Diabetes Causes, Prevention, and Treatment - PowerPoint Presentation

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Diabetes Causes, Prevention, and Treatment

Joan Plummer RD LMNT CDE

402-562-4462

jlplummer@columbushosp.org

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Diabetes Pathophysiology

Insulin deficiency

Quantitative: decreased in production by the β-cells of the pancreas

Qualitative: insulin resistance especially muscle, liver, adipose, myocardial

Improvements in insulin function

Weight loss to decrease insulin resistance

Can in turn improve β-cell function

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Diabetes Pathophysiology

Excess secretion of glucagon by α-cells of pancreas

Glucose overproduction by liver; underutilized by body

Gluconeogenesis (making glucose from glycerol and amino acids)

Renal tubular transport of glucose to the urine due to hyperglycemia

Incretin system deviations (relationship to DM still not fully clear)

Glucagon-like peptide 1 (GLP-1)

Glucose dependent

insulinotropic

peptide (GIP)

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Who has Diabetes?

Incidence of diabetes is rising(2015 stats)

Incidence is over 30 million in the US or 9.4% of population

Incidence is higher in certain populations

Incidence of prediabetes is estimated at over 84 million

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Who has Diabetes

Of the 30 million adults with diabetes, 23 million were diagnosed and 7 million were undiagnosed

In Americans over the age of 65 and older, 25% have diabetes

1.5 million Americans are diagnosed each year

Diabetes is the 7

th

leading cause of death in the US

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Cost of Diabetes

As of 2012= $245 billion total cost of diagnosed diabetes in the United States

$176 billion for direct medical costs

$69 billion in reduced productivity

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National Diabetes Prevention Program

A year long program to help prevent diabetes

Columbus Community Hospital started in 2017

Using CDC curriculum

Goals are 150 minutes of activity and 5-7% weight loss

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Lifestyle Modifications for

Pre-Diabetes and Diabetes

Can decrease progression from pre-DM to DM

Group and individual delivery methods have both been found to be effective

Monitoring for and managing other CVD risk factors:

Hypertension (HTN)

Hyperlipidemia (HLD)

Overweight/obesity (especially excessive abdominal fat)

Tobacco use

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American Diabetes Association (ADA) Professional Practice Committee. Standards of medical care in diabetes - 2016

Diabetes Care

. 2016 Vol 37.

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Lifestyle Modifications for

Pre-Diabetes and Diabetes

Medical Nutrition Therapy (MNT)

Moderation, variety of carbohydrates

Increased physical activity

Minimum 150 minutes/week moderate level

Weight loss/maintenance

Initial 7% of body weight and maintenance of weight loss

Smoking cessation

Encourage and support with counseling and/or pharmacotherapy

20

American Diabetes Association (ADA) Professional Practice Committee. Standards of medical care in diabetes - 2016

Diabetes Care

. Vol . 37

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Blood Glucose and A1c Management

Recommended blood glucose levels:

-- 80-120 fasting and before meals

--less than 160 two hours after meals

A1c is an average over several months and would not be able to be used to see if an employee can safely perform a job

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Hypoglycemia

Blood glucose level <70 mg/dl

Too much medication or activity or too little food

Symptoms may include:

- shaking, sweating, weakness, headache

- fast heartbeat, impaired vision, hunger, anxious, dizziness, irritable, disoriented

Severe hypoglycemia – may included confusion, seizures or eventual loss of consciousness

With hypoglycemia unawareness- may have no symptoms

Recurrent episodes of hypoglycemia need to be evaluated to minimize the risk

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Hypoglycemia treatment

Check blood sugar. If less than 70 treat with 15 grams of carbohydrate such as:

- ½ cup of fruit juice or regular soda

- 1 cup milk

- 3-4 glucose tabs

- several soft candies to equal 15 grams of carbohydrate ( chocolate and hard candies not recommended)

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Hyperglycemia

Symptoms develop over hours and days

Too much food, stress, illness, not enough medications.

Short term symptoms may include thirst, urination, dry skin, hunger, blurred vision, drowsiness and nausea

Long term complications include nerve damage(neuropathy), eye damage(retinopathy), kidney disease(nephropathy) or heart problems

.

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Carbohydrate Counting

Carbohydrate converts 100% to glucose

Starchy and sweet foods contain carbohydrate

Found in grains, cereals, breads, dried beans

Found in starchy vegetables such as corn, peas and potatoes

Found in fruit, fruit juices, milk and yogurt

Non- starchy vegetables such as carrots and green beans contain very little carbohydrate. Protein and fat have little effect on blood sugars

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Carbohydrate Counting

Keep

carb

consistent for those on oral medications and set doses of insulin

Recommend 45-60 grams(3-4 choices)/ meal for women and 60-75 grams (4-5 choices)/meal for men

1 choices = 15 grams of carbohydrate

May use choices or grams

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Carbohydrate Counting

Grains = 15 grams of

carb

1 slice bread, mini bagel or mini muffin(1 oz)

½ hamburger bun, hot dog bun or English muffin

1/2 cup cooked cereal or ¾ cup cold cereal

6 saltine crackers

1/3 cup rice or pasta

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Carbohydrate Counting

*Starchy vegetables

-- ½ cup mashed or small baked or sweet potato

--1/2 cup corn or peas, beans or lentils

**Fruits

--1 small piece of fruit

--½ cup grapes or canned fruit in juice

--1 cup berries or melon

--1/4 cup dried fruit

--1/2 cup fruit juice

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Carbohydrate Counting

1 cup milk or light yogurt

½ cup ice cream or frozen yogurt

15 potato chips( 1 ounce)

15 wheat thins or 5 saltines

Small brownie

3 cups of popped popcorn

1 T. sugar, syrup, honey, jams, or jellies

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Carbohydrate Counting

1 cup oatmeal, 1 cup milk, 1 slice toast w/ margarine

Sandwich( 2

sl

bread/ 2 oz. meat) , 1 cup watermelon, 1 cup carrots, 1 cup milk

3 oz. chicken breast, ½ cup sweet potatoes, 1 cup green beans, ½ cup pears, 1 oz dinner roll, 1 cup skim milk

Snacks: 1 cup yogurt or 1 cup blueberries

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Label reading

Read total carb on

Label vs. sugars.

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Physical Activity with diabetes

Lowers blood sugars

Heart benefit

Increases metabolism

Reduces stress

Gives more energy

Helps with sleep

Carry carb if on insulin

30-60 minutes on most days

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Medications

Oral medications

Sulfonylureas

- hypoglycemia

Biguanides

- usually used 1st

TZD’s

DPP-4

SGLT-2

GLP-1

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Medications

Rapid acting insulins(Ex. - Novolog, Humalog)

Fast acting insulins(Ex. – Regular)

Medium acting

insulins

(Ex. NPH)

Long Acting

insulins

( Ex. Lantus,

Levimir

,

Toujeo

, Tresiba)

Premixed

Insulins

( Ex.

Novolog

70/30)

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Other Devices

Insulin Pumps

Vgo

Continuous Glucose Monitor

Insulin pens/ vials

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Diabetic Employee: ADA

Diabetes is considered a disability because of the effect of the disease on the body’s endocrine function

Employers may not ask workers whether they have a disability including whether they have diabetes

Employers cannot ask question about an applicants’ own or family medical history that could reveal the presence of a disability

Once job offer is made can ask medical questions and require a medical exam if required of all employees

Must reasonably accommodate disabled workers

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Examples of Reasonable Accommodations

Break for worker to check blood sugars and give insulin anywhere at work or in a private area if requested

Break to take medication or eat meals or snacks

Grant a worker permission to keep diabetes supplies and food nearby and to treat diabetes when needed

Break to rest until blood sugars become normal

Leave for treatment, recuperation, or training on managing diabetes

Allowing a person with diabetic neuropathy – that makes it difficult to stand for long periods of time to use a stool

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Accommodations that may require medical assessment

Modifying a no-fault attendance policy to account for sickness or diabetes emergencies

Granting a modified work schedule or a standard shift instead of a swing shift

Providing medical leave beyond that provided by law

For those with diabetic retinopathy, provide large screen computer monitors or other assistive devices

Reassignment to a vacant position when the employee is not long able to perform his current job

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Who can request accommodation?

Employee

Family member

Friend

Health professional

Other representative on behalf of the employee

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The Employee with Diabetes: Safety

Concern with carrying a firearm or operating dangerous equipment

Evaluate safety by determining whether the concerns are reasonable in light of the job duties

Evaluate whether it is the first time a problem occurred (ex. Hypoglycemia)

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Employees responsibility

Bring blood glucose monitor and test strips

Check blood sugars several times during the shift

Bring snacks and treatment for hypoglycemia

Follow treatment plan at recommended by physician or CDE

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Barriers to Diabetes Care at Home

Cost of medications, health insurance, out of pocket costs

Lack of coverage for diabetes medications/ education

Level of education and income

Lack of time for medical appointments, training and education

Ethnic customs and beliefs, available

fooods

Lack of family support

Lack of access to exercise equipment/ gym memberships

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Barriers to Diabetes Care in the Workplace

Not given adequate time for breaks to eat, check blood sugars , etc.

No place for physical activity at work

Not given time off for physician appointments, diabetes education, preventative care

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Group Health Plan Benefit and Design

Medications and insulin covered at a low copay

Ease of lab services – free or very low cost?

Diabetic Education? Covered Service?

Partnering with Health Promotion Team

Patient advocacy

Benefit clarity

Referrals to healthcare resources

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Thank you!

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References

CDC Division of Diabetes Treatment

Diabetes Care January 2016

www.diabetes.org

www1.eeoc.gove//laws/tyesp/diabetes