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What You Need To Know About Diabetes and Diabetes Prevention Roger Chene MPH,RD Area Health Promotion Specialist California Diabetes Program Welcome California Diabetes Program – Introductions – Who are we? Purpose of today Agenda California Diabetes Program Within the California Department of Health Services The mission of the California Diabetes Program is to prevent diabetes and its complications in California’s diverse communities Funded primarily by Centers for Disease Control and Prevention (CDC) Collaborates with local, state and national organizations to accomplish goals California Diabetes Program Focus Areas Health Systems Communications Community Health Interventions Surveillance Public Policy Expectations What are your hopes for today’s training? What would you like to take with you? Purpose To provide you with basic diabetes knowledge to better help you care for persons with or at risk for diabetes. Agenda What is diabetes? Types of diabetes Risk factors Signs & symptoms Diabetes complications How to manage diabetes Diabetes prevention Diabetes resources Brainstorm – Action for diabetes prevention The Basics of Diabetes Diabetes is... Serious - Chronic condition, there is currently no cure. More children now diagnosed with Type 2 diabetes. Common – There are now almost 21 million people in the U.S. with diabetes. Preventable - modest changes in lifestyle can prevent diabetes and complications Controllable - take charge of your diabetes Source: National Diabetes Fact Sheet, Centers for Disease Control and Prevention, 2005 Diabetes is Costly Cost of Diabetes in the United States, 2002 Total (direct and indirect): $132 billion Direct medical costs: $92 billion Indirect costs (disability, work loss, premature death): $40 billion Average annual health care costs for a person with diabetes: $13,243 Average annual health care costs for a person without diabetes: $2,560 California Department of Health Services estimates $13 billion is spent annually Source: National Diabetes Fact Sheet, Centers for Disease Control and Prevention, 2005 Who has Diabetes? Nationwide 7.0% of the population has diabetes: – Diagnosed: 15.0 million people – Undiagnosed: 6.2 million people – 1.5 million new cases in people 20 years and older in 2005. Diabetes disproportionately burdens ethnic and older populations Source: National Diabetes Fact Sheet, Centers for Disease Control and Prevention, 2005 Who has Diabetes? In California, approximately 2 million people have diabetes For every 2 people who have been diagnosed with diabetes, there is 1 who has diabetes and doesn't know it (Add local or audience specific information) Who has Diabetes? American Indians – American Indians and Alaska Natives are 2.3 times as likely to have diabetes than non- Hispanic whites of similar age African Americans – 13.3 percent of African Americans aged 20 years or older have diabetes. – African Americans are 1.8 times as likely to have diabetes than whites of a similar age Source: National Diabetes Fact Sheet, Centers for Disease Control and Prevention, 2005 Who has Diabetes? Hispanics – 9.5 % of Hispanics aged 20 years or older have diabetes. – Hispanic Americans are 1.7 times more likely to have diabetes than whites of similar age Asian Americans – Limited data, at increased risk for developing type 2 diabetes compared with whites. – Show higher rates of pre-diabetes than whites. – In California, Asians are 1.5 times as likely to have diabetes as whites Source: National Diabetes Fact Sheet, Centers for Disease Control and Prevention, 2005 Diabetes: A Growing Epidemic “New evidence shows that 1 in 3 Americans born in 2000 will develop diabetes sometime during their lifetime” – 2 of 5 African Americans and Hispanics – 1 of 2 Hispanic Females Julie Louise Gerberding, MD, MPH Director, Centers for Disease Control and Prevention, and Administrator, ATSDR. Diabetes: Disabling, Deadly and on the Rise. Revised May 2005 The Growing Epidemic What is Diabetes? A condition where the body does not make or properly use insulin Identified by high levels of blood glucose diagnosed by your primary care provider – Fasting blood glucose 126 mg/dl – Random blood glucose > 200 mg/dl – Blood glucose > 200 mg/dl at 2 hours using a 75 gram oral glucose tolerance test Blood Glucose + Insulin After eating, much of the food we eat is turned into blood glucose (blood sugar). Insulin acts as a key that allows glucose to enter the body’s cells to be used as energy. Blood glucose is the body’s main source of energy. What happens in your body? Types of Diabetes Type 1 – The body produces little or no insulin – Must take insulin – Usually occurs in children and young adults – About 10% of people with diabetes have Type 1 Types of Diabetes Type 2 The body becomes resistant to its own insulin The insulin production in the body varies Several methods of blood glucose control (diet and exercise, oral medication, insulin) 90% of people with diabetes have type 2 Usually diagnosed in adults, but growing rate of children now developing type 2 diabetes Gestational Diabetes Gestational Diabetes is any degree of high blood glucose found during pregnancy Women who have had gestational diabetes have a 20 to 50 percent chance of developing type 2 diabetes within 5 to 10 years Other Types of Diabetes Not common; may be triggered by illness, surgery, drugs, genetic syndromes, malnutrition or infection Pre-diabetes Pre-diabetes is a higher than normal blood glucose but not high enough for a diagnosis of diabetes People with Pre-diabetes are at an increased risk of developing diabetes Diabetes Risk Factors Age Race or ethnic background Obese or overweight Family history/history of gestational diabetes Lack of activity or exercise High blood pressure High cholesterol High Risk Ethnic Populations American Indians/Alaska Natives African Americans Hispanics/Latinos Asian Americans Pacific Islanders Signs and Symptoms of Diabetes Increased thirst Increased urination Increased fatigue Weight loss Nausea/vomiting/abdominal pain Blurred vision Increased infections Cuts and sores that do not heal Those with type 2 may have no symptoms Short term Complications of Diabetes Hypoglycemia – Low blood sugar – caused by too little food, too much insulin or diabetes medicine or extra activity. Needs to be treated quickly and appropriately Hyperglycemia – High blood sugar – caused by too much food, too little insulin or diabetes medicine, illness or stress See health care provider to discuss therapy if having frequent episodes Source NIDDK Longterm Complications of Diabetes Kidney Disease/ Nephropathy–damage to blood vessels in the kidneys causing kidney failure Eye Disease/ Retinopathy– damage to vessels in back of the eye leading to blindness Heart and Blood Vessels – causes narrowing of the arteries and increases the risk of a heart attack or stroke Nerve Disease/ Neuropathy – nerve damage throughout the body. Causes numbness, pain, and weakness in the hands, arms, feet, and legs Sources AADE, CDC and NIDDK Source AADE Diabetes & Smoking Smoking increases insulin resistance – Smoking one cigarette reduces your bodies ability to use insulin by 15 percent Negatively impacts diabetes control Increases diabetes-related complications: – Such as vascular disease, nephropathy, retinopathy, and neuropathy – Increased risk for heart attack – Even if complications are treated they are more likely to progress – See Fact Sheets Diabetes & Smoking Smoking prevalence was 15.4% of adults in California in 20041 2 million people in California have diabetes – 17.9% are smokers 3 In 1999, nearly one in five deaths in California could be attributed to smoking. This loss translates to: – $5.7 billion in lost productivity – 12.4 years lost in death.2 1. California Adult Tobacco Survey 2004. 2. The Cost of Smoking in California,1999, Sacramento, CA, CDHS 2002. 3. 2003 Behavioral Risk Factor Surveillance Survey Managing Diabetes The key to managing diabetes is to balance blood glucose, blood pressure and cholesterol as near to normal as possible. This helps to: Prevent symptoms Reduce risk of complications Improve health overall Managing Diabetes Diabetes is best managed by: Healthy Eating – Individualized meal plan Physical Activity Taking medications as prescribed Receiving appropriate medical care & health education Community resources and support Other Things That Influence Diabetes Control Depression Stress Finances Family support Workplace support Healthy Eating A variety of foods High fiber, fresh fruits, vegetables and whole grains, low fat dairy Low in total fat, saturated fat and trans fats Moderate in calories Regularly scheduled meals and snacks Portion control Adequate fluid intake – six 8 oz. glasses of water a day Nutrition Labels Read the food label to look for: – Portion/serving size – Fat content – Carbohydrate content – Ingredient list Sugar free does not mean carbohydrate free or fat free Use the food label information to help make healthy food choices and work favorite foods into a healthy meal plan Carbohydrates Grains, fruits, vegetables and low and non fat milk are healthy foods Provide energy for everyday activities Provide vitamins, minerals and fiber Important for people with diabetes The balance of carbohydrate intake and insulin action determines how much blood sugar rises after meals Portion control is key! Portion Sizes Equaling 15 Grams of Carbohydrate or 1 Carbohydrate Serving 1 slice of bread 1/2 grapefruit 8 oz of milk 1/2 banana 4 oz juice 1 kiwi 1/3 cup baked beans 1 small orange 3/4 cup cereal 8 animal crackers 1/3 cup rice 1/2 cup canned fruits 17 grapes 2 Tbsp raisins 1/2 English muffin 1 1/4 cup strawberries 1/2 cup mashed potatoes 1 1/4 cup watermelon 3 graham crackers 1/2 cup sugar free ice-cream 6 saltine crackers 3/4 cup low-fat yogurt 6 vanilla wafers Portion Size in Your Hand! 1 palm = 3 oz = a deck of cards 1 fist = 1 cup 1 handful = 1/2 oz 1 thumb = 1 oz 1 thumb tip = 1 teaspoon Planning & Shopping Tips Planning - take some time to think about meals - keep a good stock of basics on hand - buy and keep mostly healthy foods Shopping - healthiest foods around the sides of the market - shop with a list and when least crowded - don’t shop when you are hungry - read food labels Eating Out Tips Ask about what’s in a dish or what the serving size is Try to eat the same portions you would eat at home Eat slowly Ask for salad dressings, gravy, sauces on the side Avoid fried foods Ask for substitutions Ask for low calorie items even if not on menu Fast Food Tips Balance intake with healthy food choices Watch out for “jumbo, giant, deluxe, super size” Choose grilled or broiled sandwiches Order items plain, without toppings, sauces or mayonnaise Go for salads, but watch out for high fat toppings and dressings Be alert for traps – fat free muffins may have plenty of sugar, skinless fried chicken has almost the same amount of fat as the regular kind The New Food Guide Pyramid Old Pyramid New Pyramid Mypyramid.gov Tour MyPyramid Tour the Mypyramid.gov animated tool Mini-Poster Download View and download the MyPyramid mini-poster to learn the basics about eating healthy and physical activity. Inside The Pyramid Explore the pyramid to learn about the Food groups and to see how much physical activity you should be getting. Tips & Resources Learn how to make MyPyramid work for you. Find a wealth of ideas that can help you get started toward a healthy diet. There are tips for each food group, physical activity, eating out, a sample menu, and more... Physical Activity A physical activity program should include body strengthening, flexibility, and endurance activities Physical activity includes anything that gets you moving, such as brisk walking, dancing, or working in the yard You can earn the benefits of being physically active without going to a gym, playing sports, or using fancy equipment Benefits of Physical Activity For People with Diabetes Can lower blood glucose Increases insulin sensitivity Helps to lower blood pressure and cholesterol More Benefits of Physical Activity Increases muscular strength and flexibility Promotes long-term weight control Can play a role in reducing stress and enhancing psychological well-being Be Active Safely Physical exam to assess presence of complications and obtain MD approval Hypoglycemia/ hyperglycemia prevention and treatment Fluid intake Modify physical activity if complications are present Foot care Physical Activity Program Frequency – How often: – Most, if not all, days of the week Intensity – How hard: – Low to moderate intensity physical activity( like brisk walking) is recommended Duration – How long: – If just starting out a 10-15 min/session is good. Increase to at least 30 minutes. Physical activity can be divided into three 10 min sessions. – Up to 90 minutes a day may be needed to control weight Mode – What kind of activity: – Aerobic activity such as brisk walking, cycling, swimming. – Strengthening and resistance – Always include warm-up and cool down, Physical Activity Ideas A brisk walk Dancing Aerobics class Swimming Walk instead of drive, whenever possible Work in the garden, rake leaves, do some housework Look for activity opportunities like: – Taking the stairs – Park at the far end of the shopping center lot and walk to the store Medications as Prescribed Pills and insulin are used to manage diabetes Medications work by different means - stimulate the pancreas to make more insulin - shut off the liver’s excess production of glucose - increase the body’s sensitivity to insulin - slows absorption of carbohydrates in the intestines Different medications should be taken at different times Appropriate Diabetes Care The Basics Blood sugar records – every visit Blood pressure – every visit with the Weight – every visit Foot exam – every visit Diabetes Health Record A1C – every three months Microalbuminuria – every year Dilated eye exam – every year Cholesterol, HDL, LDL, triglycerides – every year Flu shots – every year Pneumonia vaccine – at least once Diabetes Prevention What can you do to prevent diabetes? Diabetes Prevention Program research study found that type 2 diabetes can be delayed or prevented in persons at risk How? Through moderate lifestyle changes 5 to 7 percent reduction in body weight Regular physical activity (30 minutes a day) This study was especially successful for people over age 60 Small Steps, Big Rewards Move More Eat Healthier Start Your Game Plan for Preventing Diabetes Modeling for others What’s your Game Plan? Make a plan to change behavior Decide what you want to do and when to do it Think about what might prevent you from reaching your goals Find support (family, friends) Decide how you will be rewarded when you do what you have planned Diabetes Resources California Diabetes Program – Basic Guidelines for Diabetes Care – Diabetes Health Record Card National & State Resources – NDEP, CDC and NIDDK – American Diabetes Association – Other state programs What are Your Local Resources? Smoking Cessation: Diabetes and Smoking California Smokers Helpline 1-800- NO BUTTS http://www.californiasmokershelpline.org/ Be Proactive Provider Tool Kit available at www.caldiabetes.org Helpline Free Services: – one-on-one confidential counseling, – self-help materials – Referrals Brainstorm What can you do to improve care for persons living with diabetes or at risk for diabetes? Conclusion What is something new you learned today? How can you apply what you learned today in your daily work ? Did we meet your expectations? What more would you like learn about diabetes?
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