diabetes – ask the experts!

Diabetes – Ask the Experts!

Debra Margulies, MD – EndocrinologistMargaret Eckler, RD, Certified Diabetes Educator

Summit Medical GroupBerkeley Heights, NJ

November 18, 2014

What is Diabetes Mellitus?• Blood sugar (glucose) is a main nutrient that

all cells in the body use for fuel• Insulin is required for cells to get glucose from

the blood• If there is not enough insulin or the insulin

does not work as well, glucose stays in the blood resulting in high blood glucose levels

NIDDK, National Diabetes Statistics fact sheet. HHS, NIH, 2014.

Diagnosis of Diabetes

Types of Diabetes• Type 1 Diabetes (no insulin produced)

• Previously termed juvenile/childhood-onset, insulin dependent

• 5% to 10%

• Type 2 Diabetes (insulin produced doesn’t work well)• Previously termed adult-onset, non-insulin dependent• 90% to 95%


Pre-diabetes• At least 86 million U.S. adults have pre-

diabetes

• Increased risk of developing diabetes in the future and increased risk of cardiovascular disease

• People with pre-diabetes can prevent or delay the onset of type 2 diabetes through lifestyle change and/or medication


Risk factors for Diabetes- Prediabetes

- Over age 45

- Family history of diabetes

- Overweight

- Do not exercise regularly

- Low HDL cholesterol or high triglycerides, high blood pressure

- Certain racial and ethnic groups

- Women who had gestational diabetes, or who have had a baby weighing 9 pounds or more at birth

Obesity Trends* Among U.S. AdultsBRFSS, 1986

(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)

No Data <10% 10%–14%



No Data <10% 10%–14%



No Data <10% 10%–14% 15%–19%



No Data <10% 10%–14% 15%–19% ≥20%



No Data <10% 10%–14% 15%–19% 20%–24% ≥25%



No Data <10% 10%–14% 15%–19% 20%–24% 25-29% ≥30%

1999

Obesity Trends* Among U.S. AdultsBRFSS, 1990, 1999, 2009

(*BMI ≥30, or about 30 lbs. overweight for 5’4” person)

2009

1990

No Data <10% 10%–14% 15%–19% 20%–24% 25-29% ≥30%

1994

Age-Adjusted Percentage of Adultswith Diagnosed Diabetes

No Data <4.5 4.5-5.9% 6-7.4% 7.5-8.9% >9%

1995


No Data <4.5 4.5-5.9% 6-7.4% 7.5-8.9% >9%

1996


No Data <4.5 4.5-5.9% 6-7.4% 7.5-8.9% >9%

1997


No Data <4.5 4.5-5.9% 6-7.4% 7.5-8.9% >9%

1998


No Data <4.5 4.5-5.9% 6-7.4% 7.5-8.9% >9%

1999


No Data <4.5 4.5-5.9% 6-7.4% 7.5-8.9% >9%

2000


No Data <4.5 4.5-5.9% 6-7.4% 7.5-8.9% >9%

2001


No Data <4.5 4.5-5.9% 6-7.4% 7.5-8.9% >9%

2002


No Data <4.5 4.5-5.9% 6-7.4% 7.5-8.9% >9%

2003


No Data <4.5 4.5-5.9% 6-7.4% 7.5-8.9% >9%

2004


No Data <4.5 4.5-5.9% 6-7.4% 7.5-8.9% >9%

2005


No Data <4.5 4.5-5.9% 6-7.4% 7.5-8.9% >9%

2006


No Data <4.5 4.5-5.9% 6-7.4% 7.5-8.9% >9%

2007


No Data <4.5 4.5-5.9% 6-7.4% 7.5-8.9% >9%

2008


No Data <4.5 4.5-5.9% 6-7.4% 7.5-8.9% >9%

2009


No Data <4.5 4.5-5.9% 6-7.4% 7.5-8.9% >9%

U.S. Diabetes Prevalence2014

• 29.1 million adults have diabetes– 8.1 million are not yet diagnosed

• 9.3% of adult population– 26.9% of all people over age 60


Diabetes Complications• Microvascular – Small blood vessels in:

– Eyes (retinopathy)

– Kidneys (nephropathy)

– Nerves (neuropathy)

• Macrovascular – Large blood vessels in:

– Brain (stroke)

– Heart (heart attack)

– Legs (peripheral artery disease)

Diabetes Complications• 2 in 3 people with diabetes die of heart

disease or stroke

• Diabetes is the #1 cause of adult blindness

• Diabetes is the #1 cause of kidney failure

• Diabetes causes more than 60% of non-traumatic leg/foot amputations each year


Treatment of DiabetesPrevention!

Prediabetes: 7% weight loss reduces risk of progressing to diabetes by ~60% (70% if >60 years old)

14 pounds if you weigh 200 pounds

Lifestyle change– Decreases need for medications (many patients can

control blood sugar with diet/exercise changes alone)

– Reduces risk for related illnesses, such as heart attack, stroke, arthritis, etc…

– Improves sense of well-being and overall quality of life

Strive to become morephysically active.

• Start off slowly.– Add more until you reach at least 30 minutes of moderate intensity

physical activity five days a week.

• Build physical activity into your day.– Take a brisk walk during lunchtime. – Take the stairs instead of the elevator.– Park farther away from the stores or your office.

• Keep at it.– The longer you keep at it, the better you’ll feel.– Celebrate small successes.

Nutrition Recommendations• Carbohydrates

– Whole grains, fruits, and vegetables should be included in a healthy diet

– Total amount of carbohydrate – more important than source

– Sugars are acceptable, but should be substituted for other types of carbohydrate

– Fiber (a carbohydrate) is encouraged

Nutrition (cont’d)• Protein

– No evidence to support greater or lesser intake than for non-diabetics

• Fat– Less than 7-10% of calories from saturated

fat, and less than 300 mg cholesterol– Minimize intake of trans fats (hydrogenated

vegetable oils)

Nutrition (cont’d)

• Calories– Should be appropriate to achieve weight loss

if needed– Individualized– Exercise, behavior modification, and ongoing

support are usually necessary for permanent weight control.

• Vitamins, minerals, supplements– No clear evidence of any benefit for diabetes unless a

deficiency is present– Basic multivitamin/mineral preparation recommended

• Alcohol – Limit to 1-2 drinks/day consumed with food (caution

if high triglycerides)

• Sodium / Salt– Less than 2400 mg/day for those with hypertension

Nutrition (cont’d)

Diabetes Management Goals“ABCs of Diabetes”

• A1c (Blood Sugar) <7% (<6.5% if appropriate)

– Pre-meals 90-130mg/dl– 2 hours after meals <180

• Blood Pressure <130/80– With ACE-inhibitor or ARB

• Cholesterol– Important impact on reducing cardiovascular risk (ie, heart

attack, stroke)– All patients above age 40 should be considered for ‘statin’

therapy regardless of starting cholesterol

• Aspirin therapy

Diabetes Management – (cont’d)• Diabetes/Nutrition education – as needed• Dilated eye exam – at least yearly• Kidney blood and urine testing – at least yearly• Podiatrist (foot doctor) – as needed• Routine dental care• Influenza (flu) vaccine – annually• Pneumonia vaccine – every 5-10 years (once if

over age 65) • Smoking cessation

The most important team member is YOU!

Summary• There has been a dramatic rise in the number of people

with diabetes over the past few decades– parallels the rise in obesity

• Healthy lifestyle choices may delay or prevent diabetes in those at risk

• If diabetes develops, lifestyle changes can help achieve management goals

• If diabetes is not controlled by diet/exercise, there are many treatment options now available

• A team approach is the most effective way to achieve all the goals of diabetes management

diabetes – ask the experts!

Health & Medicine

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