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

2. 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

3. 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 (~ gms/day)
Using glucose to make fat

4. 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

5. 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

6. 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?

7. 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?

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

9. 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

10. 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’

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

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

13. Diabetes Mellitus: DX Fasting Blood Glucose Levels:
Prediabetes: 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

14. 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

15. 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

16. 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

17. Health Risks Heart Disease/Stroke Kidney Disease Blindness
Nerve damage

18. 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

19. ADA General Guidelines
Glycemic Goals
A1c = 7%
Fasting & before meals: 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

20. 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

21. 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 gms CHO
Add pro at pm snack
Eating extra CHO before & during exercise & monitoring BS

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

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