1. 5/26/2016 8:44 AM Reviewing Carbohydrates

2. 5/26/2016 8:44 AM Functions of Carbohydrates Why do we need them? Provide Energy Spare Protein Promote Normal Fat Metabolism Provide Fiber

3. 5/26/2016 8:44 AM Carbohydrates What are the Building Blocks? fructosegalactoseglucose Monosaccharides

4. 5/26/2016 8:44 AM Carbohydrates Polysaccharides

5. 5/26/2016 8:44 AM Using Energy Insulin

6. 5/26/2016 8:44 AM Storing Energy to make Glycogen Rejoining the Glucose Molecules Insulin

7. 5/26/2016 8:44 AM Storing Energy to Glucose Breaking down Glycogen Glucagon

8. 5/26/2016 8:44 AM Carbohydrates 60 – 90 Normal Blood Glucose Blood Glucose Level

9. 5/26/2016 8:44 AM Normal Carbohydrate Metabolism Glucose Insulin Glucagon Somatostatin

10. 5/26/2016 8:44 AM Abnormal Glucose Metabolism Diabetes Mellitus Type 1 Diabetes – rapid onset body cannot produce insulin Type 2 Diabetes – slower onset insulin defect insulin resistance can be both

11. 5/26/2016 8:44 AM Abnormal Glucose Metabolism Diabetes Mellitus Gestational Diabetes – temporary during pregnancy Stress Induced Diabetes – illness, surgery, infection Drug Induced Diabetes – corticosteroids, beta blockers

12. 5/26/2016 8:44 AM Insulin Endogenous Insulin – produced by the body Exogenous Insulin – given by injection

13. 5/26/2016 8:44 AM Glycemic Index Diabetes Mellitus

14. 5/26/2016 8:44 AM Insulin and Glucose Levels Diabetes Mellitus Blood Glucose Levels

15. 5/26/2016 8:44 AM Insulin and Glucose Levels Diabetes Mellitus Blood Glucose Levels Endogenous Insulin Levels

16. 5/26/2016 8:44 AM Insulin and Glucose Levels Diabetes Mellitus Blood Glucose Levels Exogenous Insulin Levels

17. 5/26/2016 8:44 AM Exercise and Glucose Metabolism Diabetes Mellitus Daily exercise recommended to prevent obesity and onset of Type 2 Diabetes. Daily exercise may also help to delay cardiovascular complications associated with diabetes. Strenuous activity may precipitate a hypoglycemic event, especially with exogenous insulin. Plan ahead and keep carb foods readily available.

18. 5/26/2016 8:44 AM Dietary Recommendations Carbohydrates from fruits, vegetables, whole grains, legumes, and low fat milk Low carbohydrate diets (< 130 g / day) are NOT recommended Carbohydrates should be monitored for glycemic index and individual effect Daily soluble and nonsoluble fiber rich foods are encouraged (25 – 30 g / day) Artificial sweeteners are safe within FDA guidelines

19. 5/26/2016 8:44 AM Dietary Recommendations Fats no more than 25% to 30% of daily caloric intake should come from fats (< 7% from saturated fats) Cholesterol should be restricted (< 200 mg / day)

20. 5/26/2016 8:44 AM Dietary Recommendations Proteins should comprise 15% to 30% of the total daily caloric intake High protein diets may are not recommended due to the unnecessary stress on the kidneys to excrete the excess nitrogen

21. 5/26/2016 8:44 AM Dietary Recommendations Alcohol can be consumed in moderation. Alcohol is best consumed with food to prevent nocturnal hypoglycemia. Mixed drinks (with soda or juice) are more likely to increase blood glucose levels. 1 drink = 1 oz liquor 1 drink = 4 oz wine 1 drink = 12 oz beer

22. 5/26/2016 8:44 AM Diabetes and Growth Spurts Diabetes Mellitus Metabolism increases during growth spurts requiring adjustments in calories and insulin. Increased risk of hypoglycemic events during growth periods, especially puberty.

23. 5/26/2016 8:44 AM Diet Management Diabetes Mellitus Follow all basic FDA and Food Pyramid guidelines Determine individual needs (health, activity, food habits) Achieve and maintain a consistent level of insulin and glucose levels A healthy diet is a diet that contains optimal amounts of macro and micronutrients, is low in food choices known to be detrimental, and provides consistent release of glucose throughout the day

24. 5/26/2016 8:44 AM Diet Management Diabetes Mellitus Diet is the keystone of care for ALL types of diabetes (Type 1, Type 2, gestational, etc.) Carbohydrate Counting Food Exchange List

25. 5/26/2016 8:44 AM Diet Management Diabetes Mellitus Sound Diet Therapy Rich in complex carbohydrates and dietary fiber Low in simple sugars, fats (especially saturated), cholesterol, and salt Moderate in protein Meals should be fairly evenly distributed throughout the day Mid meal snacks are essential to maintaining stable glucose levels Carbohydrates should always be readily available in event of a hypoglycemic event

26. 5/26/2016 8:44 AM Diet Management Diabetes Mellitus Typical Diabetic Diets 1200 calorie ADA diet 1500 calorie ADA diet 1600 calorie ADA diet 1800 calorie ADA diet 2000 calorie ADA diet 2200 calorie ADA diet

27. 5/26/2016 8:44 AM Diet Management – Is it working? Diabetes Mellitus Lab Values Reflecting Diabetic Control

28. 5/26/2016 8:44 AM Assessing Carbohydrates – Glucose levels – Carbohydrate and Insulin Functions Fasting Blood Sugar ( FBS ) Glycosylated Hemoglobin ( HbA 1 )

29. 5/26/2016 8:44 AM Assessing Carbohydrates – Hypoglycemia (Decreased Glucose) FBS  (Short Term)

30. 5/26/2016 8:44 AM Assessing Carbohydrates – Hyperglycemia (Increased Glucose) FBS  (Short Term)

31. 5/26/2016 8:44 AM Assessing Carbohydrates – Hyperglycemia (Increased Glucose) HbA 1  (Long Term)

32. 5/26/2016 8:44 AM The Well Educated Diabetic Diabetes Mellitus

33. 5/26/2016 8:44 AM