DIABETES SELFMANAGEMENT SKILLS
WHY IS IT IMPORTANT?
• Diabetes is a medical condition where the body does
not properly process food for use as energy
• Most of the food we eat converts to glucose for our cells
to use.
• The pancreas makes the hormone insulin to transport
glucose into cells.
• With diabetes, the body either doesn’t make enough
insulin or isn’t efficient with the insulin it does produce.
• This causes a build-up of glucose in the blood stream.
WHAT ARE THE COMPLICATIONS?
• Diabetes is the leading cause of serious health
complications which include:
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Heart disease (heart attack and stroke)
Blindness
Kidney failure
Lower extremity amputations
Diabetes is the 7th leading cause of death in the U.S.
9.3% of the population has diabetes (29.1 million)
21.0 million are diagnosed
8.1 million (28% of people with dm) are
undiagnosed
THE FACTS
• 1 in 3 adults will have dm by the year 2050
• 1.4 million Americans diagnosed with dm each year
• 18,436 youth are newly dx with type 1 dm annually
• 5,089 youth are newly dx with type 2 dm annually
• Economic cost: 245 billion yearly (2012); 176 billion in
direct costs and 69 billion in indirect costs
• Healthcare costs = 2.3 times higher than without dm
TYPES
• Type 1 dm: absolute insulin deficiency
• Type 2 dm: limited insulin production and inefficient
use of insulin (treated by diet, oral medications,
and/or insulin)
• GDM (gestational dm): develops during pregnancy
only (diet, insulin)
• Pre-diabetes (impaired glucose range): treated by
diet, weight loss, and physical activity.
DIAGNOSIS
• Pre-dm: fbg 100-125 mg/dL
• dm: fbg >126 mg/dL
• HbAlc: measures the % of hg (in red blood cells) in the
blood that has glucose attached to it. Is an indicator of
blood glucose levels over the past 3 months.
• Pre-dm: 5.7-6.4%
• dm: >6.5%
• Type 1 dm classic symptoms: hyperglycemia leads to 1)
polyuria, 2) polydipsia, 3) polyphagia.
• Weight loss, dehydration, electrolyte disturbances,
ketoacidosis, coma, death
MANAGEMENT
• Management: all types must learn Carbohydrate (CHO)
counting
• Many will require insulin
• Weight loss and physical activity
• Other factors impacting glucose and insulin use:
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Sickness
Stress
Sleep patterns
Sports
Recreational physical activity
Hydration
Meal patterns
Alcohol
HYPOGLYCEMIA
• Defined as blood glucose level below <70 mg/dL
• Hypoglycemic Unawareness
• All patients on insulin will experience hypoglycemia
• Some patients with type 2 dm treated with oral
medications may experience hypoglycemia
• See handout for causes and treatment guidelines
MANAGEMENT: KNOWLEDGE IS
POWER!!!
• Diabetes Control and Complications Trial: intensive
therapy drastically reduced complications
• United Kingdom Prospective Diabetes Study:
elevated glucose levels cause long-term
complications in type 2 dm
• Management:
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Medical nutrition therapy: CHO counting
Physical Activity
Weight loss (BMI 18.5-24.9, 25-25.9 overwt, 30+ obesity)
Monitoring
Medications
Self-management education
WHAT IS CHO COUNTING?
• CHO counting: a typical CHO serving is 15 g CHO
• Typical recommendation for females: 45-60 g CHO at
meals
• Typical recommendation for males: 60-75 g CHO at
meals
• Snacks <20 g CHO
• Fat content in meals may delay gastric emptying which
could result in a slower rise in glucose
• Reading a food label: use total CHO g, not the sugar g
MEAL PLANNING DIFFERENCES
• Type 1 dm (insulin): flexibility on when they eat and
what they eat because they adjust insulin dosage
to fit CHO intake. Accuracy in CHO counting is very
important.
• Type 2 dm: (not on insulin) Meal timing is important,
consistency in CHO amount and meal timing can
help the body to work more efficiently
BLOOD GLUCOSE GOALS
• Pre-prandial blood glucose (FBG, FPG): 80-130
mg/dL
• 1-2 hr post-prandial glucose: <180 mg/dL
• HbAlc: <7.0%
SO, I HEAR YOU LIKE FORMULAS?
• Insulin to CHO ratio(I:CHO) : how many grams of
CHO will one unit of insulin cover?
• Example: 1:15 (standard)
• 1:10 or 1:5 (overwt and obesity)
• 1:20 (lean, child)
• Example: I:CHO ratio of 1:15. If I eat 60 g CHO for
lunch, I need 4 units of rapid acting insulin
MORE FORMULAS
• Insulin Sensitivity Factor: how much will one unit of
insulin decrease my glucose level?
• Typical ISF is 1:30 One unit of insulin will lower
glucose by 30 mg/dL
• ISF of 1:5 (obesity)
• ISF of 1:50 (lean, child)
• Insulin Correction Factor:
• Blood glucose – 130 divided by ISF.
• Example: pre-meal glucose is 240. 240 – 130 = 110.
110 / 30 = 3.6 u insulin needed for correction of high
glucose
• If I am going to eat 60 g CHO (I:CHO ratio of 1:15),
then I need a total insulin dose of 8 u (4 u to cover the
meal + 4 u for high bg)
• Glucose of 75. 75 – 130 = -55. -55/30 = -1.8. So if I
am going to eat 60 g CHO which requires 4 u rapid
acting insulin, I would only take 2 u since I am running
on the low side.
EXERCISE PRESCRIPTION
• At least 150 min/week of moderate-intensity
aerobic physical activity; or at least 90
min/week of vigorous aerobic exercise
• Distribute over at least 3 days/week with no
more than 2 consecutive days without
activity
• Resistance exercise 2×/week
WHAT EDUCATION AND
REINFORCEMENT IS NEEDED?
• Decision making!!!!
• Understand the relationships (cause and effect)
• CHO counting (people need a lot of practice)
• Recognizing and treating hypoglycemia
• Impact on blood glucose
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Illness, Stress, Sleep
Hydration
Physical activity
Alcohol
RESOURCES
• Diabetes Resource Wiki
• diabetesweightresources.pbworks.com