Next Steps Toward Better Control.

Hello, and welcome to today’s education session, “Next Steps Toward Better Control.” Its
part of an online education program from Sanofi US that brings the expertise of Certified
Diabetes Educators to diabetes education. While managing diabetes can be a challenge,
you’re taking an important step by joining us for today’s session.
I will be your host today; I am a Certified Diabetes Educator, or CDE. CDEs are skilled and
trained healthcare professionals certified by the National Certification Board for Diabetes
Educators. Always remember to consult with your healthcare provider regarding your
diabetes treatment.
The objective of this session is to help you learn how to better manage your blood sugar. An
important feature of this online education session is its interactive component, which allows
you to give, receive, and discuss information, rather than just receive it. At times during
today’s presentation, I’ll ask you to answer some questions, which you will be able to answer
using your computer. If you have additional questions, I will be happy to answer them at the
end of the presentation using a private chat function. After the session, you’ll receive an email with a link that will allow you to view this presentation again
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Today, we’ll talk about what diabetes is, the importance of checking
A1C and blood sugar levels, why A1C and overall blood sugar
management is important as well as review the signs of high and low
blood sugar and the benefits and risks of adding insulin. And, as I
mentioned, I will also answer your questions following this
presentation.
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Let’s take a look at how the body balances blood sugar in a person
who does not have diabetes. After a person eats, the body breaks
down food from carbohydrates and other nutrients, which are
absorbed into the bloodstream. The carbohydrates in food turn into
sugar, shown here by the letter “S.” However, it’s not good for the
body if too much sugar stays in the bloodstream. It needs to be
turned into energy by going into cells, shown here by the blue circle.
Your body needs energy to survive. For example, when you breathe
or when your heart beats, your body is using energy.
For the sugar to get into cells, it must first get through the closed and
locked doors of the cell walls, known as cell membranes. That’s why
an organ in the body called the pancreas makes insulin, which is a
natural hormone in the body. When sugar builds up in the
bloodstream, the pancreas releases insulin, shown here by the green
keys. It then travels through the bloodstream to cells and unlocks the
doors into the cell walls, shown here by the door on the left side. By
unlocking and opening the doors, sugar can get in, shown here by the
open doors in the middle and right side of the blue cell.
As sugar enters the cells, it is turned into energy, and blood sugar
levels in the body go down.
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In people with type 1 diabetes, the pancreas stops making insulin.
Without these “insulin keys,” the doors to the body’s cells stay locked
and closed, and sugar can’t get in. Because it can’t get into the cells,
sugar stays in the blood. This makes blood sugar levels go up.
People who have type 1 diabetes need to inject insulin every day to
replace the insulin the body doesn’t make anymore. This way, they
have the keys they need to unlock the doors of the cell walls, so that
sugar can get inside to be used for energy.
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If you have type 2 diabetes, your body may have one or 2 problems
balancing blood sugar. This picture shows the first way your body
may have trouble turning sugar into energy. Although your pancreas
is still making insulin, it’s not making enough. In other words, your
body has missing “insulin keys,” shown here by the green keys in the
bloodstream. Because you don’t have enough insulin keys, some of
the cell doors stay closed and locked, which causes some of the
sugar to stay in the blood and build up to cause high blood sugar.
Another way the body may have trouble balancing blood sugar is
when the body is still making “insulin keys,” but they no longer match
the locks on the doors to the cell. When the keys don’t work in the
locks, the doors stay closed and sugar can’t get into cells to be turned
into energy, so it builds up in the blood to cause high blood sugar.
Type 2 diabetes may get harder to manage over time, because the
pancreas usually makes less and less insulin as time goes on. This is
why people with type 2 diabetes, after diet and exercise and oral antidiabetic medications, may need to add insulin injections to their
treatment plan―to make up for the limited insulin keys made by their
pancreas.
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If you have type 2 diabetes, your insulin levels may have started dropping
years before you were diagnosed. Beta cells in your pancreas produce insulin.
However, beta cell function declines, on average, about 5% per year in people
with type 2 diabetes. Because of the progressive decline in beta-cell function
and the progression of the disease, patients with type 2 diabetes may
eventually require insulin therapy to achieve or maintain blood glucose
control. In fact, at diagnosis, more than 50% of beta cell function may have
been lost.
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1. Holman RR. Assessing the potential for α-glucosidase inhibitors in prediabetic states. Diabetes Res Clin Pract.
1998;40(suppl):S21-S25.
2. DeFronzo RA. Banting lecture. From the triumvirate to the ominous octet: a new paradigm for the treatment of
type 2 diabetes mellitus. Diabetes. 2009;58(4):773-795.
3. American Diabetes Association. Standards of medical care in diabetes—2013. Diabetes Care.
2013;36(suppl 1):S11-S66.
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Type 2 diabetes may get harder to manage over time, which means
that your treatment plan may also need to change. Healthy eating,
exercise, and diabetes medications are 3 key ways to help keep your
diabetes in check; finding the right balance among them can help you
to better manage your diabetes. At the end of today’s program, I will
let you know about another on-line session that you can attend that
focuses just on healthy eating and exercise.
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Checking your blood sugar levels as directed by your Health Care
Provider is an important part of diabetes management. Most people
can check their blood sugar levels at home. Talk with your Health
Care Provider to find out how often you should check your blood
sugar levels. Write the results in a blood sugar log, and look for
extreme numbers. Take your log and notes to your visits with your
Health Care Provider, and call him or her right away if there are any
unusual changes in your levels.
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Keep track of blood sugar levels by writing the results in a blood
sugar log, and watch for readings outside of your recommended
target range. Make sure to include the time of day you checked your
blood sugar and, if it was around mealtime, what you ate. If your
readings are higher than what your Health Care Provider
recommends, you may need to reduce the amount or change the
type of food you’re eating, increase your physical activity, or ask your
Health Care Provider about adjusting your treatment plan. Review
your blood sugar log often to see how food, activity, and stress affect
your blood glucose readings. If you keep seeing the same patterns—
for instance, if your levels are too high or too low—it might be time to
find a plan that works better for you. Work with your Health Care
Provider to understand what these patterns mean and how they may
affect your treatment plan.
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In addition to blood sugar checks, another way to see if your blood
sugar is under control is by checking A1C. An A1C test is needed to
give you and your healthcare team a picture of your average blood
sugar control over the past 2 to 3 months. Your A1C reading is a
reflection of your average blood sugar levels and is impacted by premeal blood sugar levels, which are also known as fasting blood sugar
levels, as well as your blood sugar levels after you eat. It’s important
that your Health Care Provider performs this test at least 2 to 4 times
per year, depending on how well your blood sugar is controlled. But
remember, the A1C is just one way to measure blood sugar control.
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The American Diabetes Association or ADA recommends an A1C goal
of less than 7%, which works for most people with diabetes; however,
your Health Care Provider may have a different goal for you, so be sure
to discuss this with him or her.
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Let’s take a closer look at the relationship between blood sugar and A1C.
As you can see, your A1C level may get lower as your blood sugar becomes
better controlled. For example, an A1C of 6% is equal to an average plasma
glucose, or sugar, of 126 mg/dL, which is within the ADA target range for
fasting plasma glucose of 70 to 130 mg/dL.
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Another reason A1C is important in people with type 2 diabetes is the
relationship between A1C and the risk of developing diabetes-related
complications, such as heart attack or death caused by the blockage of blood
vessels, and complications with the eyes, kidneys, or nerves. Data from an
analysis of a medical study showed that each 1% reduction in A1C was linked
with a significant reduction in the risk of diabetes- related complications. For
example, a 1% reduction in A1C resulted in a 37% reduction in complications
with the eyes, kidneys, or nerves.
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Since A1C reduction may help reduce the risk of complications, it’s important
for your healthcare provider to take action if blood sugar goals are not met.
Every three months your healthcare provider will check your A1C until it is
7% or the individual goal that he or she has set for you. Once your A1C is
stabilized, they will continue checking your A1C at least every 6 months
afterwards to make sure you are staying at goal. Your healthcare provider
should continue to encourage you to maintain those healthy lifestyle changes
and remind you to take all of your medication exactly as prescribed. And you
can expect your healthcare provider to take action if your A1C remains above
your individual goal.
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One of the most important things you can do to manage your
diabetes is to keep your blood sugar levels within your target range.
The guidelines shown here are from the American Diabetes
Association, or ADA, and are the recommended treatment targets for
most adults with diabetes. These guidelines suggest a fasting, or premeal, plasma glucose, or sugar, of 70 to 130 mg/dL and plasma
glucose, or sugar, 1 to 2 hours after starting a meal—also known as
post- meal plasma glucose—of less than 180 mg/dL. Be sure to ask
your Health Care Provider what blood sugar targets are right for you.
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It’s important to know the symptoms of high blood sugar. Possible
symptoms include increased hunger, blurred vision, fatigue, weight
loss, dry, itchy skin, frequent infections, frequent urination, slowhealing cuts or sores, and tingling or numbness in the feet or hands.
But you may have high blood sugar without any symptoms, so
checking your blood sugar is important.
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Too much food, usually those that are high in carbohydrates, can
cause high blood sugar in people with diabetes. Common sources of
carbohydrates are breads and grains, starchy vegetables like
potatoes and corn, milk, and fruit, as well as table sugar, sweetened
beverages, and dessert-type sweets or foods. Food is not the only
cause of high blood sugar. Other things that can cause blood sugar
levels to rise above target ranges include too little physical activity;
too little diabetes medication; other medications, such as steroids;
and stress or illness.
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If your blood sugar is above your target range, you’ll want to work
with your Health Care Provider to adjust your meal plan and/or
physical activity routine. Talk with your Health Care Provider about
adjusting your medications. Also, find out what your Health Care
Provider considers to be very high blood sugar for you, so that you’ll
know at what point to take emergency action.
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Now let’s talk about low blood sugar. Possible symptoms of low blood
sugar include anxiety, blurred vision, confusion, dizziness, fatigue,
heart palpitations, hunger, nervousness, nightmares, shakiness, and
sweating. But you may have low blood sugar without any symptoms,
so checking your blood sugar is important!
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For people with diabetes, low blood sugar may be the result of too
little food, too much physical activity, too much diabetes medication,
other medications, and alcohol. When you experience low blood
sugar, it’s important to understand what may have caused it so that
you can better manage that situation in the future.
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If you have low blood sugar, you should eat 15 grams of fast-acting
carbohydrate, contained in glucose tablets or such foods as hard
candies (not chocolate and not sugar-free), or 4 ounces, or half a cup,
of juice or regular (not diet) soda. Then wait 15 minutes and check
your blood sugar again.
Repeat until your blood sugar is within range, and follow up with
regular snacks and meals to keep blood sugar levels up.
To make this easier to remember, think of it as the “rule of 15.”
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Now that we’ve discussed high and low blood sugars, let’s take a look
at how type 2 diabetes advances, and then we’ll discuss the different
types of medications used to manage blood sugar.
Type 2 diabetes develops over time, and it doesn’t stay the same
over time. That’s why treatment plans may also change as the
condition advances. Impaired glucose tolerance and insulin
resistance usually develop for several years, before advancing to
diabetes. It may take several more years for diabetes to be
diagnosed.
It’s important to note that this diagram shows what typically might
happen in people with type 2 diabetes over time. This won’t always
happen, and early treatment and careful management may prevent or
delay the onset of the complications shown in this diagram.
Traditionally, a slow-paced, stepwise approach has been used in type
2 diabetes care, starting with diet and exercise upon diagnosis. By
the time a person is started on diabetes pills, he or she may have
already developed complications in the small blood vessels, such as
damage to the eyes, kidneys, and nerves. Insulin therapy is too often
started when diabetes is more advanced. Usually, people have had
the condition for 10 to 15 years before adding insulin to their
treatment plan. However, if your body is no longer making enough
insulin, it may be better to start insulin therapy earlier rather than
later.
Insulin is not a last resort. In fact, the ADA identifies it as the most
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effective way to control blood sugar when diet, exercise, and other non-insulin
therapies are no longer enough.
Now let’s take a closer look at the different treatment options. But first, a poll
question.
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True or False? Insulin can help with better control of diabetes. If you
believe this statement is true, please select “True” now. If you believe
this statement is false, please select “False.” The correct answer is
True. As we’ve discussed, diabetes may get harder to manage over
time, which means your treatment plan may need to change. In fact,
adding insulin may help to better control blood sugar, even if you’re
still active and otherwise healthy.
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People without diabetes typically secrete insulin in 2 different ways.
The first is called basal insulin, which is steadily produced 24 hours a
day. Basal insulin prevents the production of too much blood sugar
during the night, and it maintains a nearly constant level of insulin
throughout the day. The second is called prandial, or mealtime,
insulin, which is produced in response to eating food. Prandial insulin
limits increases in blood sugar that happen after a meal.
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There are different types of replacement insulin that you can take by
injection. Prandial insulins include rapid-acting and regular or shortacting insulins. Rapid-acting insulin starts to work in about 5 minutes
after injection and continues to work for 2 to 4 hours. Regular or
short-acting insulin begins to work within 30 minutes after injection
and continues working for up to 6 hours. Basal insulins include
intermediate- and long- acting insulins. Intermediate-acting insulins
usually begin to work in 2 to 4 hours after injection and continues to
work for about 12 to 18 hours. And long-acting insulins begin to work
in 2 to 4 hours after injection and can work for up to 24 hours. Premix
insulin is a mixture of 2 insulins in predetermined proportions. It
combines an intermediate-acting and a rapid- or short-acting insulin
in 1 dose.
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Important safety information about insulin: All medications have side
effects. The most common side effect of insulin is low blood sugar.
Some people may experience symptoms such as
shaking, sweating, fast heartbeat and blurred vision, while some
experience no symptoms at all. That’s why it’s important to check
your blood sugar often.
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There are several devices that can be used to deliver insulin. When using a
vial, or bottle, the user fills a syringe with insulin from the vial and, through a
needle, injects the contents of the syringe under the skin. Another option is
an insulin pen. The pen has a view window that lets you see and set your
insulin dose. It is either prefilled with insulin or contains a cartridge of insulin,
and features a push-button injection system. And remember: Many people
using a pen or syringe are surprised at how small the needle really is. Your
Health Care Provider may also prescribe a pump as your insulin delivery
method. The pump is a device that pumps insulin continuously through
plastic tubing attached to a needle under the skin. Consult your Health Care
Provider about proper injection technique for the device you’re using.
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Here is some additional information about insulin that you may not
know:
• Many insulins do not require refrigeration, always check the
storage conditions for all your medications
• Some insulins come in pens
• Insulin pens are generally easy to use – but if you have vision (or
other) problems, have someone help you
• Traveling with insulin is manageable – check with your healthcare
professional about how to dose when crossing time zones
• Insulin can be injected with a very small, thin needle.
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Now it’s time for another poll question; this one allows you to type
your answer in the Q & A box at the bottom of your screen.
Remember, no one except you and I can see what you are typing.
What are the benefits of going on insulin? I’ll let you take a few
minutes to type in your answers. Everyone may identify different
benefits of starting insulin, but one of the most important benefits of
going on insulin is that insulin is the most effective way to help control
blood sugar when diet, exercise, and oral anti-diabetes medicines are
no longer enough.
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So what are your next steps for better control? Be sure to talk to your
healthcare provider today about how to achieve your goals. Since
you and your Health Care Provider will have so much to share with
each other, it’s important that you have an open line of
communication. Being open and honest with him or her is very
important when it comes to managing your diabetes, so make sure to
ask any questions that you might have. Asking questions will show
your Health Care Provider that you are taking an active role in
managing your blood sugar.
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Before I get to your individual questions, I do want to share with you
some information about additional on-line education sessions that you
can sign up for to learn how to get better blood sugar control. You
can sign up for these free sessions just as you did for today’s
session, by going to www.CDEHelpTeam.com. In “The Highs and
Lows of Blood Sugar” you can get more information about blood
sugar control. In “Making Healthy Choices” you’ll learn about healthy
meal planning, carbohydrate counting, exercise, and more. And in
“Guide to Routine Diabetes Tests and Meds” you’ll find out more
about regular in-office diabetes tests and diabetes medications.
Always remember that ongoing education is an important part of
managing your diabetes. You can sign up for these and other CDE
HELP Team sessions by using the convenient website link that will be
displayed on-screen after this session.
I will now go over the answers to your individual questions that you
sent into the Q & A box.
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