diet and diabetes mellitus

• Diabetes Mellitus


  Chronic disease characterized by elevated blood sugar (glucose) concentrations
• Glucose


  • Primary source of energy for body
  • Transported by blood
  • Entry into cells controlled by insulin
• Diabetes Mellitus


  • A group of serious and chronic disorders affecting metabolism of carbohydrates
  • Characterized by high blood glucose (BG) concentrations resulting from defects in insulin secretion, insulin action, or both

  
• Diabetes Mellitus


  Greek words "diabetes" meaning "to flow through" (excess urine) and "mellitus" meaning "honeyed" (high amount of glucose in urine)

  
• 366 million people have diabetes in 2011; by 2030 this will have risen to 552 million

  
• The number of people with type 2 diabetes is increasing in every country
• 80% of people with diabetes live in low- and middle-income countries
• The greatest number of people with diabetes are between 40 to 59 years of age

  
• 183 million people (50%) with diabetes are undiagnosed
• Diabetes caused 4.6 million deaths in 2011
• Diabetes caused at least USD 465 billion dollars in healthcare expenditures in 2011; 11% of total healthcare expenditures in adults (20-79 years)

  
• 78,000 children develop type 1 diabetes every year
• Prevalence of DM increases with increasing age
• DM contributes to increased morbidity and mortality rates
• 146,000 people had diabetes in Lebanon in the year 2000, projected to be 378,000 in 2030

  
• Approximately 1/2 of those suffering from diabetes in Lebanon are not aware of their condition

  
• Insulin


  • Secreted as blood glucose rises, such as after a meal
  • Signals the muscle + liver cells to store excess glucose as glycogen
• Glucagon


  • Secreted as blood glucose falls, such as in prolonged fasting
  • Signals the breakdown of liver glycogen into glucose
• Adrenaline


  • Secreted in times of anger or fear
  • Signals the breakdown of liver glycogen into glucose, increasing blood sugar levels (same effect as glucagon)
• Causes of Diabetes Mellitus


  • Genetics
  • Environmental factors
  • Viruses
  • Obesity
• Diabetes


  1. The body's ability to make or use insulin is affected

  2. Glucose builds up in the blood

  3. The high levels of glucose in the body causes damage to cells

  
• Types of Diabetes


  • Prediabetes (impaired glucose homeostasis)
  • Type 1 (formerly IDDM, type I)
  • Type 2 (formerly NIDDM, type II)
  • Gestational diabetes mellitus (GDM)

  
• Symptoms of Diabetes


  • Glycosuria: Glucose in urine
  • Polyuria: Excessive urination
  • Polydipsia: Excessive thirst
  • Polyphagia: Excessive appetite
  • Weight loss
  • Weakness
  • Fatigue

  
• Symptoms of Diabetes


  • Inability of the body to metabolize glucose from diet, body breaks down tissue protein and fat leading to polyphagia (excessive appetite/hunger), loss of weight (type I in particular), weakness and fatigue
  • Excretion of N increases with protein metabolism
  • Ketones are produced rapidly among diabetic patients (No CHOs; excessive amounts of fats broken down) leading to ketonemia and ketonuria, which lower blood pH and can cause diabetic coma

  
• Diseases associated with Diabetes

  • Atherosclerosis
  • Cardiovascular diseases
  • Retinopathy: damage to small blood vessels leading to blindness
  • Neuropathy: nerve damage leading to infections particularly of urinary tract
  • Nephropathy (kidney)
  • Can lead to amputation

  
• Insulin


  • Secreted by beta cells of islets of Langerhans in pancreas gland
  • Hyperglycemia can result from inadequate production of insulin or inability of body to use insulin

  
• Glucagon


  • Secreted by the alpha-cells of the pancreas
  • Helps release energy by converting glycogen to glucose
  • Helps protect the body from hypoglycemia
• Prediabetes


  • Impaired Glucose Homeostasis
  • Improper use of insulin by cells of body
  • Fasting blood glucose > 110 mg per dL but < 126 mg per dL
  • May advance to type 2 diabetes

  
• Forms of Prediabetes

  • Impaired fasting glucose (IFG): fasting plasma glucose (FPG) above normal
  • Impaired glucose tolerance (IGT): plasma glucose elevated after 75-g glucose load
  • Hgb A1C (a blood test to determine how well blood glucose has been controlled for the last 3 months)
• Type 1 Diabetes


  • Two forms: Immune mediated (beta cells destroyed by autoimmune process) and Idiopathic (cause of beta cell function loss unknown)
  • Symptoms: hyperglycemia, polyuria, polydipsia, weight loss, dehydration, electrolyte disturbance, and ketoacidosis
  • 5% to 10% of all diagnosed diabetes
  • Risk factors: Genetics, autoimmune status, and environment
  • Leading chronic disease among children and young adults
  • Requires insulin therapy (Insulin shots/inhalers) plus diet

  
• Type 2 Diabetes


  • Most common form of diabetes, accounting for 90% to 95% of diagnosed cases
  • Combination of insulin resistance and beta cell failure (insulin deficiency)
  • Trigger glucose uptake more slowly than normal (Insulin Resistance)
  • Progressive disease: hyperglycemia develops gradually and may not cause the classic symptoms of type 1 diabetes
  • Previously called adult-onset diabetes
  • Now found in teens and young adults due to obesity

  
• Risk Factors for Type 2 Diabetes

  • BMI >25
  • Physical inactivity
  • High-risk ethnic groups (African American, Latino, Native American, Asian America, Pacific Islander)
  • Previous delivery of baby >4 kg or GDM
  • Hypertension
  • Family history
  • Old age
  • History of gestational diabetes or Previous delivery of baby >4 kg
  • Race or ethnicity
  • HDL <35 mg/dL or triglycerides >250 mg/dL
  • PCOS
  • Acanthosis nigricans
  • IGT (Impaired glucose tolerance) or IFG (insulin like growth factor)
  • History of vascular disease

  
• Gestational Diabetes


  • Temporary condition in pregnancy
  • Occurs between 16th and 28th week of pregnancy
  • Insulin required if not responsive to diet and exercise
  • Usually disappears after infant born
  • Type 2 diabetes can develop 5 to 10 years after pregnancy
• Methods of Diagnosis

  • Fasting plasma glucose (FPG)
  • Casual plasma glucose (any time of day)
  • Oral glucose tolerance test (OGTT)
• Diagnosis of Diabetes Mellitus and Impaired Glucose Homeostasis


  • Diabetes: FPG ≥126 mg/dL, CPG ≥200 mg/dL plus symptoms, 2hPG ≥200 mg/dL
  • Prediabetes: Impaired fasting glucose (FPG 100–125 mg/dL), Impaired glucose tolerance (2hPG 140–199 mg/dL)
  • Normal: FPG <100 mg/dL, 2hPG <140 mg/dL

  
• Treatment Goals


  • Control blood glucose levels to normal range
  • Maintain a lipid and lipoprotein profile that reduces CVD risk
  • Maintain blood pressure levels in the normal range
  • Provide optimal nourishment
  • Address individual nutrition needs
  • Prevent symptoms
  • Delay complications
  • Maintain the pleasure of eating by limiting choices only when indicated by scientific evidence

  
• Treatment Options


  • Diet alone
  • Diet combined with glucose-lowering medication
  • Diet combined with insulin
  • Exercise in addition to any of the above
  • Regular monitoring of blood glucose levels in addition to any of the above

  
• The ultimate responsibility for treatment rests with the client
• Recommendations for Glycemic Control for Adults With Diabetes

  • A1C <7.0%
  • Preprandial capillary plasma glucose 90–130 mg/dL
  • Peak postprandial capillary plasma glucose <180 mg/dL

  
• Recommendations for Lipid and Blood Pressure for Adults With Diabetes


  • LDL cholesterol <100 mg/dL
  • HDL cholesterol: Men >40 mg/dL, Women >50 mg/dL
  • Triglycerides <150 mg/dL
  • Blood Pressure <130/80 mm Hg