There are several types of diabetes caused by the body's inability to produce or properly use insulin. Diabetes is diagnosed through blood tests and those at higher risk are people who are overweight, have a family history of diabetes, or have had gestational diabetes. Treatment involves education on a diabetic diet, exercise, and monitoring blood sugar levels through food intake, medication if needed, and lifestyle changes. Maintaining a healthy diet and exercise routine is important for managing diabetes.

1. Diet and DiabetesDiet and Diabetes
Created by:Created by:
Tricia Fleming, University of Kansas Dietetic InternTricia Fleming, University of Kansas Dietetic Intern
Tammy Beason, MS, RD, Nutrition EducationTammy Beason, MS, RD, Nutrition Education
Specialist, Family Nutrition Education ProgramSpecialist, Family Nutrition Education Program
December 2001December 2001

2. Diabetes- What is it?Diabetes- What is it?
• Body is not producing or has lostBody is not producing or has lost
sensitivity to insulin.sensitivity to insulin.
• Insulin is a hormone that is needed toInsulin is a hormone that is needed to
convert sugar, starches and other foodconvert sugar, starches and other food
into energy.into energy.
• Insulin is produced in the body by theInsulin is produced in the body by the
pancreas.pancreas.

3. Types of DiabetesTypes of Diabetes
There are several types of diabetes:There are several types of diabetes:
• Type I - body does not produce anyType I - body does not produce any
insulin.insulin.
• Type II- body is not making enough orType II- body is not making enough or
is losing sensitivity to insulin made.is losing sensitivity to insulin made.

4. Types of DiabetesTypes of Diabetes
• Secondary - a consequence fromSecondary - a consequence from
another disease. For example,another disease. For example,
pancreatitis or cystic fibrosis.pancreatitis or cystic fibrosis.
• Gestational Diabetes- diabetes duringGestational Diabetes- diabetes during
pregnancy.pregnancy.
• Impaired Glucose Tolerance- anImpaired Glucose Tolerance- an
intermediate between normal andintermediate between normal and
diabetes.diabetes.

5. Quick Review-Anatomy of theQuick Review-Anatomy of the
PancreasPancreas
• A gland that lies behind the stomachA gland that lies behind the stomach
• Clusters of cells inside the pancreasClusters of cells inside the pancreas
known as the islets of Langerhansknown as the islets of Langerhans
produces three hormones.produces three hormones.
• The islets contain 3 types of cells:The islets contain 3 types of cells:
• Alpha, beta, and delta.Alpha, beta, and delta.
• Alpha cells produce glucagon.Alpha cells produce glucagon.

6. Pancreas contd.Pancreas contd.
• Beta cells- produce insulinBeta cells- produce insulin
• Delta cells- produce somatostatinDelta cells- produce somatostatin
• These cells have special sensors thatThese cells have special sensors that
monitor levels of blood sugar andmonitor levels of blood sugar and
stimulate the release of the correctstimulate the release of the correct
hormone.hormone.

7. Insulin and the otherInsulin and the other
hormoneshormones
• Glucagon - Hormone that increases theGlucagon - Hormone that increases the
amount of glucose in the blood when itamount of glucose in the blood when it
is needed.is needed.
• Somatostatin - Hormone that canSomatostatin - Hormone that can
suppress both glucagon and insulinsuppress both glucagon and insulin
when needed.when needed.
• Insulin- Hormone that lowers bloodInsulin- Hormone that lowers blood
glucose.glucose.

8. How Does Insulin Work?How Does Insulin Work?
• A person normally secretes insulin inA person normally secretes insulin in
response to an elevated blood sugarresponse to an elevated blood sugar
level.level.
• It does this by accelerating bloodIt does this by accelerating blood
sugars movement out of the blood andsugars movement out of the blood and
into the cells.into the cells.
• Cells will not allow blood sugar inCells will not allow blood sugar in
without insulin. - this can cause awithout insulin. - this can cause a
problem.problem.

9. Why isn’t the body makingWhy isn’t the body making
insulin?insulin?
• In people with Type I, the immuneIn people with Type I, the immune
system has made a big mistake!system has made a big mistake!
• It attacks the beta cells and destroysIt attacks the beta cells and destroys
them!them!
• In people with Type II, the pancreas isIn people with Type II, the pancreas is
still making insulin, just not enough tostill making insulin, just not enough to
keep up, or their bodies have becomekeep up, or their bodies have become
insulin resistant!insulin resistant!

10. Type IType I
• Usually diagnosed in children andUsually diagnosed in children and
young adults.young adults.
• Must take daily insulin shots to stayMust take daily insulin shots to stay
alive.alive.
• Type I accounts for 5-10% of theType I accounts for 5-10% of the
population with diabetes.population with diabetes.

11. Type IIType II
• The most common form of the disease.The most common form of the disease.
• Approximately 50% of men and 70% ofApproximately 50% of men and 70% of
women are obese at the time ofwomen are obese at the time of
diagnosis.diagnosis.
• Nearing epidemic proportions, due toNearing epidemic proportions, due to
increase # of older Americans, greaterincrease # of older Americans, greater
occurrence of obesity and sedentaryoccurrence of obesity and sedentary
lifestyles.lifestyles.

12. Gestational DiabetesGestational Diabetes
• Pregnant women have a higher insulinPregnant women have a higher insulin
level.level.
• If woman has hyperglycemia, her bloodIf woman has hyperglycemia, her blood
glucose crosses the placenta but herglucose crosses the placenta but her
insulin does not.insulin does not.
• This can cause a high birth weight forThis can cause a high birth weight for
baby.baby.

13. What are the Symptoms?What are the Symptoms?
• Polyphasia- excessive eatingPolyphasia- excessive eating
• Polyurea- excessive urinationPolyurea- excessive urination
• Polydypsia-excessive fluid intakePolydypsia-excessive fluid intake
• Blurred visionBlurred vision
• Poor wound healingPoor wound healing
• IrritabilityIrritability

14. How are you diagnosed withHow are you diagnosed with
diabetes?diabetes?
• In June 1997, the ADA redefined it’sIn June 1997, the ADA redefined it’s
criteria for diagnosing diabetes.criteria for diagnosing diabetes.
• Normal fasting blood glucose is <110Normal fasting blood glucose is <110
mg/dl.mg/dl.
• Impaired fasting glucose is >110 andImpaired fasting glucose is >110 and
<126 mg/dl.<126 mg/dl.
• Provisional diagnosis for diabetes>126Provisional diagnosis for diabetes>126
mg/dlmg/dl

15. Diagnosis contd.Diagnosis contd.
• In order to be diagnosed with diabetes:In order to be diagnosed with diabetes:
• Person must have symptoms ofPerson must have symptoms of
diabetes +diabetes +
• Causal plasma glucose >200Causal plasma glucose >200
• Fasting blood glucose of >126 mg/dlFasting blood glucose of >126 mg/dl
• 2-hour plasma glucose >200 mg/dl on2-hour plasma glucose >200 mg/dl on
oral glucose testoral glucose test

16. Who’s at risk?Who’s at risk?
ADA now recommends that screeningADA now recommends that screening
for diabetes should be considered forfor diabetes should be considered for
all patients at age 45. If the results areall patients at age 45. If the results are
normal it should be repeated every 3normal it should be repeated every 3
years.years.
Screening should be considered at aScreening should be considered at a
younger age if patient meets followingyounger age if patient meets following
risk factors:risk factors:

17. Who’s at risk?Who’s at risk?
• ObesityObesity
• First degree relative with diabetesFirst degree relative with diabetes
• Belongs to a high-risk ethnic groupBelongs to a high-risk ethnic group
• Was diagnosed with gestationalWas diagnosed with gestational
diabetes or delivered a baby whosediabetes or delivered a baby whose
birth weight >9 lbs.birth weight >9 lbs.
• HypertensionHypertension

18. Who’s at risk?Who’s at risk?
• HDL level<35 or triglycerides >250HDL level<35 or triglycerides >250
• Found to have impaired glucoseFound to have impaired glucose
tolerance or impaired fasting on atolerance or impaired fasting on a
previous test.previous test.

19. I’ve got Diabetes, now what?I’ve got Diabetes, now what?
• After diagnosis, there is a great needAfter diagnosis, there is a great need
for education.for education.
• A diabetic diet is no different fromA diabetic diet is no different from
anyone else’s but they must keep trackanyone else’s but they must keep track
of what they eat.of what they eat.
• A food diary is a great start!A food diary is a great start!
• Serving sizes must be emphasized.Serving sizes must be emphasized.

20. Treatment Goals for Type ITreatment Goals for Type I
• Match insulin to food intake.Match insulin to food intake.
• Type I’s are encouraged to be preciseType I’s are encouraged to be precise
and regular from day to day with foodand regular from day to day with food
intake, insulin regimen, and activity.intake, insulin regimen, and activity.

21. Exercise and Type I’sExercise and Type I’s
• Increases flexibility, muscular strength ,Increases flexibility, muscular strength ,
and well being.and well being.
• Must monitor insulin and food intake toMust monitor insulin and food intake to
match exercise regimen.match exercise regimen.
• Increases insulin effectiveness andIncreases insulin effectiveness and
sensitivity in the body.sensitivity in the body.

22. Treatment Goals for Type IITreatment Goals for Type II
• Achieve normal or near-normal bloodAchieve normal or near-normal blood
glucose levels.glucose levels.
• Provide adequate calories forProvide adequate calories for
reasonable body weight.reasonable body weight.
• Prevent, delay or treat nutrition relatedPrevent, delay or treat nutrition related
complications.complications.
• Improve health through optimalImprove health through optimal
nutrition.nutrition.

23. Exercise and Type IIExercise and Type II
• Especially beneficial in type II diabetes.Especially beneficial in type II diabetes.
• Promotes weight lossPromotes weight loss
• Increases insulin sensitivity.Increases insulin sensitivity.
• Must also be aware of medication andMust also be aware of medication and
intake to prevent hypoglycemia.intake to prevent hypoglycemia.

24. Treatment of DiabetesTreatment of Diabetes
• Diet plays a major role.Diet plays a major role.
• Carbohydrates are the component ofCarbohydrates are the component of
food that causes an increase in bloodfood that causes an increase in blood
sugar.sugar.
• Diabetics are encouraged to keep trackDiabetics are encouraged to keep track
of the amount of CHO they eat.of the amount of CHO they eat.

25. Methods of CarbohydrateMethods of Carbohydrate
ControlControl
There are many new methods ofThere are many new methods of
controlling diabetes, these are still thecontrolling diabetes, these are still the
two most common.two most common.
• Exchange ListsExchange Lists
• Carbohydrate counting- Very basic,Carbohydrate counting- Very basic,
allows a little more freedom and variety.allows a little more freedom and variety.

26. Blood Glucose MonitoringBlood Glucose Monitoring
• All diabetics must keep track of bloodAll diabetics must keep track of blood
glucose levels.glucose levels.
• This is the only way to know if the treatmentThis is the only way to know if the treatment
is effective.is effective.
• Gives the diabetic a good indication of whatGives the diabetic a good indication of what
affects their blood sugar level.affects their blood sugar level.
• Must check at least 2 times a day and fourMust check at least 2 times a day and four
times a day for at least 3 days a week.times a day for at least 3 days a week.

27. Hemoglobin A1cHemoglobin A1c
• A good indicator of blood glucoseA good indicator of blood glucose
control.control.
• Gives a % that indicates control overGives a % that indicates control over
the preceding 2-3 months.the preceding 2-3 months.
• Performed 2 times a year.Performed 2 times a year.
• A hemoglobin of 6% indicates goodA hemoglobin of 6% indicates good
control and level >8% indicates actioncontrol and level >8% indicates action
is needed.is needed.

28. Dietary GuidelinesDietary Guidelines
• Eat a diet low in saturated and total fat.Eat a diet low in saturated and total fat.
• Eat a diet moderate in sodium andEat a diet moderate in sodium and
sugar.sugar.
• Eat 5 or more fruits and vegetables aEat 5 or more fruits and vegetables a
day.day.
• Choose a diet rich in whole grains.Choose a diet rich in whole grains.
• Moderate use of alcoholModerate use of alcohol

29. Dietary GuidelinesDietary Guidelines
• Eat at the same time everyday , at leastEat at the same time everyday , at least
within 1 hour of regular time.within 1 hour of regular time.
• Eat about the same amount ofEat about the same amount of
carbohydrate with each meal.carbohydrate with each meal.

30. Other TreatmentsOther Treatments
• Type I and sometimes Type II patientsType I and sometimes Type II patients
need to be treated with insulin.need to be treated with insulin.
• There are more than 20 types.There are more than 20 types.
• They differ in how they are made, howThey differ in how they are made, how
they work in the body and their cost.they work in the body and their cost.

31. Oral MedicationsOral Medications
Used to treat Type II diabetics. There areUsed to treat Type II diabetics. There are
four basic types:four basic types:
• Sulfonylurea-stimulates the body toSulfonylurea-stimulates the body to
make more insulin.make more insulin.
• Metformin-lowers blood sugar byMetformin-lowers blood sugar by
helping the insulin work betterhelping the insulin work better

32. Oral medicationsOral medications
• Thiazolidinediones- increases muscleThiazolidinediones- increases muscle
sensitivity to insulin.sensitivity to insulin.
• Alpha-glucosidase inhibitors- slow theAlpha-glucosidase inhibitors- slow the
process of carbohydrate digestion.process of carbohydrate digestion.

33. Treatment GoalsTreatment Goals
• The main goal is to normalize bloodThe main goal is to normalize blood
sugar. Realistic goals for diabetics aresugar. Realistic goals for diabetics are
70-140 mg/dl before meals, <180 mg/dl70-140 mg/dl before meals, <180 mg/dl
after and a glycosolated hemoglobinafter and a glycosolated hemoglobin
within 1% of normal.within 1% of normal.
• Need good blood glucose control toNeed good blood glucose control to
avoid complications.avoid complications.

34. Diabetes ComplicationsDiabetes Complications
Diabetes complications are the seventhDiabetes complications are the seventh
leading cause of death. They include:leading cause of death. They include:
• Blindness- caused by diabeticBlindness- caused by diabetic
retinopathy.retinopathy.
• Kidney Disease- diabetic nephropathyKidney Disease- diabetic nephropathy
• Heart Disease and StrokeHeart Disease and Stroke

35. Complications contdComplications contd
• Nerve disease and amputationsNerve disease and amputations
• ImpotenceImpotence

36. How to Avoid ComplicationsHow to Avoid Complications
• Control weightControl weight
• Eat a healthy well-balanced diet.Eat a healthy well-balanced diet.
• Get regular exerciseGet regular exercise
• Have regular checkupsHave regular checkups
• Check feet everyday for cuts andCheck feet everyday for cuts and
blistersblisters
• Do not smoke!Do not smoke!

37. How to Avoid ComplicationsHow to Avoid Complications
• Keep blood sugars normalKeep blood sugars normal
• Avoid the 2 common diabetic problems,Avoid the 2 common diabetic problems,
hypoglycemia and hyperglycemiahypoglycemia and hyperglycemia

38. HypoglycemiaHypoglycemia
• Hypoglycemia- low blood sugarHypoglycemia- low blood sugar
• Happens to everyone with diabetesHappens to everyone with diabetes
• Symptoms include shakiness,Symptoms include shakiness,
dizziness, sweating, hunger, headache,dizziness, sweating, hunger, headache,
pale skin, sudden moodiness, clumsypale skin, sudden moodiness, clumsy
or jerky movements, difficulty payingor jerky movements, difficulty paying
attention, and tingling sensationsattention, and tingling sensations
around mouth.around mouth.

39. HypoglycemiaHypoglycemia
How to treat Hypoglycemia:How to treat Hypoglycemia:
• Quickest way to raise blood glucose isQuickest way to raise blood glucose is
with some form of sugar.with some form of sugar.
• 3 glucose tablets, 1/2 cup of fruit juice,3 glucose tablets, 1/2 cup of fruit juice,
5-6 pieces of candy.5-6 pieces of candy.
• Wait 15-20 minutes and test bloodWait 15-20 minutes and test blood
sugar again. If still low retreat.sugar again. If still low retreat.

40. HypoglycemiaHypoglycemia
• If hypoglycemia goes untreated, patientIf hypoglycemia goes untreated, patient
could get worse and pass out!could get worse and pass out!
• Stress the importance of a night timeStress the importance of a night time
snack in older patients.snack in older patients.

41. HyperglycemiaHyperglycemia
Ketoacidosis: Develops when the bodyKetoacidosis: Develops when the body
does not have enough insulin. Thedoes not have enough insulin. The
body can’t break down sugar so itbody can’t break down sugar so it
breaks down fat instead. Ketones arebreaks down fat instead. Ketones are
what is left from this process.The bodywhat is left from this process.The body
does not tolerate ketones and tries todoes not tolerate ketones and tries to
pass them out of the body.pass them out of the body.

42. HyperglycemiaHyperglycemia
Symptoms that may result in ketoacidosisSymptoms that may result in ketoacidosis
occur when:occur when:
• Too little insulin has been ejected, or insulinToo little insulin has been ejected, or insulin
is not effective.is not effective.
• Consumed more food and/or exercised lessConsumed more food and/or exercised less
than expected.than expected.
• High blood sugar, high levels of sugar in theHigh blood sugar, high levels of sugar in the
urine, frequent urination, and increased thirsturine, frequent urination, and increased thirst

43. How to treat HyperglycemiaHow to treat Hyperglycemia
• Usually can lower it by exercising, orUsually can lower it by exercising, or
injecting more insulin, be careful of theinjecting more insulin, be careful of the
somogyi effectsomogyi effect..
TheThe somogyi effectsomogyi effect is the condition ofis the condition of
hypoglycemia resulting from thehypoglycemia resulting from the
treatment of hyperglycemia.treatment of hyperglycemia.

44. ConclusionConclusion
Diabetes is a very complicated disease.Diabetes is a very complicated disease.
For more information: www.diabetes.orgFor more information: www.diabetes.org