Diabetes Essentials ACCESS TRANSCONA What is Diabetes Diabetes
Diabetes Essentials ACCESS TRANSCONA
What is Diabetes? Diabetes is a chronic disease and progressive disease in which the body either cannot produce enough insulin or cannot properly use the insulin it produces or a combination of both. Insulin is a hormone that controls the amount of glucose (or sugar) in the blood. The body needs insulin in order to be able to use sugar as an energy source. Diabetes leads to high blood sugar levels, which can damage organs, blood vessels and nerves.
Types of Diabetes Type 1 diabetes occurs when the pancreas is unable to produce any insulin. This type will usually develop in childhood or adolescence but can be diagnosed at any age. It affects 10 % of people living with diabetes. Type 2 diabetes occurs when the pancreas does not produce enough insulin, when the body does not effectively use the insulin that is produced, or both. Type 2 diabetes affects 90% of people living with diabetes.
Types of Diabetes Pre diabetes refers to blood glucose levels that are higher than normal, but not yet high enough to be diagnosed as type 2 diabetes. Many people with prediabetes will go on to develop type 2 diabetes, but not all. It’s important to note that while type 2 diabetes is not reversible, prediabetes may be. Gestational diabetes mellitus refers to glucose intolerance with onset or first recognition during pregnancy.
What is Diabetes? www. youtube. com/watch? v=IGNPPmkw 5 Ws
Risk factors associated with Diabetes • Age >40 yrs • Behaviours related to: nutrition, physical activity, sleep, stress and smoking • Environment • Weight management (abdominal obesity or extra weight around the middle) • Other medical conditions (including high blood pressure and high cholesterol) and certain medications • Genetics (Family History , Ethnicity -People of African, Arab, Asian, Hispanic, Indigenous, or South Asian descent are at higher risk) • History of pre-diabetes or gestational diabetes
Fact or Fiction? “I would know I have diabetes because I would feel it. ” Fiction: Many people who have type 2 diabetes don’t display any symptoms! This is why checking your blood sugar at home or at the lab is important.
Symptoms associated with Diabetes • Unusual thirst • Frequent urination • Weight change (gain or loss) • Extreme fatigue or lack of energy • Blurred vision • Frequent or recurring infections • Cuts and bruises that are slow to heal • Tingling or numbness in the hands or feet • Trouble getting or maintaining an erection
How is diabetes diagnosed? Fasting Plasma Glucose (FPG): A simple blood test that measures the concentration of glucose (sugar) in the blood after several hours of not eating. You will need to fast for 8 hours before getting your blood taken. Glycosylated Hemoglobin (A 1 C): Another blood test that can estimate the average of your blood glucose levels over the past 3 months. You do not need to fast for this test. 75 gram Oral glucose tolerance test (OGTT): You are given a standard dose of glucose in an orange drink and your blood glucose levels are tested at several intervals (usually fasting, 1 hr, and 2 hrs after drinking). Note: this test is not routinely recommended anymore.
Hb. A 1 C
How is Diabetes diagnosed?
Fact or Fiction? “When my aunt started on insulin she ended up losing her vision. ” Fiction: We often hear statements like this. It was likely not the insulin that caused the loss of vision, but could be related to her blood sugars if they weren’t in target for a long time. Maybe that insulin wasn’t started early enough (for various reasons) or there were other factors affecting her eye health. The goal is to stay healthy with diabetes. We do this by managing our blood sugars, blood pressure, cholesterol and staying up to date with some health checks.
Complications of Diabetes Foot ulcer/amputation Uncontrolled blood sugars from Diabetes Blindness Heart Attack/Heart disease Dental disease Stroke Kidney Failure
Retinopathy (Eye Damage) Having high blood sugars can cause a build up of glucose in the lens of the eye. This can cause swelling, clouding and weak spots to develop in the blood vessels in the eyes. This may lead to cataracts and blindness. • Get your eyes checked once every 1 -2 years (with no disease and controlled blood sugars) • Tell your eye care provider (optometrist or ophthalmologist) that you have diabetes. A portion of their testing is then covered by Manitoba Health • People living with diabetes are at higher risk of glaucoma, cataracts and retinopathy (a disease of the blood vessels at the back of your eyes that can lead to blindness). • You may need to have your pupils dilated for this exam and would not be able to drive home
Dental Problems Uncontrolled blood sugars can make the blood vessels in gums narrower. This increases you risk for gum disease. Uncontrolled blood sugars can also decrease the saliva in the mouth which can result in dry mouth, increased tooth decay and ulcers. • Go to the dentist at least once per year (or as your insurance plan permits) • Let your dentist know that you have diabetes • People living with diabetes are at higher risk for gum disease and cavities • If you have dentures, you should ensure they fit well and there are no sore spots. If you notice a sore that is not healing please see your provider.
Heart Disease and Stroke • High blood sugars along with being overweight, inactive lifestyles, high blood pressure and high cholesterol can put you at risk for heart attack or stroke. People who smoke or have a family history of heart disease or stroke are at even higher risk. • The recommended target for people with diabetes is less than 130/80 mm Hg. Have your blood pressure checked at every visit.
Nephropathy (Kidney Disease) • High blood sugars may damage the small blood vessels in the kidney that causes the kidney’s ability to filter the blood. • Without treatment, the kidneys will eventually fail and dialysis or a kidney transplant will be required • Have your kidneys checked by having your urine tested for protein. • Another test used to check your kidney function is the estimated Glomerular Filtration Rate (e. GFR).
Neuropathy • Uncontrolled blood sugars may cause nerve damage and poor circulation to the legs and feet. • Poor circulation and nerve damage can reduce feeling in your legs and feet. You may not even know you have a blister or cut. If left untreated you may develop a serious infection or lead to amputation. • Once a year, your health care provider will do a 10 g monofilament test or use a 128 -Hz tuning fork to test the health of your nerves • If you ever feel like your feet are numb or on “pins and needles” talk to your provider
Emotions Your provider should check in at least once a year about your mental health Depression and anxiety are common feelings that occur with or without diabetes. Diabetes itself can negatively affect your mental health and those symptoms in turn can negatively affect your diabetes control.
Nerves People living with Diabetes have a higher risk of sexual dysfunction due to issues with blood flow and damage to nerves. Your provider should check in with your sexual health at least once a year There are management strategies and treatments available
Smoking • Realize the benefits of quitting • Not only helps to reduce your blood pressure but also has financial rewards • Talk to your health care provider about the methods, programs and medications that will help you to quit
Self monitoring of blood sugar Why do we check our blood sugars at home? • provide a quick measurement of your blood sugar level at a given time • show your lifestyle and medication affect your blood sugar levels • help you and your diabetes health-care team to make lifestyle and medication changes that will improve your blood sugar levels. • Important to check when we feel ill.
Self Monitoring of blood sugar How Often Should I check? The frequency of monitoring BG should be individualized to each person's unique circumstances. Factors influencing this include: • type of diabetes • medications • changes to medications • blood sugar targets • patient comprehension (i. e. literacy/numeracy) • risks for hypoglycemia, awareness of hypoglycemia • occupational requirements • acute illness • finances or coverage
Targets for type 2 diabetes
Hb. A 1 c and Average Blood Glucose
Targets for Glycemic Control
Fact or Fiction? Is there a cure? “If my blood sugars get back to ‘normal range, ’ I no longer have diabetes”. Fiction: Once you have been diagnosed with type 2 diabetes, you will always have it. Careful diabetes management can get your numbers in the target ranges and decrease your risk of symptoms and complications, but diabetes must be managed for life - whether you’re using healthy behaviours alone or along with medications. Currently there is no cure… but researchers are continuing to look for one!
Diabetes is a chronic progressive disease
Ways to treat type 2 diabetes Four different management strategies for type 2 diabetes. 1. Healthy Eating 2. Physical Activity 3. Medications and Insulin 4. Stress Management
Healthy Eating • Eating healthy helps reduce your blood sugars and your blood pressure • Provides the body with more energy
Nutrition Carbohydrate Increase blood glucose Protein Fat No increase in blood glucose
Nutrition tips • Eat three meals per day at regular times and space meals no more than 6 hours apart. You may benefit from a healthy snack. • Limit sugars and sweets such as sugar, regular pop, desserts, candies, jam and honey. • Limit the amount of high fat food you eat such as fried foods, chips and pastries. • Eat more high fibre foods such as whole grain breads and cereals, lentils, dried beans and peas, brown rice, vegetables and fruits. • If you are thirsty, drink water. • Use “the plate method” to get the right amount of different nutrients. • Use “the hand jive” to measure out portions. • Follow Canada’s Food Guide • Reduce the amount of salt in your diet
Canada’s Food Guide
Physical Activity • Physical activity helps reduce your blood sugar and your blood pressure • Uses up glucose (cardiovascular activity) • Makes your cells recognize insulin better (strengthening activities) • Get Active! Its easier than you think • Ask your Health Care Provider which activities are good for you
Fact or Fiction? Losing weight “If I’m not losing any weight, my health changes aren’t working” Fiction: Getting physical activity and eating healthy provides benefits to your health regardless of weight change. Try to use other measurements to monitor your health behavior change efforts: blood sugar monitoring, blood pressure, energy levels/how you feel, and physical fitness are all more accurate ways to gauge your success.
Fact or Fiction? Medications and Insulin “Going on a medication for diabetes means I’ve failed with my healthy behaviour changes and my diabetes is getting worse. ” Fiction: Diabetes is a progressive disease. What works today to manage your blood sugars may not always be enough. Healthy behaviours (healthy eating and activity) are the cornerstone of diabetes management and should always be recommended and encouraged throughout the course of diabetes. Medications can be offered at any time throughout the course of diabetes as well – either to improve symptoms and/or prevent complications. This can be the case even as early on as in prediabetes.
Medications • Oral medications and/or insulin may be prescribed to help control your diabetes • Take the medications as prescribed by your health care provider. • You may need more than 1 medication to control your diabetes • Talk to your pharmacist or health care provider if you are experiencing any side effects
Fact or Fiction? “It’s better to treat my diabetes naturally than with medications. ” Fiction: There are many “natural products” that are advertised as the newest, coolest thing for treating (or even curing!) diabetes, but they often don’t have any evidence to show that they work OR even to show that they’re safe. Many have already been shown to be ineffective, but are still marketed because natural products have different advertising rules than medications. Many of these could be dangerous to your health and are not recommended.
Sick Day Management Prevention is key Drink plenty of extra sugar-free fluids Check your blood sugars more often than usual Even if you may not be eating as much, you still need to take your medications, including insulin • Always check with the pharmacist before using any over the counter cold remedies or cough syrups • •
Hypoglycemia is a blood sugar level less than 4. 0 mmol/L
What causes a low blood sugar level (hypoglycemia)? • • • More physical activity than usual Not eating on time Eating less than you should have Taking too much medication The effects of drinking alcohol
Treating a low blood sugar If blood sugar is less than 4 mmol/l: Eat or drink a fast-acting carbohydrate (15 grams): • 15 g of glucose in the form of glucose tablets • 15 m. L (1 tablespoon) or 3 packets of sugar dissolved in water • 150 m. L (2/3 cup) of juice or regular soft drink • 6 Life. Savers® (1 = 2. 5 g of carbohydrate) • 15 m. L (1 tablespoon) of honey (do not use for children less than 1 year old) Wait 15 minutes, then check your blood sugar again. If it is still low: • Treat again; wait 15 minutes, check your blood sugar. Continue these steps until your blood sugar is above 4 When your blood sugar is above 4: • If your next meal is more than one hour away, or you are going to be active, eat a snack, such as half of a sandwich or cheese and crackers (something with 15 grams of carbohydrate and a protein source) • Wait 40 minutes after treating a low blood sugar before driving
Fact or Fiction? Chocolate Bar Emergency If you have diabetes you should always carry a chocolate bar with you “just in case” you go low? Fiction: Chocolate bars are actually a mix of protein, fats and Carbohydrates so this will not digest fast enough to get the sugar into your blood, like you’d need with a true low blood sugar.
Stress Management • Take time to relax • Make time for yourself to do something you enjoy: exercises, read, hobbies, gardening, vacation, socialize - ANYTHING! • Get active Do exercises such as deep breathing, stretching, walking • Get a good night’s sleep (without sleeping pills) • Keep routines • Mindfulness and meditation • Get support: Peer support groups, friend groups or family, professional support: counsellor, psychologist, family doctor/nurse practitioner, or psychiatrist
In Summary… • Lead a healthy lifestyle. • Maintaining control of your blood sugars can prevent or delay these complications. ( Target 4 -7 mmol/l before meals and 5 -10 mmol/l 2 hrs post meals). • Control your blood pressure. ( Blood pressure of <130/80 is ideal). • Attend annual eye exams. • Take care of your feet. Wear appropriate footwear. • Inspect your feet daily for cuts, bruises, blisters etc. • Brush your teeth and gums daily • Have your cholesterol , urine and blood tests checked by your health care provider. • Take your medications as prescribed.
Conclusion For more opportunities to learn, please check out our Group Program Guide: www. wrha. mb. ca/groups
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