Class Updates

1
Class Updates

• Updated Syllabus
• Nephrology presentation is 11/29
• Note attendance policy
• Miss more than 2 classes you may be dropped
• Test is This Week
• Chapter 24 25
• 25 pt. Bonus Assignment reviewed

2
Chapter 24 Carbohydrate-Modified Diets for
Diabetes

• Name and Differentiate Between the Two Major
  Types of Diabetes
• Diabetes Mellitus Metabolic disorder
  characterized by high blood glucose and
  insufficient or ineffective insulin
• Type 1 IDDM - autoimmune disorder
• Type 2 NIDDM/ADOM cells not responsive to
  insulin/obesity-related

3
Diabetes

• Identify the Acute Complications of Diabetes
  Handout in Class
• Hypoglycemia Low blood sugar
• Too much insulin
• Strenuous exercise
• Skipped or delayed meals
• Inadequate food intake
• Vomiting
• Diarrhea

4
Hypoglycemia

• Symptoms of hypoglycemia
• Hunger
• Headache
• Sweating
• Shakiness
• Nervousness
• Confusion
• Disorientation
• Slurred speech

5
Hyperglycemia

• Symptoms of hyperglycemia
• Intense thirst and, sometimes, hunger
• (Polydypsia and Polyphagia)
• Increased urination (Polyuria)
• Blurred vision
• Fatigue
• Acetone breath
• Labored breathing

6
Chronic Complications of Diabetes

• Does Better Control Help? DCCT UKPDS
• Identify the Chronic Complications
• Damage to blood vessels nerves
• Frequent Infections
• Gangrene
• Cardiovascular Disease major cause of death
• Loss of kidney function and loss of vision
• Neuropathy Nerve tissues deterioration tissue
  death
• Diabetic Gastroparesis -Delayed gastric
  emptyingirregular nutrient absorption BG

7
Treatment of Diabetes Mellitus

• Treatment goals
• Maintain blood glucose
• within a fairly normal range
• Achieve optimal blood
• lipid levels
• Control blood pressure
• Support health and
• well-being
• Prevent and treat
• complications
• The most important goal
• is blood glucose control

8
What are the Goals? Depends on Who you Ask . .
.
9
Medical and Diet Therapy for DM

• Describe an Appropriate Diet for a Diabetic
• Same nutrient requirements as another person of
  same age
• Energy maintain a healthy body weight type 2
  may need to lose weight
• Protein 10-20 Carbo 45-60
• Complex vs simple sugars SS 10
• Fat 30 or less of kcalories and lt10 from
  saturated fat sources
• Sodium and Alcohol Mod to restricted

10
Medical and Diet Therapy

• Why is Consistent Timing and Composition of Meals
  and Snacks Important?
• Matching Glucose to Insulin
• Time and Composition of Meals
• Adherence to a meal plan
• Appropriate treatment of hypo hyperglycemia
• Consistent and appropriate bedtime snacking
• Federal Law to offer all SNF residents a Bedtime
  snack
• Snacking my increase weight gain

11
Medical and Diet Therapy

• Explain the common meal planing strategies to
  maintain blood glucose
• Exchange Lists
• Foods grouped according to their carbohydrate,
  fat and protein content
• Carbohydrate Counting
• Allows clients more flexibility in adjusting
  diets maintaining blood glucose levels
• Done at MVRMC

12
Class Activity What Counts as 15g CHO?

• 1 Serving of Bread
• 1 Serving of Starch
• 1 Serving of Starchy Vegetables
• 1 Serving of Fruit
• ½ Fruit Juice
• 1c. Milk
• 1c. Yogurt
• Now, What doesnt COUNT?

13
Why 15 grams of CHO?

• 15 g 1 bread 1 fruit 1 fluid milk
• 10-15 g CHO 1 unit Regular Insulin

14
Meal Planning DM

• Exchange lists
• The exchange system sorts foods into six main
  groups by their proportions of carbohydrate, fat,
  and protein
• The foods in these three groupsthe carbohydrate
  group, the fat group, and the meat and meat
  substitutes group (protein)are then organized
  into several exchange lists
• Limitations Limits flexabililty

15
Meal Planning DM

• Carbohydrate counting
• Carbohydrate counting allows clients more
  flexibility in adjusting their diets
• A Carb-Budget is planned for the day
• Generally 1 u Regular insulin covers10-15 g CHO
• Clients may first learn the exchange list system
  to help them establish healthy eating habits,
  understand portion sizes, control their intake of
  energy and energy nutrients, and learn to eat
  consistent amounts of carbohydrates at regular
  times
• Research supports use in Type Is vs. Type IIs
• Limitations May not help Type IIs lose weight,
  Requires Math skill

16
Meal Planning DM

• Plate Method
• Plate is divided to show general diabetic diet
  using a plate as a reference guide
• Class activity to discuss
• May be beneficial for clients with limited
  cognitive skill, low literacy and/or low
  motivation
• Limitation May be too flexible to meet BG
  control goals.

17
Medical and Diet Therapy

• Relationship between Physical Activity and Food
  Intake
• Beneficial to Type 1 diabetic
• Improves blood glucose control
• Contributes to weight loss
• Benefits to Type 2
• Benefits cardiovascular system
• May require checking blood glucose levels before
  and after exercising
• Appropriate Drug Therapy
• IDDM requires insulin
• NIDDM Oral anti-diabetic agents

18
Diabetic Gastroparesis

• Mechanical Problem Mechanical
  SolutionLow-residue, small frequent meals
• Pharmacological Reglan, PPI, Erythromycin
• Implant gastric pacemaker
• Note! Increased incidence of Celiac disease in
  Type I Diabetics!

19
Age Groups at Risk

• Identify factors to consider with child and
  elderly diabetics
• Children and Elderly with Diabetes
• Children
• Flexible, balanced meals and snacks
• Can eat same foods as rest of the family
• Three meals with two-three snacks
• Elderly
• Increased risk of hypoglycemia
• Reduced appetite, altered thirst reg., altered
  kidney and liver functions, and use of medications

20
Gestational Diabetes

• Distinguish between Preexisting Diabetes and
  Gestational Diabetes
• Pregnancy elevates blood insulin and alters
  insulin resistance
• Later in pregnancy insulin remains high, but
  cells become antagonistic
• Risks include PIH, maternal infant mortality
• Larger infants with hypoglycemia

21
Gestational Diabetes, cntd.

• Diet Therapy for Gestational Diabetes
• Adequate but not excessive kcalories
• Carbohydrate at 40-45
• Frequent meals and bedtime snack
• May require coordination with insulin
• NO juice!
• Glucose levels usually return to normal following
  pregnancy
• 50 of Women with GDM who require insulin will go
  on to be Type II Diabetics

22
How does DM CVD relate?

• Diabetics 6-8 of the General Population
• Diabetics 20-30 of the Cardiac Population
• A person with Diabetes has the same coronary risk
  as someone without Diabetes who has had an MI