Diet and Diabetes

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  • 5.9% of the US population has diabetes that is approximately 15.1 million people. Each day 2,200 people are diagnosed. 798,000 will be diagnosed this year. It is the 7 th leading cause of death. There is no cure for diabetes only methods to treat its symptoms.
  • Gestational Diabetes develops in 2.5% of all pregnancies but disappears when the pregnancy is over. The women are at an increased risk for developing type II later in life. It is temporary form of production, or the pancreas’s inability to produce enough insulin. If the woman has hyperglycemia, her blood glucose crosses the placenta but her insulin does not. This can cause a high birth weight for baby
  • Diabetes often goes undiagnosed because many of it’s symptoms seem so harmless. Early detection and treatment can lower the incidence of complications.
  • Doctors diagnose on the basis of high levels of glucose in the blood. There are 2 types of blood tests used for screening and diagnostic. Screening is done on people with no symptoms of diabetes. You have probably seen these done at health fairs where blood is taken by pricking your finger. For a diagnostic tests, the physician draws blood from a vein. Two of the diagnostic tests are: Fasting Plasma Glucose Test – fasted for at least 8 hours. Oral Glucose Tolerance Test: Must fast overnight, then your fasting blood sugar is tested. You then receive 75 grams of glucose and blood samples are taken four times to measure blood glucose levels. Diabetes is actually diagnosed when two diagnostic test completed at different times/days show that your blood sugar is high.
  • Diabetics also must be pay close attention to their feet, this may be an issue with exercise. 1 in 5 people with diabetes enter the hospital due to foot problems. Usually due to poor wound healing which is caused by poor circulation.
  • Hemoglobin A1C is the blood test with a memory. Hemoglobin is the protein in red blood cells that carries oxygen. These blood cells stay in circulation for 2-3 months. It is not used to diagnose just to monitor blood sugar control. It is performed two times a year. A hemoglobin of 6% indicates good control and level>8% indicates action is needed.
  • Nutrition along with exercise and medication is important for good diabetes control. Diabetes control means keeping the blood sugar level as close to normal as possible. This can be done by eating a diet low in saturated fat and total fat, moderate in sodium and sugar, eating 5 or more fruits a day, a diet rich in whole grains, and moderate use of alcohol. Alcohol moves quickly through the blood without being broken down. The alcohol content of blood can be measured within 5 minutes of a having a drink. If you have diabetes alcohol can cause hypoglycemia.
  • Each year 190,000 people die as a result of diabetic complications. Diabetes complications are the seventh leading cause of death. They are all strongly related to high blood sugar. They include blindness- this is the leading cause of blindness in people 20 to 74 years of age. Kidney Disease – 10 –21% develop kidney disease, it is the most common cause of end-stage renal disease requiring the need of dialysis to live. Heart Disease and Stroke – diabetes are 2 –4 times more likely to have heart disease.
  • Nerve disease and amputations occur in 60 – 70% of diabetic patients. The risk is 40 times greater for a diabetic person to have some form of nerve damage. Impotence is due to diabetic nephropathy or blood vessel blockage it affects 13% of people with Type I and 8% of those with Type II.
  • After they feel better they need to eat regular meals and snacks.
  • Ketoacidosis is also known as a diabetic coma.
  • Hyperglycemia happens from time to time to all people who have diabetes. It is the technical term for high blood sugar. Other stresses can also cause it.
  • It is very important to treat it as soon as possible. Usually can lower it by exercising or injecting more insulin, be careful of the somogyi effect. This is the condition of hypoglycemia resulting from the treatment of hyperglycemia. Need to test blood sugar often. Testing and finding high blood sugar early can help avoid complications and symptoms of hyperglycemia.
  • Diabetes is a very complicated disease. It is the cause of great discomfort and death in this country alone. The best defense is to make everyone aware of the risk factors and symptoms to prevent and detect.
  • Diet and Diabetes

    1. 1. Diet and Diabetes Created by: Tricia Fleming, University of Kansas Dietetic Intern Tammy Beason, MS, RD, Nutrition Education Specialist, Family Nutrition Education Program December 2001
    2. 2. Diabetes- What is it? <ul><li>Body is not producing or has lost sensitivity to insulin. </li></ul><ul><li>Insulin is a hormone that is needed to convert sugar, starches and other food into energy. </li></ul><ul><li>Insulin is produced in the body by the pancreas. </li></ul>
    3. 3. Types of Diabetes <ul><li>There are several types of diabetes: </li></ul><ul><li>Type I - body does not produce any insulin. </li></ul><ul><li>Type II- body is not making enough or is losing sensitivity to insulin made. </li></ul>
    4. 4. Types of Diabetes <ul><li>Secondary - a consequence from another disease. For example, pancreatitis or cystic fibrosis. </li></ul><ul><li>Gestational Diabetes- diabetes during pregnancy. </li></ul><ul><li>Impaired Glucose Tolerance- an intermediate between normal and diabetes. </li></ul>
    5. 5. Quick Review-Anatomy of the Pancreas <ul><li>A gland that lies behind the stomach </li></ul><ul><li>Clusters of cells inside the pancreas known as the islets of Langerhans produces three hormones. </li></ul><ul><li>The islets contain 3 types of cells: </li></ul><ul><li>Alpha, beta, and delta. </li></ul><ul><li>Alpha cells produce glucagon. </li></ul>
    6. 6. Pancreas contd. <ul><li>Beta cells- produce insulin </li></ul><ul><li>Delta cells- produce somatostatin </li></ul><ul><li>These cells have special sensors that monitor levels of blood sugar and stimulate the release of the correct hormone. </li></ul>
    7. 7. Insulin and the other hormones <ul><li>Glucagon - Hormone that increases the amount of glucose in the blood when it is needed. </li></ul><ul><li>Somatostatin - Hormone that can suppress both glucagon and insulin when needed. </li></ul><ul><li>Insulin- Hormone that lowers blood glucose. </li></ul>
    8. 8. How Does Insulin Work? <ul><li>A person normally secretes insulin in response to an elevated blood sugar level. </li></ul><ul><li>It does this by accelerating blood sugars movement out of the blood and into the cells. </li></ul><ul><li>Cells will not allow blood sugar in without insulin. - this can cause a problem. </li></ul>
    9. 9. Why isn’t the body making insulin? <ul><li>In people with Type I, the immune system has made a big mistake! </li></ul><ul><li>It attacks the beta cells and destroys them! </li></ul><ul><li>In people with Type II, the pancreas is still making insulin, just not enough to keep up, or their bodies have become insulin resistant! </li></ul>
    10. 10. Type I <ul><li>Usually diagnosed in children and young adults. </li></ul><ul><li>Must take daily insulin shots to stay alive. </li></ul><ul><li>Type I accounts for 5-10% of the population with diabetes. </li></ul>
    11. 11. Type II <ul><li>The most common form of the disease. </li></ul><ul><li>Approximately 50% of men and 70% of women are obese at the time of diagnosis. </li></ul><ul><li>Nearing epidemic proportions, due to increase # of older Americans, greater occurrence of obesity and sedentary lifestyles. </li></ul>
    12. 12. Gestational Diabetes <ul><li>Pregnant women have a higher insulin level. </li></ul><ul><li>If woman has hyperglycemia, her blood glucose crosses the placenta but her insulin does not. </li></ul><ul><li>This can cause a high birth weight for baby. </li></ul>
    13. 13. What are the Symptoms? <ul><li>Polyphasia- excessive eating </li></ul><ul><li>Polyurea- excessive urination </li></ul><ul><li>Polydypsia-excessive fluid intake </li></ul><ul><li>Blurred vision </li></ul><ul><li>Poor wound healing </li></ul><ul><li>Irritability </li></ul>
    14. 14. How are you diagnosed with diabetes? <ul><li>In June 1997, the ADA redefined it’s criteria for diagnosing diabetes. </li></ul><ul><li>Normal fasting blood glucose is <110 mg/dl. </li></ul><ul><li>Impaired fasting glucose is >110 and <126 mg/dl. </li></ul><ul><li>Provisional diagnosis for diabetes>126 mg/dl </li></ul>
    15. 15. Diagnosis contd. <ul><li>In order to be diagnosed with diabetes: </li></ul><ul><li>Person must have symptoms of diabetes + </li></ul><ul><li>Causal plasma glucose >200 </li></ul><ul><li>Fasting blood glucose of >126 mg/dl </li></ul><ul><li>2-hour plasma glucose >200 mg/dl on oral glucose test </li></ul>
    16. 16. Who’s at risk? <ul><li>ADA now recommends that screening for diabetes should be considered for all patients at age 45. If the results are normal it should be repeated every 3 years. </li></ul><ul><li>Screening should be considered at a younger age if patient meets following risk factors: </li></ul>
    17. 17. Who’s at risk? <ul><li>Obesity </li></ul><ul><li>First degree relative with diabetes </li></ul><ul><li>Belongs to a high-risk ethnic group </li></ul><ul><li>Was diagnosed with gestational diabetes or delivered a baby whose birth weight >9 lbs. </li></ul><ul><li>Hypertension </li></ul>
    18. 18. Who’s at risk? <ul><li>HDL level<35 or triglycerides >250 </li></ul><ul><li>Found to have impaired glucose tolerance or impaired fasting on a previous test. </li></ul>
    19. 19. I’ve got Diabetes, now what? <ul><li>After diagnosis, there is a great need for education. </li></ul><ul><li>A diabetic diet is no different from anyone else’s but they must keep track of what they eat. </li></ul><ul><li>A food diary is a great start! </li></ul><ul><li>Serving sizes must be emphasized. </li></ul>
    20. 20. Treatment Goals for Type I <ul><li>Match insulin to food intake. </li></ul><ul><li>Type I’s are encouraged to be precise and regular from day to day with food intake, insulin regimen, and activity. </li></ul>
    21. 21. Exercise and Type I’s <ul><li>Increases flexibility, muscular strength , and well being. </li></ul><ul><li>Must monitor insulin and food intake to match exercise regimen. </li></ul><ul><li>Increases insulin effectiveness and sensitivity in the body. </li></ul>
    22. 22. Treatment Goals for Type II <ul><li>Achieve normal or near-normal blood glucose levels. </li></ul><ul><li>Provide adequate calories for reasonable body weight. </li></ul><ul><li>Prevent, delay or treat nutrition related complications. </li></ul><ul><li>Improve health through optimal nutrition. </li></ul>
    23. 23. Exercise and Type II <ul><li>Especially beneficial in type II diabetes. </li></ul><ul><li>Promotes weight loss </li></ul><ul><li>Increases insulin sensitivity. </li></ul><ul><li>Must also be aware of medication and intake to prevent hypoglycemia. </li></ul>
    24. 24. Treatment of Diabetes <ul><li>Diet plays a major role. </li></ul><ul><li>Carbohydrates are the component of food that causes an increase in blood sugar. </li></ul><ul><li>Diabetics are encouraged to keep track of the amount of CHO they eat. </li></ul>
    25. 25. Methods of Carbohydrate Control <ul><li>There are many new methods of controlling diabetes, these are still the two most common. </li></ul><ul><li>Exchange Lists </li></ul><ul><li>Carbohydrate counting- Very basic, allows a little more freedom and variety. </li></ul>
    26. 26. Blood Glucose Monitoring <ul><li>All diabetics must keep track of blood glucose levels. </li></ul><ul><li>This is the only way to know if the treatment is effective. </li></ul><ul><li>Gives the diabetic a good indication of what affects their blood sugar level. </li></ul><ul><li>Must check at least 2 times a day and four times a day for at least 3 days a week. </li></ul>
    27. 27. Hemoglobin A1c <ul><li>A good indicator of blood glucose control. </li></ul><ul><li>Gives a % that indicates control over the preceding 2-3 months. </li></ul><ul><li>Performed 2 times a year. </li></ul><ul><li>A hemoglobin of 6% indicates good control and level >8% indicates action is needed. </li></ul>
    28. 28. Dietary Guidelines <ul><li>Eat a diet low in saturated and total fat. </li></ul><ul><li>Eat a diet moderate in sodium and sugar. </li></ul><ul><li>Eat 5 or more fruits and vegetables a day. </li></ul><ul><li>Choose a diet rich in whole grains. </li></ul><ul><li>Moderate use of alcohol </li></ul>
    29. 29. Dietary Guidelines <ul><li>Eat at the same time everyday , at least within 1 hour of regular time. </li></ul><ul><li>Eat about the same amount of carbohydrate with each meal. </li></ul>
    30. 30. Other Treatments <ul><li>Type I and sometimes Type II patients need to be treated with insulin. </li></ul><ul><li>There are more than 20 types. </li></ul><ul><li>They differ in how they are made, how they work in the body and their cost. </li></ul>
    31. 31. Oral Medications <ul><li>Used to treat Type II diabetics. There are four basic types: </li></ul><ul><li>Sulfonylurea-stimulates the body to make more insulin. </li></ul><ul><li>Metformin-lowers blood sugar by helping the insulin work better </li></ul>
    32. 32. Oral medications <ul><li>Thiazolidinediones- increases muscle sensitivity to insulin. </li></ul><ul><li>Alpha-glucosidase inhibitors- slow the process of carbohydrate digestion. </li></ul>
    33. 33. Treatment Goals <ul><li>The main goal is to normalize blood sugar. Realistic goals for diabetics are 70-140 mg/dl before meals, <180 mg/dl after and a glycosolated hemoglobin within 1% of normal. </li></ul><ul><li>Need good blood glucose control to avoid complications. </li></ul>
    34. 34. Diabetes Complications <ul><li>Diabetes complications are the seventh leading cause of death. They include: </li></ul><ul><li>Blindness- caused by diabetic retinopathy. </li></ul><ul><li>Kidney Disease- diabetic nephropathy </li></ul><ul><li>Heart Disease and Stroke </li></ul>
    35. 35. Complications contd <ul><li>Nerve disease and amputations </li></ul><ul><li>Impotence </li></ul>
    36. 36. How to Avoid Complications <ul><li>Control weight </li></ul><ul><li>Eat a healthy well-balanced diet. </li></ul><ul><li>Get regular exercise </li></ul><ul><li>Have regular checkups </li></ul><ul><li>Check feet everyday for cuts and blisters </li></ul><ul><li>Do not smoke! </li></ul>
    37. 37. How to Avoid Complications <ul><li>Keep blood sugars normal </li></ul><ul><li>Avoid the 2 common diabetic problems, </li></ul><ul><li>hypoglycemia and hyperglycemia </li></ul>
    38. 38. Hypoglycemia <ul><li>Hypoglycemia- low blood sugar </li></ul><ul><li>Happens to everyone with diabetes </li></ul><ul><li>Symptoms include shakiness, dizziness, sweating, hunger, headache, pale skin, sudden moodiness, clumsy or jerky movements, difficulty paying attention, and tingling sensations around mouth. </li></ul>
    39. 39. Hypoglycemia <ul><li>How to treat Hypoglycemia: </li></ul><ul><li>Quickest way to raise blood glucose is with some form of sugar. </li></ul><ul><li>3 glucose tablets, 1/2 cup of fruit juice, 5-6 pieces of candy. </li></ul><ul><li>Wait 15-20 minutes and test blood sugar again. If still low retreat. </li></ul>
    40. 40. Hypoglycemia <ul><li>If hypoglycemia goes untreated, patient could get worse and pass out! </li></ul><ul><li>Stress the importance of a night time snack in older patients. </li></ul>
    41. 41. Hyperglycemia <ul><li>Ketoacidosis: Develops when the body does not have enough insulin. The body can’t break down sugar so it breaks down fat instead. Ketones are what is left from this process.The body does not tolerate ketones and tries to pass them out of the body. </li></ul>
    42. 42. Hyperglycemia <ul><li>Symptoms that may result in ketoacidosis occur when: </li></ul><ul><li>Too little insulin has been ejected, or insulin is not effective. </li></ul><ul><li>Consumed more food and/or exercised less than expected. </li></ul><ul><li>High blood sugar, high levels of sugar in the urine, frequent urination, and increased thirst </li></ul>
    43. 43. How to treat Hyperglycemia <ul><li>Usually can lower it by exercising, or injecting more insulin, be careful of the somogyi effect . </li></ul><ul><li>The somogyi effect is the condition of hypoglycemia resulting from the treatment of hyperglycemia. </li></ul>
    44. 44. Conclusion <ul><li>Diabetes is a very complicated disease. </li></ul><ul><li>For more information: www.diabetes.org </li></ul>

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