1. Judith E. Brown Prof. Albia Dugger Miami-Dade College www.cengage.com/nutrition/brown Diabetes Now Unit 13

2. The Diabetes Epidemic Diabetes Disease characterized by abnormal utilization of carbohydrates by the body and elevated blood glucose levels Diabetes epidemic 6% of adults worldwide 10% of US adults (up from <1% in 1960)

3. Three Types of Diabetes Three major forms of diabetes Type 1 diabetes Type 2 diabetes Gestational diabetes (diabetes during pregnancy) Diagnosed by fasting blood glucose of >126 mg/dl and higher

4. Key Terms Type 1 diabetes mellitus (formerly juvenile- onset or insulin-dependent diabetes) High blood glucose resulting from destruction of insulin-producing cells of the pancreas Type 2 diabetes mellitus (formerly adult- onset or non-insulin-dependent diabetes) High blood glucose due to the inability to use insulin normally, or to produce enough insulin

5. Diabetes Types 1 and 2

6. Effects of Insulin Insulin is a hormone produced by the pancreas that helps glucose enter cells If glucose can’t get into cells: Cells become starved for glucose Cell and tissue functions decline, resulting in elevated triglycerides and blood pressure, hardening of arteries, chronic inflammation

7. Key Terms Chronic inflammation Low-grade inflammation that lasts weeks to years Inflammation Immune system response to infection or irritation Triggers release of biologically-active substances that promote oxidation and other harmful reactions

8. Health Consequences of Diabetes Short-term Blurred vision, frequent urination, weight loss, infection, delayed wound healing, extreme hunger and thirst Long-term Heart disease, hypertension, nerve damage, blindness, kidney failure, stroke, amputation

9. Type 2 Diabetes Most likely to occur in overweight or obese, inactive people Usually develops in people over 40

10. Obesity and Type 2 Diabetes

11. Development of Diabetes Years before type 2 diabetes, individuals tend to develop insulin resistance Insulin resistance When cell membranes have reduced sensitivity to insulin, more insulin than normal is required to transport glucose into cells High levels of serum insulin, glucose and triglycerides, and increased blood pressure

12. Prediabetes Condition in which blood glucose levels are higher than normal but not high enough for diagnosis of diabetes Impaired glucose tolerance (fasting blood glucose levels 100-126 mg/dL) Risk factors include abdominal obesity, inactivity, and genetic predisposition

13. Insulin Resistance Insulin binds to receptors on cell membranes and allows glucose to pass into cells With insulin resistance, cell membranes “resist” the effects of insulin Pancreas overworks to makes more insulin Eventually insulin production slows, blood glucose rises

14. Insulin Resistance cont. Adverse health effects: Use of fat stores as the primary source of energy increases blood levels of free fatty acids and triglycerides Promotes development of fatty liver disease, chronic inflammation, hypertension, and plaque formation in arteries Results in many metabolic abnormalities (metabolic syndrome)

15. Key Terms Fatty liver disease Reversible condition characterized by fat infiltration of liver (10% or more by weight) Can produce liver damage and other disorders Associated with obesity, diabetes, and excess alcohol consumption

16. Key Terms Metabolic syndrome (Syndrome X) Group of metabolic abnormalities that increase the risk of heart disease and type 2 diabetes Characterized by insulin resistance, abdominal obesity, high blood pressure and triglyceride levels, low HDL cholesterol, impaired glucose tolerance

17. Metabolic Syndrome Symptoms related to metabolic syndrome Waist ≥ 40” in males, ≥ 35” in females Blood pressure ≥130/85 mmHg Triglycerides ≥150 mg/dL HDL < 40 mg/dL in males, < 50 mg/dL in women Fasting blood glucose ≥ 110 mg/dL Metabolic syndrome is diagnosed when 3 or more metabolic abnormalities are identified

18. Managing Metabolic Syndrome

19. Managing Type 2 Diabetes Weight loss (if overweight) 5-10% of body weight Regular physical activity 150 minutes or more per week Dietary management to reduce risk of heart disease and control blood glucose

20. Managing Type 2 Diabetes Diabetes 2 diet: Calorie reduction (if overweight) Complex carbohydrates, whole grains, high fiber, fruits and vegetables, low-fat milk and meats, and fish Unsaturated fats, especially monounsaturated Regular meals and snacks

21. Glycemic Index and Glycemic Load Carbohydrate-containing foods have a range of effects on blood glucose Glycemic index (GI) Measure of the extent to which blood glucose level is raised by a 50-gram portion of a carbohydrate-containing food compared to 50 grams of glucose or white bread

22. Glycemic Index of Foods

23. Glycemic Load Glycemic load is less confusing than glycemic index when determining what to eat Glycemic load (GL) A measure of the extent to which blood glucose level is raised by a given amount of a carbohydrate-containing food Calculated by multiplying a food’s GI by carbohydrate content

24. Sugar Intake and Diabetes Total carbohydrate intake and glycemic index, rather than sugars specifically, are strongly related to blood glucose levels High sugar intake contributes to diabetes by promoting weight gain, and may have other effects in people with metabolic syndrome

25. Preventing Type 2 Diabetes People with prediabetes reduced their risk of type 2 diabetes by: Weight loss (~7% of body weight) Exercise (150 minutes/week) Diet rich in whole-grains and fiber Coffee (1-4 cups/day) and moderate alcohol (1-2 drinks/day)

26. Type 1 Diabetes Type 1 diabetes is an autoimmune disease that causes insulin deficiency Develops when the immune system destroys insulin-producing beta cells in the pancreas Triggered by medications or viral infection in genetically susceptible people

27. Key Terms Autoimmune disease Disease initiated by destruction of body cells by components of the immune system that misidentify certain body cells as harmful Immune system Body tissues that provide protection against bacteria, viruses, foreign proteins, and other harmful substances

28. Managing Type 1 Diabetes Diets are designed to match insulin doses to keep blood glucose within normal ranges Carefully planned meals are consumed in specific amounts at specific times Physical activity improves blood glucose levels and insulin utilization

29. Insulin and New Technologies Type 1 diabetes requires insulin injections Amount and type depends on many factors Blood glucose levels are measured frequently to determine the appropriate amount of insulin injected

30. New Technology Insulin pumps with continuous glucose monitors give advance warning if a problem develops

31. Gestational Diabetes 5-6% of women develop gestational diabetes during pregnancy Risk depends on age, body weight, ethnicity Increases risk of high-birth-weight babies who have increased risk of diabetes later in life Often disappears after delivery Increased risk of type 2 diabetes later

32. Hypoglycemia Disorder resulting from abnormally low blood glucose levels Caused by excess insulin in blood Symptoms include irritability, nervousness, weakness, sweating, and hunger

33. Diabetes in the Future By 2030, cases of type 2 diabetes related to overweight and obesity are expected to more than double in some parts of the world Environmental and lifestyle changes could reduce the risk

34. Diabetes Projections: 2000 to 2030