Diabetes Management Lecture 2
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Diabetes Management Lecture 2 Diabetes Management Lecture 2 Presentation Transcript

  • The Basics of Blood Glucose Control (or The Cans and Cannots of Good Diabetes Management ) Lecture 2 by Eric Holzman
  • A Diabetic’s Guide to Managing Diabetes Carbohydrates—our friend and our enemy • Food is the human body’s energy source. • Most of our food comes from plants. • Our digestive system converts carbohydrate in plants to glucose. • Glucose is present in our blood stream at all times. – primary source of energy for the body’s cells. – excess glucose is stored as fat. • Glucometer: device that measures the amount of glucose in blood. • A non-diabetic person has about 90 milligrams of glucose per deca-liter of blood* – or just 1 teaspoon in the entire human circulatory system. – Amount is controlled very tightly by the pancreas and liver. *Guyton & Hall, p.890. 9-13-07 by Eric Holzman 2
  • A Diabetic’s Guide to Managing Diabetes Insulin—we cannot live without it • Insulin is a hormone secreted by the pancreas. • It must be present for glucose to enter a cell. • Diabetics suffer from insulin-related problems. • A person with untreated diabetes can easily have a blood glucose level that is many times the normal concentration. *Guyton & Hall, p.890. 9-13-07 by Eric Holzman 3
  • A Diabetic’s Guide to Managing Diabetes Diabetes is caused by the body’s inability to make or use insulin • Specialized cells in the pancreas create insulin. • Type 1 diabetes: body attacks pancreas & destroys insulin-making cells. • Type 2 diabetes: insulin ineffective in transferring glucose across cellular boundary. • Diabetics have too much glucose in their blood. • Over time, high blood glucose wears down the entire body. Type 1 Diabetes: Immune system attacks pancreas’ Type 2 Diabetes: insulin-producing cells. insulin is unable to transfer glucose into Blood flows to every cells effectively. part of the body. glucose insulin cell 9-13-07 by Eric Holzman 4
  • A Diabetic’s Guide to Managing Diabetes Diabetes left untreated means a shorter life and horrible complications • The damage caused by diabetes accumulates over time. • Too much blood glucose will damage nearly every organ in your body. • Severe complications such as kidney failure, blindness, heart failure, stroke and nerve damage are sure to occur. 9-13-07 by Eric Holzman 5
  • A Diabetic’s Guide to Managing Diabetes It is never too late to stop the disease’s progression • Today’s medication and glucometers enable tight blood glucose control and prevention of complications. • Diabetics still must exercise and limit their intake of carbohydrates. • Diabetics cannot expect to live like normal people, eating as much as they want of whatever they want, whenever they want. • The goal of every diabetic should be a blood glucose level in the normal range all the time. 9-13-07 by Eric Holzman 6
  • A Diabetic’s Guide to Managing Diabetes Eating a low carbohydrate diet makes maintaining a normal blood glucose level easier • Diet is a big part of diabetes management. • Foods with carbohydrate raise the body’s blood glucose level. • Insulin causes the blood glucose level to decrease. • The less carbohydrate eaten, the less the rise in blood glucose level, and the less insulin needed. • One well-respected diabetic endocrinologist recommends eating no more than 30 grams (1 ounce) of carbohydrate a day*. • Arctic people live with nearly no carbohydrate in their diet. – The rest of us might not enjoy their diet, which includes raw seal meat. *Bernstein, p. 145 9-13-07 by Eric Holzman 7
  • A Diabetic’s Guide to Managing Diabetes Many foods that have carbohydrate contain other important nutrients • People can live without carbohydrate, but… – many vegetables contain vitamins and minerals that are essential for our body’s metabolic processes. – carbohydrate is a source of energy—without it, energy must come from fat or protein. – carbohydrate tastes good. • Saturated fat—raises cholesterol*. • Unsaturated fat—high in calories, but generally healthy. • Protein—too much protein may not be good for those with kidney problems†. • How much carbohydrate can a diabetic eat? • As much as he or she can eat while maintaining a normal blood glucose level. *Guyton and Hall †Franz 9-13-07 by Eric Holzman 8
  • A Diabetic’s Guide to Managing Diabetes Food—you cannot eat like a normal person • There is too much uncertainty in how your body will respond – to the carbohydrate in food, to the medication you take, and to your activity level. • The more carbohydrate you eat, the bigger your risk of – a serious low blood glucose reaction – an unacceptably high blood glucose level • You must limit your carbohydrate intake – to prevent problems and – maintain a normal blood glucose level. • Carb-counting is essential for all Type 1 and many Type 2 diabetics. – you must count each gram of CHO by weighing your food or reading the package. – The better you do it, the more you can eat without problems. • I eat about 110 grams of carbohydrate daily, spread over 4 meals. – breakfast (10 grams), lunch (40 grams), dinner (40 grams), snack (20 grams) – BG level: below 100 mg/dL 80% of the time. Meter monthly average is 85-95 mg/dL. – I have had no low blood glucose reactions that I could not treat myself. 9-13-07 by Eric Holzman 9
  • A Diabetic’s Guide to Managing Diabetes Medication is Not a Cure, but it Helps • There are two types of medication—(1) insulin and (2) everything else. Insulins Other medications 1. enable carbohydrates to enter cells 1. improve body’s ability to use insulin 2. treat Type 1 and Type 2 diabetes 2. treat Type 2 diabetes 3. lower blood glucose quickly (~1 hour) 3. lower blood glucose slowly (weeks) 4. overdose causes low blood glucose 4. Mostly do not cause hypoglycemia 5. organ-safe, even after long term use 5. may have other side-effects 6. Inject or inhale 6. ingestible as pills We will focus on insulin 9-13-07 by Eric Holzman 10
  • A Diabetic’s Guide to Managing Diabetes Exercise is an essential part of diabetes management • How much insulin you need depends on your activity level. – Are you a couch potato or an athlete? • Exercise immediately increases the body’s sensitivity to insulin. – you need less insulin if you exercise after eating. • The increased insulin sensitivity can last for hours or days depending on your exercise’s – frequency, – duration and – intensity. • How does one compensate injected insulin dosing for exercise? – By eating more – By taking less insulin 9-13-07 by Eric Holzman 11
  • A Diabetic’s Guide to Managing Diabetes Self blood glucose testing is the only way to know how you are doing • Your blood glucose (BG) level is continuously varying. • A glucometer measures your BG level at one instant in time. – One test does not tell you whether your BG level is stable, rising or falling. – A minimum of two readings are needed to assess change in BG level. • Unless you know your BG level, you – don’t know if it is normal, – don’t know if it is too high, – may not know if it is too low, – can’t treat yourself. • How often should you test your blood glucose level? – The answer depends on how quickly and how much your blood glucose level changes and how variable is your lifestyle. – Most Type 1 diabetics should test before & after each meal & at bed time. • All diabetics should take an HbA1c blood test 2-4 times a year. – a long-term (2-4 months) “average” of your BG level. 9-13-07 by Eric Holzman 12
  • A Diabetic’s Guide to Managing Diabetes The essentials of good diabetes management—treat your body like a temple • Always aim for a normal blood glucose level: 80-100 mg/dl – Never go to sleep or wake up above your goal range. • Diet – Don’t eat much “worthless” carbohydrate (potatoes, bread, rice,…). – Don’t overeat—limit carbohydrate intake to 40-50 grams per meal. – Count carbs: weigh all food and calculate carbohydrate content. • Exercise at least 30 minutes every day. • Measure blood glucose before & after each meal—6 to 8 times a day. – Use the data to select insulin dosing. • Record daily in writing carbohydrate eaten, medication taken, and minutes of exercise. • Take an HbA1c blood test at least twice a year. – Independent confirmation of your blood glucose level. • See a doctor every year for a physical. – See an endocrinologist (diabetes specialist) and an ophthalmologist (eyes) 9-13-07 by Eric Holzman 13
  • A Diabetic’s Guide to Managing Diabetes Three Simple Metrics Assist Me in Keeping my Blood Glucose Level Normal • A metric is a “standard of measurement” (Merriam-Webster on-line). • My metrics help me interpret my records in a consistent, quantifiable way. • They are easy to calculate. • I can understand quantitatively how my blood glucose level changes with carbohydrate intake, exercise and medication. • Insulin metric: how many points my blood glucose level decreases for every unit of insulin I take. • Blood glucose metric: how many points my blood glucose level increases for every gram of carbohydrate I eat. • Exercise metric: how many points my blood glucose level decreases for every minute I exercise. -40 points/unit +6 points/gram -2 points/minute 9-13-07 by Eric Holzman 14
  • A Diabetic’s Guide to Managing Diabetes References 1. R. Bernstein, Dr. Bernstein’s Diabetes Solution, Little, Brown and Company, 1997. 2. A. C. Guyton and J. E. Hall, Textbook of Medical Physiology, 10th edition, W. B. Saunders Company, 2000. 3. M. J. Franz,”Protein: New Research/New Recommendations,” Diabetes Self-Management, November/December 2001, pp. 85-87. 4. Images from Google™ Image Search at http://images.google.com 9-13-07 by Eric Holzman 15