COUNSELING

A DIABETIC
PATIENT
OBJECTIVES

At the end of the presentation the

presentation, the participants should be
able to:
–Understand the basic information
about diabetes
–Know how to counsel a diabetic
patient
• Refers to a group of common
metabolic disorders that share the
phenotype of hyperglycemia.
(Harrison’s 19th
edition)

• Diabetes is a complex, chronic

illness requiring continuous medical
care with multifactorial risk-reduction
strategies beyond glycemic control.
(ADA
Guidelines 2018)
• Diabetes can be classified into the following general
categories:

1. Type 1 diabetes (due to autoimmune b-cell destruction,

usually leading to absolute insulin deficiency)
2. Type 2 diabetes (due to a progressive loss of b-cell
insulin secretion frequently on the background of insulin
resistance)
3. Gestational diabetes mellitus (GDM) (diabetes
diagnosed in the second or third trimester of pregnancy)
 Classification of Diabetes
Characteristics Type 1 Diabetes Type 2 Diabetes
Mellitus Mellitus
Onset Acute-symptomatic Slow-often asymptomatic
Manifestations Weight loss, polyuria, If symptomatic similar
polydipsia picture as T1 DM- weight
loss, polyuria, polydipsia
• Obese
• Strong family history of
T2DM
• Acanthosis Nigricans
• PCOS
Ketosis Almost always present Usually absent
Therapy Insulin Lifestyle
Oral anti-diabetic agents
 Classification of Diabetes
Characteristics Type 1 Diabetes Type 2 Diabetes
Mellitus Mellitus
Onset Acute-symptomatic Slow-often asymptomatic
Manifestations Weight loss, polyuria, If symptomatic similar
polydipsia picture as T1 DM- weight
loss, polyuria, polydipsia
• Obese
• Strong family history of
T2DM
• Acanthosis Nigricans
• PCOS
Ketosis Almost always present Usually absent
Therapy Insulin Lifestyle
Oral anti-diabetic agents
 Classification of Diabetes
Characteristics Type 1 Diabetes Type 2 Diabetes
Mellitus Mellitus
Onset Acute-symptomatic Slow-often asymptomatic
Manifestations Weight loss, polyuria, If symptomatic similar
polydipsia picture as T1 DM- weight
loss, polyuria, polydipsia
• Obese
• Strong family history of
T2DM
• Acanthosis Nigricans
• PCOS
Ketosis Almost always present Usually absent
Therapy Insulin Lifestyle
Oral anti-diabetic agents
 Classification of Diabetes
Characteristics Type 1 Diabetes Type 2 Diabetes
Mellitus Mellitus
Onset Acute-symptomatic Slow-often asymptomatic
Manifestations Weight loss, polyuria, If symptomatic similar
polydipsia picture as T1 DM- weight
loss, polyuria, polydipsia
• Obese
• Strong family history of
T2DM
• Acanthosis Nigricans
• PCOS
Ketosis Almost always present Usually absent
Therapy Insulin Lifestyle
Oral anti-diabetic agents
 RISK FACTORS

CPG 2011
EPIDEMIOLOGY

CDC 2017
EPIDEMIOLOGY

CDC 2017
CDC 2017
• Diabetes is the 6th leading cause of death
among the Filipinos based on the data from the
2013 Philippine Health Statistics. (DOH)

PPG 2011
WHO 2016
 What can we do with these
statistics?
• Use them to help focus efforts to prevent
and control diabetes in the Philippines
• Teach them the prevention especially
those at risk of developing diabetes
• Cite them when communicating with
employers to promote diabetes self-
management education and support
program
 APPROACH TO THE
PATIENT
• History taking
• Physical examination
HISTORY TAKING
• Concordance of T2DM in identical twins is 70-90%
• With both parents have T2DM risk is 40%
 PHYSICAL EXAMINATION
• Body mass index
• Waist circumference/waist to hip ratio
• Blood pressure
• Retinal Examination
• Foot examination
• Periodontal examination
Body mass index
Waist Circumference
Blood pressure
Retinal Examination
 Foot examination
• Blood flow
• Sensation
• Foot deformities
• Potential ulcerations
Periodontal examination
 ADA guidelines 2016: Criteria for
diagnosis of diabetes
• Symptoms of diabetes (polyuria, polydipsia,
polyphagia, unexplained weight loss) + random
plasma glucose of >/= 200mg/dL (11.1 mmol/L)
• Fasting glucose >/= 126mg/dL
• 2 hours plasma glucose of > or = 200mg/dL
during an oral glucose tolerance test (OGTT)
• HbA1c >6.5
 LABORATORY
• HbA1c
• Fasting blood sugar
(FBS)
• Oral glucose test (OGT)
• Cholesterol
– LDL <100mg/dL
– HDL >40mg/dL in men
and >50mg in women
– Triglycerides
<150mg/dL
 VALUES
NORMAL PRE DIABETIC DM

FBS <100mg/dL 100-125mg/dL >/= 126 mg/dL

(5.5 mmol/L) (5.5-6.9 mmol/L) (7.0 mmol/L)

2h post glucose < 140 mg/dL 140-199 mg/dL >/= 200 mg/dL
challenge (7.8 mmol/L) (7.8-11 mmol/L) (11.1mmol/L)

Hba1c <5.5 5.6-6.4 >/= 6.5

 Diabetes
Management
Ercilla, Charmaigne D.
Can Diabetes be CURED?
 Diabetes is Managed,
But it Does Not Go Away.

GOAL:
To maintain target
blood glucose
Drugs

Sulfonylureas Meglitinide
Glipizide analogs
Insulins Glyburide Repaglinide
Biguanides
Rapid-acting: Lispro, Glimepiride Nateglinide
Metformin
aspart, glulisine, inhaled Gliclazide Mitiglinide
regular

Shortacting:
(new drugs) Dipeptidyl Peptidase -4
Regular
Sodium glucose inhibitors
Intermediate acting: co-transporter 2 Sitagliptin
NPH inhibitors Saxagliptin
Canaglifozin linagliptin
Long acting: Detemir, Dapaglifozin
Glargine Empaglifozin
Islet amyloid polypeptide
Analog
Alpha Glucosidase Glucagon-like Polypetide-1 Pramlintidine
inhibitors Receptor agonist
Acarbose Exenatide
Miglitol Liraglutide
voglibose Albiglutide Dopamine
Agonist
Bromocriptine
Bile acid Thiazolidinediones
sequestrants Pioglitazone
Colesevelam HCl rosiglitazone
Summary of Drugs used for Diabetes

Pharmacokinetics,
Subclass, Clinical
MOA Effects toxicities,
Drug applications
interactions

Parenteral (SC/V)
Toxicity:
Activate insulin Reduce circulating Type 1 & type 2
Insulins Hypoglycemia
receptor glucose diabetes
Weight gain
Lipodystrophy (rare)

Insulin
Reduce circulating Orally active
secretagogues;
glucose in Duration 10-24hr
Close K+ in the
Sulfonylureas patients with Type 2 diabetes Toxicity
beta cells
functioning beta • Hypoglycemia
Increase insulin
cells • Weight gain
release
Summary of Drugs used for Diabetes

Subclass, MOA Effects Clinical Pharmacokinetics,

Drug applications toxicities,
interactions
Meglitinides Insulin In patients with Type 2 diabetes Oral. Very fast onset of
analogs; secretagogues; functioning beta cel action.
D- Similar with ls,reduce circulating Duration: 5-8hours
phenylanaline sulfonylureas with glucose Nateglinide = <4h
derivative some overlap in Toxicity: hypoglycemia
binding sites

Biguanides Activates AMP Decrease circulating Type 2 diabetes Oral.

kinase glucose Maximal plasma
Reduces hepatic concentration in 2-3h
& renal Toxicity:
gluconeogenesis  Lactic acidosis (rare)
 CHF
 Alcoholism
 Cannot use if impaired
renal/hepatic function
Summary of Drugs used for Diabetes
Subclass, MOA Effects Clinical Pharmacokinetics,
Drug applications toxicities,
interactions
a-glucosidase Inhibit intestinal Reduce conversion Type 2 Oral. Rapid onset
inhibitors alpha- of starch and diabetes Toxicity:
glucosidases disaccharides to  GI symptoms
monosaccharides  Cannot use if impaired
Reduce renal/hepatic function
postprandial  Intestinal disorders
hyperglycemia
Thiazolidinedion Regulate gene Reduce insulin Type 2 Oral. Long acting (>24h)
es expression by resistance diabetes Toxicity:
binding to PPAR-  Fluid retention
y and PPAR-a  Edema
 Anemia
 Weight gain
 Macular edema
 Bone fractures in women
 Cannot use if CHF,
hepatic disease
Summary of Drugs used for Diabetes

Subclass, MOA Effects Clinical Pharmacokinetics,

Drug applications toxicities,
interactions
Glucagon –like Analog of GLP-1  Reduces post meal Type 2 diabetes Parenteral (SC)
Polypeptide (GLP-1) Binds to GLP-1 glucose excursions Toxicity:
receptor antagonist receptors  Increased glucose  Nausea
mediated insulin  Headache
release  vomiting, anorexia
 Lower glucagon  mild weight loss
levels  Pancreatitis
 Slow gastric
emptying
 Decrease appetite

Dipeptidyl Blocks degradation of  Reduces post-meal Type 2 diabetes Oral.

Peptidase -4 (DDP- GLP-1, raises circulating glucose excursions Half-life: 12h
4) Inhibitors GLP-1 levels  Increases glucose – Duration: 24h
mediated insulin Toxicity:
release  Rhinitis
 Lowers glucagon  URTI
levels  Headaches
 Slows gastric  Pancreatitis
emptying  Rare allergic reaction
 Decrease appetite
 Summary of Drugs used for Diabetes

Subclass, MOA Effects Clinical Pharmacokinetics,

Drug applications toxicities,
interactions
Sodium-Glucose Blocks renal glucose  Increase Type 2 diabetes Oral.
Co-transporter 2 resorption glucosuria Half-life: 10h
(SGLPT2)  Lower plasma Toxicity:
Inhibitors glucose levels  Genital & urinary tract
infections
 Polyuria
 Pruritus
 Thirst
 Osmotic diuresis
 constipation
Islet amyloid Analog of amylin  reduces post- Type 1 & 2 diabetes Parenteral (SC)
polypeptide Binds to amylin meal glucose Rapid onset
analog receptors excursions Half-life:48mins
 lowers glucagon Toxicity:
levels  Nausea
 slows gastric  Anorexia
emptying  Hypoglycaemia
 decrease  Headache
appetite
Summary of Drugs used for Diabetes

Subclass, MOA Effects Clinical Pharmacokinetics,

Drug applications toxicities,
interactions
Bile acid Bile acid binder  Reduce Type 2 diabetes Oral
sequestrant Lowers glucose glucose levels Duration: 24h
through Toxicity:
unknown  Constipation
mechanism  Indigestion
 Flatulence

Dopamine D2 receptor  Reduce Type 2 diabetes Oral

agonist agonist: glucose levels 24h action
Lowers glucose Toxicity:
through  Nausea
unknown  Vomiting
mechanism  Dizziness
 headache
Commonly used diabetic drugs

Insulin therapy
• Insulin is the mainstay of therapy for individuals with type 1 diabetes.
• Starting insulin dose is based on weight
• Doses ranging from 0.4 to 1.0 units/kg/day of total insulin with higher amounts
required during puberty.
• American Diabetes Association/JDRF (Juvenile Diabetes Research Foundation)

• 0.5 units/kg/day as a typical starting dose

in patients with type 1 diabetes who are
metabolically stable,
Commonly used diabetic drugs

Insulin therapy
• Insulin is obtained from pork pancreas or is made chemically
identical to human insulin by recombinant DNA technology or
chemical modification of pork insulin.
• Insulin analogs have been developed by modifying the amino
acid sequence of the insulin molecule.
• The appropriate insulin dosage is dependent on the glycemic
response of the individual to food intake and exercise
regimens. For virtually all type 1 patients and many type 2
patients, the time course of insulin action requires three or
more injections per day to meet glycemic goals.
Insulin
therapy
Commonly used diabetic drugs

Insulin INJECTION

Wash hands Clean the site Numbing the area

Commonly used diabetic drugs

Insulin INJECTION

Pinch up a fold of skin surrounding the site

you've selected
Commonly used diabetic drugs

Insulin INJECTION
Rotating Injection Sites
Injecting in the same place much of the time can cause hard
lumps or extra fat deposits to develop. These lumps are not only
unsightly; they can also change the way insulin is absorbed,
making it more difficult to keep your blood glucose on target.
Follow these two rules for proper site rotation:
• Same general location at the same time each day.
• Rotate within each injection site.
Commonly used diabetic drugs

Insulin INJECTION
Tips for Site Rotation
• Do not inject close to the belly button. The tissue there is tougher, so the
insulin absorption will not be as consistent.
• For the same reason, do not inject close to moles or scars
• inject in the thigh, stay away from the inner thighs. If thighs rub together
while walking, if might make the injection site sore.
• Do not inject in an area that will be exercised soon. Exercising increases
blood flow, which causes long-acting insulin to be absorbed at a rate
that’s faster than you need.
• Move to a new injection site every week or two.
• Use the same area for at least a week to avoid extreme blood sugar
variations.
Commonly used diabetic drugs

Insulin INJECTION
Tips for Site Rotation
• Do not inject close to the belly button. The tissue there is tougher, so the
insulin absorption will not be as consistent.
• For the same reason, do not inject close to moles or scars
• inject in the thigh, stay away from the inner thighs. If thighs rub together
while walking, if might make the injection site sore.
• Do not inject in an area that will be exercised soon. Exercising increases
blood flow, which causes long-acting insulin to be absorbed at a rate
that’s faster than you need.
• Move to a new injection site every week or two.
• Use the same area for at least a week to avoid extreme blood sugar
variations.
Commonly used diabetic drugs

Insulin INJECTION
Injection Site Selection
• abdomen (or stomach)- most
common
• back of the upper arms,
• the upper buttocks or hips
• outer side of the thighs
• These sites are the best to inject into for two reasons:
• They have a layer of fat just below the skin to absorb the insulin, but not
many nerves - which means that injecting there will be more comfortable
than injecting in other parts of your body.
• They make it easier to inject into the subcutaneous tissue, where insulin
injection is recommended.
• Injecting in the abdomen isn't right for everyone, especially young children
or people who are so thin and/or heavily muscled that they can't pinch up
a half-inch of fat
Commonly used diabetic drugs

METFORMIN
Description: Metformin is a biguanide w/ antihyperglycaemic effects, lowering
both basal and postprandial plasma glucose. It decreases hepatic glucose
production by inhibiting gluconeogenesis and glycogenolysis; delays intestinal
absorption of glucose; and enhances insulin sensitivity by increasing peripheral
glucose uptake and utilisation.
Pharmacokinetics:
Absorption: Slowly and incompletely absorbed from the GI tract. Absolute
bioavailability: Approx 50-60% (fasting); reduced if taken w/ food. Time to peak
plasma concentration: 2-3 hr (immediate-release); 4-8 hr (extended-release).
Distribution: It crosses the placenta and distributed in breast milk (small
amounts). Volume of distribution: 654 ± 358 L. Plasma protein binding:
Negligible.
Metabolism: Not metabolised.
Excretion: Via urine (90% as unchanged drug). Elimination half-life: Approx 2-
6 hr.
Commonly used diabetic drugs

METFORMIN

Dosage Details Oral

Type 2 diabetes mellitus
Adult: Conventional
Anorexia, preparation:
nausea, vomiting, Initially,abdominal
diarrhoea, 500 mg bidpain,
or tid, or 850 mg
taste
1-2 times daily,hepatitis.
disturbance, may increase gradually
Rarely, decreasedto 2000-3000 mg daily erythema,
vit B12 absorption, at
intervals
pruritusofand
at least 1 wk. Modified-release preparation: Initially, 500
urticaria.
mg once daily,
Potentially mayLactic
Fatal: increase in increments of 500 mg at intervals of at
acidosis.
least 1 wk to max 2000 mg once daily at night. If glycaemic control is
not sufficient, dose may be divided to give 1000 mg bid. Doses >2000
mg daily, admin the conventional preparation.
Child: ≥10 yr Initially, 500 mg 1-2 times daily or 850 mg once daily, may
increase gradually to max 2000 mg daily in 2 or 3 divided doses at
intervals of at least 1 wk.
Elderly: Initial and maintenance dosing should be conservative.
Commonly used diabetic drugs

METFORMIN
Food Food decreases the extent and slightly delays absorption. Concomitant
Interaction use w/ alcohol may increase risk of hypoglycaemia and lactic acidosis.

Administration Should be taken with food.

Adverse Drug Anorexia, nausea, vomiting, diarrhoea, abdominal pain, taste

Reactions disturbance, hepatitis. Rarely, decreased vit B12 absorption, erythema,
pruritus and urticaria.
Potentially Fatal: Lactic acidosis.
Routine
care
 Recommended foods
• Healthy carbohydrates
• Fiber-rich foods
• healthy fish
• "Good" fats.
 DM DIET
• Formula: IBW = lbs / 2.2
• Height = feet  106 boy
100 girl + (inches times 6-boy and 5 girl)
• IBW times weight of activity
– Heavy 40-45
– Moderate 35-40
– Sedentary 30 – 35
• Answer times CHONS (0.15)
CHO (0.65)
FATS (0.20)
• CALORIE Requirement
– Answer Divided by CHO (4)
CHONS (4)
FATS (4)
 What foods and drinks should I
limit if I have diabetes?
Foods and drinks to limit include
• fried foods and other foods high in saturated
fat and trans fat
• foods high in salt, also called sodium
• sweets, such as baked goods, candy, and ice cream
• beverages with added sugars, such as juice, regular
soda, and regular sports or energy drinks
COMPLICATIONS
 Microvascular complications
• Retinopathy
• Nephropathy
• Neuropathy
• Diabetic foot disorder
Diabetic retinopathy (eye disease)
• Leading cause of blindness and visual
disability.
• It is caused by small blood vessel damage to
the back layer of the eye, the retina, leading
to progressive loss of vision, even blindness.
• Usually the patient complains of blurred
vision, although other visual symptoms may
also be present.
 Types
• Non-proliferative diabetic retinopathy - blood
vessels can weaken, bulge, or leak into the
retina.

• Proliferative diabetic retinopathy - if the

disease gets worse, some blood vessels close
off, which causes new blood vessels to grow,
or proliferate, on the surface of the retina.
 The best ways to manage your
diabetes and keep your eyes healthy
are to:
• Manage your blood glucose, blood pressure,
and cholesterol
• If you smoke, get help to quit smoking
• Have a dilated eye exam once a year
Eye exam guidelines for diabetes
• Type 1: Yearly eye exams
should start within 5 years of
diagnosis.
• Type 2: Yearly eye exams
should start right after
diagnosis.
• Pregnancy: Women with type
1 and type 2 diabetes need an
eye exam before pregnancy or
within the first 3 months. Your
doctor may want you to repeat
the exam later in your
pregnancy and until your baby
is 1 year old.
 Nephropathy (kidney disease)
• Diabetic kidney disease is also caused by damage to
small blood vessels in the kidneys.
• This can cause kidney failure, and eventually lead to
death.
• In developed countries, this is a leading cause of
dialysis and kidney transplant.
• Patients usually have no symptoms early on, but as the
disease progresses, they may feel tired, become
anemic, not think clearly, and even develop dangerous
electrolyte imbalances.
• Early diagnosis can be made by a simple urine test for
protein as well as a blood test for kidney function.
How can I keep my kidneys healthy if I
have diabetes?
Develop or maintain healthy lifestyle
habits
• Stop smoking.
• Work with a dietitian to develop a diabetes
meal plan and limit salt and sodium.
• Make physical activity part of your routine.
• Stay at or get to a healthy weight.
• Get enough sleep. Aim for 7 to 8 hours of
sleep each night.
 Neuropathy (nerve disease)
• Diabetes causes nerve damage through different
mechanisms, including direct damage by the hyperglycemia
and decreased blood flow to nerves by damaging small
blood vessels.
• This nerve damage can lead to sensory loss, damage to
limbs, and impotence in diabetic men.
• It is the most common complication of diabetes.
• The symptoms are many, depending on which nerves are
affected: for example, numbness in extremities, pain in
extremities, and impotence.
• Decreased sensation to feet can lead to patients not
recognizing cuts and developing foot infections. If not
treated early, these can lead to amputation.
 Diabetic foot disease
• It is due to changes in blood vessels and nerves, often
leads to ulceration and subsequent limb amputation.
• It is one of the most costly complications of diabetes,
especially in communities with inadequate footwear.
• It results from both vascular and neurological disease
processes.
• Regular inspection and good care of the foot can
prevent amputations.
• Comprehensive foot programs can reduce amputation
rates by 45-85%.
 Types of Neuropathy
• Peripheral neuropathy
• Autonomic neuropathy
• Focal neuropathies
• Proximal neuropathy
 Peripheral neuropathy
• It typically affects the feet and legs and
sometimes affects the hands and arms.
• This type of neuropathy is very common.
About one-third to one-half of people with
diabetes have peripheral neuropathy.
• Symptoms are often worse at night.
• Most of the time, symptoms on both sides of
your body. However, you may have symptoms
only on one side.
• Your feet, legs, hands, or arms
may feel:
– Burning
– tingling, like “pins and needles”
– Numb
– Painful
– Weak
• You may feel extreme even
when they are touched lightly.
• You may also have problems
sensing pain or temperature in
these parts of your body.
If you have peripheral neuropathy, you
might experience:
• changes in the way you walk
• loss of balance, which could make you fall
more often
• loss of muscle tone in your hands and feet
• pain when you walk
• problems sensing movement or position
• swollen feet
 How can I prevent the problems
caused by peripheral neuropathy?
• You can prevent the problems caused by peripheral
neuropathy by managing your diabetes, which means
managing your blood glucose, blood pressure, and
cholesterol. Staying close to your goal numbers can
keep nerve damage from getting worse.
• If you have diabetes, check your feet for problems
every day and take good care of your feet. If you notice
any foot problems, call or see your doctor right away.
• See your doctor for a foot exam at least once a year—
more often if you have foot problems. Your doctor may
send you to a podiatrist.
 Autonomic neuropathy
• Is damage to nerves that control your internal
organs, leading to problems with your heart
rate and blood pressure, digestive system,
bladder, sex organs, sweat glands, and eyes.
• Over time, high blood glucose and high levels
of fats, such as triglycerides, in the blood from
diabetes can damage your nerves and the
small blood vessels that nourish your nerves,
leading to autonomic neuropathy.
 Focal neuropathies
• Are conditions in which you typically have
damage to single nerves, most often in your
hand, head, torso, or leg.
• The most common types of focal neuropathy
are entrapment syndromes, such as carpal
tunnel syndrome.
 Entrapments or entrapment
syndromes
• Most common type of focal neuropathy.
• It occur when nerves become compressed or
trapped in areas where nerves pass through
narrow passages between bones and tissues.
• The most common entrapment is called carpal
tunnel syndrome .
 Entrapments
• Carpal tunnel syndrome, which causes pain,
numbness, and tingling in your thumb, index
finger, and middle finger, and sometimes
weakness of your grip.
• Ulnar entrapment, which causes pain, numbness,
and tingling in your little and ring fingers.
• Peroneal entrapment, which causes pain on the
outside of your lower leg and weakness in your
big toe.
 Proximal neuropathy
• Is a rare and disabling type of nerve damage in
your hip, buttock, or thigh.
• The damage typically affects one side of your
body and may rarely spread to the other side.
• Symptoms gradually improve over a period of
months or years.
• Symptoms:
• sudden and sometimes severe pain in
your hip, buttock, or thigh
• weakness in your legs that makes it
difficult to stand from a sitting position
• loss of reflexes such as the knee-jerk
reflex
• muscle wasting, or the loss of muscle
tissue
• weight loss

• After symptoms start, they typically get

worse and then gradually improve over a
period of months or years. In many
cases, the symptoms do not go away
completely.
 Macrovascular complications
Cardiovascular disease
• Hyperglycemia damages blood vessels through a
process called “atherosclerosis”, or clogging of
arteries. This narrowing of arteries can lead to
decreased blood flow to heart muscle (causing a
heart attack), or to brain (leading to stroke), or to
extremities (leading to pain and decreased
healing of infections).
Symptoms
• Are varied: ranging from chest pain to leg pain, to
confusion and paralysis.
 What else increases my chances of
heart disease or stroke if I have
diabetes?
• Smoking
• High blood pressure
• Abnormal cholesterol levels
• Obesity and belly fat
• Family history of heart disease
 How can I lower my chances of a
heart attack or stroke if I have
diabetes?
• Manage your diabetes ABCs
• A is for the A1C test. The A1C test shows your
average blood glucose level over the past 3
months. The A1C goal for many people with
diabetes is below 7 percent.
• B is for blood pressure. If your blood pressure
gets too high, it makes your heart work too hard.
High blood pressure can cause a heart attack or
stroke and damage your kidneys and eyes. The
blood pressure goal for most people with
diabetes is below 140/90 mm Hg.
• C is for cholesterol. LDL or “bad” cholesterol
can build up and clog your blood vessels. Too
much bad cholesterol can cause a heart attack
or stroke. HDL or “good” cholesterol helps
remove the “bad” cholesterol from your blood
vessels.
• S is for stop smoking both smoking and
diabetes narrow blood vessels, so your heart
has to work harder.
PREVENTION
 Will influenza vaccination benefit
diabetics? If so, at what age should it
be started and how often should it be
given?
• Influenza vaccination is recommended for all diabetics
>6 months of age, especially those who are >65 years
old, residents of chronic care facilities, require regular
medical follow-up or hospitalization, or have chronic
disorders of the cardiopulmonary and renal system.
(Level 3, Grade B)
• Vaccination of health care workers and family of
patients with diabetes who can transmit influenza is
also recommended. (Level 4, Grade D)
• Yearly influenza vaccination is recommended. (Level 4,
Grade D)
Will pneumococcal vaccination benefit
diabetics? If so, at what age should it
be started and how often should it be
given?is recommended for
• Pneumococcal vaccination
all diabetics >2 years of age, especially those who
are >65 years old, residents of chronic care
facilities, require regular medical follow-up or
hospitalization, or have chronic disorders of the
cardiopulmonary and renal system. (Level 3,
Grade C)
• A one-time pneumococcal revaccination is
recommended for individuals >65 years of age if
the original vaccine was administered when they
were 5 years earlier. (Level 4, Grade D)
 Will Tdap benefit diabetics? If so, at
what age should it be started and how
often should it be given?
• Tetanus and Pertussis are preventable with
appropriate immunization. A Tdap vaccine can
protect adolescents and adults from tetanus,
diphtheria, and pertussis.
• One dose of Tdap is routinely given at age 11
or 12. People who did not get Tdap at that age
should get it as soon as possible.
COUNSELING
Six Steps to Living Well with Diabetes
• Get the facts - Learning about diabetes and
understanding your specific diagnosis will help you
make informed decisions to manage your condition.
• Accept your feelings - Studies show that people who
acknowledge negative feelings about their diabetes are
better at caring for themselves and keeping glucose
levels stable.
• Maintain a balanced perspective - Don't allow
diabetes to become your main focus, continue to do
things you enjoy as you learn to live well with your
disease.
• Be realistic - Set small goals that are easily
attainable.
• Try new things - it also provides an opportunity
to try new recipes, foods or activities.
• Develop a strong support network - Studies
show that people are more likely to follow health
regimens when they have a support network.
communicate with family and friends about how
they can help you.
THANK YOU FOR LISTENING