Navigating Diabetes The essential knowledge for the Diabetic

Overview        Tuesday 4:30 to 5:30 On time Limited space – 9 person capacity Must pre register to reserve your space If more space is need we will move class For now no charges Deal with life style issues Classes and Dates  Diabetic health education - first Tuesday of every month (8/2/05,9/6/05,10/4/05, 11/1/05).    Weight loss program -second Tuesday of every month (8/9/05,9/13/05,10/11/05, 11/8/05). Nutritional principles classes -third Tuesday of every month (8/16/05,9/20/05,10/18/05, 11/15/05). Overcoming depression without medication and stress management - fourth Tuesday of every month (8/23/05, 9/27/05, 10/25/05, 11/22/05)  Healthy cooking Classes -fifth Tuesday of every month (8/02/05, 11/29/05) Session 1  David E. Allen MD  Diabetic Education Course Outline  Overview of Diabetes  Complications of Diabetes  Part 1 of the diabetic diet  Definitions - Diabetes is a noun from the Greek word “diabainein” meaning to walk with the legs apart. Types of Diabetes  Type 1-Less than 10% of diabetics have this type of diabetes.  Type 2 – More than 90% of diabetics have this type of diabetes Prevention Type 1 diabetes prevention is limited. Consisting of maintaining a healthy immune system and avoiding cows milk. Studies have demonstrated that the protein in cow’s milk is a immune trigger for pancreatic destruction leading to type 1 diabetes Prevention Type 2 diabetes prevention is vast. Normalizing weight, exercise and proper diet are the keys. Avoiding a high fat diet and refined carbohydrates is important Diabetic Facts A 10-kg (22lb) weight loss in a obese type 2 Diabetic Will  Reduces fasting glucose – 40%  Reduces Systolic Bp 10 mm/Hg  Reduces Total cholesterol 10%  Reduces LDL 15%  Reduces Triglycerides 30%  Reduces diabetes-related mortality 33%  Increases life expectancy + 3years Causes of type 2 Diabetes     Insulin resistance Genetics Life Style Glucose Toxicity Treatments Type 1 diabetes. Diet Insulins: Humalog, Regular, NPH, Lantus. Delivery methods include SQ shot, Insulin pump SQ Treatment for type 2  Diet  Exercise  Medications Sulfonaureas (Glucotrol, Glyburide, etc.) Metformin (Glucophage) Actose, Avandia  Vitamins, Minerals and Herbs Monitoring       Home blood glucose monitoring HgbA1c Lipids Blood pressure Urinary albumin Eye examinations Diabetic Diet 1  Type 1 diabetic diet is mainly designed to match insulin level to food intake. Timing, amount and frequency are very important.  Carbohydrate counting is important. Diabetic Diet 2 Type 2 diabetic diet is mainly designed for:  Reducing weight,  Avoiding refined and toxic foods. Types and quantities of food are the main issues. Complications of Diabetes  Small vessel disease     Eye damage Kidney diseases Nerve damage Skin diseases  Large vessel disease (Arteriosclerosis)  Heart disease  Strokes  Leg vascular disease Prevention Generally the person has diabetes for 10 years before the complications of diabetes become evident. Normalizing blood sugar, controlling blood pressure and lipids will prevent or delay these. Glucose Toxicity Glucose (blood sugar) is toxic at abnormally high levels. Glucose Toxicity  Large Vessels – Heart and Brain Abnormal lipid  Small Vessels – Neuropathy, Eyes, Kidneys, Glycoprotein and capillary damage Glucose Toxicity     Damages pancreatic ilet cells Oxidizes lipids Glycoprotien in the small muscular arteries Damages the capillaries Kidney Disease  Diabetes is the major reason for dialysis in the adult.  High blood pressure accelerates the disease. Peripheral Neuropathy Treatment and prevention:  Normalizing blood sugar,  Controlling blood pressure and  Normalizing lipids. Diet, exercise, and sometimes medications are required to achieve these goals Arteriosclerosis  The high glucose, and toxic products of high glucose, damage the blood vessel wall.  An accumulation of oxidized cholesterol and white blood cells on a damaged artery is the mechanism. Obesity and diabetes  Obesity causes insulin resistance in the fat cells (and other cells) by altering the insulin receptors.  Insulin levels are increased to compensate. Obesity and diabetes  The pancreas eventually becomes unable to produce enough insulin to keep the blood sugar down and diabetes is manifested.  High insulin levels inhibit the breakdown of fat making it more difficult to loose weight. Obesity And Diabetes In the U.S. 60% of adults are overweight or obese, 35% of American adults are overweight, and 26% are obese Overweight = 10% more than ideal weight or BMI +25 Obesity = 20% more than ideal weight or BMI + 30 Obesity and diabetes  Type 2 diabetes used to be called “Adult Onset Diabetes”. Type 2 diabetes in children and youth has increased by 10 fold, comparing 1982 to 1994 statistics, and is still on the rise.  The rate of Diabetes in Adults has tripled since 1960 Obesity And Diabetes "We live in a toxic environment, physical activities have been engineered out of dayto-day life, and the food environment grows worse by the day.” Obesity and diabetes The Obese person has overwhelmed their natural weight "set point“, readjusting it higher with: 1. High fat diet 2. Low fiber diet 3. Nutritional depleted food 4. High concentrated sugar diet 5. Excess total calories Obesity and diabetes Insulin resistance cause the pancreas to produce more insulin than is normal, attempting to maintain a normal Blood sugar. Problems with a high Insulin  Insulin causes glucose to be converted to fat and stored in fat cell.  Insulin prevents the conversion of fat to glucose.  Insulin signals the liver to make cholesterol.  Insulin is a appetite stimulant. Why the epidemic of obesity  Refined carbohydrates – Sugar, packaged foods, white bread, hybrid corn  Excess Calories  Refined oil  Decreased exercise What has worked in weight loss       Did not quit trying despite several failures. Rewarded themselves on occasion with the foods they liked. Near daily planned exercise – about 1 hour per day on average. Added little bits of physical activity during the day. Used a low fat, high unrefined carbohydrate diet. (Food as grown) Eat 3 to 5 meals per day Nationwide Food Consumption Survey estimated the following (highlights) : % of people who get less than the RDA Calcium 68% Magnesium 75% Iron 57% Vitamin B6 80% Chromium 90% Selenium 60% Alpha Linolenic Acid (Omega 3) 95% Ten Essential Nutrients 1. Oxygen 2. Water 3. Whole grains (rice, corn, wheat etc) 4. Fruits and vegetables 5. Dark green vegetables 6. Nuts and seeds 7. Beans (legumes, soybeans, tofu) 8. Garlic and onions 9. Sun light 10. Friendly bacteria A vitamin B12 supplement is currently advised in a strict vegetarian Over half the calories in the normal American diet comes from food from which much of the minerals, vitamins, essential fatty acids and fiber has been removed. Polished rice has lost between 26 and 83% of each mineral present in brown rice. White bread has lost between 20 and 95% of the minerals and vitamins of whole wheat bread. Sugar has lost nearly all the vitamins and minerals of raw sugar. Refined oil has lost most of the minerals, fiber and vitamins Exercise And Diabetes The "couch potato syndrome" has become epidemic. 70% of the adults are sedentary or under active, and nearly half of America's youth (aged 12-21 years) are not involved in any regular physical exercise Exercise Many people with chronic health problems have felt that they are not able to exercise. The evidence is just the opposite; those with chronic health problems will benefit the most by exercise. Those who are “healthy” need to start a program. It will add at least 2 years to your life, and you will feel happier and better. Begin physical activities such as brisk walking or equivalent 10 to 15 minutes twice a day. Skin diseases  Diabetics heal slower because: Poor circulation especially in the feet. High glucose is toxic to white blood cells causing slow healing. Poor nerve function This results in infected diabetic foot ulcers. Diabetics need to inspect their feet at least once a day  Herbal Medicines  Bitter melon (Momordica charantia):: 30-60 ml fresh juice three times/day or dried concentrate.  Gurmar (Gymnema sylvestre): extract: 200mg two times/day  Defatted fenugreek powder: 5g to 50 gram/day Atriplex halimus: 3gram/day  Green tea: two 120 ml cups daily or 200-300mg of green tea polyphenols  Ginko biloba: extract 40mg three times daily  Korean ginseng (Panax ginseng): extract 100mg one to three times/day (to a max of two to four 500-mg capsules per day)  Holy basil (Ocimum sanctum): 1-4 g of dried leaf daily  Flax seed: Grid and mix in juice, about ¼ cup per day  Banaba Leaf (Lagerstroemia speciosa) For Diabetic Neuropathy 1. Primrose oil can reverse diabetic damage to peripheral (as opposed to autonomic) nerves. 2. Alpha-lipoic acid (ALA) can partly restore diabetic nerve function after only four months of high-dose oral treatment (800 mg/day). 3. Contrast footbaths Session 2  David E. Allen MD’s  Diabetic Education Course Goals of Glycemic Control for People with Diabetes Biochemical Index Normal Goal 90 – 130 < 160 Action Suggested < 80, > 140 > 180 Average Fasting Plasma* <100 Glucose (mg/dl) Average Postprandial 2 hours (mg/dl) Average Bedtime Glucose (mg/dl) HgA1C (%) < 140 < 120 < 6% 110 – 150 < 110, > 160 <7% > 7% Blood pressure Goals     Less than 130 systolic is Diabetic Less than 135 in a Non Diabetic Ideal is less than 125 Focus on the systolic is consistent with the research The multiplication of Risk for Coronary Artery Disease:  Diabetes almost doubles (1.8 X) the risk for heart disease.  Combine diabetes and hypertension and your risk are more than 5 times (5.4 X).  If you have all thee risks (diabetes, hypertension and high cholesterol) and your risk is 22 times the risk as someone with none of these problems. Hypertension in the Diabetes Blood pressure is a test of cardiovascular health. Blood pressure Goals     Less than 130 systolic is Diabetic Less than 135 in a Non Diabetic Ideal is less than 125 Focus on the systolic is consistent with the research Causes of Ischemic Heart Disease 1. Smoking 2. High Cholesterol 3. Excess Homocystine 4. Hypertension 5. Diabetes 6. Obesity (20% higher than a healthy weight) 7. Lack of fruit and vegetables 8. Lack of dietary fiber Arteriosclerosis A type 2 diabetic typically has an abnormal lipid profile with high bad cholesterol (LDL), low good cholesterol (HDL) and high triglycerides. Glyburide, Glucotrol, Amaryl  Stimulate insulin production  Loses it benefit in 3 to 5 years  Cheap Diabetic Medication      Glyburide, Glucotrol, Amaryl Glucophage Avandia, Actose Precose Humalog, Regular, NPH, Lenta, Ultralenta, Lantus Glucophage  Slow release of sugar from the liver  May cause Stomach upset  Lactic Acidosis in Heart or kidney failure Avandia, Actose     Increase the response of cells to insulin Longer duration of benefit Not for patients with heart failure Expensive Precose  Slow the breakdown of carbohydrates to sugar in the intestines  Like fiber  Causes gas Insulins       Humalog Regular NPH Lenta Lantus 70/30 Vitamins And Minerals For Diabetes          Chromium picolinate: 200-1000mcg/day Vitamin C: 500 to 2000 mg/day Biotin: 9 mg/day Pyridoxine: 25 mg/day Selenium: 200 mcg/day Magnesium: 300-500 mg/day Manganese: 30 mg/day Zinc 25 mg/day Mixed Flavonoids: 1000-2000mg/day Check list       Urine albumen HgbA1c Lipids Daily feet exam Blood pressure control Yearly Eye exam Metabolic syndrome This is a condition of high glucose, abdominal obesity, hypertension, and high Triglycerides.