Diet and Diabetes

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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

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Diabetes- What is it?

• 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 produced in the body by the pancreas.

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Types of Diabetes

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

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Types of Diabetes

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

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Quick Review-Anatomy of the Pancreas

• A gland that lies behind the stomach
• Clusters of cells inside the pancreas known as
  the islets of Langerhans produces three hormones.
• The islets contain 3 types of cells
• Alpha, beta, and delta.
• Alpha cells produce glucagon.

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Pancreas contd.

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

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Insulin and the other hormones

• 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.
• Insulin- Hormone that lowers blood glucose.

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How Does Insulin Work?

• 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.
• Cells will not allow blood sugar in without
  insulin. - this can cause a problem.

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Why isnt the body making insulin?

• In people with Type I, the immune system has made
  a big mistake!
• 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!

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Type I

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

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Type II

• The most common form of the disease.
• 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.

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Gestational Diabetes

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

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What are the Symptoms?

• Polyphasia- excessive eating
• Polyurea- excessive urination
• Polydypsia-excessive fluid intake
• Blurred vision
• Poor wound healing
• Irritability

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How are you diagnosed with diabetes?

• In June 1997, the ADA redefined its criteria for
  diagnosing diabetes.
• Normal fasting blood glucose is lt110 mg/dl.
• Impaired fasting glucose is gt110 and lt126 mg/dl.
• Provisional diagnosis for diabetesgt126 mg/dl

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Diagnosis contd.

• In order to be diagnosed with diabetes
• Person must have symptoms of diabetes
• Causal plasma glucose gt200
• Fasting blood glucose of gt126 mg/dl
• 2-hour plasma glucose gt200 mg/dl on oral glucose
  test

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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

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Whos at risk?

• Obesity
• First degree relative with diabetes
• Belongs to a high-risk ethnic group
• Was diagnosed with gestational diabetes or
  delivered a baby whose birth weight gt9 lbs.
• Hypertension

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Whos at risk?

• HDL levellt35 or triglycerides gt250
• Found to have impaired glucose tolerance or
  impaired fasting on a previous test.

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Ive got Diabetes, now what?

• 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 food diary is a great start!
• Serving sizes must be emphasized.

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Treatment Goals for Type I

• 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.

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Exercise and Type Is

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

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Treatment Goals for Type II

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

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Exercise and Type II

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

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Treatment of Diabetes

• Diet plays a major role.
• 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.

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Methods of Carbohydrate Control

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

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Blood Glucose Monitoring

• All diabetics must keep track of blood glucose
  levels.
• 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.
• Must check at least 2 times a day and four times
  a day for at least 3 days a week.

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Hemoglobin A1c

• A good indicator of blood glucose control.
• Gives a that indicates control over the
  preceding 2-3 months.
• Performed 2 times a year.
• A hemoglobin of 6 indicates good control and
  level gt8 indicates action is needed.

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Dietary Guidelines

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

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Dietary Guidelines

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

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Other Treatments

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

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Oral Medications

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

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Oral medications

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

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Treatment Goals

• The main goal is to normalize blood sugar.
  Realistic goals for diabetics are 70-140 mg/dl
  before meals, lt180 mg/dl after and a glycosolated
  hemoglobin within 1 of normal.
• Need good blood glucose control to avoid
  complications.

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Diabetes Complications

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

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Complications contd

• Nerve disease and amputations
• Impotence

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How to Avoid Complications

• Control weight
• Eat a healthy well-balanced diet.
• Get regular exercise
• Have regular checkups
• Check feet everyday for cuts and blisters
• Do not smoke!

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How to Avoid Complications

• Keep blood sugars normal
• Avoid the 2 common diabetic problems,
• hypoglycemia and hyperglycemia

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Hypoglycemia

• Hypoglycemia- low blood sugar
• Happens 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.

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Hypoglycemia

• How to treat Hypoglycemia
• 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.
• Wait 15-20 minutes and test blood sugar again.
  If still low retreat.

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Hypoglycemia

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

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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.

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Hyperglycemia

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

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How to treat Hyperglycemia

• 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.

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Conclusion

• Diabetes is a very complicated disease.
• For more information www.diabetes.org