Diet and DiabetesDiet and Diabetes

Created by:Created by:

Tricia Fleming, University of Kansas Dietetic InternTricia Fleming, University of Kansas Dietetic Intern

Tammy Beason, MS, RD, Nutrition Education Tammy Beason, MS, RD, Nutrition Education Specialist, Family Nutrition Education ProgramSpecialist, Family Nutrition Education Program

December 2001December 2001

Diabetes- What is it?Diabetes- What is it?

• Body is not producing or has lost Body is not producing or has lost sensitivity to insulin.sensitivity to insulin.

• Insulin is a hormone that is needed to Insulin is a hormone that is needed to convert sugar, starches and other food convert sugar, starches and other food into energy.into energy.

• Insulin is produced in the body by the Insulin is produced in the body by the pancreas.pancreas.

Types of DiabetesTypes of Diabetes

There are several types of diabetes:There are several types of diabetes:

• Type I - body does not produce any Type I - body does not produce any insulin.insulin.

• Type II- body is not making enough or Type II- body is not making enough or is losing sensitivity to insulin made.is losing sensitivity to insulin made.

Types of DiabetesTypes of Diabetes

• Secondary - a consequence from Secondary - a consequence from another disease. For example, another disease. For example, pancreatitis or cystic fibrosis.pancreatitis or cystic fibrosis.

• Gestational Diabetes- diabetes during Gestational Diabetes- diabetes during pregnancy.pregnancy.

• Impaired Glucose Tolerance- an Impaired Glucose Tolerance- an intermediate between normal and intermediate between normal and diabetes.diabetes.

Quick Review-Anatomy of Quick Review-Anatomy of the Pancreasthe Pancreas

• A gland that lies behind the stomachA gland that lies behind the stomach

• Clusters of cells inside the pancreas Clusters of cells inside the pancreas known as the islets of Langerhans known as the islets of Langerhans produces three hormones.produces three hormones.

• The islets contain 3 types of cells:The islets contain 3 types of cells:

• Alpha, beta, and delta.Alpha, beta, and delta.

• Alpha cells produce glucagon.Alpha cells produce glucagon.

Pancreas contd.Pancreas contd.

• Beta cells- produce insulinBeta cells- produce insulin

• Delta cells- produce somatostatinDelta cells- produce somatostatin

• These cells have special sensors that These cells have special sensors that monitor levels of blood sugar and monitor levels of blood sugar and stimulate the release of the correct stimulate the release of the correct hormone. hormone.

Insulin and the other Insulin and the other hormoneshormones

• Glucagon - Hormone that increases the Glucagon - Hormone that increases the amount of glucose in the blood when it amount of glucose in the blood when it is needed. is needed.

• Somatostatin - Hormone that can Somatostatin - Hormone that can suppress both glucagon and insulin suppress both glucagon and insulin when needed.when needed.

• Insulin- Hormone that lowers blood Insulin- Hormone that lowers blood glucose.glucose.

How Does Insulin Work?How Does Insulin Work?

• A person normally secretes insulin in A person normally secretes insulin in response to an elevated blood sugar level.response to an elevated blood sugar level.

• It does this by accelerating blood sugars It does this by accelerating blood sugars movement out of the blood and into the movement out of the blood and into the cells.cells.

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

Why isn’t the body making Why isn’t the body making insulin?insulin?

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

• It attacks the beta cells and destroys It attacks the beta cells and destroys them!them!

• In people with Type II, the pancreas is In people with Type II, the pancreas is still making insulin, just not enough to still making insulin, just not enough to keep up, or their bodies have become keep up, or their bodies have become insulin resistant!insulin resistant!

Type IType I

• Usually diagnosed in children and Usually diagnosed in children and young adults.young adults.

• Must take daily insulin shots to stay Must take daily insulin shots to stay alive.alive.

• Type I accounts for 5-10% of the Type I accounts for 5-10% of the population with diabetes.population with diabetes.

Type IIType II

• The most common form of the disease.The most common form of the disease.• Approximately 50% of men and 70% of Approximately 50% of men and 70% of

women are obese at the time of women are obese at the time of diagnosis.diagnosis.

• Nearing epidemic proportions, due to Nearing epidemic proportions, due to increase # of older Americans, greater increase # of older Americans, greater occurrence of obesity and sedentary occurrence of obesity and sedentary lifestyles. lifestyles.

Gestational DiabetesGestational Diabetes

• Pregnant women have a higher insulin Pregnant women have a higher insulin level.level.

• If woman has hyperglycemia, her blood If woman has hyperglycemia, her blood glucose crosses the placenta but her glucose crosses the placenta but her insulin does not.insulin does not.

• This can cause a high birth weight for This can cause a high birth weight for baby. baby.

What are the Symptoms?What are the Symptoms?

• Polyphasia- excessive eatingPolyphasia- excessive eating

• Polyurea- excessive urinationPolyurea- excessive urination

• Polydypsia-excessive fluid intakePolydypsia-excessive fluid intake

• Blurred vision Blurred vision

• Poor wound healingPoor wound healing

• IrritabilityIrritability

How are you diagnosed How are you diagnosed with diabetes?with diabetes?

• In June 1997, the ADA redefined it’s In June 1997, the ADA redefined it’s criteria for diagnosing diabetes.criteria for diagnosing diabetes.

• Normal fasting blood glucose is <110 Normal fasting blood glucose is <110 mg/dl.mg/dl.

• Impaired fasting glucose is >110 and Impaired fasting glucose is >110 and <126 mg/dl.<126 mg/dl.

• Provisional diagnosis for diabetes>126 Provisional diagnosis for diabetes>126 mg/dlmg/dl

Diagnosis contd.Diagnosis contd.

• In order to be diagnosed with diabetes:In order to be diagnosed with diabetes:

• Person must have symptoms of Person must have symptoms of diabetes +diabetes +

• Causal plasma glucose >200Causal plasma glucose >200

• Fasting blood glucose of >126 mg/dlFasting blood glucose of >126 mg/dl

• 2-hour plasma glucose >200 mg/dl on 2-hour plasma glucose >200 mg/dl on oral glucose testoral glucose test

Who’s at risk?Who’s at risk?

ADA now recommends that screening ADA now recommends that screening for diabetes should be considered for all for diabetes should be considered for all patients at age 45. If the results are patients at age 45. If the results are normal it should be repeated every 3 normal it should be repeated every 3 years. years.

Screening should be considered at a Screening should be considered at a younger age if patient meets following younger age if patient meets following risk factors:risk factors:

Who’s at risk?Who’s at risk?

• ObesityObesity

• First degree relative with diabetesFirst degree relative with diabetes

• Belongs to a high-risk ethnic groupBelongs to a high-risk ethnic group

• Was diagnosed with gestational Was diagnosed with gestational diabetes or delivered a baby whose diabetes or delivered a baby whose birth weight >9 lbs.birth weight >9 lbs.

• HypertensionHypertension

Who’s at risk?Who’s at risk?

• HDL level<35 or triglycerides >250HDL level<35 or triglycerides >250

• Found to have impaired glucose Found to have impaired glucose tolerance or impaired fasting on a tolerance or impaired fasting on a previous test. previous test.

I’ve got Diabetes, now I’ve got Diabetes, now what?what?

• After diagnosis, there is a great need After diagnosis, there is a great need for education. for education.

• A diabetic diet is no different from A diabetic diet is no different from anyone else’s but they must keep track anyone else’s but they must keep track of what they eat.of what they eat.

• A food diary is a great start!A food diary is a great start!

• Serving sizes must be emphasized.Serving sizes must be emphasized.

Treatment Goals for Type ITreatment Goals for Type I

• Match insulin to food intake.Match insulin to food intake.

• Type I’s are encouraged to be precise Type I’s are encouraged to be precise and regular from day to day with food and regular from day to day with food intake, insulin regimen, and activity. intake, insulin regimen, and activity.

Exercise and Type I’sExercise and Type I’s

• Increases flexibility, muscular strength , Increases flexibility, muscular strength , and well being.and well being.

• Must monitor insulin and food intake to Must monitor insulin and food intake to match exercise regimen. match exercise regimen.

• Increases insulin effectiveness and Increases insulin effectiveness and sensitivity in the body.sensitivity in the body.

Treatment Goals for Type Treatment Goals for Type IIII

• Achieve normal or near-normal blood Achieve normal or near-normal blood glucose levels.glucose levels.

• Provide adequate calories for Provide adequate calories for reasonable body weight.reasonable body weight.

• Prevent, delay or treat nutrition related Prevent, delay or treat nutrition related complications.complications.

• Improve health through optimal Improve health through optimal nutrition.nutrition.

Exercise and Type IIExercise and Type II

• Especially beneficial in type II diabetes.Especially beneficial in type II diabetes.

• Promotes weight lossPromotes weight loss

• Increases insulin sensitivity.Increases insulin sensitivity.

• Must also be aware of medication and Must also be aware of medication and intake to prevent hypoglycemia.intake to prevent hypoglycemia.

Treatment of DiabetesTreatment of Diabetes

• Diet plays a major role.Diet plays a major role.

• Carbohydrates are the component of Carbohydrates are the component of food that causes an increase in blood food that causes an increase in blood sugar.sugar.

• Diabetics are encouraged to keep track Diabetics are encouraged to keep track of the amount of CHO they eat.of the amount of CHO they eat.

Methods of Carbohydrate Methods of Carbohydrate ControlControl

There are many new methods of There are many new methods of controlling diabetes, these are still the controlling diabetes, these are still the two most common.two most common.

• Exchange ListsExchange Lists

• Carbohydrate counting- Very basic, Carbohydrate counting- Very basic, allows a little more freedom and variety.allows a little more freedom and variety.

Blood Glucose MonitoringBlood Glucose Monitoring

• All diabetics must keep track of blood All diabetics must keep track of blood glucose levels.glucose levels.

• This is the only way to know if the treatment This is the only way to know if the treatment is effective. is effective.

• Gives the diabetic a good indication of what Gives the diabetic a good indication of what affects their blood sugar level.affects their blood sugar level.

• Must check at least 2 times a day and four Must check at least 2 times a day and four times a day for at least 3 days a week.times a day for at least 3 days a week.

Hemoglobin A1cHemoglobin A1c

• A good indicator of blood glucose A good indicator of blood glucose control.control.

• Gives a % that indicates control over Gives a % that indicates control over the preceding 2-3 months.the preceding 2-3 months.

• Performed 2 times a year.Performed 2 times a year.

• A hemoglobin of 6% indicates good A hemoglobin of 6% indicates good control and level >8% indicates action control and level >8% indicates action is needed.is needed.

Dietary GuidelinesDietary Guidelines

• Eat a diet low in saturated and total fat.Eat a diet low in saturated and total fat.

• Eat a diet moderate in sodium and Eat a diet moderate in sodium and sugar.sugar.

• Eat 5 or more fruits and vegetables a Eat 5 or more fruits and vegetables a day.day.

• Choose a diet rich in whole grains.Choose a diet rich in whole grains.

• Moderate use of alcoholModerate use of alcohol

Dietary GuidelinesDietary Guidelines

• Eat at the same time everyday , at least Eat at the same time everyday , at least within 1 hour of regular time.within 1 hour of regular time.

• Eat about the same amount of Eat about the same amount of carbohydrate with each meal.carbohydrate with each meal.

Other TreatmentsOther Treatments

• Type I and sometimes Type II patients Type I and sometimes Type II patients need to be treated with insulin. need to be treated with insulin.

• There are more than 20 types.There are more than 20 types.

• They differ in how they are made, how They differ in how they are made, how they work in the body and their cost.they work in the body and their cost.

Oral MedicationsOral Medications

Used to treat Type II diabetics. There are Used to treat Type II diabetics. There are four basic types:four basic types:

• Sulfonylurea-stimulates the body to Sulfonylurea-stimulates the body to make more insulin.make more insulin.

• Metformin-lowers blood sugar by Metformin-lowers blood sugar by helping the insulin work betterhelping the insulin work better

Oral medications Oral medications

• Thiazolidinediones- increases muscle Thiazolidinediones- increases muscle sensitivity to insulin.sensitivity to insulin.

• Alpha-glucosidase inhibitors- slow the Alpha-glucosidase inhibitors- slow the process of carbohydrate digestion.process of carbohydrate digestion.

Treatment GoalsTreatment Goals

• The main goal is to normalize blood The main goal is to normalize blood sugar. Realistic goals for diabetics are sugar. Realistic goals for diabetics are 70-140 mg/dl before meals, <180 mg/dl 70-140 mg/dl before meals, <180 mg/dl after and a glycosolated hemoglobin after and a glycosolated hemoglobin within 1% of normal.within 1% of normal.

• Need good blood glucose control to Need good blood glucose control to avoid complications.avoid complications.

Diabetes Complications Diabetes Complications

Diabetes complications are the seventh Diabetes complications are the seventh leading cause of death. They include:leading cause of death. They include:

• Blindness- caused by diabetic Blindness- caused by diabetic retinopathy.retinopathy.

• Kidney Disease- diabetic nephropathyKidney Disease- diabetic nephropathy

• Heart Disease and StrokeHeart Disease and Stroke

Complications contdComplications contd

• Nerve disease and amputationsNerve disease and amputations

• ImpotenceImpotence

How to Avoid How to Avoid ComplicationsComplications

• Control weightControl weight

• Eat a healthy well-balanced diet.Eat a healthy well-balanced diet.

• Get regular exerciseGet regular exercise

• Have regular checkupsHave regular checkups

• Check feet everyday for cuts and Check feet everyday for cuts and blistersblisters

• Do not smoke!Do not smoke!

How to Avoid How to Avoid ComplicationsComplications

• Keep blood sugars normal Keep blood sugars normal

• Avoid the 2 common diabetic problems,Avoid the 2 common diabetic problems,

hypoglycemia and hyperglycemiahypoglycemia and hyperglycemia

HypoglycemiaHypoglycemia

• Hypoglycemia- low blood sugarHypoglycemia- low blood sugar• Happens to everyone with diabetesHappens to everyone with diabetes• Symptoms include shakiness, Symptoms include shakiness,

dizziness, sweating, hunger, headache, dizziness, sweating, hunger, headache, pale skin, sudden moodiness, clumsy or pale skin, sudden moodiness, clumsy or jerky movements, difficulty paying jerky movements, difficulty paying attention, and tingling sensations attention, and tingling sensations around mouth.around mouth.

HypoglycemiaHypoglycemia

How to treat Hypoglycemia:How to treat Hypoglycemia:

• Quickest way to raise blood glucose is Quickest way to raise blood glucose is with some form of sugar.with some form of sugar.

• 3 glucose tablets, 1/2 cup of fruit juice, 3 glucose tablets, 1/2 cup of fruit juice, 5-6 pieces of candy.5-6 pieces of candy.

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

HypoglycemiaHypoglycemia

• If hypoglycemia goes untreated, patient If hypoglycemia goes untreated, patient could get worse and pass out!could get worse and pass out!

• Stress the importance of a night time Stress the importance of a night time snack in older patients.snack in older patients.

HyperglycemiaHyperglycemia

Ketoacidosis: Develops when the body Ketoacidosis: Develops when the body does not have enough insulin. The body does not have enough insulin. The body can’t break down sugar so it breaks can’t break down sugar so it breaks down fat instead. Ketones are what is down fat instead. Ketones are what is left from this process.The body does left from this process.The body does not tolerate ketones and tries to pass not tolerate ketones and tries to pass them out of the body.them out of the body.

HyperglycemiaHyperglycemia

Symptoms that may result in ketoacidosis Symptoms that may result in ketoacidosis occur when:occur when:

• Too little insulin has been ejected, or insulin Too little insulin has been ejected, or insulin is not effective.is not effective.

• Consumed more food and/or exercised less Consumed more food and/or exercised less than expected.than expected.

• High blood sugar, high levels of sugar in the High blood sugar, high levels of sugar in the urine, frequent urination, and increased thirsturine, frequent urination, and increased thirst

How to treat How to treat HyperglycemiaHyperglycemia

• Usually can lower it by exercising, or Usually can lower it by exercising, or injecting more insulin, be careful of the injecting more insulin, be careful of the somogyi effectsomogyi effect..

The The somogyi effectsomogyi effect is the condition of is the condition of hypoglycemia resulting from the hypoglycemia resulting from the treatment of hyperglycemia.treatment of hyperglycemia.

ConclusionConclusion

Diabetes is a very complicated disease.Diabetes is a very complicated disease.

For more information: www.diabetes.orgFor more information: www.diabetes.org