Diabetes: Self-Care Flashcards
What is Diabetes?
- Hyperglycemia
- Endocrine System
- Insulin secretion, action, or both
What is Insulin?
“STORES”
• Produced by pancreatic beta cells
• Hormone that facilitates glucose metabolism
• Stimulates glucose storage in muscle & liver cells as glycogen
• Decreases hepatic glucose output
• Converts excess glucose in the blood to fatty acids/triglycerides, promotes storage in adipose tissues
• Inhibits lypolysis & production of ketone bodies
• Enhances incorporation of amino acids into proteins
Glucagon: “Breaks down”, insulin’s antagonist
Diabetes Classification by Etiology
- Type 1 (T1D) (3 stages): autoimmune beta cell destruction; leading to absolute insulin deficiency
- Type 2 (T2D): progressive loss of beta cell insulin secretion with background, insulin resistance
- Gestational: diabetes diagnosed in 2nd or 3rd trimester of pregnancy (not before)
• Others: genetic defects of beta cell function, exocrine pancreatic diseases, endocrinopathies, drug- or chemical-induced
“Prediabetes”: Impaired Fasting Glucose (IFG), Impaired Glucose Tolerance (IGT)
Type 1 Diabetes: Incidence, Onset, Body, Family Hx, Treatment
- Incidence: 5-10%
- Onset: under 30, actue/rapid
- Body: normal weight
- Family Hx: rare (1st degree)
- Treatment:
- activity/nutrition: ALL
- insulin: 100%
- oral med: Not FDA indicated
Type 2 Diabetes: Incidence, Onset, Body, Family Hx, Treatment
- Incidence: 90-95%
- Onset: over 40, some adolescent, gradual/asymptomatic
- Body: obese
- Family Hx: very common
- Treatment:
- activity/nutrition: ALL
- insulin: 25-40%
- oral med: one or more
Signs & Symptoms of Diabetes
• Differences between T1D & T2D – acuity, ketosis – T2D: may be asymptomatic for years • 3 P’s: – Polyuria, Polydipsia, Polyphagia – Dehydration, dry mouth • Fatigue • Weight loss (unexplained) • Others: – Blurred vision – Poor wound healing – Frequent bladder, vaginal, & skin infections – Numbness or pain in legs or hands, muscle weakness, or impotence
Diabetes Diagnosis
• FPG
≥ 126 mg/dL
• Random Glucose
≥ 200 mg/dL
• A1C
≥ 6.5%
• OGTT
≥ 200 mg/dl at 2 hrs post 75 gm glucose load
Guidelines for Glycemic Control
- HbA1C: < 7% (individualization), (6-6.5 for younger/healthier), (7.5-8 for older, comorbidities)
- Preprandial glucose: 80-130 mg/dL
- Postprandial glucose: <180 mg/dL
A1C: What is it?
• The weighted average of blood glucose values over the previous 2-3 months
Comprehensive Monitoring ADA Standards of Care 2021
- Team approach
- Every visit: BP goal < 140/90 mmHg, BMI goal < 25.0 kg/m2
- Every 3-6 months: follow up visit, A1C
- Annually: eye exam, microalbuminuria test, lipid panel, foot exam, flu vaccine
- Vaccinations: pneumoccocal (2 shots, 12 mo apart), all others up to date
Medical Nutrition Therapy (MNT)
- Individualized approach
- No such thing as a “diabetic diet”: quality vs. quantity, portion sizes, hand jive, dessert plate
- Carbs: high fiber (20-28g/d), vegetables, fruits, whole grains, lumens, don’t need to avoid “sugars”
- Protein: 15 - 20%, low fat meat, poultry, fish, eggs, milk, yogurt, cheese, soy
- Fat: < 30%, beware of light/fat-free, decrease trans fats, cholesterol < 200mg/d, two+ fish servings per week (omega-3 FA)
MNT - Alcohol / sod
• Acute consumption: hypoglycemia, especially empty stomach, eat first & space drinks
• Impairs judgment/coordination
• Must include in daily calories calculation (counted as a fat)
• IF the patient is going to consume alcohol
- Men: 2 drinks or less per day
- Women: 1 drink or less per day
- 1 drink = 5 oz wine, 1.5 oz distilled beverages, or 12 oz beer
Sodium
• Limited, ideally < 2,300 mg daily
Physical Activity (Exercise)
Benefits!
Increases
• Insulin sensitivity, muscle/tone (more efficient use of energy), strength, endurance, flexibility, self-esteem & feelings of well-being
Decreases
• Fat, weight, BP, cholesterol, stress & anxiety
Weight Loss & Physical Activity
- Can decrease A1C !
- Regular physical activity
• Evaluation by PCP first
• Baby steps!
• Limit sedentary time
• BG improves when sitting is interrupted every 30 minutes with just 3 minutes or more of standing or light-intensity activities - At least 150 min/wk of moderate-aerobic activity
- Burst exercise: 3 periods of 10 minutes at 85% of target heart rate
- Results in greater improvement in A1C, lipids, BMI & cardiopulmonary fitness
- Resistance training at least 2 times per week if no contraindications
Recommend Sugar Free Products
Cough & cold medicine • Caution: sugar products will increase BG - Nyquil - Robitussin products - Cough drops
• Recommend
- Sugar Free products when possible
- Nasal decongestant over oral
