Diabetes Mellitus - Mgt

• Calculate and define diets for diabetes mellitus.

• Integrate physiological functions of organ systems and effects of disease on MNT.

DCCT

• 10 year study

• 1,400 subjects

• Decreased risk of complications by 70% if blood glucose as near normal as possible

Management of DM

• MNT

• Medications

• Exercise

• SMBG and Pattern Management

• Self-management education

Goals of MNT

• Near-normal blood glucose

• Optimal blood lipid levels

• Provide adequate kcal

Goals of MNT

• Prevent, delay, treat nutrition-related risk factors or complications

• Improve or maintain overall health through optimal nutrition

Role of CHO

• CHO = CHO = CHO

• Scientific evidence does not support the restriction of sucrose in an overall healthy diet

Role of CHO

• Sucrose and sucrose-containing foods can substitute for other CHO foods in the total meal plan

• Next 2 slides research by Bantle and Laine in Type 1 diabetes mellitus and varying % kcal from sucrose

Mg%glu

Sucrose & blood glucose values in Type 1 diabetes mellitus

Mg%glu

Sucrose & blood glucose values in Type 2 diabetes mellitus

15 g CHO

• 2 small cookies

• 1/2 donut

• 1/2 cup ice cream

• 1 tbsp syrup

• 3 cups popcorn

• How much fat in each item on previous slide?

• How may kcal?

Food Myths

• 50 – 60% of protein becomes glucose

• Eating a protein with a cho snack slows absorption of cho

• Bedtime snack needs protein

• Eating too much protein can damage kidneys

Food Myths

• Protein foods are like meat, cheese, and peanut butter.

• Look up kcal from pro, fat & cho of shrimp, extra-lean ground beef, Am cheese, bologna, 2% milk, % lentils

• Look up kcal from pro & fat of sirloin, mozerella cheese, almonds, p butter, hot dog

• Will work with meal plan approaches in a case study format

• Please read in ADA Clinical Manual & text

Medications

• Www.niddk.nih.gov/health/diabetes/pubs/med/index

• Medicines for People with Diabetes

Medication - Insulin

• Handout of insulin types and oral hypoglycemic agents

• Next slide lispro or Humalog

Lispro - fastest acting human insulin

Peak Effect of Insulin

• At your tables draw what the blood glucose might be at the peak times of Humalog, Humulin N, Humulin U

• Blood glucose starts at 100mg%

• All taken at 8am

Medication - Oral agents

• Sulfonylureas

• Biguanides

• Thiazolidinedione

• Meglitinides

• Alhpa-glucosidase inhibitors

Sulfonylureas

• Stimulate pancreas to make insulin

• Can result in hypoglycemia

• Do not take with alcohol

• Wt gain

• Orinase, Tolinase

• DiaBeta, Amaryl, Glucotrol

Biguanides

• Antihyperglycemic in effect

• Not at risk for hypoglycemia

• Enhances peripheral glucose uptake

• Do not take with alcohol

• Metallic taste

• Glucophage

Thiazolidinedione

• Helps cells to take in more glucose

• Monitor liver function

• Gain wt

• Risk of anemia & edema

• Actos

• Avandia

Meglitinides

• Repaglinide

• Helps pancreas make more insulin right after meals

• Can get hypoglycemia

• Gain wt

Alpha-glucosidase inhibitor

• Gas, bloating, diarrhea if dose to high

• Take with first bite or 30 min before meal

• Glyset

• Precose

Exercise

• Glucose will enter muscle cell without insulin

• What might be potential problems?

Exercise Guidelines

• SMBG before and after ex.

• Adjust food intake or insulin dose

• 1 hr increased ex need additional 15 g cho

Acute Complications

• Hypoglycemia– hunger– shakiness– cold sweats– palpitations

• Hypoglycemia– headache– confusion– lack of

coordination– anger– seizures, coma ,

death

Acute Complications

• Hypoglycemia–Why these symptoms?–What are the causes of hypoglycemia?

Acute Complications

• Hypoglycemia– treatment– 15 g CHO– SMBG–more 15 g CHO if not increasing

Long Term Monitoring

• Glycosylated hemoglobin– glucose attaches to hemoglobin non-

enzymatically– normal 6%

Long Term Monitoring

• Glycosylated hemoglobin

• Next slide the relation between average blood glucose & HbA1c

HbA1c and average blood glucose

Long Term Monitoring

• Ketones in urine– important during illness– check if blood glucose consistently

over 240 mg%

Long Term Monitoring

• Triglycerides

• Blood cholesterol

• End lecture on management

• Questions

• Now to work on case studies and do the work