Diabetes Mellitus NS335 Unit 4 Melinda Boyd, MPH, MHR, RD

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Diabetes –Quick Facts  Diabetes is a disease in which the body does not produce or properly use insulin  There are 23.6 million children and adults in the United States, or 7.8% of the population, who have diabetes. While an estimated 17.9 million have been diagnosed with diabetes, unfortunately, 5.7 million people (or nearly one quarter) are unaware that they have the disease. 

What is Diabetes?  Body is not producing or has lost sensitivity to insulin.  Insulin is a hormone that is needed to convert sugar, starches and other food into energy.  Insulin is produced in the body by the pancreas.

Types of Diabetes  Type I: Results from the body's failure to produce insulin, the hormone that "unlocks" the cells of the body, allowing glucose to enter and fuel them. It is estimated that 5-10% of Americans who are diagnosed with diabetes have type 1 diabetes.  Type: 2 Results from insulin resistance (a condition in which the body fails to properly use insulin), combined with relative insulin deficiency. Most Americans who are diagnosed with diabetes have type 2 diabetes

More Types of Diabetes  Gestational Diabetes:  Immediately after pregnancy, 5% to 10% of women with gestational diabetes are found to have diabetes, usually, type 2.  Pre-diabetes:  Pre-diabetes is a condition that occurs when a person's blood glucose levels are higher than normal but not high enough for a diagnosis of type 2 diabetes. There are 57 million Americans who have pre-diabetes, in addition to the 23.6 million with diabetes.

Diabetes- The Diagnosis  With the FPG test, a fasting blood glucose level between 100 and 125 mg/dl signals pre-diabetes.  A person with a fasting blood glucose level of 126 mg/dl or higher has diabetes.

Diagnosis contd.  In order to be diagnosed with diabetes:  Person must have symptoms of diabetes +  Causal plasma glucose >200  Fasting blood glucose of >126 mg/dl  2-hour plasma glucose >200 mg/dl on oral glucose test

Symptoms of Diabetes  Diabetes often goes undiagnosed because many of its symptoms seem so harmless. Recent studies indicate that the early detection of diabetes symptoms and treatment can decrease the chance of developing the complications of diabetes.  Some diabetes symptoms include: Frequent urination (polyuria) Excessive thirst (polydipsia) Extreme hunger (polyphagia) Unusual weight loss Increased fatigue Irritability Blurry vision 

What’s the Risk?  A family history of diabetes.  Age over 45.  Race or ethnic background.  Metabolic syndrome  Being overweight.  Hypertension.  Abnormal cholesterol levels.  History of gestational diabetes  History of polycystic ovary disease (PCOS)  Habitually inactive  History of vascular disease (such as stroke)

Treatments for Diabetes  DIET  Insulin / Insulin Pumps  Oral Medications  Alternative Therapies  Islet Cell Transplant  Pancreas Transplant

Quick Review-Anatomy of the Pancreas  A gland that lies behind the stomach  Clusters of cells inside the pancreas known as the islets of Langerhans produces three hormones.  The islets contain 3 types of cells:  Alpha, beta, and delta.  Alpha cells produce glucagon.

Pancreas contd.  Beta cells- produce insulin  Delta cells- produce somatostatin  These cells have special sensors that monitor levels of blood sugar and stimulate the release of the correct hormone.

Insulin and the other hormones  Glucagon - Hormone that increases the amount of glucose in the blood when it is needed.  Somatostatin - Hormone that can suppress both glucagon and insulin when needed.  Insulin- Hormone that lowers blood glucose.

How Does Insulin Work?  A person normally secretes insulin in response to an elevated blood sugar level.  It does this by accelerating blood sugars movement out of the blood and into the cells.  Cells will not allow blood sugar in without insulin. - this can cause a problem.

Why isn’t the body making insulin?  In people with Type I, the immune system has made a big mistake!  It attacks the beta cells and destroys them!  In people with Type II, the pancreas is still making insulin, just not enough to keep up, or their bodies have become insulin resistant!

I’ve got Diabetes, now what?  After diagnosis, there is a great need for education.  A diabetic diet is no different from anyone else’s but they must keep track of what they eat.  A food diary is a great start!  Serving sizes must be emphasized.

Type I  Usually diagnosed in children and young adults.  Must take daily insulin shots to stay alive.  Type I accounts for 5-10% of the population with diabetes.

Treatment Goals for Type I  Match insulin to food intake.  Type I’s are encouraged to be precise and regular from day to day with food intake, insulin regimen, and activity.

Exercise and Type I’s  Increases flexibility, muscular strength, and well being.  Must monitor insulin and food intake to match exercise regimen.  Increases insulin effectiveness and sensitivity in the body.

Type II  The most common form of the disease.  Approximately 50% of men and 70% of women are obese at the time of diagnosis.  Nearing epidemic proportions, due to increase # of older Americans, greater occurrence of obesity and sedentary lifestyles.

Treatment Goals for Type II  Achieve normal or near-normal blood glucose levels.  Provide adequate calories for reasonable body weight.  Prevent, delay or treat nutrition related complications.  Improve health through optimal nutrition.

Exercise and Type II  Especially beneficial in type II diabetes.  Promotes weight loss  Increases insulin sensitivity.  Must also be aware of medication and intake to prevent hypoglycemia.

Gestational Diabetes  Pregnant women have a higher insulin level.  If woman has hyperglycemia, her blood glucose crosses the placenta but her insulin does not.  This can cause a high birth weight for baby.

Diet as a Treatment (MNT)  Diet plays a major role.  Carbohydrates are the component of food that causes an increase in blood sugar.  Diabetics are encouraged to keep track of the amount of CHO they eat.  There needs to be a balance between the diet and the carbs consumed, along with the activity level and medications used (if any.

Methods of Carbohydrate Control There are many new methods of controlling diabetes, these are still the two most common.  Exchange Lists  Carbohydrate counting- Very basic, allows a little more freedom and variety.

Dietary Guidelines  Eat a diet low in saturated and total fat.  Eat a diet moderate in sodium and sugar.  Eat 5 or more fruits and vegetables a day.  Choose a diet rich in whole grains.  Moderate use of alcohol

Dietary Guidelines  Eat at the same time everyday, at least within 1 hour of regular time.  Eat about the same amount of carbohydrate with each meal.

Blood Glucose Monitoring  All diabetics must keep track of blood glucose levels.  This is the only way to know if the treatment is effective.  Gives the diabetic a good indication of what affects their blood sugar level.  Must check at least 2 times a day and four times a day for at least 3 days a week.

Hemoglobin A1c  A good indicator of blood glucose control.  Gives a % that indicates control over the preceding 2-3 months.  Performed 2 times a year.  A hemoglobin of 6% indicates good control and level >8% indicates action is needed.

Other Treatments- Pharmacology  Type I and sometimes Type II patients need to be treated with insulin.  There are more than 20 types of medications.  They differ in how they are made, how they work in the body and their cost.

Oral Medications Used to treat Type II diabetics. There are four basic types:  Sulfonylurea-stimulates the body to make more insulin.  Metformin-lowers blood sugar by helping the insulin work better  Thiazolidinediones- increases muscle sensitivity to insulin.  Alpha-glucosidase inhibitors- slow the process of carbohydrate digestion.

Treatment Goals  The main goal is to normalize blood sugar. Realistic goals for diabetics are mg/dl before meals, <180 mg/dl after and a glycosolated hemoglobin within 1% of normal.  Need good blood glucose control to avoid complications.

Diabetes Complications Diabetes complications are the seventh leading cause of death. They include:  Blindness- caused by diabetic retinopathy.  Kidney Disease- diabetic nephropathy  Heart Disease and Stroke  Nerve disease and amputations  Impotence

How to Avoid Complications  Control weight  Eat a healthy well-balanced diet.  Get regular exercise  Have regular checkups  Check feet everyday for cuts and blisters  Do not smoke!

How to Avoid Complications  Keep blood sugars normal  Avoid the 2 common diabetic problems, hypoglycemia and hyperglycemia

Hypoglycemia  Hypoglycemia- low blood sugar  Happens to everyone with diabetes  Symptoms include shakiness, dizziness, sweating, hunger, headache, pale skin, sudden moodiness, clumsy or jerky movements, difficulty paying attention, and tingling sensations around mouth.

Hypoglycemia How to treat Hypoglycemia:  Quickest way to raise blood glucose is with some form of sugar.  3 glucose tablets, 1/2 cup of fruit juice, 5-6 pieces of candy.  Wait minutes and test blood sugar again. If still low retreat.  Once WNL want to continue with regularly scheduled meals and snacks.

Hypoglycemia  If hypoglycemia goes untreated, patient could get worse and pass out!  Stress the importance of a night time snack in older patients.

Hyperglycemia Ketoacidosis: Develops when the body does not have enough insulin. The body can’t 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.

Hyperglycemia Symptoms that may result in ketoacidosis occur when:  Too little insulin has been ejected, or insulin is not effective.  Consumed more food and/or exercised less than expected.  High blood sugar, high levels of sugar in the urine, frequent urination, and increased thirst

How to treat Hyperglycemia  Usually can lower it by exercising, or injecting more insulin, be careful of the somogyi effect. The somogyi effect is the condition of hypoglycemia resulting from the treatment of hyperglycemia.

Conclusion Diabetes is a very complicated disease. For more information: