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

2. Survival Camp Topics  Training 2 Calibrate your Diabetes Compass Calibrate your Diabetes Compass Boots are made for Walking! Boots are made for Walking! Medications and Insulin 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 6126 7154 8183 9212 10240 11259 12345 12345 American Diabetes Association 2008

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

8. Glucose Goals – How do we Get there?  Test Pre-meal blood sugar Pre-meal blood sugar 1-2 hours after meal blood sugar 1-2 hours after meal blood sugar  Goal 70 – 130 Less than 180 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%) Heart failure (56%) Stroke (44%) Stroke (44%) Death from diabetes (32%) Death from diabetes (32%)

11. Blood Pressure Goal Less than 140 / 80 (check each office visit )

12. Blood Fat (Cholesterol Goals) 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

13. Diabetes ABC’s A 1c (less than 7%) B lood Pressure (140/80) C holesterol (LDL 40, Trig 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 Goal is more than 60 Talk to your doctor if less 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 mouth infections more common flushing, brushing, regular check-ups important! flushing, brushing, regular check-ups important! See your dentist at least every 6 months. See your dentist at least every 6 months.

17. Schedule Regular Visits with Diabetes Care Providers

18. Mr. Jones -What Should We Do? 64 yr old with type 2 with heart problems Labs: A1c 9.3% A1c 9.3% HDL 41mg/dl HDL 41mg/dl LDL 156 mg/dl LDL 156 mg/dl Triglyceride 260mg/dl Triglyceride 260mg/dl Last eye exam, 1992 Last eye exam, 1992 B/P 142/92 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

19. You Can Survive and Thrive with Diabetes  Steps A1c less than 7% A1c less than 7% Get blood pressure to goal Get blood pressure to goal Get lipids to goal Get lipids to goal Get active Get active Stop Smoking Stop Smoking Partner with your health care team Partner with your health care team Attend our support group 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 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 and Insulin 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. Most Common Medications for Type 2 1. Increase insulin release from pancreas 2. Decrease sugar release from liver 3. Make your own insulin work better 4. Makes you feel fuller 5. Tell your kidneys to release sugar

35. Oral Medications for Type 2 Diabetes: Sulfonylureas

36. Oral Medications for Type 2 Diabetes: Biguanides

37. Oral Medications for Type 2 Diabetes: Insulin Sensitizers

38. Human Gut Hormones Liver reduces glucose production Brain promotes satiety and reduction of appetite Stomach slows emptying Beta cell stimulates insulin secretion Alpha cell blocks glucagon secretion

39. Diabetes = 50% Less Gut Hormone Protect what you do have  Januvia  Onglyza  Tradjenta  Nesina Inject Synthetic Gut Hormone  Byetta  Victoza  Bydureon

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

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

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

43. 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 Blood sugar effect Other side effects Other side effects Ease of use for YOU Ease of use for YOU

44. Diabetes Medications

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

49. Insulin(µU/mL) Glucose(mg/dL) Physiologic Insulin Secretion: 24- Hour Profile 150 100 50 0 789101112123456789 A.M.P.M. Basal Glucose Time of Day 50 25 0 Basal Insulin Breakfast Lunch Dinner Breakfast Lunch Dinner Meal Insulin Meal Glucose

50. Insulin Action Categories   Bolus: lowers after meal glucose levels Rapid Acting Rapid Acting Aspart, Lispro, Glulisine Aspart, Lispro, Glulisine Short Acting Short Acting Regular Regular   Basal: controls glucose between meals, hs Intermediate Intermediate NPH NPH Long Acting Long Acting Detemir (Levemir) Detemir (Levemir) Glargine (Lantus) Glargine (Lantus)

51. Insulin Injection Sites

52. Insulin Needles and Pens

53. Care for Insulin and Needles

54. Safe Disposal of Syringes and Lancets  Take to Hazardous Waste Collection Site  In Paradise - 920 American Way (near Clark Rd.) Monday- Friday, Hours-8am – 5pm. Phone 876-3340  In Chico - 1101 Marauder Street (near the airport) Hours – 9am – 1pm on Friday and 9-4pm on Saturday  More info - Call (866) 429-2288  Or Get BD Safe Clip