1. Diet and Diabetes Created by: Tricia Fleming, University of Kansas Dietetic Intern Tammy Beason, MS, RD, Nutrition Education Specialist, Family Nutrition Education Program December 2001

2. Diabetes- What is it? Body is not producing or has lost sensitivity to insulin.Body is not producing or has lost sensitivity to insulin. Insulin is a hormone that is needed to convert sugar, starches and other food into energy.Insulin is a hormone that is needed to convert sugar, starches and other food into energy. Insulin is produced in the body by the pancreas.Insulin is produced in the body by the pancreas.

3. Types of Diabetes There are several types of diabetes: Type I - body does not produce any insulin.Type I - body does not produce any insulin. Type II- body is not making enough or is losing sensitivity to insulin made.Type II- body is not making enough or is losing sensitivity to insulin made.

4. Types of Diabetes Secondary - a consequence from another disease. For example, pancreatitis or cystic fibrosis.Secondary - a consequence from another disease. For example, pancreatitis or cystic fibrosis. Gestational Diabetes- diabetes during pregnancy.Gestational Diabetes- diabetes during pregnancy. Impaired Glucose Tolerance- an intermediate between normal and diabetes.Impaired Glucose Tolerance- an intermediate between normal and diabetes.

5. Quick Review-Anatomy of the Pancreas A gland that lies behind the stomachA gland that lies behind the stomach Clusters of cells inside the pancreas known as the islets of Langerhans produces three hormones.Clusters of cells inside the pancreas known as the islets of Langerhans produces three hormones. The islets contain 3 types of cells:The islets contain 3 types of cells: Alpha, beta, and delta.Alpha, beta, and delta. Alpha cells produce glucagon.Alpha cells produce glucagon.

6. Pancreas contd. Beta cells- produce insulinBeta cells- produce insulin Delta cells- produce somatostatinDelta cells- produce somatostatin These cells have special sensors that monitor levels of blood sugar and stimulate the release of the correct hormone.These cells have special sensors that monitor levels of blood sugar and stimulate the release of the correct hormone.

7. Insulin and the other hormones Glucagon - Hormone that increases the amount of glucose in the blood when it is needed.Glucagon - Hormone that increases the amount of glucose in the blood when it is needed. Somatostatin - Hormone that can suppress both glucagon and insulin when needed.Somatostatin - Hormone that can suppress both glucagon and insulin when needed. Insulin- Hormone that lowers blood glucose.Insulin- Hormone that lowers blood glucose.

8. How Does Insulin Work? A person normally secretes insulin in response to an elevated blood sugar level.A person normally secretes insulin in response to an elevated blood sugar level. It does this by accelerating blood sugars movement out of the blood and into the cells.It does this by accelerating blood sugars movement out of the blood and into the cells. Cells will not allow blood sugar in without insulin. - this can cause a problem.Cells will not allow blood sugar in without insulin. - this can cause a problem.

9. Why isnt the body making insulin? In people with Type I, the immune system has made a big mistake!In people with Type I, the immune system has made a big mistake! It attacks the beta cells and destroys them!It attacks the beta cells and destroys them! In people with Type II, the pancreas is still making insulin, just not enough to keep up, or their bodies have become insulin resistant!In people with Type II, the pancreas is still making insulin, just not enough to keep up, or their bodies have become insulin resistant!

10. Type I Usually diagnosed in children and young adults.Usually diagnosed in children and young adults. Must take daily insulin shots to stay alive.Must take daily insulin shots to stay alive. Type I accounts for 5-10% of the population with diabetes.Type I accounts for 5-10% of the population with diabetes.

11. Type II The most common form of the disease.The most common form of the disease. Approximately 50% of men and 70% of women are obese at the time of diagnosis.Approximately 50% of men and 70% of women are obese at the time of diagnosis. Nearing epidemic proportions, due to increase # of older Americans, greater occurrence of obesity and sedentary lifestyles.Nearing epidemic proportions, due to increase # of older Americans, greater occurrence of obesity and sedentary lifestyles.

12. Gestational Diabetes Pregnant women have a higher insulin level.Pregnant women have a higher insulin level. If woman has hyperglycemia, her blood glucose crosses the placenta but her insulin does not.If woman has hyperglycemia, her blood glucose crosses the placenta but her insulin does not. This can cause a high birth weight for baby.This can cause a high birth weight for baby.

13. What are the Symptoms? Polyphasia- excessive eatingPolyphasia- excessive eating Polyurea- excessive urinationPolyurea- excessive urination Polydypsia-excessive fluid intakePolydypsia-excessive fluid intake Blurred visionBlurred vision Poor wound healingPoor wound healing IrritabilityIrritability

14. How are you diagnosed with diabetes? In June 1997, the ADA redefined its criteria for diagnosing diabetes.In June 1997, the ADA redefined its criteria for diagnosing diabetes. Normal fasting blood glucose is <110 mg/dl.Normal fasting blood glucose is <110 mg/dl. Impaired fasting glucose is >110 and 110 and <126 mg/dl. Provisional diagnosis for diabetes>126 mg/dlProvisional diagnosis for diabetes>126 mg/dl

15. Diagnosis contd. In order to be diagnosed with diabetes:In order to be diagnosed with diabetes: Person must have symptoms of diabetes +Person must have symptoms of diabetes + Causal plasma glucose >200Causal plasma glucose >200 Fasting blood glucose of >126 mg/dlFasting blood glucose of >126 mg/dl 2-hour plasma glucose >200 mg/dl on oral glucose test2-hour plasma glucose >200 mg/dl on oral glucose test

16. Whos at risk? ADA now recommends that screening for diabetes should be considered for all patients at age 45. If the results are normal it should be repeated every 3 years. Screening should be considered at a younger age if patient meets following risk factors:

17. Whos at risk? ObesityObesity First degree relative with diabetesFirst degree relative with diabetes Belongs to a high-risk ethnic groupBelongs to a high-risk ethnic group Was diagnosed with gestational diabetes or delivered a baby whose birth weight >9 lbs.Was diagnosed with gestational diabetes or delivered a baby whose birth weight >9 lbs. HypertensionHypertension

18. Whos at risk? HDL level 250HDL level 250 Found to have impaired glucose tolerance or impaired fasting on a previous test.Found to have impaired glucose tolerance or impaired fasting on a previous test.

19. Ive got Diabetes, now what? After diagnosis, there is a great need for education.After diagnosis, there is a great need for education. A diabetic diet is no different from anyone elses but they must keep track of what they eat.A diabetic diet is no different from anyone elses but they must keep track of what they eat. A food diary is a great start!A food diary is a great start! Serving sizes must be emphasized.Serving sizes must be emphasized.

20. Treatment Goals for Type I Match insulin to food intake.Match insulin to food intake. Type Is are encouraged to be precise and regular from day to day with food intake, insulin regimen, and activity.Type Is are encouraged to be precise and regular from day to day with food intake, insulin regimen, and activity.

21. Exercise and Type Is Increases flexibility, muscular strength, and well being.Increases flexibility, muscular strength, and well being. Must monitor insulin and food intake to match exercise regimen.Must monitor insulin and food intake to match exercise regimen. Increases insulin effectiveness and sensitivity in the body.Increases insulin effectiveness and sensitivity in the body.

22. Treatment Goals for Type II Achieve normal or near-normal blood glucose levels.Achieve normal or near-normal blood glucose levels. Provide adequate calories for reasonable body weight.Provide adequate calories for reasonable body weight. Prevent, delay or treat nutrition related complications.Prevent, delay or treat nutrition related complications. Improve health through optimal nutrition.Improve health through optimal nutrition.

23. Exercise and Type II Especially beneficial in type II diabetes.Especially beneficial in type II diabetes. Promotes weight lossPromotes weight loss Increases insulin sensitivity.Increases insulin sensitivity. Must also be aware of medication and intake to prevent hypoglycemia.Must also be aware of medication and intake to prevent hypoglycemia.

24. Treatment of Diabetes Diet plays a major role.Diet plays a major role. Carbohydrates are the component of food that causes an increase in blood sugar.Carbohydrates are the component of food that causes an increase in blood sugar. Diabetics are encouraged to keep track of the amount of CHO they eat.Diabetics are encouraged to keep track of the amount of CHO they eat.

25. Methods of Carbohydrate Control There are many new methods of controlling diabetes, these are still the two most common. Exchange ListsExchange Lists Carbohydrate counting- Very basic, allows a little more freedom and variety.Carbohydrate counting- Very basic, allows a little more freedom and variety.

26. Blood Glucose Monitoring All diabetics must keep track of blood glucose levels.All diabetics must keep track of blood glucose levels. This is the only way to know if the treatment is effective.This is the only way to know if the treatment is effective. Gives the diabetic a good indication of what affects their blood sugar level.Gives the diabetic a good indication of what affects their blood sugar level. Must check at least 2 times a day and four times a day for at least 3 days a week.Must check at least 2 times a day and four times a day for at least 3 days a week.

27. Hemoglobin A1c A good indicator of blood glucose control.A good indicator of blood glucose control. Gives a % that indicates control over the preceding 2-3 months.Gives a % that indicates control over the preceding 2-3 months. Performed 2 times a year.Performed 2 times a year. A hemoglobin of 6% indicates good control and level >8% indicates action is needed.A hemoglobin of 6% indicates good control and level >8% indicates action is needed.

28. Dietary Guidelines Eat a diet low in saturated and total fat.Eat a diet low in saturated and total fat. Eat a diet moderate in sodium and sugar.Eat a diet moderate in sodium and sugar. Eat 5 or more fruits and vegetables a day.Eat 5 or more fruits and vegetables a day. Choose a diet rich in whole grains.Choose a diet rich in whole grains. Moderate use of alcoholModerate use of alcohol

29. Dietary Guidelines Eat at the same time everyday, at least within 1 hour of regular time.Eat at the same time everyday, at least within 1 hour of regular time. Eat about the same amount of carbohydrate with each meal.Eat about the same amount of carbohydrate with each meal.

30. Other Treatments Type I and sometimes Type II patients need to be treated with insulin.Type I and sometimes Type II patients need to be treated with insulin. There are more than 20 types.There are more than 20 types. They differ in how they are made, how they work in the body and their cost.They differ in how they are made, how they work in the body and their cost.

31. Oral Medications Used to treat Type II diabetics. There are four basic types: Sulfonylurea-stimulates the body to make more insulin.Sulfonylurea-stimulates the body to make more insulin. Metformin-lowers blood sugar by helping the insulin work betterMetformin-lowers blood sugar by helping the insulin work better

32. Oral medications Thiazolidinediones- increases muscle sensitivity to insulin.Thiazolidinediones- increases muscle sensitivity to insulin. Alpha-glucosidase inhibitors- slow the process of carbohydrate digestion.Alpha-glucosidase inhibitors- slow the process of carbohydrate digestion.

33. Treatment Goals The main goal is to normalize blood sugar. Realistic goals for diabetics are 70-140 mg/dl before meals, <180 mg/dl after and a glycosolated hemoglobin within 1% of normal.The main goal is to normalize blood sugar. Realistic goals for diabetics are 70-140 mg/dl before meals, <180 mg/dl after and a glycosolated hemoglobin within 1% of normal. Need good blood glucose control to avoid complications.Need good blood glucose control to avoid complications.

34. Diabetes Complications Diabetes complications are the seventh leading cause of death. They include: Blindness- caused by diabetic retinopathy.Blindness- caused by diabetic retinopathy. Kidney Disease- diabetic nephropathyKidney Disease- diabetic nephropathy Heart Disease and StrokeHeart Disease and Stroke

35. Complications contd Nerve disease and amputationsNerve disease and amputations ImpotenceImpotence

36. How to Avoid Complications Control weightControl weight Eat a healthy well-balanced diet.Eat a healthy well-balanced diet. Get regular exerciseGet regular exercise Have regular checkupsHave regular checkups Check feet everyday for cuts and blistersCheck feet everyday for cuts and blisters Do not smoke!Do not smoke!

37. How to Avoid Complications Keep blood sugars normalKeep blood sugars normal Avoid the 2 common diabetic problems,Avoid the 2 common diabetic problems, hypoglycemia and hyperglycemia

38. Hypoglycemia Hypoglycemia- low blood sugarHypoglycemia- low blood sugar Happens to everyone with diabetesHappens to everyone with diabetes Symptoms include shakiness, dizziness, sweating, hunger, headache, pale skin, sudden moodiness, clumsy or jerky movements, difficulty paying attention, and tingling sensations around mouth.Symptoms include shakiness, dizziness, sweating, hunger, headache, pale skin, sudden moodiness, clumsy or jerky movements, difficulty paying attention, and tingling sensations around mouth.

39. Hypoglycemia How to treat Hypoglycemia: Quickest way to raise blood glucose is with some form of sugar.Quickest way to raise blood glucose is with some form of sugar. 3 glucose tablets, 1/2 cup of fruit juice, 5-6 pieces of candy.3 glucose tablets, 1/2 cup of fruit juice, 5-6 pieces of candy. Wait 15-20 minutes and test blood sugar again. If still low retreat.Wait 15-20 minutes and test blood sugar again. If still low retreat.

40. Hypoglycemia If hypoglycemia goes untreated, patient could get worse and pass out!If hypoglycemia goes untreated, patient could get worse and pass out! Stress the importance of a night time snack in older patients.Stress the importance of a night time snack in older patients.

41. Hyperglycemia Ketoacidosis: Develops when the body does not have enough insulin. The body cant break down sugar so it breaks down fat instead. Ketones are what is left from this process.The body does not tolerate ketones and tries to pass them out of the body.

42. Hyperglycemia Symptoms that may result in ketoacidosis occur when: Too little insulin has been ejected, or insulin is not effective.Too little insulin has been ejected, or insulin is not effective. Consumed more food and/or exercised less than expected.Consumed more food and/or exercised less than expected. High blood sugar, high levels of sugar in the urine, frequent urination, and increased thirstHigh blood sugar, high levels of sugar in the urine, frequent urination, and increased thirst

43. How to treat Hyperglycemia Usually can lower it by exercising, or injecting more insulin, be careful of the somogyi effect.Usually can lower it by exercising, or injecting more insulin, be careful of the somogyi effect. The somogyi effect is the condition of hypoglycemia resulting from the treatment of hyperglycemia.

44. Conclusion Diabetes is a very complicated disease. For more information: www.diabetes.org