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Aetna Presentation Diabetes

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Diabetes Mellitus …

Diabetes Mellitus

Evelyn Schumacher, MS, RD, CDE, Shands Jacksonville

May 27. 2005 - UNF Hispanic Health Issues Seminar

This is part 4 of an 8 part series of seminars on Hispanic Health Issues brought to you by the University of North Florida’s Dept. of Public Health, College of Health, a grant from AETNA, and the cooperation of Duval County Health Department.

Published in: Health & Medicine

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  • Transcript

    • 1. Diabetes Mellitus Presented by: Evelyn Schumacher, MS, RD, CDE
    • 2. What is Diabetes?
      • Diabetes Mellitus - “sweet urine”
      • The body’s inability to make or use insulin properly.
    • 3. Types of Diabetes
      • Type 1 Diabetes - body makes NO insulin
      • Type 2 Diabetes - body doesn’t make enough insulin or doesn’t use it properly
      • Gestational Diabetes - diabetes diagnosed during pregnancy
    • 4. The Disease: Diabetes
      • Over 18 million Americans have diabetes.
      • Diabetes is the sixth leading cause of death by disease among adults and second leading cause of death among children.
      • It is a national and world epidemic
    • 5. Signs and Symptoms
      • Frequent urination
      • Crave extra liquids
      • Always hungry
    • 6. Signs and Symptoms
      • Always tired
      • Blurry vision
      • Wounds that won’t heal
    • 7. Signs and Symptoms
      • Frequent infections
      • Numbness & tingling feet
      • Sexual dysfunction
      • Unexplained weight loss
    • 8. Risk Factors
      • Family member with diabetes
      • Overweight
      • Age
      • Ethnicity
    • 9. Diabetes Causes Serious Health Problems and Death
      • At least 210,000 deaths each year
      • 22 every hour
      • Causes 24,000 cases of diabetic blindness -- about 2 every hour
    • 10. Diabetes Causes Serious Health Problems and Death
      • Causes about 100,000 diabetic kidney failure -- 1,900 every week
      • Causes about 67,000 diabetic amputations -- about 7 every hour
    • 11. PRE-TEST
      • With diabetes, fruit juice raises your sugar less than regular soda? (T or F)
      • I have diabetes - I can eat sweet cereals? (T or F)
      • On the “Nutrition Facts” label which is more important? (Sugar or Total Carb)
      • High protein diets like Dr. Atkins and Sugar Busters are good for diabetes? (T or F)
      • Grapefruit juice burns calories and fat (T or F)
    • 12. PRE-TEST
      • About 50% of the food we eat in a day should come from? (Carb, Pro, Fat)
      • Eating protein provides quick energy? (T or F)
      • Cereal, milk and juice is a well balanced breakfast (T or F)
      • I understand reading food labels? (T or F)
      • People with diabetes need to eat special foods to control blood sugar? (T or F)
    • 13. BASIC DIGESTION S S S S S S S S S S S S S CELL
    • 14. BASIC DIGESTION S S S S S S S S S S S S S I I I Insulin Insulin Insulin
    • 15. BASIC DIGESTION S S S S S S S S S S S S S I I I I I I ENERGY
    • 16. DIABETES NOT A PROBLEM
      • Diabetes is a problem with the
      • way the body uses food .
      SUGAR
    • 17. WHAT TO DO...
      • Breakfast Lunch Supper
      B Lunch Dinner
    • 18. WHAT TO DO...
      • No breakfast - what happens by lunch?
      Lunch
    • 19. MORE DIFFICULT FOR YOUR BODY TO HANDLE THE FOOD EATEN S S S S S S S S S S S S S SSSSSS ENERGY I I I I I I
    • 20. NO DIABETES:
      • Blood sugar levels, appetite, and energy levels can remain stable.
      Breakfast 6am Lunch 12 noon
    • 21. 3 MAIN FOOD PARTS
      • Carbohydrate =
      • (sugar)
      • Protein =
      • Fat =
      ENERGY Building Block Protects
    • 22. FOOD GUIDE PYRAMID Bread, Cereal, Rice and Pasta Group Vegetable Fruit Milk Yogurt Meat Fish Poultry Oil Mayo Protein Fat Picture Story Of How We Should Eat
    • 23. 3 MAIN FOOD PARTS
      • Carbohydrate =
      • (sugar)
      ENERGY
    • 24. Sweet Beverages
      • Juice
      • Regular Soda
      • Sweet Tea
      • Kool-aid
      • Punch
    • 25. BASIC DIGESTION S S S S S S S S S S S S S CELL
    • 26. 3 MAIN FOOD PARTS
      • Carbohydrate =
      • (sugar)
      ENERGY 15 min
    • 27. Sweet Beverages (absorption is quick) Breakfast 6am Lunch 12 noon
    • 28. Fruit vs. Juice
      • Skin
      • Peel
      • Membranes
      • Strings
      • Seeds
    • 29. Fruit vs. Juice Fiber
    • 30. Fruit by Itself (absorption is quick) Breakfast 6am Lunch 12 noon
    • 31. Fruit by Itself (absorption is quick) Breakfast 6am Lunch 12 noon
    • 32. 3 MAIN FOOD PARTS
      • Carbohydrate =
      • (sugar)
      • Protein =
      • Fat =
      ENERGY Building Block Protects 15 min- 1 hr 2 - 3 hrs 6 - 12 hrs
    • 33. Balanced Meal (absorption is slower)
      • Appetite, energy level, and blood sugar are all more stable.
      Breakfast 6am Lunch 12 noon
    • 34. High Fat Meals (slows gastric emptying)
      • The high fat story
    • 35. How Much Fat?
      • 1 tsp oil = 1 fat serving
    • 36. How Much Fat?
      • To fry torillas - 1 tsp oil ?
      • NO
      • __?__ Fat servings
    • 37. How Much Fat?
      • To fry meat - 1 tsp oil ?
      • NO
      • __?__ Fat servings
    • 38. How Much Fat?
    • 39. How Much Fat?
    • 40. 3 MAIN FOOD PARTS
      • Carbohydrate =
      • (sugar)
      • Protein =
      • Fat =
      ENERGY Building Block Protects 15 min- 1 hr 2 - 3 hrs 6- 12 hrs
    • 41. High Fat Meals (slows gastric emptying) Breakfast 6am Lunch 12 noon 12 noon Midnight
    • 42. Blood Sugars are Elevated
      • Not because of the
    • 43. Blood Sugars are Elevated
      • But because of the
    • 44. Goals for Meal Planning
      • 1 st Goal: How many meals per day?
    • 45. Goals for Meal Planning
      • 1 st Goal: How many meals per day?
      • 3
    • 46. Goals for Meal Planning
      • 1 st Goal: How many meals per day?
      • 3
      • 2 nd Goal: How to balance the meals?
    • 47. Goals for Meal Planning
      • 1 st Goal: How many meals per day?
      • 3
      • 2 nd Goal: How to balance the meals?
      • ~50% carbohydrate
      • SMALL protein
      • SMALL fat
    • 48. FOOD GUIDE PYRAMID Bread, Cereal, Rice and Pasta Group Vegetable Fruit Milk Yogurt Meat Fish Poultry Oil Mayo 15 gr 15 gr 15 gr 5 gr
    • 49. 1800 Calorie Meal Plan 4 Carbohydrate Groups 4 Carbohydrate Groups 4 Carbohydrate Groups 2 Carbohydrate Groups 60 gr 60 gr 60 gr 30 gr
    • 50. Food Labels Nutrition Facts Serving Size 1 cup (248 g) Servings Per Container 4 Amount Per Serving Calories 150 Calories from Fat 35 % Daily Value Total Fat 4 g 6% Saturated Fat 2.5 g 12% Cholesterol 20 mg 7% Sodium 170 mg 7% Total Carbohydrate 17 g 6% Dietary Fiber 0 g 0% Sugars 17 g Protein 13 g
    • 51. Food Labels Nutrition Facts Serving Size 1 cup (248 g) Servings Per Container 4 Amount Per Serving Calories 150 Calories from Fat 35 % Daily Value Total Fat 4 g 6% Saturated Fat 2.5 g 12% Cholesterol 20 mg 7% Sodium 170 mg 7% Total Carbohydrate 17 g (15g) 6% Dietary Fiber 0 g 0% Sugars 17 g Protein 13 g
    • 52. Food Labels Nutrition Facts Serving Size 1 cup (248 g) Servings Per Container 4 Amount Per Serving Calories 150 Calories from Fat 35 % Daily Value Total Fat 4 g 6% Saturated Fat 2.5 g 12% Cholesterol 20 mg 7% Sodium 170 mg 7% Total Carbohydrate 17 g (15g) 6% Dietary Fiber 0 g 0% Sugars 17 g Protein 13 g
    • 53. What About Alcohol
      • Alcohol is processed like fat
      • Replaces 2 fat servings in the meal
      • Suppresses gluconeogenesis
      • Always consume a carb food with alcohol
    • 54. What About Alcohol
      • Alcohol is processed like fat
      • Replaces 2 fat servings in the meal
      • Suppresses gluconeogenesis
      • Always consume a carb food with alcohol
      • count carbs for alcohol
      DO NOT
    • 55. PRE-TEST
      • With diabetes, fruit juice raises your sugar less than regular soda? (T or F)
      • I have diabetes - I can eat sweet cereals? (T or F)
      • On the “Nutrition Facts” label which is more important? (Sugar or Total Carb)
      • High protein diets like Dr. Atkins and Sugar Busters are good for diabetes? (T or F)
      • Grapefruit juice burns calories and fat (T or F)
    • 56. PRE-TEST
      • About 50% of the food we eat in a day should come from? (Carb, Pro, Fat)
      • Eating protein provides quick energy? (T or F)
      • Cereal, milk and juice is a well balanced breakfast (T or F)
      • I understand reading food labels? (T or F)
      • People with diabetes need to eat special foods to control blood sugar? (T or F)
    • 57. We’re Here for You. . . Cure. Care. Commitment.
      • Visit us on the web at
      • www.diabetes.org
      • During the work week
      • Call 1-800-DIABETES
      • (1-800-342-2383)
      • (Monday-Friday, 8AM-8PM, EST)
    • 58. WHAT IS DIABETES?
      • A disease in which the body no longer produces or uses insulin properly
      • Type 1 diabetes – body makes no insulin
      • Type 2 diabetes – body doesn’t make enough insulin or doesn’t use it properly
    • 59. STATISTICS
      • Prevalence of Type 2 diabetes is 1.5 times higher in Latinos than non-Latino whites
      • Two million or 8.2% of all Latino Americans aged 20 years or older have diabetes
    • 60. STATISTICS
      • In the United states among those between ages 45 – 74:
      • ~24% of Mexican Americans have diabetes
      • ~26% of Puerto Ricans have diabetes
      • ~ 16% of Cuban Americans have diabetes
    • 61. DIABETES
      • ~ 18.2 million Americans have diabetes
      • ~ 1/3 of these are not diagnosed
      • ~ 41 million Americans have pre-diabetes
      • 6 th leading cause of death (69,301 listed on death certificates) in 2000
      • Contributed to 213,062 deaths
    • 62. COMPLICATIONS
      • Heart disease
      • Leading cause of diabetes related deaths
        • Adults with diabetes have 2 – 4 times higher heart disease death rate
      • - 2 studies have shown lower rates of heart attacks
      • among Mexican Americans
      • Stroke
        • Adults with diabetes have 2 – 4 times higher risk for stroke
    • 63. COMPLICATIONS
      • High Blood Pressure
      • ~ 73% of adults with diabetes have blood pressure > 130/80 or use medication for hypertension
    • 64. COMPLICATIONS
      • Blindness
        • Diabetes is leading cause of new blindness among adults 20-74 years old
        • Diabetic retinopathy causes 12,000 – 24,000 new cases of blindness every year
      • - Diabetic retinopathy among Hispanics is twice the
      • rate of non-Hispanic whites
    • 65. COMPLICATIONS
      • Kidney Disease
      • Diabetes is the leading cause of end stage kidney disease (dialysis)
      • No clear evidence of increased risk among Hispanics (survive longer on dialysis than non-Hispanic whites per one report)
    • 66. COMPLICATIONS
      • Nervous System Disease
      • 60% - 70% of people with diabetes have nervous system disease.
      • - impaired sensation or pain in hands/feet
      • - slowed digestion of food in stomach
      • - carpal tunnel syndrome
      • - other nerve problems
    • 67. COMPLICATIONS
      • Amputations
      • More than 60% of nontraumatic lower limb amputations are among those with diabetes
    • 68. COMPLICATIONS
      • Dental Disease
      • Gum disease more common among those with diabetes.
      • ~1/3 of people with diabetes have severe gum disease
    • 69. COMPLICATIONS
      • Pregnancy
      • Poorly controlled diabetes before conception and during first trimester can cause major birth defects in 5% - 10% of pregnancies and spontaneous abortions in 15% - 20% of pregnancies
      • Poorly controlled diabetes during 2 nd and 3 rd trimesters can result in excessively large babies
    • 70. COMPLICATIONS
      • Other Complications
      • People with diabetes are more susceptible to many other illnesses. Those who get the flu or pneumonia are more likely to die than those without diabetes
    • 71. DIABETES SIGNS & SYMPTOMS
      • Excessive thirst
      • Frequent urination
      • Extreme hunger
      • Increased fatigue
      • Irritability
      • Blurry vision
    • 72. RISK FACTORS
      • African Americans
      • Latinos
      • Native Americans
      • Asian Americans
      • Pacific Islanders
    • 73. RISK FACTORS
      • Family history
      • Obesity
      • Inactivity
      • Women who have had a baby weighing more than 9 pounds
      • 45 – 64 years old
    • 74. RISK FACTORS ( GENETIC IN HISPANICS)
      • American Indian or African genes thought to increase risk
    • 75. HISPANICS HOW MANY HAVE DIABETES?
      • Of minority groups - the 2 nd largest
      • The fastest growing minority group
      • 30 million had diabetes in 1998
      • By 2050 estimated 97 million Hispanics in the US (1/4 of the US population)
    • 76. DIABETES PREVENTION PROGRAM (DPP)
      • Diet and exercise can effectively delay diabetes
        • in a diverse population of overweight people
        • with impaired glucose tolerance (pre-diabetes)
    • 77. FREE PUBLICATION
      • “Take Charge of Your Diabetes”
      • Published by the CDC
      • In Spanish
      • In English
      • Call toll-free 1-877-232-3422
    • 78. DIABETES & NUTRITION
      • Some studies suggest that
      • More advanced diabetes in Hispanics
      • increases risk of inadequate nutrition
      • Diet and lifestyle change can prevent or lessen this impact
      • People with diabetes have the same nutritional needs as anyone else
    • 79. DIABETES MEAL PLAN
      • A guide to help you determine how much and the types of food you can choose
      • It should fit in with your schedule and eating habits
      • The right meal plan will help improve your blood sugar, blood pressure, cholesterol and help with weight goals
    • 80. DIABETES REMEDIES
      • Many Hispanics may use numerous diabetes remedies based on beliefs , in the hope of curing diabetes
      • Some may be harmless, some dangerous
      • There is no cure for diabetes – you can control it.
    • 81. TRADITIONAL ADVANTAGES
      • Many advantages in the traditional Hispanic diet:
        • Use of complex carbohydrates
        • Consumption of fruits and vegetables rich in vitamins A and C
        • Limited use of processed foods
        • Simple preparation and nutritionally balanced
    • 82. TRADITIONAL DRAWBACKS
      • Traditional Hispanic diets have a few drawbacks:
        • Liberal use of added fat
        • Many foods are fried (beans, meat, tortillas, rice and potatoes)
    • 83. NUTRITION MODIFICATIONS
      • Use corn tortillas (instead of flour)
      • Use part-skim cheeses
      • Use more fresh vegetables (cooked without added fat)
      • Use sugar substitutes instead of sugar
      • Use diet or sugar free beverages and water instead of high sugar beverages
    • 84. NUTRITION MODIFICATIONS
      • Use no added sugar (or sugar substitutes) in licuados and aguas frescas
      • Reduce oil in preparing sopas to < 1 tsp
      • Prepare frijoles cocidos (boiled beans) instead of frijoles refritos (refried beans)
      • Prepare meats asadas (grilled) instead of fried
      • Skim fat off broths and stocks when preparing caldos (soups)
    • 85. NUTRITION MODIFICATIONS
      • Use low-fat milk instead of whole milk or cream
      • Bake corn tortilla chips to replace fried chips
      • Instead of frying tortillas, heat them in the oven in foil; or in a heavy pan for a short time of each side; or in the microwave
    • 86. NUTRITION MODIFICATIONS
      • Taste food before salting it
      • Use lemon instead of salt on fruits or in beer
      • Add flavor using onions, garlic, cumin, oregano, cilantro, or other spices
      • If you fit alcoholic beverage into your meal plan do it according to guidelines and choose “light” beer
    • 87. Questions

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