Diabetes

Making Changes
for
Self-Management

Deb Burlage,RN, CDE

 Objectives
Participants will be able to…..
Discuss Basics of Diabetes
How to Impact Change
Apply Concepts to Exercise
 Epidemic
Approximately 17
million people in the
US have diabetes

Another 16 million
have a condition now
known as pre-
diabetes
 Prevalence
The incidence of
diagnosed diabetes has
increased by 61% since
12 1990.

10

8 3-D
Column 1
6 DX_DM

4 UnDx-DM

0
1990 1998
Basic Diabetes Information
Diabetes is a disease in which the body
does Not produce or properly use insulin

Insulin is a hormone that is needed to

convert sugar, starches and other food
into energy needed for daily life

Cause: Genetics/Environment

Sings and Symptoms

 Classification of Diabetes
Type 1 diabetes: failure to produce insulin

Type 2: results from insulin resistance

Pre-diabetes: BS in between normal and

high

Gestational Diabetes: affects 4 % of

pregnant women per year
 Current Criteria for
Diagnosis of Diabetes

Symptoms of diabetes and a casual

plasma glucose ≥ 200 mg/dl*

FPG ≥ 126 mg/dl**

 Criteria for Diagnosis of
Pre-diabetes (IFG/IGT)

„IFG: ≥ 110 mg/dL and < 126

„IGT

„Fasting: <126 mg/dL

„2-h: ≥140-<200 mg/dL
 Complications
Heart Disease
Stroke
High Blood Pressure
Blindness
Kidney Disease
Nervous System
Amputations
Dental Disease
 Cost $$$$$$$$$
2002: 132 Billion

Per Person:
– Individuals with
diabetes: $13,243
per year

– Individuals
without diabetes:
$2,560 per year
 ABCs of Diabetes
Good News

Studies have proven:

DCCT/UKS

You Can Make A

Difference
 Standards of Care
ABCs
A A1C
B Blood Pressure
C Cholesterol
D Diabetes Ed/Dental
Exam/Diet
E Eye Exam/Exercise
F Foot Exam
G Glucose monitoring
H Heart Health
I Indications for
specialties
K Kidney
 Recommended Goals
Glycemic control
– A1C <7.0%
– Fasting BS 80-110mg/dl
– Non-fasting <180mg/dl

Blood Pressure <130/80

Lipids
– LDL Cholesterol <100mg/dl
– Triglycerides <150mg/dl
– HDL Cholesterol >40mg/dl
 Change Is HARD
KISS
Knowledge: get the
facts!!!
Individual: set goals
that are
yours/understand
Benefits and Barriers
Start with what
motivates YOU
Support: Health care
team/family/friends
 Example

Exercise
– K: what do you need to know before you
exercise
– I: what works for you (schedules,
limitations)
– S: start with what motivates you (family,
friends, hobby, travel……………..)
– S: Find a friend or colleague that will
motivate you!!!
 Exercise

Exercise can control blood sugars and lower

you risk of heart disease!
 Examples of Exercise
Examples of exercise:
– Aerobic: Walking, Swimming, Bicycling,
Jogging, and Skating
– Strength: Weight/Resistance
– Flexibility: Yoga, Tai Chi
 Three Key Parts To Any
Exercise Program
– Frequency: Exercise at least 3-5 days per
week
– Intensity: This means how hard you work
during exercise. You should feel like you are
working harder than usual but still be able to
carry on a conversation
– Time: Exercise for at least 20-30 minutes at a
time (Start out gradual).
 Exercise Tips
Type 1: do not exercise if sugars <70 or
>300 or if ketones are present
Type 2: do not exercise if sugars < 70 or
>350
Exercise at peak insulin times may cause
low blood sugars
Exercise can cause low blood sugars
several hours after exercise
Schedule exercise 45-60 minutes after
eating
 Guidelines
– Always check with your physician before
beginning any exercise program or if you
have any complications during exercise
– Check Blood Sugars before and after exercise
– Warm up and cool down
– Wear good shoes and check feet after
exercise for any blisters or signs or irritation
 Further Guidelines
Keep a daily log Exercise with a
Wear Medical ID partner
Drink plenty of fluids Modify Caloric Intake
Carry fast acting
sugar
Do NOT inject into
area where exercise
is involved
Knowledge (continued)
BS Type of Exercise Extra Food Needed

< 100 mg/dl Low 15 gms Carb

Moderate 30 gms Carb
Strenuous 60 gms Carb
101-170 mg/dl Low No extra food
Moderate 15 gms Carb
Strenuous 30 gms Carb
171-300 mg/dl Low No extra food
Moderate No extra food
Strenuous 15 gms Carb
> 300 mg/dl No Exercise No extra food
 Individualize Exercise
Benefits and Barriers to Exercise

– Maybe You are not ready to change

– Maybe you are thinking about change
– This is a good time to think about the benefits,
the barriers, and becoming more physically
active!
Individualize: Pros-Why do you
want to change
Physical Reasons

Emotional Reasons
 Individual Barriers: What is
Stopping You???

Physical Barriers

Emotional Barriers
 Next Step
Summarize your findings
– ID benefits you are most excited about
– ID barriers you feel strongest about
– Ask yourself if you are confident and ready to
commit to change
– Ask yourself if you are satisfied with status
quo
– Are you open to learning more?
Start With What Motivates You
What is meaningful in your life
What do you enjoy doing
What are you passionate about
What have you always wanted to do?

So Let’s Get started

 Support
Multi-disciplinary Team
Family
Friends
Summary for Success

Knowledge
Individualize
Start
Support
 Conclusion

Life is not simply holding a good hand

Life is playing poor hand well…….
-Danish Saying
 Resources/References
American Diabetes Association:
www.diabetes.org

Center for Disease Control:

www.cdc.gov/diabetes

Clinical Diabetes:
http://clinical.diabetesjournals.
org

Diabetes is South Dakota:

www.sddiabetes.net
The Gift………..