2.  Provide a high level overview of diabetes head to toe.  Discuss the importance of keeping A1Cs under 8.  Identify ways to prevent long-term complications. There are no conflicts of interest to disclose.

3.  Diabetes self management is key  Self motivation  “Take home message”

4. Type 1 Diabetes  10% of cases  Insulin deficiency  Autoimmune related Type 2 Diabetes  90% of cases  Insulin resistance

5.  Family History  Gestational Diabetes  Cardiovascular disease  Hypertension  Hyperlipidemia  Long term use of certain medications such as steroids or antipsychotics  PCOS, acanthosis nigricans

6.  Blurred vision  Feeling tired  Sores that do not heal  Recurrent yeast infections  Increased thirst  Increased urination  May be asymptomatic

7. NormalPre-diabetesDiabetes FBG< 100 md/dLIFG >100-125 mg/dLFBG >126 mg/dL 2 hr PG < 140 mg/dLIGT 2 hr > 140-199 mg/dL 2 hr PG >200mg/dL A1C < 5.5%A1C 5.8% - 6.4%A1C > 6.5%

8. Finger sticks  Pre-meal  2 hours post prandial Hemoglobin A1C testing  Every 3 months if not well controlled  Goal <7%

9. A1C%6789101112 Average 126 154 183 212 242 269298 glucose

11. Yearly Screening

12.  Maintain blood sugar control  Acuity vs Retinal changes or bleeding  Dilated eye exam yearly  If diagnosed with retinopathy check with eye specialist regarding exercise restrictions

14.  Maintain blood sugar control  Maintain Normal B/P ( 130/80-140/90  ACE Inhibitor class blood pressure medication  Avoidance of NSAIDS (non-steroidal anti- inflammatories)  Yearly Microalbumin –urine albumin secretion

15.  Maintain blood sugar control  Daily foot exams  Office foot exams during each diabetes visit  Avoid injury/exposure  Goal is to prevent damage are no therapies actually proven to reverse damage  Symptom control – gabapentin,

16.  Maintain blood sugar control  Maintain normal B/P  Maintain normal cholesterol profile  Aspirin therapy  Weight Control  Smoking Cessation

17.  Healthy Weight – 5-10% reduction  Physical Activity – 150 min /week  Diet – Low in saturated fats, high in fiber, carbohydrate controlled  Self Monitoring of blood glucose  Medication Adherence  Immunizations Flu Pneumonia >65 yr Hep B 19-59 yrs of age

18.  11 types or classes of diabetes medications  Know the actions and side effects of each medication  Insulin Therapy  Basal – Long acting  Bolus – Quick acting  Combination or mixed insulin  Vial/syringes, Pre-filled pens, Insulin Pump

19.  Causes Medication Skipping or delaying meals Increased activity or exercise  Symptoms Shaky & anxious Sweating Hunger Fast heartbeat Difficulty concentrating Unconsciousness, seizure, coma, death

20.  15:15 Rule ◦ 15gms of carbohydrates and recheck blood sugar in 15 minutes ◦ Correct blood sugar and then eat a snack with protein Prevent events ◦ Know the actions and side effects of medications ◦ Test blood sugar more often when adding or changing medication ◦ Carry glucose meter and something to treat ◦ Keep records and watch for trends, report to PCP ◦ Test before driving ◦ Wear medical alert

21.  If unable to self treat then assistance will be needed from family or bystander  Have a plan  Glucagon injection  Call 911  Report any trends and or events to PCP  Hypoglycemic unawareness can occur

22.  Depression Screening for ages >65 Loss of motivation Non adherence to plan of care  Goal Setting Short term goals Long term goals

23.  Patient  Family members  Health care provider  Certified Diabetes Educator  Dietitians  Counselor  Social Worker  Pharmacist

24.  Early diagnosis  Lifestyle changes  Self management

25.  American Diabetes Association. Standards of Medical Care in diabetes – 2015. Diabetes Care. 2015; 38 (Suppl 1): S1-S93. January 2015 American Diabetes Association. Standards of Medical Care in diabetes – 2015. Diabetes Care. 2015; 38 (Suppl 1): S1-S93. January 2015  https://sugarhighsugarlow.files.wordpress.com/20 13/04/retinopathy.jpg https://sugarhighsugarlow.files.wordpress.com/20 13/04/retinopathy.jpg  http://www.ndei.org/patienteducation.aspx http://www.ndei.org/patienteducation.aspx  http://www.hyderabadendocrinology.com/sites/de fault/files/diab%20kidney.png http://www.hyderabadendocrinology.com/sites/de fault/files/diab%20kidney.png