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Strike The Spike

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Strike The Spike

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    1. Strike The Spike! Strategies for Combatting After-Meal Highs Gary Scheiner MS, CDE

    2. Overview Definitions Risks Detection Management

    3. After-Meal Peaks Defined The net rise that occurs from before eating to the highest point after eating. ADA Goal: <180 mg/dl 1-2 hrs after start of meal DCCT Goals: <180 mg/dl 2 hrs after meal European Diabetes Policy Grp: <165 (to prevent complications)

    4. After-Meal Goals for Children Under 5 Years: <250 @ 1 hr. post-meal (<120 pt. Rise) 5-11 Years: <225 @ 1 hr. post-meal (<100 pt. Rise) 12 Years + < 200 @ 1 hr. post-meal (<80 pt. Rise)

    5. After-Meal Peaks: Reality for children

    6. After-Meal Peaks: Reality in Children

    7. After-Meal Highs: Immediate Problems Tiredness Difficulty Concentrating Impaired Athletic Performance Decreased desire to move Mood Shifts Enhanced Hunger

    8. Long-Term Problems

    9. Long-Term Problems (contd)

    10. Long-Term Problems (contd)

    13. Measurement of After-Meal Peaks SMBG Capillary (finger) test After completion of meal Check BG 1 Hr PP (or) every 15, 20 or 30 min until 2 consecutive BG drops occur No addl. Food/insulin until test is completed

    14. Meter Test Example

    15. Meter Test Example Time pp BG Value Premeal 135 :20 155 :40 168 1:00 214 1:20 222 1:40 175 2:00 141

    16. Measurement of After-Meal Peaks CGMS (Medtronic) Worn for 72 hrs (or more), then data is downloaded Meals should be entered as “events” while wearing Calculates 1 & 3-hr post-meal averages

    17. Measurement of After-Meal Peaks Real-Time Continuous Glucose Monitors Allow tracking of post-meal trends Produce BG estimates every 5 minutes

    18. CGMS Case Study

    19. CGMS Case Study

    20. CGMS Case Studies

    21. After-Meal Spike Reduction Lifestyle Approaches Medicinal Approaches

    22. Glycemic Index All carbs (except fiber) convert to blood glucose eventually G.I. Reflects the magnitude of blood glucose rise for the first 2 hours following ingestion G.I. Number is % or rise relative to pure glucose (100% of glucose is in bloodstream within 2 hours)

    23. Glycemic Index (contd.) Example: Spaghetti GI = 37 Only 37% of spaghetti’s carbs turn into blood glucose in the first 2 hours. The rest will convert to blood glucose over the next several hours.

    24. Glycemic Index (contd)

    25. Glycemic Index (contd) Use of Glycemic Index Lower GI foods digest & convert to glucose more slowly High-fiber slower than low Hi-fat slower than low Solids slower than liquids Cold foods slower than hot Type of sugar/starch affects GI

    26. Glycemic Index (contd.)

    27. Examples: Use of GI

    28. Choice of Bolus Insulin

    29. Timing of Bolus Insulin

    30. Timing of Bolus Insulin

    31. Does Timing Matter?

    32. Does Timing Matter? Bolus w/meal Bolus pre-meal

    33. Choice of Insulin Program

    34. Injectible Symlin (Amylin Pharmaceuticals)

    35. Injectible Symlin (Amylin Pharmaceuticals)

    36. Physical Activity Intervention

    37. Examples: After-Meal/Snack Activity Walking Pets Household Chores Planned Exercise Yard Work Gym Class??? Shooting Hoops Dancing Bowling Mini Golf Skating

    38. Examples: After-Meal/Snack Activity

    39. Summary

    40. For More Information: Gary Scheiner MS, CDE Integrated Diabetes Services 877-735-3648 (877-SELF-MGT) Website: www.integrateddiabetes.com E-mail: gary@integrateddiabetes.com

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