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Jennifer Wagner Cayemberg, MS, RD, LDN
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Diabetes is a disease in which the body does not
produce or properly use insulin
There are 25.8 million children and adults in the
U.S., or 8.3% of the population, who have
diabetes.
Estimated 18.8 million diagnosed with diabetes,
7.0 million people are unaware that they have the
disease.
Centers for Disease Control and Prevention. National diabetes fact sheet: national
estimates and general information on diabetes and prediabetes in the United States,
2011. Atlanta, GA: U.S. Department of Health and Human Services, Centers for
Disease Control and Prevention, 2011.
Number and Percentage of U.S. Population with Diagnosed Diabetes,
1958-2009
CDC’s Division of Diabetes Translation. National Diabetes Surveillance System
available at http://www.cdc.gov/diabetes/statistics
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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A gland that lies behind the stomach
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Islets of Langerhans produces three hormones.
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The islets contain 3 types of cells:
◦ Alpha, beta, and delta.
◦ Alpha cells produce glucagon.
◦ Beta cells produce insulin
◦ Delta cells produce somatostatin
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These cells have special sensors
that monitor levels of blood sugar and stimulate the
release of the correct hormone.
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Glucagon : Hormone that increases the amount
of glucose in the blood when it is needed.
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Somatostatin: Hormone that can suppress both
glucagon and insulin when needed.
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Insulin: Hormone that lowers blood glucose.
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A person normally secretes insulin in response to
an elevated blood sugar level.
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It does this by accelerating blood sugar movement
out of the blood and into the cells.
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Cells will not allow blood sugar in without insulin…
this can cause a problem.
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Type 1: immune system has made a big mistake!
It attacks the beta cells and destroys them!
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Type 2: pancreas is still making insulin, just not
enough to keep up, or their bodies have become
insulin resistant!
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Screening for all patients at age 45. If results are
normal, repeat every 3 years.
Screening at a younger age if patient meets following:
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Obesity
First degree relative with diabetes
Belongs to high-risk ethnic group
Was diagnosed with gestational diabetes or delivered a
baby whose birth weight >9 lbs.
◦ Hypertension
◦ HDL level<35 or triglycerides >250
◦ Found to have impaired glucose tolerance or impaired
fasting on a previous test.
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Usually diagnosed in children and young adults.
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Must take daily insulin shots to stay alive.
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Type 1 accounts for 5-10% of the population with
diabetes.
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Results from the body's failure
to produce insulin, the hormone
that "unlocks" the cells of the body,
allowing glucose to enter and fuel them.
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The most common form of the disease.
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Approximately 50% of men and 70% of women are obese at
the time of diagnosis.
Nearing epidemic proportions, due to increase # of older
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Americans, greater occurrence of obesity and sedentary
lifestyles.
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Results from insulin resistance (a condition in which the body
fails to properly use insulin), combined with relative insulin
deficiency.
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Reported rates of gestational diabetes range from 2% - 10%.
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Pregnant women have a higher insulin level.
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If woman has hyperglycemia, her blood glucose crosses the placenta
but her insulin does not.
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This can cause a high birth weight for baby as baby is receiving
glucose.
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Women who have had gestational diabetes have a 35% - 60%
chance of developing diabetes in the next 10–20 years.
Centers for Disease Control and Prevention. National diabetes fact sheet: national estimates and
general information on diabetes and prediabetes in the United States, 2011. Atlanta, GA: U.S.
Department of Health and Human Services, Centers for Disease Control and Prevention, 2011.
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Occurs when blood glucose levels are higher than normal, but
not high enough for a diagnosis of Type 2.
In 2005–2008, based on fasting glucose or hemoglobin A1c
levels, 35% of U.S. adults aged 20 years or older had
prediabetes .
People with prediabetes have an increased risk of developing
type 2 diabetes, heart disease, and stroke.
Studies have shown that people with prediabetes who
lose weight and increase their physical activity can
prevent or delay type 2 diabetes and in some cases
return their blood glucose levels to normal.
Centers for Disease Control and Prevention. National diabetes fact sheet: national estimates and general
information on diabetes and prediabetes in the United States, 2011. Atlanta, GA: U.S. Department of
Health and Human Services, Centers for Disease Control and Prevention, 2011.
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Some diabetes symptoms include:
Frequent urination: polyurea
Excessive thirst : polydypsia
Extreme hunger: polyphasia
Unusual weight loss
Increased fatigue
Irritability
Blurry vision
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Fasting blood glucose level between
100 - 125 mg/dl signals pre-diabetes.
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A person with a fasting blood glucose
level of 126 mg/dl or higher has
diabetes.
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In order to be diagnosed with diabetes
person must have symptoms of
diabetes +
◦ Nonfasting plasma glucose >200
◦ Fasting blood glucose of >126 mg/dl
◦ 2-hour plasma glucose >200 mg/dl on oral
glucose test
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After diagnosis, there is a great need for
education.
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A diabetic diet is no different from anyone else’s
but they must keep track of what they eat.
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A food diary is a great start!
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Serving sizes must be emphasized.
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Match insulin to food intake.
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Type I’s are encouraged to be precise and regular
from day to day with food intake, insulin regimen,
and activity.
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Increases flexibility, muscular strength , and well
being.
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Must monitor insulin and food intake to match
exercise regimen.
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Increases insulin effectiveness and sensitivity in
the body.
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Achieve normal or near normal blood glucose
levels.
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Provide adequate calories for reasonable body
weight.
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Prevent, delay or treat nutrition related
complications.
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Improve health through optimal nutrition.
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Especially beneficial in
type 2 diabetes.
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Promotes weight loss
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Increases insulin
sensitivity.
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Must also be aware of
medication and intake to
prevent hypoglycemia.
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Diet plays a major role.
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Carbohydrates are the component of food that
causes an increase in blood sugar.
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Diabetics are encouraged to keep track of the
amount of CHO they eat.
There are many new methods of controlling
diabetes, these are still the two most common.
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Exchange Lists
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Carbohydrate counting: basic, allows a little more
freedom and variety; eat at the same time
everyday , at least within 1 hour of regular time.
◦ Eat about the same amount of carbohydrate with
each meal and snack.
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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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A good indicator of blood glucose control.
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Gives a % that indicates control over the
preceding 2-3 months.
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Performed 2 times a year.
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A hemoglobin of 6% indicates good control and
level >8% indicates action is needed.
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DIET 
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Insulin / Insulin Pumps
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Oral Medications
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Alternative Therapies
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Islet Cell Transplant
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Pancreas Transplant
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Type 1 and sometimes Type 2 patients need to be
treated with insulin.
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There are more than 20 types.
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They differ in how they are made, how they work
in the body and their cost.
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Used to treat Type 2 diabetics. There are four
basic types:
Sulfonylurea: stimulates the body to make more
insulin.
Metformin: lowers blood sugar by helping the
insulin work better
Thiazolidinediones: increases muscle sensitivity
to insulin.
Alpha-glucosidase inhibitors: slow the process of
carbohydrate digestion.
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Main goal is to normalize blood sugar.
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Realistic goals for diabetics are 70-140 mg/dl
before meals, <180 mg/dl after and a glycosolated
hemoglobin within 1% of normal.
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Need good blood glucose control to avoid
complications.
Diabetes is the leading cause of kidney failure,
nontraumatic lower limb amputations, and new
cases of blindness among adults; 7th leading
cause of death in U.S.
◦ Blindness: caused by diabetic retinopathy.
◦ Kidney Disease: diabetic nephropathy
◦ Heart Disease and Stroke
◦ Nerve disease and amputations
Centers for Disease Control and Prevention. National diabetes fact sheet: national estimates and general
information on diabetes and prediabetes in the United States, 2011. Atlanta, GA: U.S. Department of
Health and Human Services, Centers for Disease Control and Prevention, 2011.
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Control weight
Eat a healthy well-balanced diet.
Get regular exercise
Have regular checkups
Check feet everyday for cuts and
blisters
Do not smoke!
Keep blood sugar, BP, lipids
normal
Avoid the 2 common diabetic
problems:
hypoglycemia and hyperglycemia
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Hypoglycemia: low blood sugar
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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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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 minutes and test blood sugar again. If still low
repeat.
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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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Ketoacidosis: Develops when the body does not
have enough insulin. The body can’t break down
sugar so it breaks down fat instead. Ketones build
up in blood & urine.The body does not tolerate
ketones in high levels (poisonous).
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Acidosis can lead to fluid buildup in brain, heart
attack, death of bowel tissue, kidney failure,
severe illness or death.
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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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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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Be aware of risk factors and symptoms of
diabetes.
Prevention is key with changes in lifestyle.
American Diabetes Association: www.diabetes.org
CDC: http://www.cdc.gov/diabetes/