1. Nutrition 10 Today Tues. May 9 Thurs. May 11 Topics
Finish Carbs
Diabetes (DM)
Market Assignment due today 20 points
Thurs. May 11
Topic: Protein Calorie Estimate (PCE) and Diet Assignment
PCE 5 points Due Tues. May 16
NO CLASS Thurs MAY 18
Diet Assignment 20 points Due Tues. May 23

2. Blood Sugar Lows and Highs
NOTE: Blood sugar level and Blood Glucose Level are the same thing. The sugar in our blood IS glucose!

3. Tools for Blood Sugar Level Control
Goal BSL ~ mg %
Insulin
Protein based, pancreatic hormone
Opens cells to let blood sugar inside
Lowers blood sugar level
Glucagon
Raises BSL by breaking down glycogen
or Trouble
NOTE: Blood sugar level and Blood Glucose Level are the same thing. The sugar in our blood IS glucose!

4. sweaty, rapid heart rate
How low can you go?
sweaty, rapid heart rate
Symptoms
Low blood sugar
grouchy, anxious
dizzy, confused

5. Hypoglycemia (Low BSL)
Acute danger but uncommon condition
Need sugar (glucose, a simple carb) in blood 24/7
To treat give simple carb (sugars) immediately
To prevent trickle in carbs over the day
No meal skipping
Healthy complex carb/protein at meals
Limit simple (especially‘added’) sugar
Why limit only simple sugar?
CNS (brain and nerves) always need some glucose to use for fuel. RBC’s, part of retina of eye and part of kidneys can only use glucose as fuel.
Specific cause of Hypoglycemia varies…exercise and failure to eat, tumor, insulin production not in sync with glucose demand, etc.
Diet recommendations for low BSL is s diet good for all of us!
There is no medicine treatment to prevent low bsl.

6. What’s to know bout Fast ‘n Slow…carbs?
‘Fast’and‘slow’ refer to rate carb enters blood. Ideal is for carbs to trickle into blood!
Complex carbs….‘slow’
Whole grains best…. enter blood most slowly
Enriched grains… enter blood more quickly (why?)
Simple carb….. ‘fast’
Natural sugar (milk/fruit) enters blood quickly
Added sugars by far, enter blood most quickly!
** ‘added’ sugars enter the blood most quickly of all. Hardly any digestion of them is needed at all. If have trouble maintaining BSL (e.g. hypoglycemia or diabetes) , then these really need to be limited. Some people with these problems need to limit their natural sugar and even their enriched grain intake.

7. Diabetes Projections: 2000 to 2030
About 30 million+ people in US have DM; 1 of 4 is unaware that they have Diabetes.
7th leading cause of death in the US
>70% eligible for Medicare have diabetes or prediabetes.
•One in three Medicare dollars is currently spent on people with diabetes.
•Total national costs associated with diabetes exceeded $245 billion in 2012, up from $174 billion in 2007.

8. Diabetes: a global problem
Diabetes in the US!
1 of 9 in US has diabetes
only 1 of 4 aware of it
1 of 3 Medicare $ spent to treat DM

9. Diabetes Mellitus (DM)
Hyperglycemia (high fasting BSL)
Cause: not enough or ineffective Insulin
Result: too much sugar in blood-not enough in cell
Consequence: cells/tissues are glucose starved
chronic inflammation occurs
blood lipids and pressure rise, arteries harden
tissue/cell function declines
Basically in Diabetes, cells are in starvation mode…even though blood loaded with glucose (sugar)… kind of like starving to death in a supermarket. The key (insulin) is not working or is ineffective so the glucose cannot get into the cell. So the cell kicks into ‘starvation mode’, making protein into glucose to meet glucose need, burning fat inefficiently to make ATP since carb is missing (remember it has to be able to get into the cell to be useful to the cell. Without insulin, this cannot happen)
Fasting BSL goal mg% is still considered normal, but may be referred to as pre-diabetes. If > 126mg% = diabetic via 2010 ADA recommendations.
Many causes of DM, but all categorized into ~ three major groups Type 1, 2 and Gestational DM
Inflammation is OK, if acute as in when immune system responds to infection or irritation.
Problem arises when inflammation is chronic. Then it triggers release of biologically-active substances that promote oxidation and other harmful reactions increase blood pressure, arterial blockage, elevation of blood lipids (cholesterol). Uh oh….bad stuff happens in the body : (
Note: ‘Fasting’ means 12 hours or more with no caloric intake from food or beverage.

10. DM: A chronic, progressive disease
Common consequences
Heart disease (#1 cause-diabetic deaths)
Blindness
Amputations
Kidney disease
All complications are associated with the negative effects of high blood sugar (glucose) on blood vessel walls…makes them narrow and harden…. making them more easy to block off (occlude).
Dialysis is used when kidney function is too low (inefficient) to adequately filter the blood of toxins. For most it is required the rest of their life unless
They are one of the few who qualifies for, and receives a kidney transplant. Many who need dialysis have had diabetes for a long time. High BSL,among other causes, is damaging to the kidneys.

11. Classifications of Diabetes
Type 1
Uncommon
Inadequate insulin
Treatment
requires insulin healthy diet regular exercise
Most common in kids/young. Makes up small % of DM cases.
May be an autoimmune reaction in some post viral exposure

12. Classifications of Diabetes
Type 2
Majority of cases
Ineffective insulin
Treatment:
Medical  pills and/or insulin
Lifestyle  diet/exercise/stress mgt.
Most common in adults, but now increasing in kids as well. Thoughts are this is associated with lifestyle choices (poor diet and lack of exercise). Problem is that damaging effects of high BSL take time. If diagnosed with DM at 60 years of age, then only ~20 years for bad stuff to happen. If diagnosed when 25 years old, then there are many decades for bad stuff to happen. Often young people do not appreciate their own mortality and do not take care of self even when diagnosed with DM.

13. Tips to manage BSL Trickle in healthy carbs over day
More healthy complex (slow) carbs
Less simple (fast) carbs
No meal skipping
Limit added sugar (~25g/35g)
Replace saturated (animal) with unsat. (plant) fats
Achieve a healthy weight
Quit smoking
Maximize exercise!!!!!
Glycemic Index (GI). See text for more description. It is not a panacea (cure all). It does gives idea of the sugar load body sees from certain foods. Best to look at Glycemic Load which is GI x gms of CHO in the food. Short coming of GI and GL is that it measures a food in isolation for other foods…not very realistic. We eat mixtures of foods, not one food in isolation. We do not have measures of GI or GL for a peanut butter sandwich, apple, chips and milk. We have GI or GL for peanut butter, for bread, for apple, for chips, et.
You will NOT be tested on GI or GL////mostly because I don’t think it is worth depending on as a tool to RX diabetes (or for that matter, weight control).
Also advised that people with diabetes be monitored for vitamin D levels. Vit D is being studied for its relationship to normal blood sugar control. Currently vitamin D and BSL are being studied. By current standards many of us at our latitude (bay area) and north seem to be deficient, particularly those with darker skin pigmentation.

14. Optional slides follow

15. Concept Map: carb review
Objective: learn to link terms with ideas covered in class
Terms: Start with carbohydrate. Now add simple carb, added sugar, natural sugar, lactose, fructose, glucose, sucrose, complex carb, fiber, glycogen, starch, grains, honey, soda, plain yogurt, fruit and liver/muscle glycogen to your map
Practice: Draw a diagram logically linking all of the terms.
Identify blood, milk, fruit and table sugar and where glycogen stored.
What is meant by the term ‘fast’ and ’slow’ carb?
Purpose: practice drawing a concept map and to review carb knowledge.

16. Carbohydrate Simple carb fast Complex carb slow Fruit* Natural sugar
Veg, grains,
grain
by-products
Fructose
Honey
candy
soda
Added
sugar
Fruit*
Sucrose
Milk,
plain
yogurt
Natural
sugar
Lactose
Glucose
Blood sugar
No glycogen in food
How would you connect this map to the DM map?
Glycogen
Our storage form of glucose
Muscle/Liver storage sites
Starch
&
Fiber
Fiber

17. Concept Map: Blood Sugar Level
Terms: blood sugar (glucose), hyperglycemia, hypoglycemia, glucagon, insulin, Type 1 diabetes (DM), Type 2 diabetes, ineffective insulin, inadequate insulin.
Note: You may want to use descriptors along your arrows to clarify action occurring e.g. increase, decrease, etc.
Draw a diagram logically linking all of the terms.