logging in or signing up CWDPostprandialGlyce micControl200603 Davide Download Post to : URL : Related Presentations : Share Add to Flag Embed Email Send to Blogs and Networks Add to Channel Uploaded from authorPOINTLite Insert YouTube videos in PowerPont slides with aS Desktop Copy embed code: (To copy code, click on the text box) Embed: URL: Thumbnail: WordPress Embed Customize Embed The presentation is successfully added In Your Favorites. Views: 54 Category: Entertainment License: All Rights Reserved Like it (0) Dislike it (0) Added: February 07, 2008 This Presentation is Public Favorites: 0 Presentation Description No description available. Comments Posting comment... Premium member Presentation Transcript Strike The Spike!: Strike The Spike! Strategies for Combatting After-Meal Highs Gary Scheiner MS, CDE Overview: Overview Definitions Risks Detection Management After-Meal Peaks Defined: After-Meal Peaks Defined The net rise that occurs from before eating to the highest point after eating. ADA Goal: <180 mg/dl 1-2 hrs after start of meal DCCT Goals: <180 mg/dl 2 hrs after meal After-Meal Goals for Children: After-Meal Goals for Children Under 5 Years: <250 @ 1 hr. post-meal (<120 pt. Rise) 5-11 Years: <225 @ 1 hr. post-meal (<100 pt. Rise) 12 Years + < 200 @ 1 hr. post-meal (<80 pt. Rise) After-Meal Peaks: Reality for children: After-Meal Peaks: Reality for children Source: Boland et al, Diabetes Care 24: 1858, 2001 After-Meal Peaks: Reality in Children: After-Meal Peaks: Reality in Children Source: Boland et al, Diabetes Care 24: 1858, 2001 After-Meal Highs: Immediate Problems: After-Meal Highs:Immediate Problems Tiredness Difficulty Concentrating Impaired Athletic Performance Decreased desire to move Mood Shifts Enhanced Hunger Long-Term Problems: Long-Term Problems Percent Contribution to HbA1c Source: Monnier et al, Diabetes Care, 26, 3/03, 881-885 Long-Term Problems (contd): Long-Term Problems (contd) 52 Type 1’s, similar BP between groups Source: Kidney Intl. 1987; 32 (supp 22): S53-S56 Long-Term Problems (contd): Long-Term Problems (contd) 22-yr CVD Mortality Risk by Baseline post-challenge glucose Source: Chicago Heart Study, Lowe et al, Diabetes Care, 1997; 20: 163-170. Measurement of After-Meal Peaks: Measurement of After-Meal Peaks SMBG Capillary (finger) test After completion of meal Check BG 1 Hr PP (or) every 15, 20 or 30 min until 2 consecutive BG drops occur No addl. Food/insulin until test is completed Meter Test Example: Meter Test Example Interpretation: Excessive after-meal peak following breakfast; not after lunch or dinner Meter Test Example: Meter Test Example Time pp BG Value Premeal 135 :20 155 :40 168 1:00 214 1:20 222 1:40 175 2:00 141 Interpretation: Peak occurred at 1hr, 20min pp; rise from premeal to peak was approx. 90 mg/dl Measurement of After-Meal Peaks: Measurement of After-Meal Peaks Glucowatch (Cygnus/Animas) Takes readings every 10 minutes, following 2-hr warmup Can download to computer or retrieve readings manually May “skip” readings during periods of rapid rise or fall Measurement of After-Meal Peaks: Measurement of After-Meal Peaks CGMS (Medtronic) Worn for 72 hrs (or more), then data is downloaded Meals should be entered as “events” while wearing Calculates 3-hr post-meal averages CGMS Case Study: CGMS Case Study 37 year old man CGMS Case Study: CGMS Case Study 8 year old girl CGMS Case Studies: CGMS Case Studies 12 year old boy After-Meal Spike Reduction: After-Meal Spike Reduction Lifestyle Approaches Medicinal Approaches Dietary Intervention: Dietary Intervention Use of Glycemic Index Lower GI foods digest & convert to glucose more slowly High-fiber slower than low Hi-fat slower than low Solids slower than liquids Cold foods slower than hot Type of sugar/starch affects GI Use of Glycemic Index (contd): Use of Glycemic Index (contd) Examples: Use of GI: Examples: Use of GI Choice of Bolus Insulin: Choice of Bolus Insulin Choice of Bolus Insulin: Choice of Bolus Insulin Timing of Bolus Insulin: Timing of Bolus Insulin Timing of Bolus Insulin: Timing of Bolus Insulin (humalog/novolog) Does Timing Matter?: Does Timing Matter? Bolus w/meal Bolus pre-meal Choice of Insulin Program: Choice of Insulin Program Injectible Symlin (Amylin Pharmaceuticals) : Injectible Symlin(Amylin Pharmaceuticals) Acts on CNS Appetite Slows gastric emptying Inhibits glucagon secretion Really flattens postprandial BGs Injectible Symlin (Amylin Pharmaceuticals) : Injectible Symlin(Amylin Pharmaceuticals) Issues Nausea Must be injected*, cannot mix w/insulin Insulin doses must be adjusted, delayed Not yet FDA approved for children * pumped??? Physical Activity Intervention: Physical Activity Intervention Muscle Use Soon After Eating Accelerated Delayed Glucose Uptake/ Insulin Absorption Digestion Utilization Improved After-Meal Control Examples: After-Meal/Snack Activity: Examples: After-Meal/Snack Activity Walking Pets Household Chores Planned Exercise Yard Work Gym Class??? Shooting Hoops Dancing Bowling Mini Golf Skating Examples: After-Meal/Snack Activity: Examples: After-Meal/Snack Activity “Free Time With Siblings” Summary : Summary After-Meal Blood Sugar Levels Are: Important to Control Measurable Manageable For More Information:: For More Information: Gary Scheiner MS, CDE Integrated Diabetes Services 877-735-3648 (877-SELF-MGT) Website: www.integrateddiabetes.com E-mail: garyscheiner@prodigy.net You do not have the permission to view this presentation. In order to view it, please contact the author of the presentation.
CWDPostprandialGlyce micControl200603 Davide Download Post to : URL : Related Presentations : Share Add to Flag Embed Email Send to Blogs and Networks Add to Channel Uploaded from authorPOINTLite Insert YouTube videos in PowerPont slides with aS Desktop Copy embed code: (To copy code, click on the text box) Embed: URL: Thumbnail: WordPress Embed Customize Embed The presentation is successfully added In Your Favorites. Views: 54 Category: Entertainment License: All Rights Reserved Like it (0) Dislike it (0) Added: February 07, 2008 This Presentation is Public Favorites: 0 Presentation Description No description available. Comments Posting comment... Premium member Presentation Transcript Strike The Spike!: Strike The Spike! Strategies for Combatting After-Meal Highs Gary Scheiner MS, CDE Overview: Overview Definitions Risks Detection Management After-Meal Peaks Defined: After-Meal Peaks Defined The net rise that occurs from before eating to the highest point after eating. ADA Goal: <180 mg/dl 1-2 hrs after start of meal DCCT Goals: <180 mg/dl 2 hrs after meal After-Meal Goals for Children: After-Meal Goals for Children Under 5 Years: <250 @ 1 hr. post-meal (<120 pt. Rise) 5-11 Years: <225 @ 1 hr. post-meal (<100 pt. Rise) 12 Years + < 200 @ 1 hr. post-meal (<80 pt. Rise) After-Meal Peaks: Reality for children: After-Meal Peaks: Reality for children Source: Boland et al, Diabetes Care 24: 1858, 2001 After-Meal Peaks: Reality in Children: After-Meal Peaks: Reality in Children Source: Boland et al, Diabetes Care 24: 1858, 2001 After-Meal Highs: Immediate Problems: After-Meal Highs:Immediate Problems Tiredness Difficulty Concentrating Impaired Athletic Performance Decreased desire to move Mood Shifts Enhanced Hunger Long-Term Problems: Long-Term Problems Percent Contribution to HbA1c Source: Monnier et al, Diabetes Care, 26, 3/03, 881-885 Long-Term Problems (contd): Long-Term Problems (contd) 52 Type 1’s, similar BP between groups Source: Kidney Intl. 1987; 32 (supp 22): S53-S56 Long-Term Problems (contd): Long-Term Problems (contd) 22-yr CVD Mortality Risk by Baseline post-challenge glucose Source: Chicago Heart Study, Lowe et al, Diabetes Care, 1997; 20: 163-170. Measurement of After-Meal Peaks: Measurement of After-Meal Peaks SMBG Capillary (finger) test After completion of meal Check BG 1 Hr PP (or) every 15, 20 or 30 min until 2 consecutive BG drops occur No addl. Food/insulin until test is completed Meter Test Example: Meter Test Example Interpretation: Excessive after-meal peak following breakfast; not after lunch or dinner Meter Test Example: Meter Test Example Time pp BG Value Premeal 135 :20 155 :40 168 1:00 214 1:20 222 1:40 175 2:00 141 Interpretation: Peak occurred at 1hr, 20min pp; rise from premeal to peak was approx. 90 mg/dl Measurement of After-Meal Peaks: Measurement of After-Meal Peaks Glucowatch (Cygnus/Animas) Takes readings every 10 minutes, following 2-hr warmup Can download to computer or retrieve readings manually May “skip” readings during periods of rapid rise or fall Measurement of After-Meal Peaks: Measurement of After-Meal Peaks CGMS (Medtronic) Worn for 72 hrs (or more), then data is downloaded Meals should be entered as “events” while wearing Calculates 3-hr post-meal averages CGMS Case Study: CGMS Case Study 37 year old man CGMS Case Study: CGMS Case Study 8 year old girl CGMS Case Studies: CGMS Case Studies 12 year old boy After-Meal Spike Reduction: After-Meal Spike Reduction Lifestyle Approaches Medicinal Approaches Dietary Intervention: Dietary Intervention Use of Glycemic Index Lower GI foods digest & convert to glucose more slowly High-fiber slower than low Hi-fat slower than low Solids slower than liquids Cold foods slower than hot Type of sugar/starch affects GI Use of Glycemic Index (contd): Use of Glycemic Index (contd) Examples: Use of GI: Examples: Use of GI Choice of Bolus Insulin: Choice of Bolus Insulin Choice of Bolus Insulin: Choice of Bolus Insulin Timing of Bolus Insulin: Timing of Bolus Insulin Timing of Bolus Insulin: Timing of Bolus Insulin (humalog/novolog) Does Timing Matter?: Does Timing Matter? Bolus w/meal Bolus pre-meal Choice of Insulin Program: Choice of Insulin Program Injectible Symlin (Amylin Pharmaceuticals) : Injectible Symlin(Amylin Pharmaceuticals) Acts on CNS Appetite Slows gastric emptying Inhibits glucagon secretion Really flattens postprandial BGs Injectible Symlin (Amylin Pharmaceuticals) : Injectible Symlin(Amylin Pharmaceuticals) Issues Nausea Must be injected*, cannot mix w/insulin Insulin doses must be adjusted, delayed Not yet FDA approved for children * pumped??? Physical Activity Intervention: Physical Activity Intervention Muscle Use Soon After Eating Accelerated Delayed Glucose Uptake/ Insulin Absorption Digestion Utilization Improved After-Meal Control Examples: After-Meal/Snack Activity: Examples: After-Meal/Snack Activity Walking Pets Household Chores Planned Exercise Yard Work Gym Class??? Shooting Hoops Dancing Bowling Mini Golf Skating Examples: After-Meal/Snack Activity: Examples: After-Meal/Snack Activity “Free Time With Siblings” Summary : Summary After-Meal Blood Sugar Levels Are: Important to Control Measurable Manageable For More Information:: For More Information: Gary Scheiner MS, CDE Integrated Diabetes Services 877-735-3648 (877-SELF-MGT) Website: www.integrateddiabetes.com E-mail: garyscheiner@prodigy.net