Diabetes Self Management Suzi 4.10.13

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Diabetes Self Management:

Diabetes Self Management Diabetes In Review & What's New Presented by: Susanne Schenk, RN, Diabetes Educator, Holistic Health Coach susanne.schenk@gmail.com


Objectives Discuss the types of diabetes Current diabetes statistics Review the future of diabetes- where research is going SMART Goals Touch on Nutrition as it relates to diabetes- focus for next Diabetes Expert Talk

Types of Diabetes:

Types of Diabetes Type 1 diabetes- 5%-10% of people with diabetes have Type 1. Acute onset. ER/ICU. Pos. Auto-antibodies. + Ketones. Type 2 diabetes- 90% of people with diabetes have Type 2. Insulin resistance. MODY- Maturity Onset Diabetes Of The Young. Caused by aberrant genes- 6 genes identified- that moderate insulin production. May or may not require insulin therapy. Highly hereditary. Usually no GAD antibodies present. Normal c-peptide, slow onset, obesity not always associated. LADA- Latent Autoimmune Diabetes in Adults. Low c-peptide eventually, presence of some auto-antibodies eventually, slow, obesity not always associated. Gestational Diabetes- 28 th week gestation, insulin resistance.

Diabetes in America 2012:

Diabetes in America 2012 28 million Americans with a diagnosis of Diabetes- 8.3% of the population 79 million Americans with pre-diabetes 8 million estimated to be undiagnosed CDC 2012

Rising Rates of Diabetes:

Rising Rates of Diabetes According to the SEARCH for Diabetes in Youth study: Type 1 diabetes rose 23% since 2001-2009 Type 2 diabetes rose 21% since 2001-2009 189,000 of the diagnosed population with diabetes are under 20 years of age ADA 2012 Science Daily 2013

Why the rise in Type 1?:

Why the rise in Type 1? Autoimmune disease rates rising overall Environmental exposures- plastics, toxins Changes in healthy Gut Flora Hygiene Hypothesis- too clean, abx, Vitamin D levels- northern latitudes, sunscreens Early exposure to certain foods- cow milk Obesity

Type 1 associated with other Autoimmune Disorders:

Type 1 associated with other Autoimmune Disorders Celiac Disease (gluten intolerance) Thyroid Disease Addison's Disease (adrenal insufficiency) Rheumatoid Arthritis (inflam. of joints) Crohn’s Disease (inflam. of digestive tract) Multiple Sclerosis (deterioration of myelin sheath of nerves)

Management of Diabetes:

Management of Diabetes Primary goals : Prevent turning on those genes- reduce exposure to triggers Preserve beta cell function- Prevent complications- maintain stable BG levels.

Management of Diabetes:

Management of Diabetes Nutrition- foods from a plant but not made in a plant. Anti-inflammatory, Omega-3 Gut Flora- fermented foods, from the earth, probiotics Physical Activity- daily Stress Management- increased cortisol levels, insulin resistance, elevated BG, Hypoglycemia, etc. Medication Management- good self advocacy- know your meds Living a life fulfilled- happiness

Management of Diabetes:

Management of Diabetes What can you do? Y ou vote with your dollars. Choose your products, foods, restaurants, get in volved- school lunch programs… P hysical activity- daily H ealthy cooking- keep it simple but do it because you are worth it! Stress reduction- short term stress/ long term stress Medication management- be your best advocate- know your medications and their actions. Ask!

New Horizons in Diabetes: Transplants:

New Horizons in Diabetes: Transplants Pancreas & Kidney transplant- most common Pancreas Transplant only- less common, usually after kidney transplant. Islet Cell Transplants- Islet cells from 2 pancreases isolated and injected into the portal vein of the liver.

New Horizons: Other trials:

New Horizons: Other trials Stem Cells- differentiated beta cells CD3-Monoclonal Antibodies Trial Net- Oral Insulin START trial- thymoglobulin

New Horizons: Artificial Pancreas:

New Horizons: Artificial Pancreas JDRF research- Closed Loop System- In Phase 3 trials, showing promise in kids and teens stabilizing glucose overnight (reducing risk of lows during the night) while incorporating a large meal before bed and moderate intensity exercise during the day. Results show increased time spent in target range from 48% to 78%. (user still sets basal insulin and mealtime bolus manually)

Closed Loop System:

Closed Loop System

Closed Loop System:

Closed Loop System The Artificial Pancreas Project is in Phase 3 Trials with Step 3. Step 4 will tighten target blood glucose levels narrowing the "range." Step 5 will eliminate manual pre-meal boluses (development of advanced insulins and improved CGM technologies will be necessary) Step 6 adds the ability to dose 2 or more drugs/insulins to more closely mimic the way the body maintains blood glucose. This will require the development of pumps that can deliver 2 or more drugs/insulins and or hormone medications. http://jdrf.org/wp-content/uploads/2012/12/app_6_steps_621.jpg

SMART goals:

SMART goals S- specific M- measurable A- attainable R- realistic T- timely

SMART goals Specific:

SMART goals Specific Get specific and clear about your goal by asking the question who- what- where- when- why. “join ‘x’ health club and work out 3 x weekly” vs “get in shape”

SMART goals Measurable:

SMART goals Measurable Ask the question- how much, how many “I know I will have reached my goal when my HbA1c is 6.5%, without lows”. vs “control my blood sugars”

SMART goals Attainable:

SMART goals Attainable Identify a goal that is most important to you. Begin seeing previously overlooked opportunities. Think “attitude”, “ability”, and “skill”. You have them!! Plan your steps wisely and establish a time frame that allows you to carry out those steps. See yourself as worthy of these goals. Visualize and become the person who has achieved these goals.

SMART goals Realistic:

SMART goals Realistic A goal can be both high and realistic but you have to be willing to go for it!

SMART goals Timely:

SMART goals Timely Ground your goal within a reasonable time frame, and step by step. This sets the unconscious mind to work along with conscious. It also is a “reality check.” If you can’t put a timeframe on it- it might not be realistic. Write down “due dates” in your daily planner/calendar/etc solidifying your path to accomplishment.

Thank You!:

Thank You! Next topic- Nutrition and Diabetes

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