Optimal Life: The Essentials of Diabetes
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Optimal Life - Christine Lee, Pharm.D., BCPS
Optimal Life: The Essentials of Diabetes
Christine Lee, Pharm. D., BCPS
Copyright © 2013 Dr. Christine V. Lee
All rights reserved. No part of this publication may be reproduced, distributed, or transmitted in any form or by any means, or stored in a database or retrieval system, without the prior written permission of the publisher. Optimal Life, OL, and associated logos are trademarks and/or registered trademarks for the use of their respective owners.
ISBN: 978-0-9833372-4-9
ISBN: 9780983337256
Printed in the United States of America
Book Design: www.KarrieRoss.com
Optimal Life Globe Design: Jim Draper www.jimdraper.com
Optimal Life and OL Logo Design: Heide Couch/RHC Design Tech rhcdesigntech.net
A NOTE TO THE READER
The material in this book is meant for informational and educational purposes only; it is not intended to replace the advice of your doctor. Please make sure to discuss all the facts and suggestions presented here with your health care provider to create a plan that is right for you.
DEDICATION
This book is dedicated to my son, Charles, who developed type 1 diabetes in 2004. He has never allowed his diabetes to be an excuse for not accomplishing his dreams and goals. Charles has traveled abroad extensively, is active in sports and mountain climbing and is currently in medical school. He’s given his family the gift of encouragement, telling us all that individually we can do anything if we really want to. Charles once said to me, Mom, don’t worry. Nothing has changed, I just happen to have diabetes.
Charles truly lives life to the fullest.
I also dedicate this book to my husband who recognized Charles’ diabetes symptoms before there were irreversible serious consequences, and for the strength he gave Charles when he said, never use your diabetes as an excuse, because the world is wonderful and yours for the taking.
ACKNOWLEDGMENTS
This book could not have been completed without the unwavering support of Sherill Conley Rohde. She spent countless hours reviewing and organizing the text so that nonmedical people could understand it, and coordinated the myriad other details that went into the finished product. As the project blossomed from concept to reality, Sherill’s constant positive feedback and friendship gave me the encouragement to forge ahead; she helped me hold onto the dream that we could do this, and help many individuals with diabetes in doing so.
ABOUT THE AUTHOR
Christine Lee received her Doctor of Pharmacy from the University of the Pacific School of Pharmacy in Stockton, California, and was granted a Bachelor of Science in Clinical Laboratory Science from the University of Nevada, Reno. She is licensed by both the California and Nevada State Boards of Pharmacy. She is also a Board Certified Pharmacotherapy Specialist and a licensed Clinical Laboratory Scientist.
Dr. Lee is the co-founder and Chief Clinical Officer of American Health Care, a health management company that specializes in delivering patient-centric pharmacy benefit, population health and therapy management programs that emphasize clinical excellence. She is also the developer of a proprietary software system that provides virtual medical records, currently in use by hospitals across the country. She is the preceptor for the company’s pharmacy residency program and co-founded the United American Pharmacy Network. She is affiliated with the American College of Managed Care Pharmacy, the American College of Clinical Pharmacy, the American Society of Health System Pharmacists and the Academy of Managed Care Pharmacy.
When not at work, Dr. Lee enjoys the company of her family, maintains her black belt in Taekwondo and loves to run. She is an avid supporter of the Juvenile Diabetes Research Foundation and has served on the boards of several consulting companies, as well as human rights advocacy groups for the mentally disabled.
You can contact the author at info@optimalife.net.
HOW TO USE THIS BOOK
The Optimal Life book is meant to enhance your knowledge of diabetes mellitus (DM) so that you can more fully understand why you need to take control of your diabetes and how to do it. Although there are three main types of diabetes (type 1, type 2, and gestational), only type 1 and type 2 are discussed in this book.
The first three chapters provide in-depth information about the science behind the disease, including why certain complications develop, their symptoms and keys to their prevention, to help you fully understand diabetes. The following chapters focus on medication and diet, which are vital to good diabetes management. A list of resources at the back offers practical information for use right now and suggests other material for further study.
The key to controlling your diabetes is understanding it. So read on and become as knowledgeable as you can.
FOREWORD
My reasons for writing this book are both personal and professional. As a Doctor of Pharmacy and medical consultant with more than 20 years in the health care field, I’ve been involved in diabetes education for most of my professional life, working to convey scientifically-based best practices to a diverse array of medical professionals and individuals with diabetes. Because the complications of diabetes can be so dire and because most of them are actually preventable, it became almost a personal crusade for me to spread this message to as many people as I could. I was passionate about the subject.
Then, in 2003, my 14-year-old son Charles was diagnosed with type 1 diabetes. You can call it coincidence, fate or destiny that my involvement with diabetes became so heartbreakingly personal after spending so many years being professionally involved with it, but I can tell you that this was a defining moment in my life. My otherwise healthy, happy son was suddenly rushed to the hospital with severe hyperglycemia, in very real danger. I’m so grateful to say that he recovered, accepted his diagnosis and is today as an active, energetic medical student who successfully manages his diabetes and enjoys all life has to offer him.
If I was passionate about diabetes education before this event, I was on fire afterward; since that time I’ve devoted hundreds of hours to understanding type 1 and type 2 diabetes. I studied not only the science of diabetes, but also the people I met who had the disease. Almost without exception, the people who were successful in managing their diabetes and avoiding complications were the ones who had become educated on what they needed to know to control the disease. They addressed their diabetes head on, took responsibility for knowing their numbers, constantly asked questions, and did whatever it took to keep their glucose in control. They made education and ownership of their disease their number one priority.
When I looked at the learning tools available to people with diabetes, I realized that the material ranged from oversimplified children’s books to highly academic and scientific discussions of the disease, with not much in between. What I began to envision was one place, a one-stop shop, where all the essential information about diabetes could be gathered – from diagnosis and medication, to testing and insider tips, along with the underlying science – presented in a way that everyone could use to become healthier.
With this in mind, I began work on Optimal Life: The Essentials of Diabetes. The goal of this book is to provide useful health information to the person with diabetes. Early diagnosis and taking an active stance in the early stages of the disease is the best solution to prevent complications and live a healthy life. However, whether you’ve had the disease for a long time or you’re newly diagnosed, this series has valuable information for you.
I believe that good health is the key to living your optimal life. This can be defined a number of ways, but for people with diabetes, I think the most important definition might be knowing that you can have diabetes and live a healthy, active life, doing all the things you want to do – whether that’s mountain climbing, playing with your children, graduating from college, or anything else you can dream of. I believe your optimal life can be achieved by learning how to take care of your diabetes and being proactive about doing so.
The Optimal Life book is meant to enhance your knowledge of diabetes mellitus (DM) so that you can more fully understand why you need to take control of your diabetes and how to do it.
I congratulate you on your decision to read this book and look forward to partnering with you on your journey to good health!
TABLE OF CONTENTS
Note to the Reader
Dedication
Acknowledgments
About the Author
How to Use This Book
Foreword
Chapter 1
What is Diabetes?
Introduction
In-Depth Information
What is Diabetes
Type 1
Type 2
Diagnosing Diabetes
Insulin and Insulin Resistance
Overview of Insulin Resistance
Hyperglycemia
Physical Activity for People with Diabetes
Exercise and Insulin
Exercise and Type 1 Diabetes
Sample Pre-exercise Checklist for People with Type 1
Post-exercise Glucose Levels
Exercise and Type 2 Diabetes
Sample Pre-exercise Checklist for People with Type 2
Summary
Facts At A Glance
Your Three Action Steps
Chapter 2
What is the Next Step?
Introduction
In-Depth Information
The ABCs of Diabetes
A1C
Blood Pressure
Cholesterol
Total Cholesterol
HDL and LDL
Triglycerides
Smoking
Summary
Facts At A Glance
Your Three Action Steps
Chapter 3
How Do I Prevent Complications? – Part 1
Introduction
In-Depth Information
Blood Pressure
What Is High Blood Pressure?
How High Blood Pressure Affects Diabetes
High Blood Pressure and Being Overweight
The Renin-Angiotensin-Aldosterone System Affect on High Blood Pressure
How the RAAS Works
How to Prevent and Control High Blood Pressure
Blood Pressure Medications
How to Get the Most Accurate Blood Pressure Reading
Cholesterol and Cardiovascular Disease
How Does Cholesterol Build Up in Your Body
What are LDL and HDL
Insulin Resistance and Cholesterol
How to Prevent and Control High Cholesterol
Low Blood Sugar/Hypoglycemia
How Glucose Works in Your Body
Why Low Glucose Levels Are Dangerous
What to Do When You’re Low
How to Prevent Hypoglycemia
Summary
Facts At A Glance
Your Three Action Steps
Chapter 4
How Do I Prevent Complications? - Part 2
Introduction
In-Depth Information
Diabetic Nephropathy (Kidney Disease)
Kidney Function
Pathogenesis – How Diabetic Nephropathy Develops
High Blood Sugar
High Blood Pressure
Proteinuria
Symptoms of Chronic Kidney Disease That Lead to Diabetic Nephropathy
Diagnosing Diabetic Nephropathy
Microalbuminuria
Glomerular Filtration Rate (GFR)
Serum Creatinine
When to Begin Testing for Diabetic Nephropathy
Prevention and Treatment
Diabetic Retinopathy (Eye Disease)
What is Diabetic Retinopathy
Pathogenesis – How Diabetic Retinopathy Develops
Symptoms of Diabetic Retinopathy
Diagnosing Diabetic Retinopathy
When to Begin Testing
Prevention and Treatment
Diabetic Neuropathy (Nerve Damage)
Pathogenesis – How Sensory Neuropathy Develops
Symptoms of Sensory Neuropathy
Prevention and Control
Treatment of Sensory Neuropathy
How to Perform Your Tests and Exams
Diabetic Foot Care
ABC MD Foot and Flu
A1C
Blood Pressure
Cholesterol and Creatinine
Microalbuminuria and Dilated Eye Exam
Microalbuminuria
Dilated Eye Examination
Foot Examination
Flu Shot
Summary
Facts At A Glance
Your Three Action Steps
Chapter 5
Medications
Introduction
Fasting Vs. Postprandial Hyperglycemia
General Medication Information
Classes of Diabetes Medications
Biguanide
Insulin Secretagogues: Sulfonylureas/Meglitinides
Thiazolidinedione (TZD)
Insulin
Incretin and Amylin
DPP-4 Inhibitor
Amylin
Summary
Facts At A Glance
Your Three Action Steps
Chapter 6
Insulin
Introduction
Insulin
The Four Classifications of Insulin
Insulin Profiles
Prandial Insulin
Basal Insulin
Prandial Insulin Dosing and the Insulin-to-Carbohydrate Ratio
Correction Factor or Dose Adjustment
Basal Insulin Dosing
Changes in Insulin Dosing
Injecting Insulin
Storing Insulin
Glucagon
Using a Glucagon Kit
Summary
Facts At A Glance
Your Three Action Steps
Chapter 7
Healthy Eating for People with Diabetes
By Kathy Kennedy-Mason, MPH, RD
The Essentials of Diet
Carbohydrates
Protein
Fats
Portions and Portion Control
How to Read a Food Label
Weight Loss
Exercise
Summary
Facts At A Glance
Your Three Action Steps
Afterword
Resources
Glossary
Bibliography
CHAPTER ONE
What is Diabetes?
Introduction
Today we have the advantage of many medical studies that demonstrate how to decrease the complications that have plagued people with diabetes. This literature tells us that the best strategy is one that is multi-focused on controlling blood glucose, blood pressure, cholesterol and protein in the urine, as well as on patient education, diet and exercise, and frequent monitoring to prevent complications. The good news is that these same medical studies provide information on how complications can be prevented or slowed. A person with diabetes does not have to be one of the statistics below.
People with diabetes face the possibility of many complications:
A two- to four-fold increase in risk for coronary heart disease. Coronary disease is the leading cause of death in people with diabetes over the age of 35.
Diabetes is the seventh leading cause of death overall;
Diabetes is the leading cause of chronic kidney disease and failure. Data from the 2005 U.S. Renal Data System documented that 44% of kidney failures occur in people with diabetes.
Nerve damage, called peripheral sensory neuropathy, may affect up to 60% of older people with type 2 diabetes.
Diabetes is the leading cause of blindness among adults 20-74 years of age.
Diabetes causes greater than 60% of all non-traumatic amputations.
75% of adults with diabetes have hypertension. People with diabetes risk increased severity of infections.
The risk of stroke is two to four times higher than people without diabetes.
When glucose is not controlled, the nature of diabetes is to progress to the complications listed above. It’s my firm belief that education about the disease is the first line of defense in understanding the reasons why these complications may develop and how to prevent them.
Many of us have daily routines in life and it’s unlikely that we’ll change those routines unless we’re given a strong enough reason to do so. At the same time, very few of us will intentionally put ourselves in a harmful situation if we actually know of the harm in advance. For example, you probably have a route to work that you drive every day. Imagine that one day, while driving on your usual route, you encountered a big sign indicating a detour because part of the road was washed out in a winter storm. You’d take the detour to work. The detour protected you by giving you important information and