Diabetes Flashcards
diabetes
one of the most challenging health problems facing the world
5th leading cause of death
complications = heart attacks, stroke, kidney failure, amputations and blindness
how many people expected to be diagnosed by 2025?
380 million
diabetes in canada
2.4 million living with it
570,000 living with undiagnosed type 2
6 million at high risk
groups at high risk
aboriginal asian south east asian latin american african boomers
economic impact
- 9 billion by 2020 in canada
1. 3 trillion in the usa as of 2015
direct acute care costs
canada = 15.36 billion as of 2012
2 in 10 hospital admissions for diabetes-related complications
types of diabetes
type 1 = autoimmune process
type 2 = insulin resistance
gestational = glucose intolerance with pregnancy
other types
type 1
“mistaken identity”
beta-cells mistakenly recognized as being foreign and are attacked by t-cells
autoimmune destruction of the beta cells
genetically determined
susceptibility factors increase risk
type 2
liver = over production of glucose gut = dysfunctional gut hormones pancreas = beta cell dysfunction cells = insulin resistance
screening for diabetes
type 1 = not really developed or recommended
type 2 = fasting plasma glucose
reasons to be screened
first-degree relative with type 2 diabetes member of high risk population presence of complications associated with diabetes vascular disease history of gestational diabetes history of delivery of a macrosomic infant hypertension dyslipidemia overweight abdominal obesity polycystic ovary syndrome schizophrenia
prevention of diabetes
type 1 = none
type 2 = intensive and structured lifestyle modification that results in loss of approximately 5% of initial body weight reduces risk, pharmacologic therapy
diabetes care depends on
daily commitment of the person with diabetes to self manage
support of an integrated diabetes healthcare team
diabetes healthcare team
should be multi and interdisciplinary
should establish and sustain a communication network among the health and community systems
ABCDES3 of diabetes care
A = A1C - optimal glycemic control B = optimal blood pressure C = cholesterol reduction D = drugs to protect heart E = exercise/ healthy eating S = screening for complications S = smoking cessation S = self-management, stress and other barriers
self management education
incorporates knowledge and skills development
cognitive-behavioural interventions
should be implemented for all individuals with diabetes
must be individualized
self management education is individualized according to
individuals type of diabetes current state of metabolic stability treatment recommendations readiness for change learning style ability resources motivation
what is fundamental to the management of diabetes
optimal glycemic control
monitoring glycemic control
should be measured every 3 months when glycemic targets are not being met and when diabetes therapy is being adjusted
physical activity and diabetes
moderate to high levels of physical activity and cardiorespiratory fitness are associated with reductions in morbidity and mortality with diabetes
people with diabetes should be assessed for what before beginning a program of physical activity more vigorous than walking
conditions that might be contraindications to certain types of exercise, predispose to injury or be associated with increased likelihood of cardiovascular disease
nutrition therapy
can reduce glycated hemoglobin by 1.0 to 2.0% and when used with other components of diabetes care can further improve clinical and metabolic outcomes
consistency in carbohydrate intake and spacing and regularity in meals may help control blood glucose and weight
replacing high-glycemic index carbohydrates with low ones affects glycemic control
insulin therapy in type 1 diabetes
insulin regimens should be tailored to individuals treatment goals, lifestyle, diet, age, general health, motivation, hypoglycemia awareness and ability for self management
all individuals with type 1 diabetes should be counselled about
the risk, prevention, and treatment of insulin-induced hypoglycemia
pharmacologic management of type 2 diabetes
should be initiated if glycemic targets are not reached within 2 to 3 months of lifestyle management
should be made to attain target A1C within 6 to 12 months
should be initiated with lifestyle management
what would save the system 2.03 billion dollars
if canadians with diabetes loss 5% of their body weight
how many people with type 2 diabetes are overweight
80 to 90%
psychological aspects of diabetes
individuals and their families should be screened for symptoms of psychological distress
preventative interventions like participative decision making, feedback and support should be incorporated into all primary care and self management education interventions to enhance adaptation to diabetes and reduce stress
what vaccine is recommended to people with diabetes
pneumococcal
