1. 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%

21. 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

25. Diabetes
Gestational DM, in 7% of women with obesity and genetics the risk factors
Test with 75gm OGTT at 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

31. 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

36. 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

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

49. 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

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

53. 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

57. 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

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