1. Diabetes Mellitus - Mgt Calculate and define diets for diabetes mellitus. Integrate physiological functions of organ systems and effects of disease on MNT.

2. DCCT 10 year study 1,400 subjects Decreased risk of complications by 70% if blood glucose as near normal as possible

3. Management of DM MNT Medications Exercise SMBG and Pattern Management Self-management education

4. Goals of MNT Near-normal blood glucose Optimal blood lipid levels Provide adequate kcal

5. Goals of MNT Prevent, delay, treat nutrition-related risk factors or complications Improve or maintain overall health through optimal nutrition

6. Role of CHO CHO = CHO = CHO Scientific evidence does not support the restriction of sucrose in an overall healthy diet

7. Role of CHO Sucrose and sucrose-containing foods can substitute for other CHO foods in the total meal plan

8. Next 2 slides research by Bantle and Laine in Type 1 diabetes mellitus and varying % kcal from sucrose

9. Mg% glu Sucrose & blood glucose values in Type 1 diabetes mellitus

10. Mg% glu Sucrose & blood glucose values in Type 2 diabetes mellitus

11. 15 g CHO 2 small cookies 1/2 donut 1/2 cup ice cream 1 tbsp syrup 3 cups popcorn

12. How much fat in each item on previous slide? How may kcal?

13. Food Myths 50 – 60% of protein becomes glucose Eating a protein with a cho snack slows absorption of cho Bedtime snack needs protein Eating too much protein can damage kidneys

14. Food Myths Protein foods are like meat, cheese, and peanut butter. Look up kcal from pro, fat & cho of shrimp, extra-lean ground beef, Am cheese, bologna, 2% milk, % lentils Look up kcal from pro & fat of sirloin, mozerella cheese, almonds, p butter, hot dog

15. Will work with meal plan approaches in a case study format Please read in ADA Clinical Manual & text

16. Medications Www.niddk.nih.gov/health/diabetes/p ubs/med/index Medicines for People with Diabetes

17. Medication - Insulin Handout of insulin types and oral hypoglycemic agents Next slide lispro or Humalog

18. Lispro - fastest acting human insulin

19. Peak Effect of Insulin At your tables draw what the blood glucose might be at the peak times of Humalog, Humulin N, Humulin U Blood glucose starts at 100mg% All taken at 8am

20. Medication - Oral agents Sulfonylureas Biguanides Thiazolidinedione Meglitinides Alhpa-glucosidase inhibitors

21. Sulfonylureas Stimulate pancreas to make insulin Can result in hypoglycemia Do not take with alcohol Wt gain Orinase, Tolinase DiaBeta, Amaryl, Glucotrol

22. Biguanides Antihyperglycemic in effect Not at risk for hypoglycemia Enhances peripheral glucose uptake Do not take with alcohol Metallic taste Glucophage

23. Thiazolidinedione Helps cells to take in more glucose Monitor liver function Gain wt Risk of anemia & edema Actos Avandia

24. Meglitinides Repaglinide Helps pancreas make more insulin right after meals Can get hypoglycemia Gain wt

25. Alpha-glucosidase inhibitor Gas, bloating, diarrhea if dose to high Take with first bite or 30 min before meal Glyset Precose

26. Exercise Glucose will enter muscle cell without insulin What might be potential problems?

27. Exercise Guidelines SMBG before and after ex. Adjust food intake or insulin dose 1 hr increased ex need additional 15 g cho

28. Acute Complications Hypoglycemia –hunger –shakiness –cold sweats –palpitations Hypoglycemia –headache –confusion –lack of coordination –anger –seizures, coma, death

29. Acute Complications Hypoglycemia –Why these symptoms? –What are the causes of hypoglycemia?

30. Acute Complications Hypoglycemia –treatment –15 g CHO –SMBG –more 15 g CHO if not increasing

31. Long Term Monitoring Glycosylated hemoglobin –glucose attaches to hemoglobin non- enzymatically –normal 6%

32. Long Term Monitoring Glycosylated hemoglobin Next slide the relation between average blood glucose & HbA1c

33. HbA1c and average blood glucose

34. Long Term Monitoring Ketones in urine –important during illness –check if blood glucose consistently over 240 mg%

35. Long Term Monitoring Triglycerides Blood cholesterol

36. End lecture on management Questions Now to work on case studies and do the work