Diabetes Prevention

1. Diabetes Prevention Essentials Nina Hammond, BSN, RN-BC

2. Challenge Learn to Challenge yourself to avoid Type 2 Diabetes

3. Why is diabetes prevention important? Davidson county diabetes rate was 12% in 2012 Up from 9.9% in 2009 29.1 million people in the US or 9.3% of the population have diabetes (2014) 27.8% of people with diabetes are undiagnosed CDC, 2015

4. Cost of Diabetes In 2012 diabetes cost the US $245 billion, 41% more than in 2007 People with diabetes spend $7,900 annually on diabetes care alone ($13,700 overall) 2.3 times more than those without diabetes ADA, 2015

5. Diabetes Complications Leading cause of blindness Leading cause of kidney failure Leading cause of amputations Major cause of heart attacks Major cause of strokes Joslin Diabetes Center

6. Who is at risk? Overweight or obesity P arent , brother, or sister with diabetes F amily background is African American, Alaska Native, American Indian, Asian American, Hispanic/Latino, or Pacific Islander American B lood pressure is 140/90 or higher, or have been diagnosed with high blood pressure C holesterol levels higher than normal Inactive lifestyle H istory of cardiovascular disease National Institute of Diabetes and Digestive And Kidney Diseases, 2015

7. What is Diabetes (Type 2) ADA definition: a group of metabolic diseases characterized by hyperglycemia resulting from defects in insulin secretion, insulin action, or both. The chronic hyperglycemia of diabetes is associated with long-term damage, dysfunction, and failure of various organs, especially the eyes, kidneys, nerves, heart, and blood vessels. T ype 2 diabetes, the most prevalent type (90-95%), is caused by a combination of resistance to insulin action and an inadequate insulin production.

8. What is insulin? Insulin is a hormone produced by the pancreas The body breaks down food into glucose that our cells use for energy Insulin is produced when we eat in order to help glucose get into your body’s cells

9. What happens in Type 2 Diabetes The cells in the body no longer respond to insulin as they should. Sugar cannot get into the cells. Sugar remains in the blood, raising blood sugar levels. The cells have no energy leading to fatigue and feeling hungry. Known as insulin resistance.

10. Insulin Resistance 1 st stage of type 2 diabetes Can begin years before diagnosis of diabetes Insulin resistance causes the pancreas to work overtime producing extra insulin Eventually the pancreas wears out and can’t keep up niddk.nih.gov

11. Why Do We Get Type 2 Diabetes Poor diet, high in fat and sugar Being overweight Sedentary lifestyle Hereditary tendency Advancing age

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13. HOW DO WE PREVENT DIABETES? HEALTHY LIFESTYLE Healthy eating Physical activity

14. Diet A dirty word? Healthy eating is not about being on a diet Its about eating healthy foods in healthy amounts Treats are OK

15. How much is enough? A 150 pound person, doing average activity, requires about 2000 calories per day to maintain weight Reduce calories for weight loss It is not recommended to consume less than 1000 calories per day

16. Food Labels Recommended daily intake is based on a 2000 calorie diet American Heart Association Recommends no more sugar than 37.5 gms for men (9 tsp ) 25 gms for women (6 tsp )

17. Sonic Sundae 520 calories 57 grams sugar

18. Different sources of sugar F resh and frozen fruits including all the berries (blue berries, black berries, strawberries, acai berries), apples, banana, citrus fruits like lemon, orange, tangerines, pineapple, cantaloupes Vegetables With fruits and fresh vegetables, you don’t have to count the calories or sugar in grams (because high fiber intake utilizes the calories during metabolism and digestion).

19. Find What Works For You Monitor portion size Share entrees at restaurants Shop the perimeter of the grocery store T ry new things Shop at farmers markets

20. Add Flavor

21. Spice it up

22. Physical Activity

23. Joslin Diabetes Center

24. Benefits of Exercise

25. Challenge Exercise opens an additional pathway for glucose to get into muscle cells Blood sugar goes down, cells get energy and health improves Challenge your muscles

26. It Takes Time The positive effects of exercise don’t happen over night. As you exercise regularly, more and more of your muscle cells reduce their insulin resistance. Gradually the whole body gets healthier.

27. Recommendations for Exercise 30 minutes of moderate intensity aerobic activity most days of the week (150 minutes) Muscle strengthening activities 2 or more days per week

28. Moderate-intensity Aerobic A ctivity Means: you're working hard enough to raise your heart rate and breath harder. One way to tell is that you'll be able to talk , but not sing the words to your favorite song.

29. Moderate Intensity Activities Walking fast Doing water aerobics Riding a bike on level ground or with few hills Playing doubles tennis Pushing a lawn mower

30. Muscle Strengthening Activities These activities should work all the major muscle groups of your body (legs, hips, back, chest, abdomen, shoulders, and arms).

31. Or you can use your own body weight for resistance .

32. Don’t Be So Hard On Yourself Walk Before You Run- building up gradually is the safest way to prevent injury, soreness, & getting discouraged Do What You Love and Love What You Do- don’t train for a marathon if you hate running Pencil It In- plan a regular exercise routine as part of your day Set Goals- set short term and long term goals Get Back In There- everyone gets off track sometimes, have a plan to get back in there It’s Never Too Late To Start!

33. What If I Don ’ t Lose Weight? Losing weight helps prevent diabetes, but even if you don’t lose weight, you still benefit from exercise. An overweight person who exercises may be healthier than a normal weight person who doesn’t.

34. Healthy Lifestyle is the Key

35. Do I Have Diabetes? Risk factors Overweight Family history Central obesity High cholesterol Anyone overweight with one additional risk factor should be tested Everyone should begin testing at age 45 If test is normal, test every 3 years ADA, 2015

36. Know your Number Testing Blood sugar Fasting blood sugar >125 2 hour post meal blood sugar of 200 or more A1c > 6.4 Indication of average blood sugar over the last 3 months ADA, 2015

37. Resources for Good Health Choosemyplate.gov American Diabetes Association CDC.gov Allrecipes.com / healthyrecipes Foodnetwork.com /healthy Apps for phone MyFitnessPal (free) Superfoods (free) Nutrino (free)

38. References American Diabetes Association. (2015). The cost of diabetes. Retrieved from http :// www.diabetes.org /advocacy/news-events/cost-of- diabetes.html Centers for Disease Control. (2015). Diabtetes public health resource, Number (in Millions) of Civilian, Noninstitutionalized Persons with Diagnosed Diabetes, United States, 1980–2011 . Retrieved from http://www.cdc.gov/diabetes/statistics/prev/national/ figpersons.htm Centers for Disease Control. (2015). 2014 National Diabetes Statistics Report. Retrieved from http:// www.cdc.gov /diabetes/data/statistics/2014statisticsreport.html The National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health. (2015). Insulin resistance and prediabetes . Retrieved from http://www.niddk.nih.gov/health-information/health-topics/Diabetes/insulin-resistance-prediabetes/Pages/ index.aspx The National Institute of Diabetes and Digestive and Kidney Diseases. (2015). Am I at risk for type 2 diabetes? Taking steps to lower your risk of getting diabetes. Retrieved from http:// www.niddk.nih.gov /health-information/health-topics/Diabetes/type-2-diabetes-taking-steps-lower-your-risk-diabetes/Pages/index.aspx#7

39. Goodyear, L. (N.D.). Diabetes and exercise: Why exercise works when insulin does not. Joslin Diabetes Center, Harvard Medical School. Retrieved from http:// outreach.mcb.harvard.edu /downloads/fall09/ lauriegoodyear.pdf