56 terms

Nutrition and Diabetes Mellitus

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Stats
-24 million in US
-54 million have pre diabetes (100-126 fasting)
-92% of T2 could avoid it through lifestyle changes
-80% T2 overweight/obese
-1/3 of babies born today are expected to have it
-6th leading cause of death (but bc it causes CVD)
-lose 15 years life expectancy
DM is a metabolic disorder characterized by
-elevated blood glucose
-disordered insulin metabolism
1. may have:
-impaired insulin secretion
-cells that do not respond to insulin normally
2. results in -hyperglycemia
Classic symptoms
Glycosuria
Polydipsia
Polyuria
Polyphagia
Other symptoms
Blurred vision
Increased infections (bc high blood glucose is food for bacteria, and bad circulation)
Loss of weight
Constant fatigue
T1 Diabetes
5-10% of cases
-autoimmune destruction of beta cells
-may be inherited or environmental
-insulin therapy needed always
-usually occurs in childhood or adolescence
-ketosis may be the first sign
T2 Diabetes
90-95% of cases
-often asymptomatic
-some insulin is produced
-insulin resistance & relative insulin deficiency
-beta cells get exhausted
-prevalence is increasing in children
T2 risk increased with
Obesity
Age
Decreased physical activity
Genetics
T2 Two most significant factors
Obesity
Age
Acute complications
-disturbances in energy metabolism
-fluid & electrolyte imbalances
-hyper & hypoglycemia
Hyperglycemia from
-low insulin
-not following diet
Hypoglycemia from
can be from too much insulin
-can also be from not eating
Hyper
Ketoacidosis: hyper or hypo?
T1 Ketoacidosis
(hyperglycemic part)
1. ketosis
-acetone breath
2. acidosis
-hyperventilation
3. hyperglycemia
-polyuria
4. causes:
-missed insulin, illness, alcohol abuse, physiological stressors
T1 Hypoglycemia
-inappropriate management
-excessive insulin or antidiabetic drugs
-prolonged exercise
-skipped/delayed meals
-alcohol without food
-you always want to assume its hypoglycemia if you don't know which and give them sugar
T2 Hyperosmolar hyperglycemic state
-fluid losses
-blood volume depletion
-electrolyte imbalances
>600-2000 mg/dL
Chronic complications:
blood vessels
AGE's (advanced glucose end products) can damage blood vessels
1. Macrovascular (large blood vessels)
-accelerated atherosclerosis (coronary artery disease)
-impaired circulation, foot ulcers (peripheral vascular disease)
-cerebrovascular accidents
2. Microvascular (small blood vessels)
-retinopathy
-nephropathy
-neuropathy-pain & burning, numbness & tingling
Chronic complications:
nerve damage, autonomic ns
-loss of visceral sensation
-delayed stomach emptying (gastroperesis)
-sexual dysfunction
-constipation
(nerve damage can affect entire body)
-50% have some type
T1 treatment
Insulin therapy
-but they should also eat healthy and exercise
T2 treatment
-diet therapy
-exercise
-oral medications or insulin
Both require
lifelong treatment
-type 2 may be able to reverse it
Treatment goals
-desirable blood glucose levels
-healthy blood lipid concentrations
-control blood pressure
-manage weight
Conventional therapy for T1
-prick/get insulin 1-2 times a day
-one or two insulin injections a day, no daily adjustments
-need a consistent diet
-more rapid progression of retinopathy, nephropathy, and neuropathy
Intensive therapy for T1
-blood glucose is monitored at least 3 times a day
-3+ daily insulin injections or use of insulin pump (dosage adjusted according to results of blood glucose and expected carb intake (bolus given with pump=when you are about to eat)
-delayed progression of retinopathy, nephropathy and neuropathy
Evaluating treatment
1. self-monitored glucose testing
-type 1: 3 or more times/day
2. long-term
-glycosylated hemoglobin (HbA1c)
-measures glycemic control in past 2-3 months (normal less than or equal to 6.5 mg/dL)
3. routine blood pressure checks
4. lipid screening
5. urinary protein screening
6. ketone testing
Body weight concerns T1
-newly diagnosed are thin
-usually gain weight with insulin therapy
Body weight concerns T2
-newly diagnosed usually overweight
-worsens insulin resistance
-weight loss
Nutrient recommendations
1. carbohydrates: -50% total calories
-high fiber, whole grain
2. fiber
-same as general population
-more fiber = less hyperglycemic index so you can actually subtract fiber from carb)
3. sugar
-minimize foods & drink with added sugars
4. fat
-same as general population unless have increased LDLs
-want heart healthy fat
5. protein
15-20% of calories
-not high protein to help avoid nephropathy
6. alcohol
-use with food
7. micronutrients
-same as general population
Meal-planning strategies:
Carb counting
-simpler & more flexible than other methods
-person given a daily carbohydrate allowance
-divided into pattern of meals & snacks
Meal-planning strategies:
Exchange lists
-more complex & difficult to learn
-sorts foods according to their proportions of CHO, fat, & protein
-each food has similar macronutrient & energy content
Insulin therapy
-for people that can't produce enough insulin
-type 1 diabetes
-some persons with type 2
-insulin formula can change with age, health, ect
Insulin delivery
-injection with syringes
-injection ports
-insulin pumps
T1 insulin regimen
-multiple daily injections
-several types of insulin
-insulin pump
T2 insulin regimen
-30% of persons need insulin
-insulin alone
-insulin with oral agents
Insulin therapy & hypoglycemia
-most common complication
-need immediate intake of glucose or CHO food
-15 to 20 grams
-relieves in 10-20 minutes
15 grams CHO
2-3 glucose tablets
4 tsp table sugar
1 tbs honey
15 small jellybeans
½ cup unsweetened grape juice
½ cup canned orange juice
Hypo
-rapid onset
-more noticeable
-sweating, fainting, HA, personality changes
-take tablets/food with sugar
Hyperglycemia
-slow onset
-thirst,urination
-sugar/ketones in urine
-deep breathing (hyperpnea)
-call doctor
-fluids without sugar
Oral anti diabetic management modes of action
modes of action:
-improves insulin secretion
-reduces liver glucose production
-improves glucose use by tissues
-delays CHO absorption
Physical activity
-central feature of management for type 2
-improves insulin sensitivity
-improves lipid levels
-lowers blood pressure
-promotes weight loss
Physical activity & insulin therapy
-doses need to be reduced
-check blood sugar before & after
(Need to know activity guidelines in book)
Type 2 and Physical activity
medical evaluation needed before starting
Sick-day management
1. type 1 diabetes
-illness increases ketoacidosis risk
2. recommendations
-frequent blood glucose testing
-regular CHO intake
-fluids to avoid dehydration
(Need to know sick day guidelines in book)
Diabetes Management & Pregnancy
-pregnancy increases insulin resistance & need for insulin
-glycemic control more difficult
Uncontrolled diabetes
Miscarriages
Birth defects
Fetal deaths
T2 and pregnancy
Deliver large babies
May need C-section
T1 and T2 with pregnancy
need glycemic control 3 months before conception
-at conception & during 1st trimester to reduce risks of birth defects
-2nd & 3rd trimesters to minimize risks of large babies & infant mortality
Gestational diabetes risk factors
-family history of diabetes
-obesity
-certain ethnic groups
-delivered babies with macrosomia
Gestational diabetes
-may need to restrict carbohydrates to 40-50% total calories
-space carbohydrates throughout the day
-regular aerobic activity
-may need insulin
-increased risk for T2 later in life
Blood Glucose Goals During Pregnancy
Fasting = < 95 mg/dl
1 hr post-prandial = < 140 mg/dl
2 hr post-prandial = < 120 mg/dl
Metabolic Syndrome
1. insulin resistance is a central feature
2. increases risk of CVD
3. three of the following:
-insulin resistance
-obesity (esp. upper body)
-hyperlipidemia
-reduced HDLs
-hypertension
4. risk increases with age
5. main cause
-obesity
-central abdominal fat
Metabolic syndrome treatment
-weight loss, dietary & lifestyle changes
-reduce sugar & refined grains
24
Postexercise hypoglycemia can occur for up to________ hrs. after strenous exercise lasting longer than 1 hr.
Acanthosis nigricans
Other Clinical signs of risk for T2DM:
-hyperpigmentation and thickening of the skin into velvety irregular folds and flexural areas
Reflects chronic hyperinsulinemia
Polycystic ovarian syndrome
Other Clinical signs of risk for T2DM:
PCOS
Associated with insulin resistance and obesity
Hypertension
Other Clinical signs of risk for T2DM:
Occurs in 20% to 30% of patients with T2DM
exercise
Girls appear more susceptible than boys to T2DM
Female-to-male ratio of 1.7:1 regardless of race
Nutrition therapy and _______________ first-line treatments
Most children with T2DM require drug therapy (oral hypoglycemics)
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