Diabetes Survival Camp

1
Diabetes Survival Camp Session 2

• You can strive and thrive with diabetes

• Welcome

2
Survival Camp Topics

• Training 2
• Calibrate your Diabetes Compass
• Boots are made for Walking!
• Medications and Insulin

3
Diabetes ABCs

• A 1c
• B lood Pressure
• C holesterol

4
A1C Blood Test
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A1c and Mean Plasma Glucose

• A1c () Mean Plasma Glucose
• 6 126
• 7 154
• 8 183
• 9 212
• 10 240
• 11 259
• 12 345
• American Diabetes Association 2008

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Know Your Check every 3 - 6 months

• A1c
• Less than 7

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Glucose Goals How do we Get there?

• Test
• Pre-meal blood sugar
• 1-2 hours after meal blood sugar

• Goal
• 70 130
• Less than 180

• Healthy Eating
• Exercise
• Medication / Insulin
• Monitoring

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Keep Your Blood Pressure In Check
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UKPDS Blood Pressure Findings

• By controlling your blood pressure you reduce
  your risk of
• Heart failure (56)
• Stroke (44)
• Death from diabetes (32)

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Blood Pressure Goal

• Less than
• 130 / 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 ABCs

• A 1c (less than 7)
• B lood Pressure (130/80)
• C holesterol
• (LDL lt100, HDL gt 40, Trig lt 150)

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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
• Talk to your doctor if less than 60

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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.

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Dental Care

• mouth infections more common
• flushing, brushing, regular check-ups important!
• See your dentist at least every 6 months.

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Schedule Regular Visits with Diabetes Care
Providers
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Mr. Jones -What Should We Do?

• 64 yr old with type 2 with heart problems
• Labs
• A1c 9.3
• HDL 41mg/dl
• LDL 156 mg/dl
• Triglyceride 260mg/dl
• Last eye exam, 1992
• B/P 142/92

• Self-Care Skills
• Walks dog around block 3 xs a week
• Bowls every Friday
• 3 bottles of beer daily
• Widowed, so usually eats out
• 15 lbs overweight

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You Can Survive and Thrive with Diabetes

• Steps
• A1c less than 7
• Get blood pressure to goal
• Get lipids to goal
• Get active
• Stop Smoking
• Partner with your health care team
• Attend our support group

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Adopt a Healthy Lifestyle
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Boots are Made for Walking

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Good News About Physical Activity
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Physical Activity Keep It Fun
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Activity Pyramid
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Success with Exercise

• What kind of activities count as exercise?
• What are some barriers to exercise?
• How do you succeed with exercise?

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Set a Realistic Exercise Goal

• Set a realistic starting goal for YOU
• 3 ten minute segments a day
• Long term goal 30 mins, 5 days a week
• Start slow, increase gradually, listen to your
  body, do not overdo
• Drink water before, during and after

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Physical Activity Can Lead to Low Blood Glucose
(Hypoglycemia)
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Tips for Safe Physical Activity
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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)

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Exercise is Restorative

• Regular physical activity reduces your risk of
  many chronic diseases and improves your overall
  quality of life.

31
Medications andInsulin

Your survival tools.
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Medications
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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

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5 Classes of Medications for Type 2

• 1. Increase insulin release from pancreas
• 2. Decrease sugar release from liver
• 3. Slow down the breakdown of starches in gut
• 4. Make your own insulin work better
• 5. Makes you feel fuller

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Oral Medications for Type 2 Diabetes
Sulfonylureas
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Oral Medications for Type 2 Diabetes Meglitinides
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Oral Medications for Type 2 Diabetes Biguanides
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Oral Medications for Type 2 Diabetes
Alpha-Glucosidase Inhibitors
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Oral Medications for Type 2 Diabetes Insulin
Sensitizers
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5. New Diabetes Medications that make you feel
fuller

• Incretin Mimetics
• Exenatide (Byetta)
• Liraglutide (Victoza)
• DPP-4 Inhibitor
• Januvia (sitagliptin)
• Onglyza (saxagliptin)
• Amylinomimetics
• Pramlintide (Symlin)

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Human Incretin Hormone GLP-1
Brain promotes satiety and reduction of appetite
Liverreduces glucose production
Stomach slows emptying
Alpha cellblocks glucagon secretion
Beta cell stimulates insulin secretion
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Gut Hormone Replacement Exenatide and Liraglutide

• Most common side effects
• Nausea, vomiting, diarrhea, dizziness, headache,
  feeling jittery, and acid stomach
• Nausea is most common when first starting but
  decreases over time in most patients
• Reduced appetite
• Report any abdominal pain

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DPP-IV Inhibitors Januvia and Onglyza

• Januvia (sitagliptin)
• Onglyza (saxagliptin)
• Lowers blood glucoses by increasing amount of
  gut hormone in your system
• Januvia dose is 100 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

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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
• Other side effects
• Ease of use for YOU

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Diabetes Medications
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Invention of Insulin 1921
The first stills used to make insulin (early-mid
1920's).
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Physiologic Insulin Secretion 24-Hour Profile
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Insulin (µU/mL)
Meal Insulin
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Basal Insulin
0
Breakfast Lunch Dinner
150
Meal Glucose
100
Glucose (mg/dL)
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Basal Glucose
0
7
8
9
10
11
12
1
2
3
4
5
6
7
8
9
A.M.
P.M.
Time of Day

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Insulin Action Categories

• Bolus lowers after meal glucose levels
• Rapid Acting
• Aspart, Lispro, Glulisine
• Short Acting
• Regular
• Basal controls glucose between meals, hs
• Intermediate
• NPH
• Long Acting
• Detemir (Levemir)
• Glargine (Lantus)

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Insulin Injection Sites
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Insulin Needles and Pens
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Care for Insulin and Needles
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• 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 [phone]
• In Chico - 1101 Marauder Street (near the
  airport)
• Hours 9am 1pm on Friday and 9-4pm on Saturday
  
• More info - Call [phone]
• Or Get BD Safe Clip