Diabetes Caused by reduced insulin secretion or resistance to insulin at cell receptor Excess BG and obesity, then insulin resistance, then excess insulin, then pancreatic dysfunction 10% of Americans have DM, with 1:3 u diagnosed and a total cost of 250 BILLION annually Hyperglycemia is chronically high fasting BG labs > 125mg/dL, hgba1c >6.5%

Diabetes Hgba1c is the glycosylated Hgb with a half-life of 3 months, for averaging level of glycemic control Type 1 or IDDM has juvenile onset <18yrs with a pancreas that does not produce insulin Type 2 or NIDDM has adult onset with obesity, age, and activity that can be reversed Secondary from surgery, infection, medications, cancers, or trauma that can often be reversed

Diabetes Gestational DM, in 7% of women with obesity and genetics the risk factors Test with 75gm OGTT at 24-28 weeks of gestation, plus 3 day 150gm CHO diet >90mg/dL fasting, >180mg/dL after 1hr, and >150 after 2hrs Women have a 60% chance of having DM after pregnancy if positive for GDM

Diabetes Glucose is the energy source for all cells, with insulin activating for GLUT receptors Insulin is considered an anabolic hormone, secreted by the pancreas Without insulin glucose stays in the blood and catabolism occurs In order to remove glucose without insulin, constant urination occurs

Diabetes Glucagon increases BG by releasing endogenous glycogen stores in the liver Glucose is mostly found in CHO, but can be found in protein, minimally in fat Protein can be provide energy by conversion of glucose while reducing insulin secretion With excess CHO insulin increases but overtime pancreatic beta cells burn out

Signs and symptoms Blurred vision Polyuria Polydipsia Polyphagia Poor wound healing Neuropathy Kidney disorders

Complications Hypoglycemia with BG <70mg/dL can be fatal, with glucose tabs available Typically causes by: Too much insulin Too little food Excessive activity Sepsis

Management Physical activity Medication Nutrition management Normoglycemia Normal serum lipid levels Provide adequate kilocalories Lower glycemic index

Carbohydrate Intake 55% of total KCALS, as estimated by Wt/IBW CHO from fruits, vegetables, whole grains, legumes, and low-fat milk Fiber is not absorbed, slows digestion, and is shown to reduce post-parandial BG Glycemic index, with a slice of white bread as the standard Sucrose-containing foods can be substituted for other CHO

Carbohydrate Intake Carb counting, 1 serving = 15gm with most meals at 45-60gm Based on national food lists which include starches, dairy, fruit, and vegetables Glycemic index <55 is low and <75 is high with glycemic load for total meal Meals high in protein and fat have lower glycemic load, also >fiber

Management Limit alcohol Nutrition in acute illnesses Preventing Hypoglycemia Limit simple CHO intake High protein, moderate fat Complex CHO as tolerated Small, frequent meals