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									 What You Need To
Know About Diabetes
Diabetes Prevention

         Roger Chene MPH,RD
    Area Health Promotion Specialist
      California Diabetes Program

   California Diabetes Program
    – Introductions
    – Who are we?
   Purpose of today
   Agenda
       California Diabetes Program
   Within the California Department of Health

   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


Community Health Interventions

 Surveillance

 Public Policy

   What are your hopes for today’s training?

   What would you like to take with you?

          To provide you with basic
diabetes knowledge to better help you care for
     persons with or at risk for diabetes.
   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
 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
    – 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
    – 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
 – 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
 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
        Other Types of Diabetes

   Not common; may be triggered by illness,
    surgery, drugs, genetic syndromes,
    malnutrition or infection

   Pre-diabetes is a higher than normal blood
    glucose but not high enough for a diagnosis of

   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
   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
 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
   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
   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
    - 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
              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
 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

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
 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
       More Benefits of Physical
   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
   Fluid intake
   Modify physical activity if complications are
   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
 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
 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
 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
   Helpline Free Services:
    – one-on-one confidential counseling,
    – self-help materials
    – Referrals

   What can you do to improve care for
    persons living with diabetes or at risk for
 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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