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‫الدولية‬ ‫المأمون‬ ‫مؤسسة‬
‫التغذية‬ ‫دبلوم‬
‫اللبان‬ ‫لؤي‬ ‫الدكتور‬
 Definition:
A condition associated with loss of sugar in the
urine.
It was diagnosed in first century AD by a Greek
phys...
 Diabetes is a Greek word means Siphon
or to pass through.
Mellitus is a Latin word means Honey
because of the sweetness ...
 The term Diabetes mellitus is used to
describe a group of conditions characterized
by raised blood glucose levels (
hype...
 Paul Langerhans found that the pancreas is
the primary organ involved in the disease.
 In 1921-1922 University of Toron...
‫بالبدانة‬ ‫السكر‬ ‫عالقة‬
 The relation between Diabetes and
obesity was observed in around 1800’s
when a French scienti...
1- Diabete gras: fat diabetes
2- Diabete maigre: thin diabetes
1-‫سمين‬ ‫سكري‬ ‫داء‬
2-‫نحيف‬ ‫سكري‬ ‫داء‬
Glucose and Insulin
Prevalence of Diabetes ‫انتشار‬ ‫حدة‬
‫السكري‬
 Total: 23.6 million children and adults --
8.0% of the population -- have...
 Undiagnosed: 5.7 million people
 Pre-diabetes: 57 million people
 1.6 million new cases of diabetes were
diagnosed in ...
In 2003, the total was 194 million.
In 2007, it is estimated that there are 246
million people with diabetes in the adult
...
‫الزيادة‬ ‫هذه‬ ‫أسباب‬
Causes of the rise:
• The alarming increase of diabetes
prevalence is projected to occur
because o...
• Population ageing ‫العمر‬ ‫أرتفاع‬
• Unhealthy diet ‫الصحية‬ ‫غير‬ ‫التغذية‬
• Overweight and obesity ‫الوزن‬ ‫زيادة‬
‫و...
Classification : ‫السكري‬ ‫الداء‬ ‫تصنيف‬
1- Type 1 diabetes ( T1DM ) previously known
as insulin-dependant diabetes. Ther...
 2- Type 2 diabetes ( T2DM ) or non-
insulin dependent diabetes which is
caused by resistance to the action of
insulin. I...
Other types of Diabetes: ‫من‬ ‫االخرى‬ ‫االنواع‬
‫السكري‬
1- Impaired Glucose Tolerance IGT
2- Impaired Fasting Glucose IF...
3- Gestational Diabetes GD: Diabetes
developed during pregnancy.
These types may represent the earliest
stages of Diabetes...
The Pancreas
INSULIN SECRETION
Insulin Production
Diabetes
Type 1 Diabetes
Diabetes prevalence
PREVALENCE OF DIABETES BY
THE AGE
Diabetes progression
CRITERIA FOR DIAGNOSING DIABETES
DIABETES
TYPE
TERM CAUSES CRITERIA
TYPE 1 DIABETES -Insulin-Dependant
Diabetes mellitus.
...
Symtoms of Diabetes type 1:
‫نوع‬ ‫السكر‬ ‫أعراض‬1:
- Increased thirst ( polydipsia )
- Increased urination ( polyuria )
-...
- Increased hunger ( polyphgia )
- Weight loss
- Fruity smell to breath ( symptoms of
ketoacidosis (
- Fatigue or weakness...
Symptoms of Diabetes type 2: ‫السكري‬ ‫أعراض‬
‫نوع‬2
- Poor wound healing or recurrent infections.
- Blurred vision ( resu...
HYPOGLYCEMIA AND
HYPERGLYCEMIA
TREATMENT OF
DIABETES
‫السكري‬ ‫الداء‬ ‫معالجة‬1- Medical approach:
- Diabetes type 1:
 Insulin injection
 Insulin pump
...
 Older children and teenagers may
benefit from Multiple Daily Injection
(MDI) of insulin to increase flexibility in
lifes...
- Diabetes type 2:
 Insulin regulating drugs
‫النوع‬ ‫السكري‬ ‫معلجة‬2:
1-‫لالنسولين‬ ‫المعدلة‬ ‫االدوية‬
Diabetes injection
MEDICATIONS FOR
DIABETES
MEAL PLANNING AND FOOD
SELECTION
‫االطعمة‬ ‫وانتقاء‬ ‫الغذائية‬ ‫الخطة‬
 Providing dietary advice and
coordinating food m...
 Distribution of carbohydrates in several
frequent small meals or snacks
improves glycemic control.
 Food selection shou...
 Taking into consideration cases of food
intolerances and allergies.
‫أية‬ ‫هناك‬ ‫كان‬ ‫أن‬ ‫االعتبار‬ ‫بعين‬ ‫نأخذ‬ ‫أ...
 Nutrition education to shift the intake
from unhealthy foods to foods that have
healthy properties like omeg-3 fatty
aci...
NUTRITIONAL MANAGEMENT OF
DIABETES
‫السكري‬ ‫داء‬ ‫لمعاجة‬ ‫الغذائي‬ ‫التدخل‬
1- Type 1 diabetes mellitus:
 Energy suffic...
 Meals and snacks should be consumed
at consistent times throughout the day
and should be synchronized with the
action of...
 Macronutrients and micronutrients are the
same as for children without diabetes.
 Fat restriction to ≤ 30% of total ene...
2- Type 2 diabetes mellitus:
‫نوع‬ ‫السكري‬2
 Weight management: loss 5-10% improves
glycemic control.
 Reduce BMI ≤ 25
...
 Exercise
 Maintenance of weight loss.
 Adjustment in hypoglycemic medications
‫الرياضة‬
‫الطبيعي‬ ‫الوزن‬ ‫على‬ ‫الم...
Carbohydrates:
 50-60% of daily energy intake from high fiber
cereals, breads, legumes. Limited amounts
of added sugars a...
 High-Glycemic-Index (GI) foods are
replaced with low-glycemic-index food to
slow glucose absorption
‫غاليسيمي‬ ‫مؤشر‬ ‫...
 Sugars up to 10% of daily energy from
sugars like fructose,sucrose.
 Fiber:intake 25-35 g/daily from different
sources....
 Break up caloric intake
○ Breakfast: 20%
○ Lunch: 40%
. Dinner : 40 %
‫كالتالي‬ ‫الحريرات‬ ‫توزيع‬:
‫االفطار‬20%
‫الغذاء...
Protein:
 Recommended intake 0.86/kg/day.
 Less than 15-20% of energy intake is not
recommended.
‫البروتين‬
‫بها‬ ‫الن...
 Sources of vegetable protein to replace
animal protein as they contain more
soluble fiber and less saturated fat and
cho...
Fats:
 Total fats ≤ 30% OF daily energy
requirements.
‫من‬ ‫أقل‬ ‫بنسبة‬ ‫تكون‬ ‫أن‬ ‫يجب‬ ‫الدهون‬30%‫من‬
‫الطاقة‬ ‫كام...
 Saturated and trans fatty acids ≤ 10% of
energy intake.
 Polyunsaturated fatty acids ≤ 10%
 Fish high in omega-3 fatty...
- Gestational diabetes:
-‫الحملي‬ ‫السكر‬ ‫معالجة‬
 Goal is to achieve normalglycemia while
eating a nutitionally adequat...
 Preconception counseling is
recommended.
 Normal weigh gain for pregnancy is
recommended.
‫الحمل‬ ‫فترة‬ ‫خالل‬ ‫باالس...
 Multivitamins with 0.4 mg to 1 mg/day
folic acids prior to conception and during
early weeks of pregnancy is
recommended...
 Food choices divided into 6 small meals
through the day to reduces glycemic peak
and hypoglycemia.
 Evening snack is re...
CO-EXISTING MEDICAL CONDITIONS
‫للسكري‬ ‫المصاحبة‬ ‫الحاالت‬ ‫بعض‬ ‫معالجة‬
 Hypertension:
- Sodium restriction to 2-4g/d...
 Dyslipidemia:
‫بالدم‬ ‫الشحوم‬ ‫أضطراب‬
- Restriction of energy from saturated fat
≤ 7% of energy and cholesterol ≤ 200...
- Consider soluble fiber sources and soy
products.
 Nephropathy:
- Limit protein intake to 0.86g/kg/day.
- Protein source...
 Gastropathy: problems with GI tract
- Chewing food thoroughly
- Frequent and small meals
- Increasing intake of higher l...
FOOD FOR DIABETES
السكري
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السكري

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Diabetes

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السكري

  1. 1. ‫الدولية‬ ‫المأمون‬ ‫مؤسسة‬ ‫التغذية‬ ‫دبلوم‬ ‫اللبان‬ ‫لؤي‬ ‫الدكتور‬
  2. 2.  Definition: A condition associated with loss of sugar in the urine. It was diagnosed in first century AD by a Greek physician Areteaus. ‫عن‬ ‫السكر‬ ‫بخروج‬ ‫تترافق‬ ‫حالة‬ ‫بانه‬ ‫المرض‬ ‫تعريف‬ ‫البول‬ ‫طريق‬. ‫الميالدي‬ ‫االول‬ ‫القرن‬ ‫في‬ ‫يوناني‬ ‫عالم‬ ‫أكتشفها‬ ‫ارتيوس‬ ‫اسمه‬.
  3. 3.  Diabetes is a Greek word means Siphon or to pass through. Mellitus is a Latin word means Honey because of the sweetness of urine . ‫السيفون‬ ‫وتعني‬ ‫اليونانية‬ ‫من‬ ‫أسمه‬ ‫أشتق‬‫أما‬ ‫نظ‬ ‫العسل‬ ‫فيعني‬ ‫االسم‬ ‫من‬ ‫الثاني‬ ‫الشق‬‫را‬“ ‫البول‬ ‫لحالوة‬.
  4. 4.  The term Diabetes mellitus is used to describe a group of conditions characterized by raised blood glucose levels ( hyperglycemia ) resulting from insulin deficiency. ‫من‬ ‫مجموعة‬ ‫على‬ ‫السكري‬ ‫الداء‬ ‫أسم‬ ‫يطلق‬ ‫ف‬ ‫السكر‬ ‫نسبة‬ ‫بأرتفاع‬ ‫تتصف‬ ‫التي‬ ‫الحاالت‬‫الدم‬ ‫ي‬ ‫المنتجة‬ ‫االنسولين‬ ‫كمية‬ ‫كفاية‬ ‫لعدم‬ ‫نتيجة‬.
  5. 5.  Paul Langerhans found that the pancreas is the primary organ involved in the disease.  In 1921-1922 University of Toronto discovered Insulin. ‫الجزء‬ ‫هو‬ ‫البنكرياس‬ ‫بأن‬ ‫النغيرهانس‬ ‫بول‬ ‫وجد‬ ‫المرض‬ ‫بهذا‬ ‫عالقة‬ ‫له‬ ‫الذي‬ ‫الرئيسي‬. ‫عام‬ ‫في‬1921-1922‫في‬ ‫االنسولين‬ ‫أكتشاف‬ ‫تم‬ ‫تورنتو‬ ‫جامعة‬.
  6. 6. ‫بالبدانة‬ ‫السكر‬ ‫عالقة‬  The relation between Diabetes and obesity was observed in around 1800’s when a French scientist Lancereaux described 2 types of diabetes: ‫في‬ ‫مالحظتها‬ ‫تمت‬ ‫بالبدانة‬ ‫السكر‬ ‫عالقة‬ ‫فرنسي‬ ‫عالم‬ ‫قبل‬ ‫من‬ ‫عشر‬ ‫التاسع‬ ‫القرن‬ ‫داء‬ ‫من‬ ‫نوعين‬ ‫حدد‬ ‫الذي‬ ‫النسيرو‬ ‫اسمه‬ ‫السكري‬:
  7. 7. 1- Diabete gras: fat diabetes 2- Diabete maigre: thin diabetes 1-‫سمين‬ ‫سكري‬ ‫داء‬ 2-‫نحيف‬ ‫سكري‬ ‫داء‬
  8. 8. Glucose and Insulin
  9. 9. Prevalence of Diabetes ‫انتشار‬ ‫حدة‬ ‫السكري‬  Total: 23.6 million children and adults -- 8.0% of the population -- have diabetes.  Diagnosed: 17.9 million people ‫الكلي‬ ‫العدد‬23.6‫أو‬ ‫مليون‬8%‫السكان‬ ‫من‬ ‫منهم‬17.9‫الحالة‬ ‫تشخيص‬ ‫تم‬ ‫مليون‬
  10. 10.  Undiagnosed: 5.7 million people  Pre-diabetes: 57 million people  1.6 million new cases of diabetes were diagnosed in people aged 20 years or older in 2007. ‫مشخصة‬ ‫غير‬ ‫حاالت‬5.7‫مليون‬ ‫السكري‬ ‫قبل‬ ‫حاالت‬57‫مليون‬ ‫عام‬ ‫في‬2007‫تشخيص‬ ‫تم‬1.6‫حالة‬ ‫مليون‬ ‫من‬ ‫اكبر‬ ‫بعمر‬20‫عام‬.
  11. 11. In 2003, the total was 194 million. In 2007, it is estimated that there are 246 million people with diabetes in the adult population. ‫عالميا‬“‫هناك‬194‫مليون‬ ‫عام‬ ‫في‬2007‫بحوالي‬ ‫الحاالت‬ ‫عدد‬ ‫يقدر‬247‫مليون‬ ‫حالة‬
  12. 12. ‫الزيادة‬ ‫هذه‬ ‫أسباب‬ Causes of the rise: • The alarming increase of diabetes prevalence is projected to occur because of:
  13. 13. • Population ageing ‫العمر‬ ‫أرتفاع‬ • Unhealthy diet ‫الصحية‬ ‫غير‬ ‫التغذية‬ • Overweight and obesity ‫الوزن‬ ‫زيادة‬ ‫والسمنة‬ • A sedentary lifestyle ‫والخمول‬ ‫الحركة‬ ‫قلة‬
  14. 14. Classification : ‫السكري‬ ‫الداء‬ ‫تصنيف‬ 1- Type 1 diabetes ( T1DM ) previously known as insulin-dependant diabetes. There is destruction of insulin producing pancreatic islet β-cells resulting from autoimmune process and insulin treatment is necessary for life. 1-‫النوع‬1‫على‬ ‫عالجه‬ ‫يعتمد‬ ‫الذي‬ ‫النوع‬ ‫وهو‬ ‫االنسولين‬.‫المنتجة‬ ‫الخاليا‬ ‫في‬ ‫تلف‬ ‫هناك‬ ‫فأن‬ ‫ولهذا‬ ‫مناعي‬ ‫أضطراب‬ ‫عن‬ ‫ناتجة‬ ‫لالنسولين‬ ‫الحياة‬ ‫مدى‬ ‫ضرورية‬ ‫باالنسولين‬ ‫المعالجة‬.
  15. 15.  2- Type 2 diabetes ( T2DM ) or non- insulin dependent diabetes which is caused by resistance to the action of insulin. It forms about 95% of total cases. ‫النوع‬2‫على‬ ‫عالجه‬ ‫اليعتمد‬ ‫الذي‬ ‫النوع‬ ‫وهو‬ ‫الجسم‬ ‫مقاومة‬ ‫نتيجة‬ ‫ويحدث‬ ‫االنسولين‬ ‫حوالي‬ ‫ويشكل‬ ‫الموجود‬ ‫لالنسولين‬95%‫من‬ ‫السكر‬ ‫حاالت‬ ‫كافة‬.
  16. 16. Other types of Diabetes: ‫من‬ ‫االخرى‬ ‫االنواع‬ ‫السكري‬ 1- Impaired Glucose Tolerance IGT 2- Impaired Fasting Glucose IFG 1-‫للغلكوز‬ ‫الضعيفة‬ ‫المقاومة‬ 2-‫الضعيفة‬ ‫الصيام‬ ‫وقت‬ ‫الغلوكوز‬ ‫نسبة‬
  17. 17. 3- Gestational Diabetes GD: Diabetes developed during pregnancy. These types may represent the earliest stages of Diabetes Type 2 (T2DM ). 3-‫الحمل‬ ‫خالل‬ ‫يحدث‬ ‫الذي‬ ‫الحملي‬ ‫السكر‬ ‫من‬ ‫االولى‬ ‫المراحل‬ ‫تشكل‬ ‫االنواع‬ ‫هذه‬ ‫كل‬ ‫نوع‬ ‫السكر‬ ‫مرض‬2
  18. 18. The Pancreas
  19. 19. INSULIN SECRETION
  20. 20. Insulin Production
  21. 21. Diabetes
  22. 22. Type 1 Diabetes
  23. 23. Diabetes prevalence
  24. 24. PREVALENCE OF DIABETES BY THE AGE
  25. 25. Diabetes progression
  26. 26. CRITERIA FOR DIAGNOSING DIABETES DIABETES TYPE TERM CAUSES CRITERIA TYPE 1 DIABETES -Insulin-Dependant Diabetes mellitus. Juvenile diabetes Β-cells destruction -Plasma glucose ≥ 200 mg/dl -Fasting plasma glucose≥126mg/dl TYPE 2 DIABETES -Non-Insulin Dependant diabetes mellitus Insulin resistance with insulin secretary defect Plasma glucose≥200 mg/dl BMI≥35 Family history Race Dyslipidemia Polycystic ovary Syndrome GESTATIONAL DIABETES GD Gestational Diabetes or type 3 diabetes Hormonal imbalance IMPAIRED GLUCOSE TOLERANCE IGT Borderline diabetes
  27. 27. Symtoms of Diabetes type 1: ‫نوع‬ ‫السكر‬ ‫أعراض‬1: - Increased thirst ( polydipsia ) - Increased urination ( polyuria ) -1-‫العطش‬ ‫زيادة‬ -2-‫التبول‬ ‫زيادة‬
  28. 28. - Increased hunger ( polyphgia ) - Weight loss - Fruity smell to breath ( symptoms of ketoacidosis ( - Fatigue or weakness. 3-‫بالجوع‬ ‫الشعور‬ ‫زيادة‬ 4-‫الفواك‬ ‫رائحة‬ ‫تشبه‬ ‫الفم‬ ‫من‬ ‫رائحة‬ ‫انبعاث‬‫ه‬ 5-‫عام‬ ‫وضعف‬ ‫تعب‬
  29. 29. Symptoms of Diabetes type 2: ‫السكري‬ ‫أعراض‬ ‫نوع‬2 - Poor wound healing or recurrent infections. - Blurred vision ( result of hyperglycemia on the shape of cornea ) - Skin irritation or infection - Recurrent gum or bladder infection. -1-‫متكررة‬ ‫والتهابات‬ ‫الجروح‬ ‫التئام‬ ‫ضعف‬ -2-‫الرؤيا‬ ‫في‬ ‫مشاكل‬ -3-‫الجلد‬ ‫في‬ ‫التهابات‬ -‫والمثانة‬ ‫اللثة‬ ‫في‬ ‫متكررة‬ ‫التهابات‬
  30. 30. HYPOGLYCEMIA AND HYPERGLYCEMIA
  31. 31. TREATMENT OF DIABETES ‫السكري‬ ‫الداء‬ ‫معالجة‬1- Medical approach: - Diabetes type 1:  Insulin injection  Insulin pump 1-‫للنوع‬ ‫الدوائي‬ ‫العالج‬1: 1-‫أنسولين‬ ‫حقن‬ 2-‫االنسولين‬ ‫مضخة‬
  32. 32.  Older children and teenagers may benefit from Multiple Daily Injection (MDI) of insulin to increase flexibility in lifestyle. ‫الحقن‬ ‫من‬ ‫واليافعين‬ ‫االطفال‬ ‫يستفيد‬ ‫أنماط‬ ‫تغيير‬ ‫عدم‬ ‫اجل‬ ‫من‬ ‫اليومية‬ ‫المتعددة‬ ‫حياتهم‬
  33. 33. - Diabetes type 2:  Insulin regulating drugs ‫النوع‬ ‫السكري‬ ‫معلجة‬2: 1-‫لالنسولين‬ ‫المعدلة‬ ‫االدوية‬
  34. 34. Diabetes injection
  35. 35. MEDICATIONS FOR DIABETES
  36. 36. MEAL PLANNING AND FOOD SELECTION ‫االطعمة‬ ‫وانتقاء‬ ‫الغذائية‬ ‫الخطة‬  Providing dietary advice and coordinating food management with hypoglycemic medication schedule. ‫يتناس‬ ‫بشكل‬ ‫الغذائية‬ ‫النصيحة‬ ‫أعطاء‬ ‫يجب‬‫ق‬ ‫لالنسول‬ ‫المعدلة‬ ‫االدوية‬ ‫تقديم‬ ‫مواعيد‬ ‫مع‬‫ين‬ ‫السكر‬ ‫ارتفاع‬ ‫من‬ ‫تحد‬ ‫والتي‬.
  37. 37.  Distribution of carbohydrates in several frequent small meals or snacks improves glycemic control.  Food selection should be according to the patient’s culture ‫لتحسي‬ ‫وجبات‬ ‫عدة‬ ‫على‬ ‫السكريات‬ ‫توزيع‬‫ن‬ ‫الغلوكوز‬ ‫ضبط‬ ‫المريض‬ ‫من‬ ‫مقبولة‬ ‫االطعمة‬ ‫تكون‬ ‫أن‬ ‫يجب‬
  38. 38.  Taking into consideration cases of food intolerances and allergies. ‫أية‬ ‫هناك‬ ‫كان‬ ‫أن‬ ‫االعتبار‬ ‫بعين‬ ‫نأخذ‬ ‫أن‬ ‫يجب‬ ‫التح‬ ‫كعدم‬ ‫المنتقاة‬ ‫الغذائية‬ ‫المواد‬ ‫مع‬ ‫مشاكل‬‫مل‬ ‫التحسسات‬ ‫أو‬.
  39. 39.  Nutrition education to shift the intake from unhealthy foods to foods that have healthy properties like omeg-3 fatty acids in fish, soy products, fruits and vegetables. ‫بأتجاه‬ ‫تكون‬ ‫أن‬ ‫يجب‬ ‫الغذائية‬ ‫التوعية‬ ‫بأخ‬ ‫الصحية‬ ‫غير‬ ‫الغذائية‬ ‫المواد‬ ‫استبدال‬‫رى‬ ‫والخضرا‬ ‫والفواكه‬ ‫الصويا‬ ‫كأستخدام‬ ‫صحية‬‫وات‬ ‫الخ‬.......
  40. 40. NUTRITIONAL MANAGEMENT OF DIABETES ‫السكري‬ ‫داء‬ ‫لمعاجة‬ ‫الغذائي‬ ‫التدخل‬ 1- Type 1 diabetes mellitus:  Energy sufficient to support growth, maintenance of a healthy body weight. 1-‫نوع‬ ‫السكري‬1: ‫لتأمي‬ ‫الطاقة‬ ‫من‬ ‫كميات‬ ‫هناك‬ ‫تكون‬ ‫أن‬ ‫يجب‬‫ن‬ ‫مثالي‬ ‫وزن‬ ‫الى‬ ‫الوصول‬ ‫وضمان‬ ‫جيد‬ ‫نمو‬
  41. 41.  Meals and snacks should be consumed at consistent times throughout the day and should be synchronized with the action of insulin to prevent hyperglycemia and hypoglycemia ‫بشكل‬ ‫والسناكات‬ ‫الوجبات‬ ‫تناول‬ ‫يجب‬ ‫بالتوافق‬ ‫ذلك‬ ‫يتم‬ ‫وان‬ ‫اليوم‬ ‫خالل‬ ‫متساوي‬ ‫هبوط‬ ‫أو‬ ‫ارتفاع‬ ‫لمنع‬ ‫وذلك‬ ‫االنسولين‬ ‫مع‬ ‫السكر‬.
  42. 42.  Macronutrients and micronutrients are the same as for children without diabetes.  Fat restriction to ≤ 30% of total energy  Avoidance of hypoglycemia is the primary goal for infants and children. ‫ب‬ ‫اعطاؤها‬ ‫يتم‬ ‫والفيتامينات‬ ‫للمعادن‬ ‫بالنسبة‬‫نفس‬ ‫االصحاء‬ ‫لالطفال‬ ‫تعطى‬ ‫التي‬ ‫النسب‬ ‫من‬ ‫أقل‬ ‫تكون‬ ‫أن‬ ‫يجب‬ ‫الدهون‬30%‫كامل‬ ‫من‬ ‫المعالجة‬ ‫أولويات‬ ‫من‬ ‫السكر‬ ‫هبوط‬ ‫منع‬ ‫وأن‬ ‫الطاقة‬ ‫واالطفال‬ ‫الرضع‬ ‫عند‬
  43. 43. 2- Type 2 diabetes mellitus: ‫نوع‬ ‫السكري‬2  Weight management: loss 5-10% improves glycemic control.  Reduce BMI ≤ 25 ‫بنسبة‬ ‫الوزن‬ ‫انزال‬5-10%‫العالج‬ ‫درجة‬ ‫من‬ ‫يحسن‬ ‫انزال‬BMI‫من‬ ‫أقل‬ ‫الى‬25
  44. 44.  Exercise  Maintenance of weight loss.  Adjustment in hypoglycemic medications ‫الرياضة‬ ‫الطبيعي‬ ‫الوزن‬ ‫على‬ ‫المحافظة‬ ‫المناسبة‬ ‫االدوية‬ ‫أختيار‬
  45. 45. Carbohydrates:  50-60% of daily energy intake from high fiber cereals, breads, legumes. Limited amounts of added sugars are recommended. ‫بنسبة‬ ‫تكون‬ ‫أن‬ ‫يجب‬ ‫السكريات‬50-60%‫من‬ ‫الحبوب‬ ‫من‬ ‫بااللياف‬ ‫غنية‬ ‫مواد‬ ‫من‬ ‫الطاقة‬ ‫كامل‬ ‫السك‬ ‫استهالك‬ ‫عدم‬ ‫ويراعى‬ ‫والخبز‬ ‫والبقوليات‬‫اكر‬ ‫قليلة‬ ‫بكميات‬ ‫اال‬ ‫البسيطة‬
  46. 46.  High-Glycemic-Index (GI) foods are replaced with low-glycemic-index food to slow glucose absorption ‫غاليسيمي‬ ‫مؤشر‬ ‫ذات‬ ‫غذائية‬ ‫مواد‬ ‫استبدال‬ ‫منخفض‬ ‫غاليسمي‬ ‫مؤشر‬ ‫ذات‬ ‫بمواد‬ ‫عالي‬ ‫الغلوكوز‬ ‫امتصاص‬ ‫تبطئ‬ ‫والتي‬
  47. 47.  Sugars up to 10% of daily energy from sugars like fructose,sucrose.  Fiber:intake 25-35 g/daily from different sources. ‫نسب‬ ‫تتجاوز‬ ‫ال‬ ‫أن‬ ‫يجب‬ ‫البسيطة‬ ‫السكاكر‬‫تها‬ 10%‫غنية‬ ‫مصادر‬ ‫ومن‬ ‫الطاقة‬ ‫كامل‬ ‫من‬ ‫والسكروز‬ ‫كالفركتوز‬
  48. 48.  Break up caloric intake ○ Breakfast: 20% ○ Lunch: 40% . Dinner : 40 % ‫كالتالي‬ ‫الحريرات‬ ‫توزيع‬: ‫االفطار‬20% ‫الغذاء‬40% ‫العشاء‬20%
  49. 49. Protein:  Recommended intake 0.86/kg/day.  Less than 15-20% of energy intake is not recommended. ‫البروتين‬ ‫بها‬ ‫النصوح‬ ‫الكميات‬0.86‫غ‬/‫حالة‬ ‫حسب‬ ‫وزن‬ ‫كغ‬ ‫عن‬ ‫نسبتها‬ ‫التقل‬ ‫أن‬ ‫يجب‬ ‫ولكن‬ ‫المريض‬15-20 %‫الطاقة‬ ‫كامل‬ ‫من‬
  50. 50.  Sources of vegetable protein to replace animal protein as they contain more soluble fiber and less saturated fat and cholesterol than animal proteins and may decrease serum cholesterol. ‫بمص‬ ‫الحيوانية‬ ‫البروتين‬ ‫مصادر‬ ‫استبدال‬‫ادر‬ ‫أق‬ ‫وكميات‬ ‫ذوابة‬ ‫ألياف‬ ‫فيها‬ ‫تكون‬ ‫نباتية‬‫من‬ ‫ل‬ ‫والكوليستيرول‬ ‫المشبعة‬ ‫الدهون‬
  51. 51. Fats:  Total fats ≤ 30% OF daily energy requirements. ‫من‬ ‫أقل‬ ‫بنسبة‬ ‫تكون‬ ‫أن‬ ‫يجب‬ ‫الدهون‬30%‫من‬ ‫الطاقة‬ ‫كامل‬
  52. 52.  Saturated and trans fatty acids ≤ 10% of energy intake.  Polyunsaturated fatty acids ≤ 10%  Fish high in omega-3 fatty acids recommended at least once weekly. ( from fish ) ‫أقل‬ ‫المشبعة‬ ‫الدهون‬ ‫نسبة‬ ‫تكون‬ ‫أن‬ ‫يجب‬ ‫من‬10%‫الطاقة‬ ‫كامل‬ ‫من‬ ‫من‬ ‫اقل‬ ‫مشبعة‬ ‫غير‬ ‫المتعددة‬ ‫الدهون‬10% ‫اسبوعيا‬ ‫مرة‬ ‫االسماك‬ ‫تناول‬ ‫يجب‬“‫على‬ ‫االقل‬
  53. 53. - Gestational diabetes: -‫الحملي‬ ‫السكر‬ ‫معالجة‬  Goal is to achieve normalglycemia while eating a nutitionally adequate diet. ‫من‬ ‫الطبيعي‬ ‫السكر‬ ‫معدل‬ ‫الى‬ ‫الوصول‬ ‫هو‬ ‫الهدف‬ ‫صحية‬ ‫وجبات‬ ‫خالل‬
  54. 54.  Preconception counseling is recommended.  Normal weigh gain for pregnancy is recommended. ‫الحمل‬ ‫فترة‬ ‫خالل‬ ‫باالستشارات‬ ‫ينصح‬ ‫الحمل‬ ‫خالل‬ ‫الوزن‬ ‫بمراقبة‬ ‫ينصح‬
  55. 55.  Multivitamins with 0.4 mg to 1 mg/day folic acids prior to conception and during early weeks of pregnancy is recommended. ‫بنسب‬ ‫أسيد‬ ‫فوليك‬ ‫مع‬ ‫فيتامينات‬ ‫أعطاء‬‫ة‬0.4 –1‫الحمل‬ ‫خالل‬ ‫باليوم‬ ‫مغ‬
  56. 56.  Food choices divided into 6 small meals through the day to reduces glycemic peak and hypoglycemia.  Evening snack is recommended.  Promote breast feeding .  Exercise at slow pace. ‫الى‬ ‫والسناكات‬ ‫الوجبات‬ ‫تقسيم‬6‫صغيرة‬ ‫وجبات‬ ‫مسائي‬ ‫سناك‬ ‫تناول‬ ‫الرياضة‬ ‫مزاولة‬
  57. 57. CO-EXISTING MEDICAL CONDITIONS ‫للسكري‬ ‫المصاحبة‬ ‫الحاالت‬ ‫بعض‬ ‫معالجة‬  Hypertension: - Sodium restriction to 2-4g/day - Salt substitute should be used. DASH diet is rich in magnesium , potassium , and calcium , fiber, low in fat, cholesterol and sodium. -1-‫الشرياني‬ ‫الضغط‬ ‫أرتفاع‬ -‫الى‬ ‫الصوديوم‬ ‫كمية‬ ‫تقليل‬2-4‫غ‬/‫يوم‬ -‫داش‬ ‫حمية‬
  58. 58.  Dyslipidemia: ‫بالدم‬ ‫الشحوم‬ ‫أضطراب‬ - Restriction of energy from saturated fat ≤ 7% of energy and cholesterol ≤ 200 mg/day. - Omega 3-PUFA once a week from fish. -‫من‬ ‫أقل‬ ‫كوليستيرول‬200‫مغ‬/‫يوم‬ -‫مشبعة‬ ‫دهون‬
  59. 59. - Consider soluble fiber sources and soy products.  Nephropathy: - Limit protein intake to 0.86g/kg/day. - Protein sources from vegetables. -‫االلياف‬ -‫الكلية‬ ‫اعتالل‬:0.86‫يوميا‬ ‫غ‬
  60. 60.  Gastropathy: problems with GI tract - Chewing food thoroughly - Frequent and small meals - Increasing intake of higher liquid consistancy -‫المعدة‬ ‫اعتالل‬
  61. 61. FOOD FOR DIABETES
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Diabetes

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