1. How to help yourself and your family
Managing Diabetes:
How to help yourself and your family
This presentation will take about 45 min to 1 hour

2. Objectives State a difference in Type 1 vs. Type 2 diabetes
State 3 ways to prevent diabetes
Understand the purpose of blood sugar monitoring

3. National Diabetes Fact Sheet
23.6 Million people (8% of the U.S. population) have diabetes
57 Million people have pre-diabetes
Risk of death is 2 x that of people similar age without diabetes
Heart disease and stroke account for 65% of those deaths
#1 Cause of adult blindness (20 to 74 year old)
#1 Cause of end-stage renal disease
#1 Cause of non-traumatic lower limb amputation
Diabetes is a BIG DEAL. It needs to be addressed, not ignored. If managed, we can prevent complications.

4. Obesity will make today's kids die younger
Life expectancy is decreasing
1 out of 3 children born after 2000 will get diabetes
What will you do to change the course?
Researchers predict that life expectancy of Americans may begin a sustained decline, reversing the gains from the last 100 years. By the middle of this century, the increased risk of diabetes, heart disease, and cancer that kids will face could lessen the average life expectancy by 2 to 5 years.

5. The Perfect Storm Hit Hard!
Toxic food environment of :
Cheap, fatty food
Highly caloric drinks (soda, juices, gatorade, energy drinks)
Gigantic portions
Processed, “boxed” foods
Pervasive food advertising
Sedentary lifestyles
$10+ billion spent on advertising unwholesome junk and fast food.
Modern society makes everyday chores continually easier, successfully eliminating activity from daily living. (Drive thrus, shopping online, etc.)
Kids stopped playing outside or walking to school.
TV and video games replaced physical activity .
Portion sizes that grew slowly enough for us to lose sight of normal portion sizes.

7. Risk Factors for Diabetes
Heredity
Age (>45)
Race and Ethnicity
(Alaska native, Hispanic-American, Pacific Islander,
African-American)
Gestational diabetes or delivering a baby >9 pounds
Being overweight
Sedentary lifestyle
Waist Circumference
Acanthosis Nigricans – darkening of the skin (at folds)
Try measuring your waist. If you are a woman and your waist circumference is 35 inches or larger you are at high risk for disease. If you are a man and your waist circumference is or larger 40 inches you are at high risk for disease.

8. Acanthosis Nigricans Develops mainly from high insulin levels
This means your body is having to work really hard to process your blood sugar.
This is a sign that you may be at risk for diabetes
Have you seen this on anyone before?
It looks like they have a dirty neck but can’t wash it off. It’ also slightly rough and thickened skin.
Do you know of anyone who has acanthosis nigricans?
Does this person know they are at high risk of developing diabetes or they have diabetes?
neck
armpit

9. How Does Family History Affect Your Risk of Diabetes?
Type 1
Type 2
Relative w/ diabetes
Your estimated risk
Mother
Father
Both parents
Sibling
Identical twin
1% - 5%
5% - 15%
10% - 25%
5% - 10%
25% – 50%
5% - 20%
25% - 50%
60% - 75%
Who in your family has diabetes? Are you at risk?

10. Signs and Symptoms Frequent Urination Excessive Thirst Dry, Itchy Skin
Weight Loss/Gain
Blurred Vision
Fatigue
Tingling/Numbness in fingers/toes
Frequent Infections or sores that don’t heal
When diabetes starts to develop, most people don’t notice signs and symptoms. Many people walk around with diabetes for 7-9 years before they are diagnosed, because they don’t “feel” it. Once you have these signs and symptoms, your diabetes has been around for a while and your blood sugars are usually very high. Typically your blood sugars have to be high consistently to feel these symptoms. People often ignore these symptoms or “write them off” as something else. We live in AK, it’s dry here in the winter so my skin is itchy and I get thirsty more. I am so busy in my life so I always feel tired. My vision is getting worse as I get older, I must need new glasses….

11. Type 1 Autoimmune Disease
Typically develops in people <30 years old
Can be triggered by virus or trauma
Body does not produce insulin, insulin shots are required.
Type 1 is not caused by eating too much sugar.

12. Type 2 Related to body weight and lifestyle Family history
Can be controlled with diet/exercise, and/or oral meds, and/or insulin.
Can develop at any age, typically seen at ages of >45 years old.

14. Pathophysiology of Type 2 Diabetes
1. You eat food and some turns to glucose (sugar)
2. The sugar goes to the blood vessel
Glucose
3. The pancreas makes insulin to get the glucose into your cells.
Cells in the Pancreas get “tired” and have trouble making insulin
You eat food, it goes into the stomach and some of the food gets broken down into “sugar” or glucose.
The glucose/sugar leaves the stomach and goes into the blood vessel.
In order for our bodies to use the glucose/sugar for energy it has to get into the cells in the body.
Insulin is the hormone that helps the sugar get into our cells.
5. Over time the pancreas can get worn out and starts to make LESS insulin.
If we are making less insulin, what do you think happens to the sugar? Answer: it starts to build up in the blood causing high blood sugar.
The other problem is sometimes the cells in our body are RESISTANT to the insulin and so it’s harder for the sugar to get into the cells.
Again, this can lead to the build up of sugar in the blood causing high blood sugar.
Sometimes the cells in the body are resistant to insulin
Dinneen SF. Diabet Med. 1997; 14 (Suppl 3): S19-24. 14

15. How do we fix it?
Sometimes your doctor will give you medicines to help your pancreas make more insulin or help your cells open up to accept the sugar
Eat smaller amounts of foods that turn to sugar. If you eat less, it’s less sugar to process at one time.
Exercise is a natural medicine! It will help the sugar get out of the blood and into your cells.
Carbohydrates are foods that turn into sugar. These foods are healthy for you, but they need to be eaten in smaller portions. What are some examples of carbohydrate foods? Answer: breads, rice, pasta, grains, beans, fruits, yogurt, milk, potatoes, corn, peas

16. Hemoglobin A1C
A weighted mean (average) of your last days of blood glucose
Measures how much sugar has attached to the red blood cells and is reported in % form
ACE guidelines - <6.5% goal for diabetes
ADA guidelines - <7% goal for diabetes
Normal is ~4-6%
This is a lab test that your doctor will do. It is ONE way to see how well your blood sugar is being controlled and tell us if you are at high or low risk of developing complications.

17. Blood Glucose Monitoring
When to check
ACE
ADA
Fasting or pre-meal
<110mg/dl
<130mg/dl
2 hours post- meal
<140mg/dl
<180mg/dl
A1C
<6.5%
<7%

18. Blood Sugar Monitoring
A way for YOU to see if your blood sugar is under control
Check before a meal, 2 hours after a meal, before bed, or when you wake up.
If your blood sugars are high, check more often.

19. Short Term Complications
Hypoglycemia
Too much meds
More exercise than normal
Too little food to match meds
Hyperglycemia
Forgot meds
Stress
Illness
Too much food, not enough exercise

20. Long Term Complications
Retionopathy – eye disease
Nephropathy – kidney disease
Heart attacks and Stroke
Neuropathy – nerve damage
Sexual Problems
Pain in hands, feet, legs
gastroparesis
Retinopathy can lead to blindness.
Nephropathy can lead to the lead for dialysis.
Gastroparesis is partial paralysis of the stomach, which can lead to problems of nausea, vomiting, and abdominal fullness

21. What can people do to live a healthy life with diabetes?
Check blood sugar regularly
Exercise regularly
Healthy food choices
Take medications as prescribed
See doctors regularly and get labs checked
Eye, heart, diabetes, internal med, therapist
Attend a diabetes education class or individual sessions with a CDE
A person with the credentials of “CDE” is a certified diabetes educator. They have receive special training on diabetes and the management of diabetes.

22. I, Jane Doe, will never eat dessert for the rest of my life!!!
This is NOT how we manage diabetes. How many of you would be willing to sign this contract? Eating healthy for diabetes is misunderstood. It doesn’t mean cutting out everything that tastes good, it means enjoying sweets less often and in moderation. Eating more fruits, vegetables, whole grains, and lean protein.
Patient Signature:
Jane Doe

23. Timing Eat SOMETHING within one hour of getting up
Eat about every 4 hours
Smaller, more frequent meals is the key
When skipping meals or going a long time without eating:
Blood sugar can increase
Metabolism can slow down
Can lead to eating tons at one meal!

24. Smaller portions of food, spread out = smaller rise in blood sugar
Has anyone tried eating smaller more frequent meals?
What did you feel like when you skipped breakfast or some other meal? How much did you eat when you finally had time to eat something?
How do you feel, how have your blood sugars been, and how have you felt on medications since you started eating smaller more frequent meals? (How does this compare to when you were skipping meals or eating 2-3 big meals a day?)
Time

25. Balancing Your Plate (No effect blood sugar) Non-starchy Vegetables
TOFU
Lots of veggies. They don’t have to be fresh. Canned and frozen vegetables are great. A traditional Alaska Native diet is a great way to prevent diabetes.
Grains, Beans & Starchy
Vegetables
(100% effect on blood sugar)
Lean Protein
(No effect on Blood Sugar)

26. Label Reading Serving Size? Grams of Total Carbohydrate?
Number of carbohydrate servings?
Use overhead to explain carbohydrates (CHO) on the label
Label Activity
Class to work through label stations in groups
Yogurts
Cereals
Breads
Soda, Juice(show sugar in soda and juice)
Sugar Free foods
Desserts
Come back as a group and examine

27. EXAMPLE meal plan 1400 kcal per day Breakfast: 40 g carbs
Lunch: 40 g carbs
Dinner: 45 g carbs
Snack: 15 g carbs
TOTAL: 140g carbs
Remember overall portion control of ALL foods is
important for weight loss, not just controlling
carbohydrates
If you know how to count the grams of carbs by reading labels or estimating portions, this is an example of how to spread and balance your carbs throughout the day for better control! Everyone’s body is different so depending on your energy needs, you may need more or less carbs and calories in a day.

28. Medications Understand proper times to take them
Understand side effects
Understand the same meds will not work for a lifetime
About half of patients with diabetes type 2 will need insulin at some point
Tell your doctor about any natural herbs, plants, or supplements you use for your health.

29. Depression Have you lost interest in things you used to enjoy?
Do you have difficulty making decisions?
Have the pleasure and joy have gone out of your life?
Do you feel sad, blue, and unhappy?
Sometimes people feel “down” when they are diagnosed with a disease. People can feel scared, angry, helpless. Talk to your health care professional about these feelings. It’s important to address your feelings. You deserve to feel happy and have a good quality of life.

30. Questions???

31. Get more information from:

32. Presentation by: Angela Manderfeld, MS, RD, CDE, LD
Diabetes Nutrition Consultant
Alaska Native Tribal Health Consortium
Phone (907)
Fax (907)
Mailing Address:
Alaska Native Medical Center (DIA)
4315 Diplomacy Dr.
Anchorage, AK 99508