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Judith E. Brown www.cengage.com/nutrition/brown Diabetes Now Unit 13 Prof. Albia Dugger • Miami-Dade College The Diabetes Epidemic • Diabetes • Disease characterized by abnormal utilization of carbohydrates by the body and elevated blood glucose levels • Diabetes epidemic • 6% of adults worldwide • 10% of US adults (up from <1% in 1960) Three Types of Diabetes • Three major forms of diabetes • Type 1 diabetes • Type 2 diabetes • Gestational diabetes (diabetes during pregnancy) • Diagnosed by fasting blood glucose of >126 mg/dl and higher Key Terms • Type 1 diabetes mellitus (formerly juvenileonset or insulin-dependent diabetes) • High blood glucose resulting from destruction of insulin-producing cells of the pancreas • Type 2 diabetes mellitus (formerly adultonset or non-insulin-dependent diabetes) • High blood glucose due to the inability to use insulin normally, or to produce enough insulin Diabetes Types 1 and 2 Effects of Insulin • Insulin is a hormone produced by the pancreas that helps glucose enter cells • If glucose can’t get into cells: • Cells become starved for glucose • Cell and tissue functions decline, resulting in elevated triglycerides and blood pressure, hardening of arteries, chronic inflammation Key Terms • Chronic inflammation • Low-grade inflammation that lasts weeks to years • Inflammation • Immune system response to infection or irritation • Triggers release of biologically-active substances that promote oxidation and other harmful reactions Health Consequences of Diabetes • Short-term • Blurred vision, frequent urination, weight loss, infection, delayed wound healing, extreme hunger and thirst • Long-term • Heart disease, hypertension, nerve damage, blindness, kidney failure, stroke, amputation Type 2 Diabetes • Most likely to occur in overweight or obese, inactive people • Usually develops in people over 40 Obesity and Type 2 Diabetes Development of Diabetes • Years before type 2 diabetes, individuals tend to develop insulin resistance • Insulin resistance • When cell membranes have reduced sensitivity to insulin, more insulin than normal is required to transport glucose into cells • High levels of serum insulin, glucose and triglycerides, and increased blood pressure Prediabetes • Prediabetes • Condition in which blood glucose levels are higher than normal but not high enough for diagnosis of diabetes • Impaired glucose tolerance (fasting blood glucose levels 100-126 mg/dL) • Risk factors include abdominal obesity, inactivity, and genetic predisposition Insulin Resistance • Insulin binds to receptors on cell membranes and allows glucose to pass into cells • With insulin resistance, cell membranes “resist” the effects of insulin • Pancreas overworks to makes more insulin • Eventually insulin production slows, blood glucose rises Insulin Resistance cont. • Adverse health effects: • Use of fat stores as the primary source of energy increases blood levels of free fatty acids and triglycerides • Promotes development of fatty liver disease, chronic inflammation, hypertension, and plaque formation in arteries • Results in many metabolic abnormalities (metabolic syndrome) Key Terms • Fatty liver disease • Reversible condition characterized by fat infiltration of liver (10% or more by weight) • Can produce liver damage and other disorders • Associated with obesity, diabetes, and excess alcohol consumption Key Terms • Metabolic syndrome (Syndrome X) • Group of metabolic abnormalities that increase the risk of heart disease and type 2 diabetes • Characterized by insulin resistance, abdominal obesity, high blood pressure and triglyceride levels, low HDL cholesterol, impaired glucose tolerance Metabolic Syndrome • Symptoms related to metabolic syndrome • • • • • Waist ≥ 40” in males, ≥ 35” in females Blood pressure ≥130/85 mmHg Triglycerides ≥150 mg/dL HDL < 40 mg/dL in males, < 50 mg/dL in women Fasting blood glucose ≥ 110 mg/dL • Metabolic syndrome is diagnosed when 3 or more metabolic abnormalities are identified Managing Metabolic Syndrome Managing Type 2 Diabetes • Weight loss (if overweight) • 5-10% of body weight • Regular physical activity • 150 minutes or more per week • Dietary management to reduce risk of heart disease and control blood glucose Managing Type 2 Diabetes • Diabetes 2 diet: • Calorie reduction (if overweight) • Complex carbohydrates, whole grains, high fiber, fruits and vegetables, low-fat milk and meats, and fish • Unsaturated fats, especially monounsaturated • Regular meals and snacks Glycemic Index and Glycemic Load • Carbohydrate-containing foods have a range of effects on blood glucose • Glycemic index (GI) • Measure of the extent to which blood glucose level is raised by a 50-gram portion of a carbohydrate-containing food compared to 50 grams of glucose or white bread Glycemic Index of Foods Glycemic Load • Glycemic load is less confusing than glycemic index when determining what to eat • Glycemic load (GL) • A measure of the extent to which blood glucose level is raised by a given amount of a carbohydrate-containing food • Calculated by multiplying a food’s GI by carbohydrate content Sugar Intake and Diabetes • Total carbohydrate intake and glycemic index, rather than sugars specifically, are strongly related to blood glucose levels • High sugar intake contributes to diabetes by promoting weight gain, and may have other effects in people with metabolic syndrome Preventing Type 2 Diabetes • People with prediabetes reduced their risk of type 2 diabetes by: • • • • Weight loss (~7% of body weight) Exercise (150 minutes/week) Diet rich in whole-grains and fiber Coffee (1-4 cups/day) and moderate alcohol (1-2 drinks/day) Type 1 Diabetes • Type 1 diabetes is an autoimmune disease that causes insulin deficiency • Develops when the immune system destroys insulin-producing beta cells in the pancreas • Triggered by medications or viral infection in genetically susceptible people Key Terms • Autoimmune disease • Disease initiated by destruction of body cells by components of the immune system that misidentify certain body cells as harmful • Immune system • Body tissues that provide protection against bacteria, viruses, foreign proteins, and other harmful substances Managing Type 1 Diabetes • Diets are designed to match insulin doses to keep blood glucose within normal ranges • Carefully planned meals are consumed in specific amounts at specific times • Physical activity improves blood glucose levels and insulin utilization Insulin and New Technologies • Type 1 diabetes requires insulin injections • Amount and type depends on many factors • Blood glucose levels are measured frequently to determine the appropriate amount of insulin injected New Technology • Insulin pumps with continuous glucose monitors give advance warning if a problem develops Gestational Diabetes • 5-6% of women develop gestational diabetes during pregnancy • Risk depends on age, body weight, ethnicity • Increases risk of high-birth-weight babies who have increased risk of diabetes later in life • Often disappears after delivery • Increased risk of type 2 diabetes later Hypoglycemia • Hypoglycemia • Disorder resulting from abnormally low blood glucose levels • Caused by excess insulin in blood • Symptoms include irritability, nervousness, weakness, sweating, and hunger Diabetes in the Future • By 2030, cases of type 2 diabetes related to overweight and obesity are expected to more than double in some parts of the world • Environmental and lifestyle changes could reduce the risk Diabetes Projections: 2000 to 2030