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.

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  • 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