Diet and Diabetes

Diet+and+Diabetes%0d%0aCreated+by%3a+Tricia+Fleming%2c+University+of+Kansas+Dietetic+Intern+Tammy+Beason%2c+MS%2c+RD%2c+Nutrition+Education+Specialist%2c+Family+Nutrition+Education+Program+December+2001%0d%0a%0d%0a%0cDiabetes-+What+is+it%3f%0d%0a%e2%80%a2+Body+is+not+producing+or+has+lost+sensitivity+to+insulin.+%e2%80%a2+Insulin+is+a+hormone+that+is+needed+to+convert+sugar%2c+starches+and+other+food+into+energy.+%e2%80%a2+Insulin+is+produced+in+the+body+by+the+pancreas.%0d%0a%0d%0a%0cTypes+of+Diabetes%0d%0aThere+are+several+types+of+diabetes%3a+%e2%80%a2+Type+I+-+body+does+not+produce+any+insulin.+%e2%80%a2+Type+II-+body+is+not+making+enough+or+is+losing+sensitivity+to+insulin+made.%0d%0a%0d%0a%0cTypes+of+Diabetes%0d%0a%e2%80%a2+Secondary+-+a+consequence+from+another+disease.+For+example%2c+pancreatitis+or+cystic+fibrosis.+%e2%80%a2+Gestational+Diabetes-+diabetes+during+pregnancy.+%e2%80%a2+Impaired+Glucose+Tolerance-+an+intermediate+between+normal+and+diabetes.%0d%0a%0d%0a%0cQuick+Review-Anatomy+of+the+Pancreas%0d%0a%e2%80%a2+A+gland+that+lies+behind+the+stomach+%e2%80%a2+Clusters+of+cells+inside+the+pancreas+known+as+the+islets+of+Langerhans+produces+three+hormones.+%e2%80%a2+The+islets+contain+3+types+of+cells%3a+%e2%80%a2+Alpha%2c+beta%2c+and+delta.+%e2%80%a2+Alpha+cells+produce+glucagon.%0d%0a%0d%0a%0cPancreas+contd.%0d%0a%e2%80%a2+Beta+cells-+produce+insulin+%e2%80%a2+Delta+cells-+produce+somatostatin+%e2%80%a2+These+cells+have+special+sensors+that+monitor+levels+of+blood+sugar+and+stimulate+the+release+of+the+correct+hormone.%0d%0a%0d%0a%0cInsulin+and+the+other+hormones%0d%0a%e2%80%a2+Glucagon+-+Hormone+that+increases+the+amount+of+glucose+in+the+blood+when+it+is+needed.+%e2%80%a2+Somatostatin+-+Hormone+that+can+suppress+both+glucagon+and+insulin+when+needed.+%e2%80%a2+Insulin-+Hormone+that+lowers+blood+glucose.%0d%0a%0d%0a%0cHow+Does+Insulin+Work%3f%0d%0a%e2%80%a2+A+person+normally+secretes+insulin+in+response+to+an+elevated+blood+sugar+level.+%e2%80%a2+It+does+this+by+accelerating+blood+sugars+movement+out+of+the+blood+and+into+the+cells.+%e2%80%a2+Cells+will+not+allow+blood+sugar+in+without+insulin.+-+this+can+cause+a+problem.%0d%0a%0d%0a%0cWhy+isn%e2%80%99t+the+body+making+insulin%3f%0d%0a%e2%80%a2+In+people+with+Type+I%2c+the+immune+system+has+made+a+big+mistake!+%e2%80%a2+It+attacks+the+beta+cells+and+destroys+them!+%e2%80%a2+In+people+with+Type+II%2c+the+pancreas+is+still+making+insulin%2c+just+not+enough+to+keep+up%2c+or+their+bodies+have+become+insulin+resistant!%0d%0a%0d%0a%0cType+I%0d%0a%e2%80%a2+Usually+diagnosed+in+children+and+young+adults.+%e2%80%a2+Must+take+daily+insulin+shots+to+stay+alive.+%e2%80%a2+Type+I+accounts+for+5-10%25+of+the+population+with+diabetes.%0d%0a%0d%0a%0cType+II%0d%0a%e2%80%a2+The+most+common+form+of+the+disease.+%e2%80%a2+Approximately+50%25+of+men+and+70%25+of+women+are+obese+at+the+time+of+diagnosis.+%e2%80%a2+Nearing+epidemic+proportions%2c+due+to+increase+%23+of+older+Americans%2c+greater+occurrence+of+obesity+and+sedentary+lifestyles.%0d%0a%0d%0a%0cGestational+Diabetes%0d%0a%e2%80%a2+Pregnant+women+have+a+higher+insulin+level.+%e2%80%a2+If+woman+has+hyperglycemia%2c+her+blood+glucose+crosses+the+placenta+but+her+insulin+does+not.+%e2%80%a2+This+can+cause+a+high+birth+weight+for+baby.%0d%0a%0d%0a%0cWhat+are+the+Symptoms%3f%0d%0a%e2%80%a2+%e2%80%a2+%e2%80%a2+%e2%80%a2+%e2%80%a2+%e2%80%a2+Polyphasia-+excessive+eating+Polyurea-+excessive+urination+Polydypsia-excessive+fluid+intake+Blurred+vision+Poor+wound+healing+Irritability%0d%0a%0d%0a%0cHow+are+you+diagnosed+with+diabetes%3f%0d%0a%e2%80%a2+In+June+1997%2c+the+ADA+redefined+it%e2%80%99s+criteria+for+diagnosing+diabetes.+%e2%80%a2+Normal+fasting+blood+glucose+is+%3c110+mg%2fdl.+%e2%80%a2+Impaired+fasting+glucose+is+%3e110+and+%3c126+mg%2fdl.+%e2%80%a2+Provisional+diagnosis+for+diabetes%3e126+mg%2fdl%0d%0a%0d%0a%0cDiagnosis+contd.%0d%0a%e2%80%a2+In+order+to+be+diagnosed+with+diabetes%3a+%e2%80%a2+Person+must+have+symptoms+of+diabetes+%2b+%e2%80%a2+Causal+plasma+glucose+%3e200+%e2%80%a2+Fasting+blood+glucose+of+%3e126+mg%2fdl+%e2%80%a2+2-hour+plasma+glucose+%3e200+mg%2fdl+on+oral+glucose+test%0d%0a%0d%0a%0cWho%e2%80%99s+at+risk%3f%0d%0aADA+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%3a%0d%0a%0d%0a%0cWho%e2%80%99s+at+risk%3f%0d%0a%e2%80%a2+%e2%80%a2+%e2%80%a2+%e2%80%a2+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+%3e9+lbs.+%e2%80%a2+Hypertension%0d%0a%0d%0a%0cWho%e2%80%99s+at+risk%3f%0d%0a%e2%80%a2+HDL+level%3c35+or+triglycerides+%3e250+%e2%80%a2+Found+to+have+impaired+glucose+tolerance+or+impaired+fasting+on+a+previous+test.%0d%0a%0d%0a%0cI%e2%80%99ve+got+Diabetes%2c+now+what%3f%0d%0a%e2%80%a2+After+diagnosis%2c+there+is+a+great+need+for+education.+%e2%80%a2+A+diabetic+diet+is+no+different+from+anyone+else%e2%80%99s+but+they+must+keep+track+of+what+they+eat.+%e2%80%a2+A+food+diary+is+a+great+start!+%e2%80%a2+Serving+sizes+must+be+emphasized.%0d%0a%0d%0a%0cTreatment+Goals+for+Type+I%0d%0a%e2%80%a2+Match+insulin+to+food+intake.+%e2%80%a2+Type+I%e2%80%99s+are+encouraged+to+be+precise+and+regular+from+day+to+day+with+food+intake%2c+insulin+regimen%2c+and+activity.%0d%0a%0d%0a%0cExercise+and+Type+I%e2%80%99s%0d%0a%e2%80%a2+Increases+flexibility%2c+muscular+strength+%2c+and+well+being.+%e2%80%a2+Must+monitor+insulin+and+food+intake+to+match+exercise+regimen.+%e2%80%a2+Increases+insulin+effectiveness+and+sensitivity+in+the+body.%0d%0a%0d%0a%0cTreatment+Goals+for+Type+II%0d%0a%e2%80%a2+Achieve+normal+or+near-normal+blood+glucose+levels.+%e2%80%a2+Provide+adequate+calories+for+reasonable+body+weight.+%e2%80%a2+Prevent%2c+delay+or+treat+nutrition+related+complications.+%e2%80%a2+Improve+health+through+optimal+nutrition.%0d%0a%0d%0a%0cExercise+and+Type+II%0d%0a%e2%80%a2+%e2%80%a2+%e2%80%a2+%e2%80%a2+Especially+beneficial+in+type+II+diabetes.+Promotes+weight+loss+Increases+insulin+sensitivity.+Must+also+be+aware+of+medication+and+intake+to+prevent+hypoglycemia.%0d%0a%0d%0a%0cTreatment+of+Diabetes%0d%0a%e2%80%a2+Diet+plays+a+major+role.+%e2%80%a2+Carbohydrates+are+the+component+of+food+that+causes+an+increase+in+blood+sugar.+%e2%80%a2+Diabetics+are+encouraged+to+keep+track+of+the+amount+of+CHO+they+eat.%0d%0a%0d%0a%0cMethods+of+Carbohydrate+Control%0d%0aThere+are+many+new+methods+of+controlling+diabetes%2c+these+are+still+the+two+most+common.%0d%0a%0d%0a%e2%80%a2+Exchange+Lists+%e2%80%a2+Carbohydrate+counting-+Very+basic%2c+allows+a+little+more+freedom+and+variety.%0d%0a%0d%0a%0cBlood+Glucose+Monitoring%0d%0a%e2%80%a2+All+diabetics+must+keep+track+of+blood+glucose+levels.+%e2%80%a2+This+is+the+only+way+to+know+if+the+treatment+is+effective.+%e2%80%a2+Gives+the+diabetic+a+good+indication+of+what+affects+their+blood+sugar+level.+%e2%80%a2+Must+check+at+least+2+times+a+day+and+four+times+a+day+for+at+least+3+days+a+week.%0d%0a%0d%0a%0cHemoglobin+A1c%0d%0a%e2%80%a2+A+good+indicator+of+blood+glucose+control.+%e2%80%a2+Gives+a+%25+that+indicates+control+over+the+preceding+2-3+months.+%e2%80%a2+Performed+2+times+a+year.+%e2%80%a2+A+hemoglobin+of+6%25+indicates+good+control+and+level+%3e8%25+indicates+action+is+needed.%0d%0a%0d%0a%0cDietary+Guidelines%0d%0a%e2%80%a2+Eat+a+diet+low+in+saturated+and+total+fat.+%e2%80%a2+Eat+a+diet+moderate+in+sodium+and+sugar.+%e2%80%a2+Eat+5+or+more+fruits+and+vegetables+a+day.+%e2%80%a2+Choose+a+diet+rich+in+whole+grains.+%e2%80%a2+Moderate+use+of+alcohol%0d%0a%0d%0a%0cDietary+Guidelines%0d%0a%e2%80%a2+Eat+at+the+same+time+everyday+%2c+at+least+within+1+hour+of+regular+time.+%e2%80%a2+Eat+about+the+same+amount+of+carbohydrate+with+each+meal.%0d%0a%0d%0a%0cOther+Treatments%0d%0a%e2%80%a2+Type+I+and+sometimes+Type+II+patients+need+to+be+treated+with+insulin.+%e2%80%a2+There+are+more+than+20+types.+%e2%80%a2+They+differ+in+how+they+are+made%2c+how+they+work+in+the+body+and+their+cost.%0d%0a%0d%0a%0cOral+Medications%0d%0aUsed+to+treat+Type+II+diabetics.+There+are+four+basic+types%3a+%e2%80%a2+Sulfonylurea-stimulates+the+body+to+make+more+insulin.+%e2%80%a2+Metformin-lowers+blood+sugar+by+helping+the+insulin+work+better%0d%0a%0d%0a%0cOral+medications%0d%0a%e2%80%a2+Thiazolidinediones-+increases+muscle+sensitivity+to+insulin.+%e2%80%a2+Alpha-glucosidase+inhibitors-+slow+the+process+of+carbohydrate+digestion.%0d%0a%0d%0a%0cTreatment+Goals%0d%0a%e2%80%a2+The+main+goal+is+to+normalize+blood+sugar.+Realistic+goals+for+diabetics+are+70-140+mg%2fdl+before+meals%2c+%3c180+mg%2fdl+after+and+a+glycosolated+hemoglobin+within+1%25+of+normal.+%e2%80%a2+Need+good+blood+glucose+control+to+avoid+complications.%0d%0a%0d%0a%0cDiabetes+Complications%0d%0aDiabetes+complications+are+the+seventh+leading+cause+of+death.+They+include%3a+%e2%80%a2+Blindness-+caused+by+diabetic+retinopathy.+%e2%80%a2+Kidney+Disease-+diabetic+nephropathy+%e2%80%a2+Heart+Disease+and+Stroke%0d%0a%0d%0a%0cComplications+contd%0d%0a%e2%80%a2+Nerve+disease+and+amputations+%e2%80%a2+Impotence%0d%0a%0d%0a%0cHow+to+Avoid+Complications%0d%0a%e2%80%a2+%e2%80%a2+%e2%80%a2+%e2%80%a2+%e2%80%a2+Control+weight+Eat+a+healthy+well-balanced+diet.+Get+regular+exercise+Have+regular+checkups+Check+feet+everyday+for+cuts+and+blisters+%e2%80%a2+Do+not+smoke!%0d%0a%0d%0a%0cHow+to+Avoid+Complications%0d%0a%e2%80%a2+Keep+blood+sugars+normal+%e2%80%a2+Avoid+the+2+common+diabetic+problems%2c+hypoglycemia+and+hyperglycemia%0d%0a%0d%0a%0cHypoglycemia%0d%0a%e2%80%a2+Hypoglycemia-+low+blood+sugar+%e2%80%a2+Happens+to+everyone+with+diabetes+%e2%80%a2+Symptoms+include+shakiness%2c+dizziness%2c+sweating%2c+hunger%2c+headache%2c+pale+skin%2c+sudden+moodiness%2c+clumsy+or+jerky+movements%2c+difficulty+paying+attention%2c+and+tingling+sensations+around+mouth.%0d%0a%0d%0a%0cHypoglycemia%0d%0aHow+to+treat+Hypoglycemia%3a+%e2%80%a2+Quickest+way+to+raise+blood+glucose+is+with+some+form+of+sugar.+%e2%80%a2+3+glucose+tablets%2c+1%2f2+cup+of+fruit+juice%2c+5-6+pieces+of+candy.+%e2%80%a2+Wait+15-20+minutes+and+test+blood+sugar+again.+If+still+low+retreat.%0d%0a%0d%0a%0cHypoglycemia%0d%0a%e2%80%a2+If+hypoglycemia+goes+untreated%2c+patient+could+get+worse+and+pass+out!+%e2%80%a2+Stress+the+importance+of+a+night+time+snack+in+older+patients.%0d%0a%0d%0a%0cHyperglycemia%0d%0aKetoacidosis%3a+Develops+when+the+body+does+not+have+enough+insulin.+The+body+can%e2%80%99t+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.%0d%0a%0d%0a%0cHyperglycemia%0d%0aSymptoms+that+may+result+in+ketoacidosis+occur+when%3a+%e2%80%a2+Too+little+insulin+has+been+ejected%2c+or+insulin+is+not+effective.+%e2%80%a2+Consumed+more+food+and%2for+exercised+less+than+expected.+%e2%80%a2+High+blood+sugar%2c+high+levels+of+sugar+in+the+urine%2c+frequent+urination%2c+and+increased+thirst%0d%0a%0d%0a%0cHow+to+treat+Hyperglycemia%0d%0a%e2%80%a2+Usually+can+lower+it+by+exercising%2c+or+injecting+more+insulin%2c+be+careful+of+the+somogyi+effect.+The+somogyi+effect+is+the+condition+of+hypoglycemia+resulting+from+the+treatment+of+hyperglycemia.%0d%0a%0d%0a%0cConclusion%0d%0aDiabetes+is+a+very+complicated+disease.%0d%0a%0d%0aFor+more+information%3a+www.diabetes.org%0d%0a%0d%0a%0c