Diabetes Survival Camp – Session 2

1. Diabetes Survival Camp –Session 2 • You can strive and thrive with diabetes Welcome

2. Survival Camp Topics • Training 2 • Calibrate your Diabetes Compass • Boots are made for Walking! • Medications and Insulin

3. Diabetes ABC’s A 1c B lood Pressure C holesterol

4. A1C Blood Test

6. A1c and Mean Plasma Glucose A1c (%) Mean Plasma Glucose 6 126 7 154 8 183 9 212 10 240 11 259 12 345 American Diabetes Association 2008

7. Know Your Check every 3 - 6 months A1c Less than 7%

8. Test Pre-meal blood sugar 1-2 hours after meal blood sugar Goal 70 – 130 Less than 180 Glucose Goals – How do we Get there? • Healthy Eating • Exercise • Medication / Insulin • Monitoring

9. Keep Your Blood Pressure In Check

10. UKPDS Blood Pressure Findings • By controlling your blood pressure you reduce your risk of: • Heart failure (56%) • Stroke (44%) • Death from diabetes (32%)

11. Less than 130 / 80 (check each office visit) Blood Pressure Goal

12. Cholesterol Levels: Check once a year LDL (lousy cholesterol) less than 100 Less than 70 with heart disease HDL (happy cholesterol) more than 40 Triglycerides (bad fat) less than 150 Blood Fat (Cholesterol Goals)

13. Diabetes ABC’s A 1c (less than 7%) B lood Pressure (130/80) C holesterol (LDL <100, HDL > 40, Trig < 150)

14. How are you Kidneys Working? • Creatinine - a simple blood test to check your kidneys. Normal is less than 1.5. • GFR- Glomerular Filtration Rate – how well your kidneys are working. • Goal is more than 60 • Talk to your doctor if less than 60

15. Flu Shot and Pneumonia Vaccine • If you have diabetes, you are more likely to get the flu. • Sign up for your flu shot in September. • Ask your doctor if you should also get a pneumonia vaccine.

16. Dental Care • mouth infections more common • flushing, brushing, regular check-ups important! • See your dentist at least every 6 months.

17. Schedule Regular Visits with Diabetes Care Providers

18. 64 yr old with type 2 with heart problems Labs: A1c 9.3% HDL 41mg/dl LDL 156 mg/dl Triglyceride 260mg/dl Last eye exam, 1992 B/P 142/92 Self-Care Skills Walks dog around block 3 x’s a week Bowls every Friday 3 bottles of beer daily Widowed, so usually eats out 15 lbs overweight Mr. Jones -What Should We Do?

19. You Can Survive and Thrive with Diabetes • Steps • A1c less than 7% • Get blood pressure to goal • Get lipids to goal • Get active • Stop Smoking • Partner with your health care team • Attend our support group

20. Adopt a Healthy Lifestyle

21. Boots are Made for Walking

22. Good News About Physical Activity

23. Physical Activity: Keep It Fun

24. Activity Pyramid

25. Success with Exercise • What kind of activities count as exercise? • What are some barriers to exercise? • How do you succeed with exercise?

26. Set a Realistic Exercise Goal • Set a realistic starting goal for YOU • 3 ten minute segments a day • Long term goal – 30 min’s, 5 days a week • Start slow, increase gradually, listen to your body, do not overdo • Drink water before, during and after

27. Physical Activity Can Lead to Low Blood Glucose (Hypoglycemia)

28. Tips for Safe Physical Activity

29. Exercising Safely • Let someone know your route • Talk/Walk Test • Effects of exercise/activity can last 24-48 hours • Keep in contact with your doctor for medication changes (blood sugars may decrease)

30. Exercise is Restorative • Regular physical activity reduces your risk of many chronic diseases and improves your overall quality of life.

31. Medications andInsulin Your survival tools.

32. Medications

33. Oral Diabetes Agents: • Diabetes medications can be used by themselves, with other medications or with insulin • Using different types of medications together may work better. • Most lower A1c 0.5 - 1.5%

34. 5 Classes of Medications for Type 2 1. Increase insulin release from pancreas 2. Decrease sugar release from liver 3. Slow down the breakdown of starches in gut 4. Make your own insulin work better 5. Makes you feel fuller

35. Oral Medications for Type 2 Diabetes: Sulfonylureas

36. Oral Medications for Type 2 Diabetes: Meglitinides

37. Oral Medications for Type 2 Diabetes: Biguanides

38. Oral Medications for Type 2 Diabetes: Alpha-Glucosidase Inhibitors

39. Oral Medications for Type 2 Diabetes: Insulin Sensitizers

40. 5. New Diabetes Medications that make you feel “fuller” • Incretin Mimetics • Exenatide (Byetta) • Liraglutide (Victoza) • DPP-4 Inhibitor • Januvia (sitagliptin) • Onglyza (saxagliptin) • Amylinomimetics • Pramlintide (Symlin)

41. Human Incretin Hormone GLP-1 Brain promotes satiety and reduction of appetite Liverreduces glucose production Stomachslows emptying • Alpha cellblocks glucagon secretion Beta cell stimulates insulin secretion

42. Gut Hormone Replacement Exenatide and Liraglutide • Most common side effects • Nausea, vomiting, diarrhea, dizziness, headache, feeling jittery, and acid stomach • Nausea is most common when first starting but decreases over time in most patients • Reduced appetite • Report any abdominal pain

43. DPP-IV Inhibitors – Januvia and Onglyza • Januvia (sitagliptin) • Onglyza (saxagliptin) • Lowers blood glucoses by increasing amount of gut hormone in your system • Januvia dose is 100 mg a day • Onglyza dose is up to 5 mg a day • Side effects: Can cause headache and flu like symptoms. Take lower dose if have kidney problems

44. Right Medication for You • Work with your health care team to determine which medications and/or combinations of medications are right for you. • Consider: • Blood sugar effect • Other side effects • Ease of use for YOU

45. Diabetes Medications

48. Invention of Insulin 1921 The first stills used to make insulin (early-mid 1920's).

50. Physiologic Insulin Secretion: 24-Hour Profile 50 Insulin (µU/mL) Meal Insulin 25 Basal Insulin 0 Breakfast Lunch Dinner 150 Meal Glucose 100 Glucose (mg/dL) 50 Basal Glucose 0 7 8 9 10 11 12 1 2 3 4 5 6 7 8 9 A.M. P.M. Timeof Day