1. Diabetes
Making Changes
for
Self-Management
Deb Burlage,RN, CDE

2. Objectives
Participants will be able to…..
Discuss Basics of Diabetes
How to Impact Change
Apply Concepts to Exercise

3. Epidemic
Approximately 17
million people in the
US have diabetes
Another 16 million
have a condition now
known as prediabetes

4. Prevalence
The incidence of
diagnosed diabetes has
increased by 61% since
1990.
12
10
6
3-D
Column 1
DX_DM
4
UnDx-DM
8
2
0
1990
1998

5. 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

6. 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

7. Current Criteria for
Diagnosis of Diabetes
Symptoms of diabetes and a casual
plasma glucose ≥ 200 mg/dl*
FPG ≥ 126 mg/dl**

8. 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

9. Complications
Heart Disease
Stroke
High Blood Pressure
Blindness
Kidney Disease
Nervous System
Amputations
Dental Disease

10. Cost $$$$$$$$$
2002: 132 Billion
Per Person:
– Individuals with
diabetes: $13,243
per year
– Individuals
without diabetes:
$2,560 per year

11. ABCs of Diabetes
Good News
Studies have proven:
DCCT/UKS
You Can Make A
Difference

12. Standards of Care
ABCs
A
B
C
D
E
F
G
H
I
K
A1C
Blood Pressure
Cholesterol
Diabetes Ed/Dental
Exam/Diet
Eye Exam/Exercise
Foot Exam
Glucose monitoring
Heart Health
Indications for
specialties
Kidney

13. Recommended Goals
Glycemic control
– A1C
– Fasting BS
– Non-fasting
Blood Pressure
<7.0%
80-110mg/dl
<180mg/dl
<130/80
Lipids
– LDL Cholesterol
– Triglycerides
– HDL Cholesterol
<100mg/dl
<150mg/dl
>40mg/dl

14. 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

15. 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!!!

16. Exercise
Exercise can control blood sugars and lower
you risk of heart disease!

17. Examples of Exercise
Examples of exercise:
– Aerobic: Walking, Swimming, Bicycling,
Jogging, and Skating
– Strength: Weight/Resistance
– Flexibility: Yoga, Tai Chi

18. 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).

19. 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

20. 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

21. Further Guidelines
Keep a daily log
Wear Medical ID
Drink plenty of fluids
Exercise with a
partner
Modify Caloric Intake
Carry fast acting
sugar
Do NOT inject into
area where exercise
is involved

22. Knowledge (continued)
BS
Type of Exercise
Extra Food Needed
< 100 mg/dl
Low
Moderate
Strenuous
15 gms Carb
30 gms Carb
60 gms Carb
101-170 mg/dl
Low
Moderate
Strenuous
No extra food
15 gms Carb
30 gms Carb
171-300 mg/dl
Low
Moderate
Strenuous
No extra food
No extra food
15 gms Carb
> 300 mg/dl
No Exercise
No extra food

23. 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!

24. Individualize: Pros-Why do you
want to change
Physical Reasons
Emotional Reasons

25. Individual Barriers: What is
Stopping You???
Physical Barriers
Emotional Barriers

26. 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?

27. 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

28. Support
Multi-disciplinary Team
Family
Friends

29. Summary for Success
Knowledge
Individualize
Start
Support

30. Conclusion
Life is not simply holding a good hand
Life is playing poor hand well…….
-Danish Saying

31. 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

32. The Gift………..