Collaborative Health Advocate Team CHAT

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Collaborative Health Advocate Team(CHAT)

• Midwestern University
• Colleges of
• Medicine, Physician Assistants Pharmacy

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Diabetes is a Growing Threat to Our Nations
Health
Every 21 seconds, someone in America is diagnosed
with diabetes.
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So, What is the BIG Deal about diabetes ????
What exactly is diabetes ?
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What is it about Diabetes that you are most
Concerned or Worried about?
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Complications of Diabetes

• Leading cause of blindness
• 12-24,000 new cases each year
• Leading cause of Kidney problems
• 43 new cases
• Major cause of foot and leg amputations
• 82,000 nontraumatic LEA each year
• 60-70 people affected

National Diabetes Fact Sheet, 2000
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Complications of Diabetes

• Heart Disease and Stroke Leading cause of
  diabetes-related deaths 2 4 times higher
  incidence
• High Blood Pressure 73 above target
• (lt130/80 mmHg)
• High Cholesterol
• Total Cholesterol lt 200 mg/dl
• Bad Cholesterol (LDL) lt 70mg/dl
• Good Cholesterol (HDL) gt 40-50 mg/dl
• Triglycerides (TG) lt 150 mg/dl

National Diabetes Fact Sheet, 2000
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Complications of Diabetes

• Delay in wound healing and infections
• Yeast and vaginal infections
• Erectile Dysfunction (ED)
• Impotence
• Dental Disease 2 times higher incidence

National Diabetes Fact Sheet, 2000
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Type 2 Diabetes

• The American Diabetes Association estimates that
  by the time a patient is finally diagnosed with
  type 2 diabetes they have actually been diabetic
  for about 9 years!

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Normal Metabolism
Adapted from slides by Donald Zettervall, RPh, CDE
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Pre-Diabetes / DIABETES
decreasing sensitivity to glucose
decreased sensitivity to insulin
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Thinking like a Pancreas
More for waking up
No food
meals
Less overnight
6 pm
3 pm
12N
9 pm
3 am
7 am
8am
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Treatment of Type 2 Diabetes

• NonPharmacological
• Diabetes Self-Management Education
• Exercise/Activity
• Medical Nutrition Therapy
• SMBG (blood glucose monitoring)
• Weight management

• Pharmacological
• Alpha Glucosidase Inhibitors
• Glitinides
• Incretins
• Insulin
• Metformin
• Sulfonylureas
• Thiazolidinedones

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Non-Pharmacological Treatments

• Diabetes Self-Management Education
• Medical Nutrition Therapy
• Exercise/Activity
• SMBG (blood glucose monitoring)
• Weight Management

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Diabetes Self-Management Education

• Knowledge is Power !!!!
• The more you know about diabetes the better YOU
  can control IT.

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Medical Nutrition Therapy

• What have you heard about what you should or
  should not eat ????

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Medical Nutrition Therapy

• Meal plans should be individualized
• Its not WHAT you eatits HOW MUCH you eat
• PORTION SIZE.PORTION SIZE ...PORTION SIZE

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History of Portion Sizes

• Coca Cola 6 oz bottle in 1913, 12 oz in 1999
• McDonalds small fries today was the large in
  1965
• 2 oz bagel in 1996 is 5 oz today
• 1994s 10 inch dinner plate is now 12 inches

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Exercise / Activity

• What have you heard about exercise ????

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Exercise / Activity

• Ideally everyone should be active for 30
  minutes a day .most days of the week
• The 30 minutes does NOT need to be at the same
  time
• 10 min. 3 times a day 30 min per day

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Exercise / Activity

• Park your car further away
• Choose stairs over elevators or escalators
• Any and Every movement counts

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What are some ways you can increase your activity
in your life ?
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Self-Monitoring Blood Glucose
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American Association of Clinical Endocrinologists

• Fasting
• lt 100mg/dl
• 2 hour post-prandial
• lt 140mg/dl
• Bedtime
• 100-140mg/dl
• A1c
• lt 6.5

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Correlation Between A1C and Mean Plasma
Glucose Levels
Diabetes Care. 2003 26 (Suppl 1)S33-50.
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Self Monitoring Blood Glucose

• Studies show that patients that test their blood
  sugar regularly have increased knowledge of what
  foods, exercise medicines are doing to their
  sugar

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Self Monitoring Blood Glucose

• An increase in the number of times a day you test
  your blood sugar CAN help to decrease your blood
  sugar (and your A1c)
• Which gives YOU better control over your diabetes

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When should you test your blood sugar ?

• Ideally 2 times every day
• Once in the morning before you eat. (fasting)
• Second, 2 hours after your largest meal of the
  day. (post-pranidal)
• Another option is to alternate testing times to
  get a better picture of your blood sugar
• Test your sugar before and after the same meal

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ADA Standards of Care

• Aspirin
• Blood Pressure
• Foot Care
• Eye Exam
• Lipid (Cholesterol) Profile
• Flu Pneumo shot
• Education

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What Questions Can We Answer For You?

• Thank you
• scorne_at_midwestern.edu