1. Nutrition and Diabetes
Jamie Pope, Steven Nizielski, and Alison McCook
NUTRITION
for a Changing World
FIRST EDITION
Chapter 5
Nutrition and Diabetes
Medical Miracles
© 2016 by W. H. Freeman and Company & Scientific American

2. Chapter 5 Objectives Describe how blood glucose is regulated
Explain what happens when sensitivity to insulin is impaired
Explain the difference between diabetes and prediabetes
List health issues that are common in people with poorly controlled diabetes
Describe how gestational diabetes differs from type 1 or type 2 diabetes
Describe factors that increase the risk for diabetes and those that protect against it, and understand how these factors relate to the Dietary Guidelines for Americans

3. Diabetes Mellitus Patients waste away to nothing
It was considered a death sentence
What happened in 1922 to change this?

4. What Is Diabetes Mellitus?
Patients have a problem with regulating blood glucose (sugar)
Normally blood glucose is tightly regulated

5. Blood Glucose Regulation
Pancreas secretes insulin in response to increased blood sugar
Stimulates cells to take up glucose from the blood
Promotes extra glucose to fat in liver and adipose
Pancreas insulin secretion increases with increased glucose concentrations in the blood; therefore, it increases after we eat. Insulin opens the channel in skeletal muscle, cardiac muscle, and adipose tissue, to take up glucose from the blood.

6. Blood Glucose Regulation
Pancreas secretes glucagon in response to decreased blood sugar
Stimulates liver to release glucose into the blood
Breaks down glycogen into glucose
Synthesizes new glucose

7. Disrupted Blood Glucose Regulation
Type 1 diabetes
Lack of insulin
Autoimmune disease
Destroys insulin-producing cells in pancreas

8. Type 1 Diabetes Mellitus
Pancreas cannot produce insulin
Muscle and adipose cannot take up glucose
Body cannot use glucose
Causes hyperglycemia
Glucose spills into the urine
Diabetes is the Greek word for “siphon”
Mellitus is the Latin word “sweet”

9. Type 1 Diabetes Mellitus
Fatty acids released from adipose tissue
Used as energy source instead of muscle protein
Cannot be used by the brain
Converted to ketone bodies in the liver
Ketoacidosis can result
Diabetic ketoacidotic coma (DKA)

10. Treatment of Type 1 Diabetes
Disease treated with insulin injections
Injections discovered in 1921 by Dr. Banting who injected it into dogs
First human patient was a 14-year-old boy
Dr. Frederick Banting began research in dogs with his assistant Charles Best at the University of Toronto. They removed the pancreas of a dog, ground it up to disrupt the digestion function and stop it from producing digestive enzymes, filtered it, and injected it into another dog with diabetes. The dog’s blood glucose went down, and he showed no bad side effects. They went to slaughter houses to get pancreases from pigs and cows, which also worked in the dogs. A 14-year-old boy, Leonard Thompson, was admitted to Toronto General Hospital with diabetes. He weighed only sixty-five pounds and was likely to die soon. The parents gave permission in January 1922 to inject him with insulin from the research project. The boy did well, and others with diabetes began getting these injections. Dr. Banting and Dr. Macleod, the head of physiology at the University of Toronto, won the Nobel Prize for Physiology of Medicine. In 1923 a pharmaceutical company, Eli-Lilly, began making insulin for treating diabetics.

11. Insulin Sensitivity and Resistance

12. Type 2 Diabetes Risk Factors
Obesity
Physical inactivity
Genetics
Lifestyle
9 out of 10 people with diabetes have type 2
Obesity: 80% to 90% of people with type 2 diabetes are obese
Genetics: if one identical twin has type 2 diabetes, the other twin will also have type 2 diabetes 75% of the time

13. Diagnosing Insulin Resistance
Prediabetes
Fasting blood glucose 100 to 125 mg/dL
Oral glucose tolerance test (OGTT) 140 to 199 mg/dL
Type 2 diabetes
Fasting blood glucose >125 mg/dL
OGTT >200 mg/dL

14. Diagnosing Insulin Resistance

15. Prediabetes Increased risk for Treatment through Type 2 diabetes
Heart disease
Stroke
Treatment through
Lifestyle strategies
Weight control
Physical activity
Dietary modifications

16. Diabetes Symptoms
Excessive thirst
Blurred vision
Weight loss

17. Complications of Diabetes
Damage to
Heart
Blood vessels
Kidneys
Eyes
Nerves

18. Gestational Diabetes
Occurs because of high blood sugar during pregnancy
Obesity increases risk
Exercise reduces risk
Increases complication of pregnancy
Causes the baby to grow too large
Creates higher risk of developing type 2 diabetes

19. Gestational Diabetes Pregnancy hormones cause insulin resistance
Glucose crosses placenta to infant
Infant produces excess insulin
Extra fuel and insulin causes infant to grow

20. Gestational Diabetes Risk Factors
Obese prior to pregnancy
Older than 25 years
Family history of type 2 diabetes
Non-White race

21. Gestational Diabetes Consequences
For the mother
Higher incidence of cesarean section
High blood pressure during pregnancy
Increased risk of developing diabetes in 10 to 20 years
For the infant
Risk of shoulder injury during birth
Higher risk of breathing problems
Increased risk of becoming an obese child
Increased risk of developing diabetes as an adult

22. Diabetes on the Rise
By 2030, 550 million people worldwide expected to have diabetes
Type 2 diabetes caused by
Obesity
Overeating
Decreased physical activity
Increased sedentary behaviors
Type 1 diabetes used to be juvenile-onset diabetes, and type 2 was adult-onset diabetes. This is no longer the case. Children developing type 2 diabetes has increased tenfold, while there is also a rise in children developing type 1; one can no longer tell the type of diabetes by age.

23. Tip the Balance in Favor of Diabetes Prevention
Anti-diabetes factors:
Lean body and physical activity
Diet rich in whole grains, beans, healthy fats, and oily fish
Pro-diabetes factors:
Sedentary lifestyle
Overweight and obesity
Diets with unhealthy fats, red and processed meats, refined grains, sugar sweetened beverages

24. Type 1 Diabetes Treatment
Insulin
Injections
Insulin pump
Glucose monitoring
Meter
Track food choices and activity
Match insulin to achieve desired blood glucose levels

25. Type 2 Diabetes Treatment and Prevention
Lifestyle modification
Changing diet
Increasing physical activity
Maintaining a healthy body weight
If lifestyle does not help control blood glucose levels
Oral medications are available
Insulin injections may be required

26. Effect of Food on Blood Glucose
Carbohydrates
Resistant starches
Glycemic index (GI)
Glycemic load
[food’s GI x food’s grams of carbohydrates]/ 100

27. Diet for Diabetes Count carbohydrate Monitor fat intake
Determine grams of carbohydrates at each meal and snack
Monitor fat intake
<7% calories from saturated fat
Limit trans fat
Increase physical activity

28. Hypoglycemia Blood sugar <70 mg/dL Fasting hypoglycemia
Reactive hypoglycemia
Epinephrine
Stimulates glucose synthesis in the liver

29. Summary
Diabetes mellitus, more commonly known as diabetes, is a disease that disrupts the body’s ability to adequately regulate glucose metabolism
Insulin and glucagon are hormones secreted by the pancreas that regulate glucose metabolism and blood glucose levels
Insulin enables cells in the skeletal muscle, cardiac muscle, and adipose tissue to take up glucose from the blood. Insulin also promotes the conversion of excess glucose to glycogen in the liver and muscle. Additionally, as glycogen storage is limited, insulin stimulates the conversion of glucose to fat in the liver and adipose tissue
Glucagon is responsible for increasing glucose availability in the blood when blood glucose levels fall, by signaling the liver to break down glycogen or synthesize new glucose molecules

30. Summary (Cont’d)
Type 1 diabetes is an autoimmune disease characterized by the destruction of insulin-producing cells in the pancreas and increased levels of blood glucose (hyperglycemia)
Type 2 diabetes is the most common form of diabetes and is characterized by insulin resistance and hyperglycemia
Insulin resistance is a common condition in which cells lose their sensitivity to insulin, and it often precedes development of type 2 diabetes
A diagnosis of diabetes is based on blood glucose concentrations of at least 126 mg/dL of blood after an 8-hour fast, and an oral glucose tolerance test result of at least 200 mg/dL 2 hours after the ingestion of 75 grams of glucose
Individuals with prediabetes or glucose levels higher than normal (typically mg/dL), but not high enough to be diagnosed with type 2 diabetes, are more likely to develop some form of diabetes and are at higher risk of heart disease and stroke

31. Summary (Cont’d)
Diabetes affects many major organs, including the heart, blood vessels, nerves, eyes and kidneys. Controlling blood glucose levels can help prevent these complications, which can be disabling or even life-threatening
Gestational diabetes is a common form of diabetes that afflicts women during pregnancy, particularly women who are overweight or obese. Most women revert to normal blood glucose levels following delivery, but they may be at increased risk of developing type 2 diabetes later in life
Although type 2 diabetes is influenced by genetics, lifestyle modifications, including a diet rich in whole grains, beans, and healthy fats, along with regular physical activity and maintenance of a healthy body weight can reduce the risk or potentially reverse the disease

32. Summary (Cont’d)
Diets that emphasize foods with resistant starch may improve insulin sensitivity, satiety, and blood glucose control
Food sources of carbohydrates can have different effects on blood glucose levels. The glycemic index (GI) is a ranking of how food affects blood glucose levels relative to the effect of an equivalent amount of carbohydrates. Although the clinical relevance of using the GI is unclear, a more applicable measure may be the glycemic load (GL), which indicates the effect of typical portions of food on blood glucose
Hypoglycemia, or low blood glucose levels, may result from overmedication in individuals with diabetes, in response to prolonged periods of not eating or consuming excessive amounts of alcohol, or in rare cases, from abnormalities in the way the body produces and responds to insulin