liver stores sugar and releases it when the body needs it (between meals). Leader Diabetes Initiative

3. What Does Insulin Do? • Food that you eat is broken down into nutrients, one of which is sugar (also called glucose). • Glucose is a fuel, which is changed into energy that the body needs to live. • Insulin causes blood glucose levels to come back down because it moves glucose from the blood stream into the fat, muscle and liver cells where it can be used for energy. • If there isn’t enough insulin available, or the insulin doesn’t work well enough, the sugar cannot leave the blood as well as it should. Leader Diabetes Initiative

4. What Does Insulin Do? • If insulin levels are correctly regulated by your body, the amount of glucose in your bloodstream does not get too high or too low. Leader Diabetes Initiative

5. Type of Diabetes… • There are three types of diabetes: • Type I • Type II • Gestational Leader Diabetes Initiative

6. Type I Diabetes • Usually diagnosed in childhood. • The body makes little or no insulin, and daily injections are needed to live. • Without proper daily management, medical emergencies can occur. Leader Diabetes Initiative

7. Type II Diabetes • About 90% of all cases of diabetes. • Usually occurs in adulthood. • The pancreas doesn’t make enough insulin and/or the insulin can’t work properly because the cells aren’t responding normally. • Sometimes the liver releases sugar when it isn’t needed (“leaky liver”). Leader Diabetes Initiative

8. Gestational Diabetes • High blood glucose that develops at any time during pregnancy in women who do not have diabetes. Leader Diabetes Initiative

9. Risk Factors for Developing Diabetes • Family history of diabetes (parent or sibling) • Obesity • Age greater than 45 years • Certain ethnic groups (Aboriginal, African-American) • Gestational diabetes or delivering a baby weighing more than 9 pounds • High blood pressure • High cholesterol levels Leader Diabetes Initiative

10. Symptoms of Type I Diabetes • Increased thirst • Increased urination • Weight loss in spite of increased appetite • Fatigue • Nausea • Vomiting Leader Diabetes Initiative

11. Symptoms of Type II Diabetes • Increased thirst • Increased urination • Increased appetite • Fatigue • Blurred vision • Slow-healing infections • Impotence in men • Many people do not even know they have diabetes, as they don’t have any symptoms Leader Diabetes Initiative

12. Treatment for Diabetes • There is no cure for diabetes. • The goals of treatment are to stabilize the blood sugar, eliminate the symptoms of high blood sugar, and prevent further complications of diabetes. • Education, diet, exercise, weight, blood pressure and cholesterol control, medication, blood glucose self-testing, and foot care are vital for good control of diabetes and prevention of its complications. Leader Diabetes Initiative

13. Diet • A well controlled diet is very important in controlling and even preventing some cases of diabetes. • Every person with diabetes should meet with a dietitian to receive important dietary information. • Canada’s Food Guide is another excellent resource for making dietary decisions. Leader Diabetes Initiative

14. Canada’s Food Guide Leader Diabetes Initiative

15. Alcohol Usage • Moderate consumption of alcohol (1-2 standard drinks) will not significantly alter blood sugar levels. • It is better to drink alcohol with a meal than alone, as alcohol may mask the symptoms of low blood sugar. • Recommendations: -Men = <14 drinks/week -Women = <9 drinks/week Leader Diabetes Initiative

16. Exercise • Exercise does many positive things for diabetes and our bodies: -Lowers blood sugar levels -Helps insulin to work better -Helps use up extra fat in our bodies -Improves overall health (lowers blood pressure, cholesterol, etc.) Leader Diabetes Initiative

17. Exercise • Start exercising slowly, gradually build up to at least 30 minutes, five days a week. Leader Diabetes Initiative

18. Quitting Smoking • Quitting smoking is essential for helping control blood sugars, blood pressure, and cholesterol, and for preventing some forms of cancer. Leader Diabetes Initiative

19. “Sugar” Medications • There are many medications used for lowering or controlling blood sugar. • Your doctor will help you to decide which medication(s) are right for you. Leader Diabetes Initiative

20. Sulfonylureas Gliclazide (Diamicron®) Glyburide (Diabeta®) Glimepiride (Amaryl®) These medications stimulate the pancreas to produce more insulin and help insulin work better in the body. These medications should be taken with your meals. Possible side effects include: low blood sugar, upset stomach, skin rash or itching, weight gain. Leader Diabetes Initiative

21. Meglitinides • Repaglinide (Gluconorm®) • Nateglinide (Starlix®) • These medications stimulate the pancreas to release insulin and help the body use insulin more effectively. • These medications should only be taken right before a meal (if a meal is skipped, the dose should also be skipped). • Possible side effects include: low blood sugar, weight gain. Leader Diabetes Initiative

22. Biguanides • Metformin (Glucophage®) • This medication helps the glucose move into the cells and stops the “leaky” liver from releasing sugar. • This medication should be taken with your meals. • Possible side effects include: nausea, diarrhea, weight loss, metallic taste in your mouth. • Metformin will not cause your blood sugar to drop too low. Leader Diabetes Initiative

23. Thiozolidinediones • Rosiglitazone (Avandia®) • Pioglitazone (Actos®) • These medications increase insulin’s action in the body by helping move the glucose into the cells, and they decrease the “leaky” liver. • These medications will not cause the blood sugar to drop too low. • Possible side effects: weight gain, swelling (edema). • May take up to 8 weeks to have their full effect. Leader Diabetes Initiative

24. Alpha-glucosidase Inhibitor • Acarbose® • This medication slows the body’s absorption of sugar and starches (carbohydrates) from food. • Possible side effects: stomach upset, gas, diarrhea. • This medication is not commonly used anymore. Leader Diabetes Initiative

25. Insulin • Type I diabetes requires the use of insulin. • Some people with Type II diabetes will eventually have to use insulin. • Insulin injections replace the insulin that should normally be produced by the pancreas. • There are many types of insulin available, and differ by how fast and for how long they work. • Onset of actions range from 30 minutes to 6 hours. Leader Diabetes Initiative

26. Insulin • People who use insulin must monitor their blood sugar often. • When insulin is being used, it is important that meals are eaten at regular times, so blood sugar levels do not fluctuate too much. Leader Diabetes Initiative

27. Blood Sugar Monitoring • Your doctor will do regular blood tests to determine how well your blood sugar is being controlled. • It is important that you regularly test your blood sugar at home. • By ensuring that your blood sugar is within the target range, you help prevent future complications. Leader Diabetes Initiative

28. Home Monitoring • Ideally, you should test your blood sugar 2-4 times daily. • Self-monitoring of blood glucose is done by checking the sugar content of a drop of blood. Regular testing tells you how well diet, medication, and exercise are working together to control your diabetes. • Recording your blood sugar levels provides valuable information for your health care provider, identifies high and low blood sugar levels, and allows for changes to be made, before serious problems develop. Leader Diabetes Initiative

29. Blood Sugar Targets • Home monitoring: • Before meals = 4.0 – 7.0 mmol/L • After meals (2 hours) = 5.0 – 10.0 mmol/L • Lab tests • A1c = <7.0% (blood glucose control over last 3 months) • Fasting Plasma Glucose <6.1 mmol/L Leader Diabetes Initiative

30. Leader Diabetes Initiative

31. Sick Days • When you are sick, your blood sugar levels will be higher than normal, no matter how little you eat during that day. • It is important to still take your medications when you are sick. • You may have to make adjustments in your insulin. Leader Diabetes Initiative

32. Diabetic Complications • Over time, high levels of sugar in the blood can damage the blood vessels and nerves in your body. • This damage can cause problems in many parts of the body, with the main areas being the heart, kidneys, eyes, legs, and feet. Leader Diabetes Initiative

33. Diabetic Complications • There are two types of complications that can occur with diabetes: • Acute = complications that occur quickly. -Hypoglycemia -Hyperglycemia • Chronic = complications that take a long time to develop. -Heart disease/stroke -Eye problems -Kidney problems -Foot problems -Nerve problems -Erectile dysfunction Leader Diabetes Initiative

34. Symptoms: -Mood changes -Headaches -Trembling -Hunger -Paleness -Sweating -Extreme tiredness -Dizziness -Blurred Vision Causes: -Failure to eat -Too much physical activity -Too much medication -Side effect of certain medications Hypoglycemia (Low Blood Sugar) Leader Diabetes Initiative

35. Treatment of Hypoglycemia • Hypoglycemia can become a serious medical emergency. • It is important to raise the blood sugar level quickly to a safe level in order to avoid the risk of injury and to alleviate symptoms. • 15 of carbohydrates (1/2 Cup of fruit juice, 8 Lifesavers®, 3 glucose tablets) will increase your blood sugar by 2.1 mmol in 20 minutes. Leader Diabetes Initiative

36. Symptoms: -Dry mouth -Extreme thirst -Frequent urge to urinate/bedwetting -Drowsiness -Stomach pain Causes: -Eating too many sugars/starches (carbohydrates) -Failure to take medications -Liver’s response to low blood sugar Hyperglycemia (High Blood Sugar) Leader Diabetes Initiative

37. Cardiovascular Complications • Approximately 80% of patients with diabetes will die as a result of a vascular event. • Over time, high blood sugar levels damage large and small blood vessels. • This is why your doctor may want to help protect your heart and blood vessels with medications and lifestyle changes that help control: -Blood Pressure -Cholesterol -Blood clot formation Leader Diabetes Initiative

38. Hypertension (High Blood Pressure) • Blood pressure is the force applied against the walls of the arteries as the heart pumps blood through the body. • The pressure is determined by the force and amount of blood pumped and the size and flexibility of the arteries. Leader Diabetes Initiative

39. Hypertension • The top number of your blood pressure measurement (systolic) represents the pressure generated when the heart beats, while the bottom number (diastolic) is the pressure when the heart is at rest. • The target blood pressure for patients with diabetes is 130/80 mmHg. Leader Diabetes Initiative

40. Hypertension • When high blood pressure is left untreated, damage to organs throughout the body can occur. Leader Diabetes Initiative

41. Hypertension • Blood pressure can be controlled by diet, exercise, and quitting smoking. • Sometimes medications are also needed. Leader Diabetes Initiative

42. Cholesterol • A soft, waxy substance that is present in all parts of the body including the nervous system, skin, muscle, liver, intestines, and heart. • It is made by the body and obtained from animal products in the diet. • Cholesterol is manufactured in the liver for normal body functions including the production of hormones, bile acid, and Vitamin D. It is transported in the blood to be used by all parts of the body. Leader Diabetes Initiative

43. Cholesterol Leader Diabetes Initiative

44. Cholesterol • Excessive cholesterol contributes to atherosclerosis and subsequent heart disease. • The risk of developing heart disease or atherosclerosis increases as the level of blood cholesterol increases. Leader Diabetes Initiative

45. Cholesterol • Because patients with diabetes already have an increased risk of heart disease we want to make sure we control cholesterol levels. Leader Diabetes Initiative

46. Cholesterol • Medications can also help control cholesterol by either reducing the amount of cholesterol made by the body, or by decreasing how much cholesterol is absorbed from the food we eat. Leader Diabetes Initiative

47. There are 3 major types of cholesterol: HDL (Good Cholesterol) LDL (Bad Cholesterol) TG (Triglycerides) Cholesterol targets for people with diabetes are: LDL <2.5 mmol/L TC Ratio < 4.0 TC = Total Cholesterol Cholesterol Targets Leader Diabetes Initiative

48. Kidney Complications • Kidney damage related to diabetes is the most common cause of kidney failure in the world. • Damage to the blood vessels that supply the kidneys can result in eventual organ failure. • High blood pressure and smoking also contribute to kidney damage. Leader Diabetes Initiative

49. Nerve Damage • Signs of nerve damage will become apparent in 40-50% of patients with diabetes within 10 years of the initial diagnosis. • High blood sugar levels damage nerves and can lead to pain, loss of feeling/reflexes, cramping, impotence, diabetic diarrhea, incontinence, and motor weakness. Leader Diabetes Initiative

50. Foot Problems • Common cause of all below-the-knee amputations. • Damage to blood vessels and nerves supplying the feet results in loss of feeling. • When minor injuries occur to the feet (blisters, ingrown toenails, splinters, etc.) they go unnoticed because nothing is felt, and infection occurs. • Infections go untreated, can become serious and may result in amputation. Leader Diabetes Initiative