Juvenile Diabetes

Susan WhitemanMA 260-01 Unit 8 Project, Professor Daniel

September 15, 2009

Frequently asked questions about Type II Diabetes

Many people have diabetes, and though a new diagnosis of diabetes mellitus is a little scary, there is a lot of information available to help you live with your condition. You may have questions like:

How should my diet change? Can I eat any of my old foods? How will I know what to eat?

Do I need to take medication? If so, what, when and how?

Can I still participate in my usual activities? Can I participate in sports?

Where can I find more information on Diabetes?

Living with Diabetes: Diet

Eat at the same times each day, and make each portion size the same (Mayo Clinic , 2009). You will find that you can eat many of the foods you usually eat, but you must be aware of what is in each food. Use an “exchange list” for each type of nutrient, listed below, to make choosing your food easier (Mayo Clinic, 2009). Here is a link to the Mayo Clinic’s Exchange list: http://www.mayoclinic.com/health/diabetes-diet/DA00077

• Carbohydrates: 45%-65% of your daily intake (Mayo Clinic, 2009) or 900-1,300 calories daily, based on a 2,000 calorie-a-day diet

Daily servings of complex carbs should include:

5 servings of dark fruits and vegetables (Young & Proctor, 2007)

6 servings of whole grains (Young & Proctor, 2007)

peas, beans, lentils, and low-fat dairy products (Young & Proctor, 2007)

Proteins: 15%- 20% of daily intake (Mayo Clinic, 2009) or 300-400 calories a day

One “serving” of lean mean is equal to 1 oz. and 45 calories (Mayo Clinic, 2009)

8.8 oz. of lean meat or low-fat cheese or other low-fat protein per day

Salmon or other fatty fish should be eaten twice a week** One serving size of salmon is one-quarter pound, and is 184 calories (Caloriecount.about.com, 2009)

Fats: 20%-35% of daily intake (Mayo Clinic, 2009) or 400-700 calories a day

Use monounsaturated fats like olive, peanut or canola oil (Young & Proctor, 2007)

French fries count as FAT!!!! (Young & Proctor, 2007)

Use food labels to determine calorie content from fat

Medications & Management of Type I

Diabetes You will need to take a medication called Insulin that replaces the

chemical your body is not producing. Your doctor will work closely with you and your mom and dad as you learn to regulate your insulin requirements, based upon your blood glucose levels.

You will learn how to test your blood glucose levels using a glucometer: testing is usually done in the morning when you get up, before meals, and before or after exercise, and blood is obtained from a tiny prick on your finger or from another part of your body (Young & Proctor, 2007).

Insulin delivery can be done by insulin pumps, injections, or through an inhaled mist (Young and Proctor, 2007).

Your doctor will decide what kind of insulin you will use and what method of delivery will suit you best. There are insulins that are quick-acting, long-acting, and continuous.

Types of Insulin Name Onset Peak Duration Notes

Lispro-Humalog 5 minutes 1/2 -1 hr. 2-4 hours Take with food *

glulisine (Apidra) Same as above *

 Regular Insulin 1/2 - 1 hr. 2-4 hrs. 5-7 hours *

isophane insulin (NPH) 1-2 hrs. 6-12 hrs 18-24 hrs taken 1-2x daily *

Lente insulin 1-2 hrs. 6-12 hrs. 18-24 hrs. Usually allergy free *

 Ultralente insulin 4-6 hrs 16-18 hrs 20-36 hrs. Lente insulins can't be mixed with any other insulins except regular insulin and other Lente insulins. *

 Lantus Once a day injection that does not have a peak; lasts up to 24 hours. *

detemir, DNA (Levemir) Another 24-hour insulin Do not mix with any other insulins. *

 NPH/regular insuling mixes of 70/30, 50/50 and 75/25 1/2 hour onset, 7-12 hour peak, and 16-24 hour duration. *

* Fulcher, E., Fulcher, R. & Soto, C. (2009). Pharmacology: principles and applications. St. Louis, MO: Saunders, Elsevier.

Lifestyle Changes ? Exercise? Resources for You and Your

Family Diabetes is a lifestyle change. You will learn how to carry insulin with you, if needed and you will

learn to check your blood glucose levels, and “re-learn” how to eat and how much exercise you can tolerate.

You may continue in your regular activities, but you will need to check your glucose level and get to know when you need to eat more, depending upon your level of activity. Your doctor may have you check your glucose levels before and after exercising until you are familiar with how exercise will affect your glucose levels.

There are many online resources for you to find information on regarding diet and specific information on diabetes. In addition to the link to the food exchange list on page 3, here are a few more links:

The American Diabetes Association

http://www.diabetes.org/about-diabetes.jsp

• The Family Doctor: Diabetes & Exercise

http://familydoctor.org/online/famdocen/home/common/diabetes/living/351.html

• The Mayo Clinic: The Diabetes Diet

http://www.mayoclinic.com/health/diabetes-diet/DA00027

References CalorieCountAbout.com. (2009). Food details: Calories in salmon, pink. Retrieved September 19,

2009, from, http://caloriecount.about.com/calories-salmon-pink-i15212

Fulcher, E., Fulcher, R. & Soto, C. (2009). Pharmacology: principles and applications.

St. Louis, MO: Saunders, Elsevier.

Mayo Clinic Staff. (2009) Diabetes diet, creating a healthy eating plan. Retrieved September 20, 2009,

from, http://www.mayoclinic.com/health/diabetes-diet/DA00027

• Proctor D, & Young, A. (2007). Kinn’s the medical assistant, 10th ed. St. Louis, MO:

Saunders, Elsevier.

U.S. Department of Health and Human Services. (2005). Dietary guidelines for

americans, 2005. Retrieved September 20, 2009 from

http://www.cnpp.usda.gov/Publications/DietaryGuidelines/2005/2005DGPolicyDocument.pdf

Hypercholesterolemia

You’ve been diagnosed with high cholesterol

What is cholesterol? Cholesterol is a substance that is naturally produced within our bodies

by our liver (Young & Proctor, 2007). Food sources like eggs and animal products also contain cholesterol,

and can lead to high cholesterol levels in the blood (Young and Proctor, 2007).

Cholesterol has useful properties, but when we have too much it can be harmful, and leads to plaque build-up in our arteries, which can eventually cause clotting or blockages.

Clots and blockages can cause heart attacks, stroke and death Ideal cholesterol levels are:

100 or under for LDL (low-density lipoprotein) cholesterol, which delivers cholesterol to our cells (Young & Proctor, 2007).

30-80 for HDL (high-density lipoprotein) cholesterol, which carries cholesterol out of the body as a waste product (Young & Proctor, 2007).

Total combined LDL and HDL cholesterol of under 200 (Young & Proctor, 2007)

What causes high cholesterol and what can I do to lower mine?

High cholesterol can be caused by:• Heredity• Food choices including foods high in animal fat, saturated fats• Alcohol consumption• Caffeine consumption• A sedentary lifestyle• Obesity

• Ways to lower cholesterol:• Eating a high-fiber, low-fat diet, with mono and polyunsaturated fats in it.• Reducing alcohol and caffeine consumption• Exercising regularly, losing weight if overweight• Taking cholesterol-lowering drugs if lifestyle changes don’t work or are not adhered to *

*Young and Proctor, 2007.

Cholesterol-lowering drugs

Some common cholesterol drugs and how they work:

Hypolipidemics: Bile acid sequestrants

• Lower LDL cholesterol by “binding bile acids to the intestine, which are eventually excreted as waste, rather than being absorbed by the body” (Fulcher et al, 2009, p. 575). Side effects can include malabsorption of vitamins A,D, K and E.

cholestyramine (Questran, Prevalite)

colestipol (Colestid)

HMG-CoA reductase inhibitors– Statins

These drugs reduce LDL cholesterol by inhibiting the liver’s ability to produce cholesterol by inhibiting the enzyme, HMG-CoA (Fulcher, et al, 2009). Statins can create a lowering of this enzyme production by 45%.

All generic drugs in this class end in “statin” and include atrovastatin, fluvastatin, lovastatin, pravastatin, simvastatin, and resuvastatin.

The trade names for these drugs are, respectively, Lipitor, Lescol, Mavacor, Pravachol, Zocor and Crestor

These drugs are usually taken for life (Fulcher et al, 2009, p. 575).

Dietary Guidelines Based on a caloric requirement of 2,500 calories a day (U.S. Department

of Health & Human Services, 2005) total calories from fat should not exceed 250, or 10% of total daily calories.**

Cholesterol intake should not exceed 300 mg per day**

Don’t consume more than 2 alcoholic drinks per day*

Use mono or polyunsaturated fats too cook with (olive oil, peanut or canola oils) and eliminate saturated fats, fatty meats, organ meats egg yolks and foods containing trans-fat. Use skim milk and reduced fat cheeses. Read food labels. *

Eat food containing Omega 3 oils, like salmon, mackerel and cod twice a week in moderate portions. Walnuts, almonds and ground flaxseeds also contain Omega 3 oils. *

Add at least 5 servings of fruits and vegetables to your daily diet *

Eat whole wheat breads and pastas *

** Young & Proctor, 2007, p. 582

* Mayo Clinic Staff, 2009

ExerciseConsult with your doctor to assess your level of

fitness

Aerobic exercise, like walking, jogging, biking, swimming, playing tennis are all acceptable forms of exercise depending upon your level of fitness

Aerobic exercise should be done for at least 30 minutes each day (The President’s Council on Fitness and Sports, 2009).

Where to find more information

The Mayo Clinic: High Blood Cholesterol: Top 5 Lifestyle Changes to Reduce Cholesterol

http://www.mayoclinic.com/health/reduce-cholesterol/CL00012

WebMd: Exercise to lower cholesterolhttp://www.webmd.com/cholesterol-management/features/exercise-to-lower-cholesterol

The American Heart Association

http://www.americanheart.org/presenter.jhtml?identifier=4500

References

Fulcher, E., Fulcher, R. & Soto, C. (2009). Pharmacology: principles and applications.

St. Louis, MO: Saunders, Elsevier.

• Mayo Clinic Staff. (2009). High blood cholesterol: top 5 lifestyle changes to reduce

cholesterol. Retrieved September 19, 2009, from http://www.mayoclinic.com/health/reduce-cholesterol/CL00012

• Proctor D, & Young, A. (2007). Kinn’s the medical assistant, 10th ed. St. Louis, MO:

Saunders, Elsevier.

• The President’s Council on Physical Fitness & Sports (2009). Exercise and

weight control. Retrieved September 20, 2009 from,

http://www.fitness.gov/exerciseweight.htm

U.S. Department of Health and Human Services. (2005). Dietary guidelines for

americans, 2005. Retrieved September 20, 2009 from

http://www.cnpp.usda.gov/Publications/DietaryGuidelines/2005/2005DGPolicyDocument.pdf

Obesity: Regaining your Health

Understanding Weight Gain

Injuries, sickness, side effects from medication can all contribute to weight gain.

Sometimes weight-gain creeps up slowly, and as our metabolism changes, we gain weight more quickly and don’t lose weight as fast as we used to.

The key to losing weight and keeping it off includes reeducating ourselves about food so that we can make healthy choices, as well as choosing to exercise.

Why Do I Need to Lose Weight?

Regardless of what current fashion trends are, weight loss can reverse some damaging health trends. Some of the things weight loss and exercise can prevent or reduce the risk of include:

Adult-onset diabetesBreast cancer and other cancersOsteoporosis (exercise builds strong bones)High cholesterolHigh blood pressureRisk of heart attack, or other heart-related problemsRisk of strokeWear and tear on joints **Young and Proctor, 2007)

How much should I weigh, and how many calories should I be consuming? What is my ideal weight?

Using the Body Mass Index (BMI) Chart (as cited in Young & Proctor, 2007, p. 585), a woman who is 5’7” will have a healthy BMI at weights ranging between approximately 121-155 pounds.

How can I calculate how many calories I should be eating?

Using the link below, find the weight you would like to be on the chart for women, and move your cursor over that weight, and according to your activity level

http://www.chartsgraphsdiagrams.com/HealthCharts/calorie-requirement.html

According to the chart, which is based on the Basel Energy Expenditure-Harris Benedict Equation, a woman who is 135 pounds with a moderate activity level should need approximately 2,000 calories per day (Chart Graph Diagrams, 2006-2007).

For comparison, a 200- pound woman who exercises moderately would need approximately 2,500 calories a day to maintain or obtain that weight, according to the same chart. Using that as a comparison, the need to reduce calories becomes apparent.

Weight loss: How much, how soon?

It is tempting to think that we can and or should lose 40 pounds in a few months time. However, rapid weight-loss is rarely sustainable or healthy.

It is best to lose a pound a week, and make changes in your lifestyle and eating habits that you can live with long-term. To lose a pound a week, you need to either burn off 500 extra calories a day, or consume 500 calories less per day (Charts Graphs Diagrams, 2007).

The percentage of fat in your diet should be 27% of your total calories, so for a 2,000 calorie/day diet, calories from fat should be fewer than 540, and within that calorie allowance, saturated fat should not exceed 10% (U.S. Department of Health and Human Services, 2005).

Spending your food calories wisely will promote a healthy diet. Fats and sugary foods, including alcohol, can easily put daily caloric allowance over in a hurry.

Keeping a food and exercise journal can be a helpful way to track calories.

What types of food should I eat? Counting calories is only part of the picture.

Choose whole grain breads and pastas-3 one-ounce servings per day or less depending upon calories *

Choose foods without trans-fat or saturated fats *

Use mono- or polyunsaturated fats for cooking, like peanut, olive or canola oils and use in moderation *

Choose lean meats and skim milk and cheese products over those products with a high fat-content *

Eat at least 5-servings a day of fruits and vegetables, totaling 2.5 cups of vegetables and 2 cups of fruit *

Limit sugars, sodas, fruit drinks, sports drinks, desserts *

Increase fiber intake *

*U.S. Department of Health and Human Services (2005).

Lifestyle Changes: Exercise!

In addition to changing your diet to modify portion sizes and what foods you are eating, exercise will be a key “ingredient” to your successful weight loss and healthy living plan

When not trying to lose weight, the recommendation for moderate exercise is 30 minutes per day (U.S. Dept. of Health & Human Services, 2005).

When weight loss is the goal, moderate exercise should be increased to 60-90 minutes per day (USDHH, 2005).

The President’s Council on Physical Fitness and Sports (2009) lists moderate exercises as burning between 150-350 calories per hour and include such sports or activities as:

Walking, dancing, biking at less than 10 mph, swimming, light housework, golf and others

More information on exercise may be obtained from that website at this address: http://www.fitness.gov/exerciseweight.htm

But dieting has never worked for me. Now what?

Diet and exercise should be tried before other measures

Pills to assist with diets to curb hunger, or to prevent fat absorption are available, but are for short-term use. They include such drugs as phentermine, sibutramine, and lipase inhibitors such as Orlistat (Young and Proctor, 2007, p. 590). Consult with your physician before taking any medication or over-the-counter drugs for weight loss.

If you fit the criteria for surgical solutions to weight control, “A BMI >40 or a BMI of 35-39.0 and a co-morbidity such as diabetes” (Young and Proctor, 2007, p. 590), you will need to consider the short-term risks of surgery as well as the costs, and then consult with your doctor over the long-term requirements such surgery demands, such as regular life-long check-ups and strict calorie control (Young & Proctor, 2007).

Hypnotism is sometimes employed to assist with weight loss.

Additional ResourcesIn addition to the resources located within this

presentation (see “How Much Should I Weigh” and “Exercise!” pages 20 & 23) the US Department of Health and Human services published a guideline in 2005 (to be updated in 2010) that has information on all aspects of nutrition, exercise and weight control. It is titled “Dietary Guidelines for Americans” and may be accessed at:http://www.cnpp.usda.gov/Publications/

DietaryGuidelines/2005/2005DGPolicyDocument.pdf

References Charts Graphs Diagrams.com (2006-2007). Health charts. Retrieved September 20, 2009 from

http://www.chartsgraphsdiagrams.com/HealthCharts/calorie-requirement.html

Proctor D, & Young, A. (2007). Kinn’s the medical assistant, 10th ed. St. Louis, MO:

Saunders, Elsevier.

• The President’s Council on Physical Fitness & Sports (2009). Exercise and

weight control. Retrieved September 20, 2009 from,

http://www.fitness.gov/exerciseweight.htm

U.S. Department of Health and Human Services. (2005). Dietary guidelines for

americans, 2005. Retrieved September 20, 2009 from

http://www.cnpp.usda.gov/Publications/DietaryGuidelines/2005/2005DGPolicyDocument.pdf

SUMMARY OF INFORMATION My chosen patient to use for this part of the assignment will be the obese

woman.

The information that I would include when I would be talking to her would be risks involved with obesity, the benefits of losing weight, and the steps she could take to lose weight, as outlined in the power point presentation, above.

Theraputic communication techniques would include asking the patient if they understood, making sure that they realized the implications of obesity, but also making sure they came away from the interview with a positive attitude and a plan for making changes. Looking at and listening to the patient, giving her the opportunity to ask questions, and making sure I was meeting her needs by asking if I could be of further help would all be appropriate communication techniques.

In a case like this, which can be a very sensitive topic for most people, being non-judgemental, sympathetic and encouraging would be important.

I would make sure the patient had the resources available to her to look up information, and would schedule a follow-up appointment.