Sugar

Diabetes Mellitus

• 20.8 million children and adults in the United States, or 7% of the population, who have diabetes

• 6.2 million people (or nearly one-third) are unaware that they have the disease

Type I and II

• Type I = pancreas produces little to no insulin

• Type II = body cells become resistant to insulin

• (Gestational diabetes, Hypoglycemia)

Type I (insulin dependant)

• Historically in ages 8-19• Thought to be related to genetic

predisposition• Autommune response creates

antibodies that attack one own pancreas (insulin secreting cells)

• Viral?

Type II(non-insulin dependant)

• More prevalent than I• Genes and obesity are related• Previously related to age …. in the last 15 years, childhood type

II increased by 33%

Obesity = One in four (in 2004)

CDC trend is on the rise (1 in 3)?

BMI (www.diabetes.org)

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Warning: off track!off tra

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Autoregulation

• cycle

High [Glucose and Insulin]

Damage

Some cells “down regulate”Others get deluged with insulin and are stimulated all the timeInsulin allows magnesium in and sodium outInsulin regulates GH, Prog and testosterone

Microvascular damage

• Small blood vessels – retina, kidney, heart, brain

• Small nerve endings – fingers, toes, genitals, pericardium

• White blood cells – poor chemotaxis and phagocytosis

“End Organ Damage”

• Heart attack…..• Stroke……• Blindness…..• Dialysis…• Infertility…..• Amputation…• Infection….

Diabetes costs in 2002

• Total (direct and indirect): $132 billion

• Direct medical costs: $92 billion• Indirect costs: $40 billion

(disability, work loss, premature mortality)

Death rates:

• Heart disease and stroke account for about 65% of deaths in people with diabetes

• Adults with diabetes have heart disease death rates about 2 to 4 times higher

• risk of death from stroke is 2.8 times higher among people with diabetes

Symptoms:

• Fatigue• Excessive thirst• Excessive hunger• Increased weight• Depression• Increase blood pressure• Poor brain function/depression

Testing - screening

• Blood glucose levels –fasting and OGTT

• Hemoglobin A1C• Insulin level• C-peptide

Pre-diabetes

• fpg ogtt

The ADA diet

• Insurance companies cover dietary evaluation if DM• Nutritionist/naturopath• Low glycemic index foods• 1800-2000 calorie ADA

Glycemic index

• A ranking of carbohydrates based on their effect on blood glucose levels within 2 to 3 hours after a meal

All-Bran Low 42

Porridge, non instant

Low 49

Oat bran Medium 55

Muesli Medium 56

Mini Wheats (wholemeal)

Medium 57

Shredded  Wheat

Medium 69

Golden Grahams

High 71

Puffed wheat

High 74

Weetabix High 77

Rice Krispies

High 82

Exercise Rx

• As a precaution for “fight or flight” encounters, skeletal muscle has a “back door” for glucose transport so exercise can be used as a tool to regulate plasma glucose levels

Medicines

• Insulin injection (inhalation) for type I or advanced type II• Oral meds for type II

• Sulfonylureas – stimulate pancreas to make more insulin (glucotrol, glynase)

• Biguanides – improve insulins ability to move glu into cells and halts liver release (glucophage)

• Thiaxolidinedions – improve insulins effectiveness in muscle/fat and halt liver release (avandia actos)

• Alpha-glucosidase inhibitors – block starch absorption (precose)

• Meglitinides – glucose dependant pancreas stimulation (prandin)

• Dipeptidyl peptidase 4 – (januvia)

Chromium Picolinate

• Human Nutrition Research Center of the United States Department of Agriculture conducted in 1996.

• Insulin effectiveness is improved• Triglycerides decrease

Vitamins …

• Magnesium• Fish oil• Antioxidants vit E, C, B

•www.diabetes.org

•www.americanheart.org