Vol 5
EXCITE Program Monthly Newsletter
In this fifth issue of the Stroke Savvy newsletter we are continuing our risk factor series with diabetes Persons with diabetes have a twofold rise in risk for stroke This is a controllable risk factor that everyone should be aware of Please feel free to send comments or suggestions for the newsletter to Carol Giuliani at carol_giuliani@meduncedu or 919 966-9796 What is Diabetes? 1 Complications of Diabetes2 Reducing Risk Factors3 Reducing Risk Factors, contd4
WHAT IS DIABETES?
Diabetes is a disease that affects the bodys ability to produce or respond to insulin, a hormone that allows blood glucose blood sugar to enter the cells of the body and be used for energy Diabetes falls into two main categories: type 1, which usually begins during childhood or adolescence, and type 2, the most common form of the disease, usually occurring after age 45 TYPE 1- Insulin-Dependent Diabetes Mellitus- an auto-immune disease in which the body does not produce any insulin, most often occurring in children and young adults People with type 1 diabetes must take daily insulin injections to stay alive Type 1 diabetes accounts for 5-10 of diabetes cases TYPE 2-
Non- Insulin-Dependent Diabetes Mellitus- a metabolic disorder resulting from the bodys inability to make enough, or properly use insulin It is the most common form of the disease Type 2 diabetes accounts for 90-95 of diabetes cases Type 2 diabetes is nearing epidemic proportions, due to an increased number of older Americans and inactive lifestyles
Courtesy of ADA
PREVALENCE Diabetes prevalence increases with age Approximately half of all diabetes cases occur in people older than 55 years of age Nearly 20 of the United States population 63 million people age 65 and older have diabetes Common Signs and Symptoms of Diabetes Excessive thirst Frequent urination Extreme fatigue Unexplained weight loss Blurry vision from time to time If you are experiencing any of these signs or symptoms make an appointment with your physician for a check-up or screening
Editors: Shelley Piner Carolyn Martonffy, UNC-Chapel Hill, Division of Physical Therapy Copyright 2000-2001 Editors Note: We hope youre enjoying these issues Let us know what you think Please call Dr Giuliani with suggestions
Stroke Savvy
Vol 5 pg 2
WHAT ARE COMPLICATIONS OF DIABETES?
Heart Disease and Stroke Coronary Heart
Disease is present in 7-20 of persons with diabetes 45 yrs Persons with diabetes are 2 to 4 times more likely to have heart disease, which is present in 75 of diabetes-related deaths more than 77,000 deaths due to heart disease annually And, people with heart disease or diabetes are 2-4 times more likely to suffer a stroke This may be due to circulation problems that diabetes can cause In addition, brain damage may be more severe and extensive if blood sugar is high when a stroke happens Treating diabetes may delay the onset of complications that increase stroke risk However, even if persons with diabetes are taking medication and have their blood sugar under control, they may still have an increased stroke risk simply because they have diabetes Diabetes affects the nerves of many different systems in the body It is very important to be aware of the changes that might occur secondary to diabetes Vision Loss and Blindness Diabetes is the leading cause of blindness in adults 20-74 yrs Nerve Disease and Amputations About 60-70 of persons with diabetes have mild to severe forms of diabetic nerve damage, which, in severe forms, can lead to lower limb amputations The effects of diabetic
nerve damage on lower limbs are discussed on page 3, Feet and Nail Care In fact, diabetes is the most frequent cause of non-traumatic lower limb amputations The risk of a leg amputation is 15-40 times greater for a person with diabetes Each year, more than 56,000 amputations are performed among persons with diabetes Kidney Disease Persons with diabetes age 65 yrs and older are twice as likely to be hospitalized for kidney infections compared to those without diabetes Diabetes causes the kidneys to work extra hard to clean the blood of contaminants This hard work makes to kidneys more susceptible to infections and failure
Courtesy of ADA
REDUCING RISK FACTORS
The good news is that Diabetes mellitus TYPE 2 is controllable
Type 2 diabetes may be prevented or delayed by reducing lifestyle risk factors Since diabetes is associated with obesity, one of the best ways to prevent it is to lose weight Regular exercise is another step that can be taken to prevent this disease Regular check-ups at the doctors office of cholesterol, blood pressure and blood glucose levels is a good idea Persons with diabetes often are overweight, have hypertension and high blood cholesterol, which even
furthers their risk of stroke Checking glucose levels daily and eating a balanced diet along with taking insulin if prescribed are all crucial in the management of diabetes Below are tips for exercise, nutrition and foot care that should be helpful in the management of diabetes
Stroke Savvy Exercise
Vol 5 pg 3
Physical activity helps to manage diabetes by strengthening muscles and bones, controlling your weight, relieving stress, lowering bad cholesterol LDL and increasing good cholesterol HDL The following tips may help you begin or continue an exercise program: Begin with a slow warm-up for about 10 minutes Exercise for a few minutes each day keeps your body in better condition as opposed to exercising intensely once a week Find a buddy to go for a walk with or swim together so you will be able to encourage one another Make sure to monitor your 
blood-glucose during exercise if you have diabetes Hypoglycemia does occur during exercise low blood sugar Eating a light snack before exercise and keeping a light snack with you during exercise is suggested if you have diabetes to prevent low blood sugar Drink water during your exercise Wear shoes that are comfortable and make sure to
check your feet before and after exercise if you have diabetes
Feet and Nail Care
As a result of diabetes, often times people begin to lose sensation in their lower extremities If you are diabetic it is very possible that you could cut your foot or get a blister and not even feel it Therefore, it is important that you learn how to properly administer a foot exam on yourself and understand certain precautions you need to take with your feet
Things to remember if you have diabetes:
Your feet should be examined at least four times a year by a health care provider and you should know how to complete a thorough foot exam on a regular basis Wash your feet every day Make sure to dry well between your toes If your choose to put cream or lotion on your feet, do so after they have been dried well Do not put the cream or lotion between your toes Your feet should be checked every day You can do this by using an unbreakable mirror to see the bottom of your feet If you have vision problems, ask another person to help you Look for cuts, blisters or scrapes Remember to look between your toes Cut your toenails by following the shape of your toe Do not cut or use chemicals to remove corns or
calluses Test water with your arm or elbow before taking a bath Always wear socks and shoes indoors and outdoors Check your shoes before putting them on for any objects inside Do not buy shoes that are too small for your foot Ask your physician which shoes would be best for you
Stroke Savvy Nutrition
Vol 5 pg 4
Eating well is likely to keep your blood sugar better regulated This means less chance of heart disease, stroke and the other complications we have mentioned that can be associated with diabetes Your meal plan should fit with your lifestyle Ask your physician or dietician to help you come up with your own meal plan Generally it should be one that is low in saturated fat and high in fiber, fruits and vegetables Below are tips that could help you in changing your diet: Set reasonable goals Changing your diet is not an easy thing to accomplish Try changing one thing you eat every 2 weeks to begin with Use nutrition labels to guide your decisions in the foods you choose to eat Starches such as bread, cereal and pasta are a good source of nutrition It is recommended to have 6 servings a day of starches Vegetables can be added as snacks during the day or in casseroles or stews
Sugars and sweets should be limited Try cutting your usual dessert portion in half Choose lean cuts of meat and skinless chicken and seafood to help lower your intake of saturated fat Also choose an oil such as olive, sunflower, soybean or canola when cooking Methods of cooking such as grilling, poaching and broiling will help to reduce saturated fat in your diet
Courtesy of Patterns of Care, Guidelines for Diabetes Care: The North Carolina Diabetes Advisory Council, 1999
Complete your Newsletter Quiz and mail it back to your site to receive credit for the month
The medical information and figures presented in this newsletter were obtained with the permission of the National Stroke Association, American Heart Association, American Stroke Association, and American Diabetes Association for reproduction in this newsletter All content contained in this newsletter is copyright protected by the National Stroke Association, American Heart Association, the American Stroke Association and American Diabetes Association and may not be reproduced, sold, broadcast or disseminated in any form without permission from the corresponding provider Additional material was provided by the
University of North Carolina at Chapel Hill, Division of Physical Therapy and is copyright protected and may not be reproduced, sold, broadcast or disseminated in any form without permission from the UNC-CH Division of Physical Therapy
Vol 5 EXCITE Program Quiz Please answer the following questions using the information provided and return this portion of the document Good Luck Complete and return to:____________________________________________________ 1 Diabetes affects the bodys ability to produce a glycolic acid c adequate oxygen supply b insulin d pyruvate 2 What percentage of all diabetes cases occur in people older than 55 years of age? a 30 b 50 c 80 3 What are common complications of diabetes? a vision impairments c heart disease and stroke b nerve disease and amputations d all of the above 4 Can diabetes mellitus Type 2 be controlled? Y____ 5 What are 2 ways risks of diabetes can be controlled? ________________________________ ________________________________ 6 People with diabetes are how much more likely to have heart disease or a stroke? a 0x b 2-4x c 7-8x 7 What is the main difference in Type 1 and Type 2 diabetes? a age of onset b Type 1 is a deficiency in insulin
and Type 2 is a deficiency in blood level c Type 2 is controllable through lifestyle factors d A C 8 What is the leading cause of blindness in adults 20-74 years of age? a motor vehicle accident c low horomone levels b diabetes d high LDL levels bad cholesterol 9 Intense exercising once a week is better for your health than gentle exercising every day T____ F___ 10 List one important fact regarding diabetes and foot care _________________________________________________________________________ N____
