Prediabetes, Type 1, Type 2 & Gestational Diabetes Diabetes Mellitus Prediabetes, Type 1, Type 2 & Gestational Diabetes

CHO Metabolism Glucose for energy Making glucose from PRO Fuels most of body’s cells Preferred for brain, nerve cells, & developing red blood cells (RBC) Making glucose from PRO Some Amino acids but not all Gluconeogenesis Pulls PRO from other functions

CHO Metabolism Ketone bodies from fat fragments Without an adequate supply of CHO Fat metabolism shifts to produce glucose Ketones formed as a by product Ketosis – acid-base balance CHO needs for PRO sparing + to prevent ketosis (~50-130 gms/day) Using glucose to make fat

CHO Metabolism Ketone bodies from fat fragments Inadequate supply of CHO Fat metabolism shifts Ketone body formation – starvation Ketosis – acid-base balance CHO needs for pro sparing + prevention of ketosis Using glucose to make fat

What is Diabetes? INSUFFICIENT INSULIN PRODUCTION (Type 1) DECREASED SENSITIVITY OF CELLS TO INSULIN OR NOT ENOUGH INSULIN (Type 2) THE RESULT IN BOTH CASES IS ELEVATED BLOOD GLUCOSE LEVELS

TYPE 1 How it differs from type 2: The pancreas produces no insulin. Usually Dx before age 30 May be caused by an infection which destroys cells producing insulin, removal of the pancreas, or chronic inflammation Treatment: Must be given insulin Body Type: Usually thin. Why?

Type 2 90-95% of diabetes Cause: The body either does not produce enough insulin or loses its sensitivity to it becoming ‘insulin resistant’ Heredity & life style are factors Body type: Usually overweight. Why?

Prediabetes/Impaired Glucose Tolerance Blood glucose levels: >nml but < than Dx for diabetes 100-120 dl/ml Increased risk for diabetes type 2, CHD, & stroke Treat: Weight loss, exercise, & increase fiber, possibly Metformin

Gestational Diabetes Occurs in pregnancy Usually resolves after pregnancy Risks: Increased risks for infant & mother Large birth weight Delivery complications Future Dx of type 2 diabetes

An explanation of diabetes Insulin unlocks cell membranes to allow glucose to enter the cells for needed energy Without insulin the cells are starved for glucose, levels of glucose raise in the blood Fat stores are burned for energy producing ketones which are acidic in the blood ‘ketoacidosis’

Symptoms EXCESSIVE thirst FREQUENT urination Blurred vision Weight loss Excessive eating ‘polyphagia’

DX/Monitoring Blood tests A1C tests Monitor: Records: In depth food diary to include Foods, exercise, blood checks, illness/fever Foods: glycemic effects

Diabetes Mellitus: DX Fasting Blood Glucose Levels: Prediabetes: 100-120 mg/dl Diabetes: Greater than or equal to120 mg/dl A1C: Recommended by an international committee of experts on diabetes as the primary test used to Dx prediabetes, type 1 diabetes & type 2 diabetes Also used to monitor diabetes control

Diabetes Mellitus: A1C Test Also called the glycated Hgb, glycosylated hgb, and hgb A1C It is the average blood sugar level for the past 2-3 months It measures the % of hgb which is coated with sugar The higher the results, the higher the risk of diabetes complications

A1C Results Normal: 4.5-6% Uncontrolled BS for a long time: 8%+ Prediabetes: 6.5% or + on 2 separate tests Diabetes Treatment goal: 7% equal to fasting blood sugar of 154 mg/dl

A1C False + or - Heavy bleeding results in false – Iron Deficiency anemia results in false – Recent blood transfusions or hemolytic anemias result in false – Labs may vary Hgb variant may give a false + or – Most common in blacks & people from Mediterranean or southeast Asian countries May need a specialized lab

Health Risks Heart Disease/Stroke Kidney Disease Blindness Nerve damage

Treatment: Going Beyond Glycemic Control & CHO Restriction is Critical Diet Weight loss for overweight Reduce fats, saturated & transfats High fiber Regulate CHOs with meds, activity, BS levels Diabetic Exchange List/CHO Counting Regulate BP (DASH Diet) Exercise Meds

ADA General Guidelines Glycemic Goals A1c = 7% Fasting & before meals: 80-130 mg/dl 1-2 hours after eating: <180 mg/dl BP Goals for Diabetes Patients with High BP 140/90 mm Hg Patients with BP > 120/80 mm Hg should engage in lifestyle changes to reduce BP

Avoiding Hyperglycemia Fatigue Thirst Fruity breath, odor Hypoglycemia Irritability Nervousness Sweating Shakiness Rapid heartbeat Headache Hunger Weakness Seizure & Coma Hyperglycemia Fatigue Thirst Fruity breath, odor Agitation/Confusion Weight Loss over time Coma & Death Hypoglycemia: BS <40-50 Hyperglycemia: BS >140

Hypoglycemia Treating 15/15 rule Avoiding Medical Alert information Carry a CHO snack (15 gms) Regular checking of BS NEVER take insulin if you are NOT ready to eat Avoid low CHO diets (<130 gms/day) Substitute high fiber foods for processed foods Eat 4-6 smaller meals vs 3 meals/day Eat snacks between meals & pm with 15-30 gms CHO Add pro at pm snack Eating extra CHO before & during exercise & monitoring BS

Hyperglycemia Treating: Avoiding Take insulin as directed in the dose & amount needed Do not skip insulin Eating disorder “diabolemia”

Potential Pitfalls Illness/fever Traveling Delayed meals Extra exercise Storage of insulin Eating Out