• A disorder of CHO metabolism resulting from A disorder of CHO metabolism resulting from inadequate or ineffective insulin, as result of inadequate or ineffective insulin, as result of that blood glucose remains high after a meal. that blood glucose remains high after a meal.

• There are tow types of diabetes There are tow types of diabetes – Type 1 Diabetes: Insulin-dependent diabetes Type 1 Diabetes: Insulin-dependent diabetes

mellitus (IDDM): this type is less common mellitus (IDDM): this type is less common type of diabetes in which the person produces type of diabetes in which the person produces no insulin at all (mostly develops in childhood, no insulin at all (mostly develops in childhood, and some cases arises in adulthood)and some cases arises in adulthood)

– Type 2 diabetes: Non insulin-dependent Type 2 diabetes: Non insulin-dependent diabetes mellitus (NIDDM):: the more diabetes mellitus (NIDDM):: the more common type of diabetes in Kuwait, in which common type of diabetes in Kuwait, in which the fat cells resist insulin, the fat cells resist insulin,

Diabetes

Metabolic Consequences of Untreated Metabolic Consequences of Untreated DiabetesDiabetes

Metabolic Consequences of Untreated Metabolic Consequences of Untreated DiabetesDiabetes

Type 1 Type 2

No Glucose enters The cells

Blood glucose Rises

(hyperglycemia)Some glucose enter

the cells, but slowly

Cells break Down protein

and fatHumger

Ketones areProduced for

energy

Diabetic acidosis Manifested by:

*acetone breath *acetonemi*acetonuria

Diabetic coma

Weight lost

( Polyphagia )Excessive eating

Hunger

( Polyphagia )Excessive eating

Weight gain

GlucoseSpills intoThe urine

(glycosuria)

Water moveTo the blood

(osmotic effects)

Dehyration

Frequent Urination

(polyuria

Excessive thirest

• Diabetes in adults may start slowly. In fact, Diabetes in adults may start slowly. In fact, millions of people don't even know they have millions of people don't even know they have it. They may just feel very tired at first, then it. They may just feel very tired at first, then later may have these symptoms:later may have these symptoms:

• Urinating more than usual, as the body tries Urinating more than usual, as the body tries to get rid of the extra sugar in the blood to get rid of the extra sugar in the blood

• Feeling unusually thirsty, because the body Feeling unusually thirsty, because the body needs to replace the lost fluid needs to replace the lost fluid

• Nausea Nausea • Blurred vision Blurred vision • Feeling hungry while losing weight Feeling hungry while losing weight • Frequent infections Frequent infections • Skin sores that won't heal Skin sores that won't heal

Diabetes

http://savvyhealthfitness.com/wp-content/uploads/2009/01/diabetes_type2.jpg

• Ketones: when the body can`t use the Ketones: when the body can`t use the glucose for energy, it uses fat instead. glucose for energy, it uses fat instead. When fats are broken down for When fats are broken down for energy, chemicals called ketones energy, chemicals called ketones appear in the blood and urine. This appear in the blood and urine. This can occur when not enough food has can occur when not enough food has been eaten to provide glucose for been eaten to provide glucose for energy, or it can occur in diabtes , energy, or it can occur in diabtes , when the body can`t use glucose when the body can`t use glucose normally. normally.

Other namesOther namesInsulin-dependent diabetes Insulin-dependent diabetes mellitus (IDDM)mellitus (IDDM)

Noninsulin-dependent Noninsulin-dependent diabetes mellitus (NIDDM)diabetes mellitus (NIDDM)

Juvenile-onset diabetesJuvenile-onset diabetesAdult-onset diabetesAdult-onset diabetes

Ketosis-prone diabetesKetosis-prone diabetesKetosis-resistant diabetesKetosis-resistant diabetes

Brittle diabetesBrittle diabetesStable diabetesStable diabetes

Onset average age Onset average age <20 (mean age 12)<20 (mean age 12)10-19; >4010-19; >40

Insulin required?Insulin required?YesYesSometimesSometimes

Insulin cell Insulin cell response response

NormalNormalResistantResistant

SymptomsSymptomsRelatively severeRelatively severeRelatively moderateRelatively moderate

Prevalence in Prevalence in diabeticsdiabetics

5-10%5-10%90-95%90-95%

Features of Diabetes

Type 1 Type 1 DiabetesDiabetes

Type 2 Type 2 DiabetesDiabetes

• Meals and snacks should be based on the Food Meals and snacks should be based on the Food pyramid. Your dietitian may tell you just how pyramid. Your dietitian may tell you just how many servings you need of each food, and how many servings you need of each food, and how large a serving should be. large a serving should be.

• The largest part of each meal should be the The largest part of each meal should be the foods at the bottom of the pyramid, such as foods at the bottom of the pyramid, such as whole grain breads, pasta and rice, and starchy whole grain breads, pasta and rice, and starchy vegetables like potatoes, corn, peas and beans. vegetables like potatoes, corn, peas and beans.

• Every day, you should have several servings of Every day, you should have several servings of vegetables and fruit. vegetables and fruit.

• Protein should come from lean meats, chicken, Protein should come from lean meats, chicken, turkey, or fish, or meat substitutes like beans, turkey, or fish, or meat substitutes like beans, eggs or low-fat cheese. eggs or low-fat cheese.

• Dairy foods should be either non-fat or low-fat. Dairy foods should be either non-fat or low-fat. • Eat fats and sugars only in small amountsEat fats and sugars only in small amounts. .

The Balanced Diet

• Hyperglycemia occurs when the blood sugar is Hyperglycemia occurs when the blood sugar is too high. too high.

• Symptoms of HyperglycemiaSymptoms of Hyperglycemia• Increased thirst Increased thirst • Nausea & vomiting Nausea & vomiting • Increased urination Increased urination • Loss of appetiteLoss of appetite• Weakness, abdominal and/or generalized pains Weakness, abdominal and/or generalized pains • Large amounts of sugar or ketones in urine Large amounts of sugar or ketones in urine

Hyperglycemia-High Blood Sugar

• A person with hypoglycemia may feel A person with hypoglycemia may feel weak, drowsy, confused, hungry, and weak, drowsy, confused, hungry, and dizzy. dizzy. Paleness, headache, irritability, Paleness, headache, irritability, trembling, sweating, rapid heart beat, trembling, sweating, rapid heart beat, and a cold, clammy feeling are also signs and a cold, clammy feeling are also signs of low blood sugar. In severe cases, a of low blood sugar. In severe cases, a person can lose person can lose consciousness and consciousness and even lapse into a coma.even lapse into a coma.

Symptoms of Hypoglycemia

• Is the most frequent cause of myocardial Is the most frequent cause of myocardial infractions and cerebrovascular accidents. infractions and cerebrovascular accidents.

• It begins gradually with the deposit of It begins gradually with the deposit of plaques in the arterial wall. plaques in the arterial wall.

• Eventually progressive thickening and Eventually progressive thickening and rigidity of the arterial wallrigidity of the arterial wall

• Narrowing of the arterial lumen makes it Narrowing of the arterial lumen makes it difficult to deliver O2 and nutrient.difficult to deliver O2 and nutrient.

StrokeStroke

• Cigaratte Cigaratte • High cholesterolHigh cholesterol• High triglycride High triglycride • High blood pressure (Hypertension)High blood pressure (Hypertension)• InactivityInactivity• ObesityObesity• HeredityHeredity• GenderGender• StressStress• ageage• DMDM

Risk factors

• Maintaining a desirable body weight• Cut down the fat consumption to 30% • Limit saturated fat to less than 7% of total Kcal and

Chol. • Replace saturated fat with unsaturated• Avoid food products that contain trance-fatty acids. • Choose foods high in soluble fibers.• Regular consume of food products that contain add

plant sterols. • Regular consume of foods that contain soy protein to

replace those that contain animal fat.• To reduce blood pressure, choose a diet that is high in

fruits and vegetables, low-fat milk products, nuts, and whole grain, limit sodium.

• Fish can be consumed regularly.• CHO (50-55% of total calories) With emphasis on fiber • Exercising regularly.

Prevention

Hypertension is high blood pressureHypertension is high blood pressure

Both Atherosclerosis and Hypertension are Both Atherosclerosis and Hypertension are life- threatening combination. The high the life- threatening combination. The high the blood pressure the greater the riskblood pressure the greater the risk

Hypertension

• What is Blood Pressure?What is Blood Pressure?– Pressure created by the heart as it pumps blood Pressure created by the heart as it pumps blood

through the arteries and the circulatory systemthrough the arteries and the circulatory system

• What do Blood Pressure Numbers Mean?What do Blood Pressure Numbers Mean?– Top number (Systolic)= Pressure while heart is beatingTop number (Systolic)= Pressure while heart is beating– Bottom number (Diastolic)= Pressure while heart is Bottom number (Diastolic)= Pressure while heart is

resting between beatsresting between beats

Hypertension

HypertensionHypertension

HypertensionHypertension

Blood pressureBlood pressureSystolicSystolicDiastoliDiastolicc

NormalNormal<<120120<<8080

PrehypertensnPrehypertensn120-139120-13980-8980-89

HypertensionHypertension140140≤≤9090≤≤

• How can I tell if I have High Blood How can I tell if I have High Blood Pressure?Pressure?– Usually NO SYMPTOMS!Usually NO SYMPTOMS!– ““The Silent Killer”The Silent Killer”– May have: May have:

• HeadacheHeadache• Blurry visionBlurry vision• Chest PainChest Pain• Frequent urination at nightFrequent urination at night

Hypertension

• How does High Blood Pressure develop?How does High Blood Pressure develop?– Certain nerve impulses cause arteries to become larger Certain nerve impulses cause arteries to become larger

(dilate) or smaller (contract)(dilate) or smaller (contract)

– If vessels wide open If vessels wide open blood flows easilyblood flows easily

– If vessel narrows pressure inside increases If vessel narrows pressure inside increases causing hypertensioncausing hypertension

Hypertension

Figure 15-7: Measurement of arterial blood pressure

Blood Pressure (BP): Measurements

• What Causes High Blood Pressure?What Causes High Blood Pressure?– Cause unknown in 90 to 95% of cases = Primary Cause unknown in 90 to 95% of cases = Primary

HypertensionHypertension– Secondary Hypertension = 5 to 10%Secondary Hypertension = 5 to 10%

Hypertension Causes

• What Causes High Blood Pressure?What Causes High Blood Pressure?• Increased salt intakeIncreased salt intake• High blood lipids.High blood lipids.• DMDM• GenderGender• AgeAge• HeredityHeredity• Race.Race.• Obesity.Obesity.• Alcohol.Alcohol.• Stress.Stress.• Lack of exercise.Lack of exercise.• SmokingSmoking

Causes Hypertension

CausesCauses HypertensionHypertension

• Women and High Blood PressureWomen and High Blood Pressure– Birth Control PillBirth Control Pill– PregnancyPregnancy– OverweightOverweight– After MenopauseAfter Menopause

Hypertension

• What does High Blood Pressure do What does High Blood Pressure do to my Body?to my Body?– StrokeStroke– heart failureheart failure– Kidney failureKidney failure– Heart attackHeart attack– Heart rhythm problemsHeart rhythm problems

Hypertension

• Reduce total fat intake to <30% of total calories, Reduce total fat intake to <30% of total calories, saturated fats intake to less than 10% of total saturated fats intake to less than 10% of total calories, & cholesterol intake <200 mg per day.calories, & cholesterol intake <200 mg per day.

• Increase intake of complex carbohydrates.Increase intake of complex carbohydrates.• Maintain protein intake at moderate levels.Maintain protein intake at moderate levels.• Balance food intake and physical activity to maintain Balance food intake and physical activity to maintain

appropriate body weight..appropriate body weight..• Limit total daily intake of sodium to <2 g.Limit total daily intake of sodium to <2 g.• The DASH Eating PlanThe DASH Eating Plan

– Eat a variety of fruits and vegetables daily fat Eat a variety of fruits and vegetables daily fat sodium and potassium, magnesium, and sodium and potassium, magnesium, and calcium calcium

• Avoid taking dietary supplements in excess.Avoid taking dietary supplements in excess.

Diet & Health Recommendations

• Weight ControlWeight Control– Aim for a healthy weightAim for a healthy weight

• Physical ActivityPhysical Activity– Increase physical activityIncrease physical activity

• AlcoholAlcohol– Do not drink alcoholDo not drink alcohol

• Sodium/Salt Intake Sodium/Salt Intake (1 tsp salt = 2 g sodium)(1 tsp salt = 2 g sodium)– Choose and prepare foods with less salt Choose and prepare foods with less salt

• The DASH Eating PlanThe DASH Eating Plan– Eat a variety of fruits and vegetables daily fat sodiumEat a variety of fruits and vegetables daily fat sodium

• Stop smokingStop smoking• Manage your stressManage your stress• Drug TherapyDrug Therapy

Reduce Hypertension Risk