Download Diabetes Mellitus – Unit 4

Mary Helen Mays, Ph.D., MPH, MBA, RD
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Diabetes is a disease in which the body
does not produce or properly use insulin
There are 23.6 million children and adults
in the United States, or 7.8% of the
population, who have diabetes. While an
estimated 17.9 million have been diagnosed
with diabetes, unfortunately, 5.7 million
people (or nearly one quarter) are unaware
that they have the disease.
 www.diabetes.org
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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Type I: 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. It is estimated that 5-10% of Americans
who are diagnosed with diabetes have type 1
diabetes.
Type: 2 Results from insulin resistance (a
condition in which the body fails to properly use
insulin), combined with relative insulin
deficiency. Most Americans who are diagnosed
with diabetes have type 2 diabetes
www.diabetes.org
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Gestational Diabetes:
Immediately after pregnancy, 5% to 10% of
women with gestational diabetes are found to
have diabetes, usually, type 2.
Pre-diabetes:
Pre-diabetes is a condition that occurs when a
person's blood glucose levels are higher than
normal but not high enough for a diagnosis of
type 2 diabetes. There are 57 million Americans
who have pre-diabetes, in addition to the 23.6
million with diabetes.
www.diabetes.org
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With the FPG test, a fasting blood glucose level
between 100 and 125 mg/dl signals prediabetes.
A person with a fasting blood glucose level of
126 mg/dl or higher has diabetes.
www.diabetes.org
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Diabetes often goes undiagnosed because many of its
symptoms seem so harmless. Recent studies indicate
that the early detection of diabetes symptoms and
treatment can decrease the chance of developing the
complications of diabetes.
Some diabetes symptoms include:
Frequent urination
Excessive thirst
Extreme hunger
Unusual weight loss
Increased fatigue
Irritability
Blurry vision
 www.diabetes,org
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A family history of diabetes.
Age over 45.
Race or ethnic background.
Metabolic syndrome
Being overweight.
Hypertension.
Abnormal cholesterol levels.
History of gestational diabetes
History of polycystic ovary disease (PCOS)
Habitually inactive
History of vascular disease (such as stroke)
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DIET 
Insulin / Insulin Pumps
Oral Medications
Alternative Therapies
Islet Cell Transplant
Pancreas Transplant
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A gland that lies behind the stomach
Clusters of cells inside the pancreas known as
the islets of Langerhans produces three
hormones.
The islets contain 3 types of cells:
Alpha, beta, and delta.
Alpha cells produce glucagon.
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Beta cells- produce insulin
Delta cells- produce somatostatin
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.
Somatostatin - Hormone that can suppress
both glucagon and insulin when needed.
Insulin- Hormone that lowers blood glucose.
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A person normally secretes insulin in
response to an elevated blood sugar level.
It does this by accelerating blood sugars
movement out of the blood and into the cells.
Cells will not allow blood sugar in without
insulin. - this can cause a problem.
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In people with Type I, the immune system has
made a big mistake!
It attacks the beta cells and destroys them!
In people with Type II, the pancreas is still
making insulin, just not enough to keep up,
or their bodies have become insulin resistant!
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Usually diagnosed in children and young
adults.
Must take daily insulin shots to stay alive.
Type I accounts for 5-10% of the population
with diabetes.
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The most common form of the disease.
Approximately 50% of men and 70% of
women are obese at the time of diagnosis.
Nearing epidemic proportions, due to
increase # of older Americans, greater
occurrence of obesity and sedentary
lifestyles.
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Pregnant women have a higher insulin level.
If woman has hyperglycemia, her blood
glucose crosses the placenta but her insulin
does not.
This can cause a high birth weight for baby.
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Polyphasia- excessive eating
Polyurea- excessive urination
Polydypsia-excessive fluid intake
Blurred vision
Poor wound healing
Irritability
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With the FPG test, a fasting blood glucose level
between 100 and 125 mg/dl signals prediabetes.
A person with a fasting blood glucose level of
126 mg/dl or higher has diabetes.
www.diabetes.org
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In order to be diagnosed with diabetes:
Person must have symptoms of diabetes +
Causal plasma glucose >200
Fasting blood glucose of >126 mg/dl
2-hour plasma glucose >200 mg/dl on oral
glucose test
ADA now recommends that screening for
diabetes should be considered for all patients
at age 45. If the results are normal it should
be repeated every 3 years.
Screening should be considered at a younger
age if patient meets following risk factors:
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Obesity
First degree relative with diabetes
Belongs to a high-risk ethnic group
Was diagnosed with gestational diabetes or
delivered a baby whose birth weight >9 lbs.
Hypertension
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HDL level<35 or triglycerides >250
Found to have impaired glucose tolerance or
impaired fasting on a previous test.
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After diagnosis, there is a great need for
education.
A diabetic diet is no different from anyone
else’s but they must keep track of what they
eat.
A food diary is a great start!
Serving sizes must be emphasized.
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Match insulin to food intake.
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.
Must monitor insulin and food intake to
match exercise regimen.
Increases insulin effectiveness and sensitivity
in the body.
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Achieve normal or near-normal blood glucose
levels.
Provide adequate calories for reasonable body
weight.
Prevent, delay or treat nutrition related
complications.
Improve health through optimal nutrition.
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Especially beneficial in type II diabetes.
Promotes weight loss
Increases insulin sensitivity.
Must also be aware of medication and intake
to prevent hypoglycemia.
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Diet plays a major role.
Carbohydrates are the component of food
that causes an increase in blood sugar.
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
Carbohydrate counting- Very basic, allows a
little more freedom and variety.
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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.
Gives a % that indicates control over the
preceding 2-3 months.
Performed 2 times a year.
A hemoglobin of 6% indicates good control
and level >8% indicates action is needed.
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Eat a diet low in saturated and total fat.
Eat a diet moderate in sodium and sugar.
Eat 5 or more fruits and vegetables a day.
Choose a diet rich in whole grains.
Moderate use of alcohol
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Eat at the same time everyday , at least within
1 hour of regular time.
Eat about the same amount of carbohydrate
with each meal.
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Type I and sometimes Type II patients need to
be treated with insulin.
There are more than 20 types.
They differ in how they are made, how they
work in the body and their cost.
Used to treat Type II diabetics. There are four
basic types:
 Sulfonylurea-stimulates the body to make
more insulin.
 Metformin-lowers blood sugar by helping the
insulin work better
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Thiazolidinediones- increases muscle
sensitivity to insulin.
Alpha-glucosidase inhibitors- slow the
process of carbohydrate digestion.
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The main goal is to normalize blood sugar.
Realistic goals for diabetics are 70-140
mg/dl before meals, <180 mg/dl after and a
glycosolated hemoglobin within 1% of
normal.
Need good blood glucose control to avoid
complications.
Diabetes complications are the seventh leading
cause of death. They include:
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Blindness- caused by diabetic retinopathy.
Kidney Disease- diabetic nephropathy
Heart Disease and Stroke
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Nerve disease and amputations
Impotence
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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!
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Keep blood sugars normal
Avoid the 2 common diabetic problems,
hypoglycemia and hyperglycemia
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Hypoglycemia- low blood sugar
Happens to everyone with diabetes
Symptoms include shakiness, dizziness,
sweating, hunger, headache, pale skin,
sudden moodiness, clumsy or jerky
movements, difficulty paying attention, and
tingling sensations around mouth.
How to treat Hypoglycemia:
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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 15-20 minutes and test blood sugar
again. If still low retreat.
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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.
Ketoacidosis: Develops when the body does
not have enough insulin. The body can’t
break down sugar so it breaks down fat
instead. Ketones are what is left from this
process.The body does not tolerate ketones
and tries to pass them out of the body.
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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
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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Diabetes is a very complicated disease.
For more information: www.diabetes.org