1. Jennifer Wagner Cayemberg, MS, RD, LDN

2.  A disease in which the body does not produce or properly use insulin  25.8 million children and adults in the U.S., or 8.3% of the population, have diabetes.  Estimated 18.8 million diagnosed with diabetes, 7.0 million people are unaware that they have the disease. Centers for Disease Control and Prevention. National diabetes fact sheet: national estimates and general information on diabetes and prediabetes in the United States, 2011. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, 2011.

3. Number and Percentage of U.S. Population with Diagnosed Diabetes, 1958-2009 CDC’s Division of Diabetes Translation. National Diabetes Surveillance System available at http://www.cdc.gov/diabetes/statistics

4. Diabetes- What is it?  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.

5.  A gland that lies behind the stomach  Islets of Langerhans produces three hormones.  The islets contain 3 types of cells: ◦ Alpha, beta, and delta. ◦ Alpha cells produce glucagon. ◦ 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.

6.  Glucagon : Hormone that increases the amount of glucose in the blood when it is needed (opposite of insulin).  Somatostatin: Hormone that can suppress both glucagon and insulin when needed.  Insulin: Hormone that lowers blood glucose.

7. Insulin

8.  A person normally secretes insulin in response to an elevated blood sugar level.  It does this by accelerating blood sugar movement out of the blood and into the cells.  Cells will not allow blood sugar in without insulin… this can cause a problem.

9.  Type 1: immune system has made a big mistake! It attacks the beta cells and destroys them!  Type 2: pancreas is still making insulin, just not enough to keep up, or their bodies have become insulin resistant!

10.  Screening for all patients at age 45. If results are normal, repeat every 3 years.  Screening at a younger age if patient meets following: ◦ Obesity ◦ First degree relative with diabetes ◦ Belongs to high-risk ethnic group ◦ Was diagnosed with gestational diabetes or delivered a baby whose birth weight >9 lbs. ◦ Hypertension ◦ HDL level 250 ◦ Found to have impaired glucose tolerance or impaired fasting on a previous test.

11.  Usually diagnosed in children and young adults.  Must take daily insulin shots to stay alive.  Type 1 accounts for 5-10% of the population with diabetes.  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.

12.  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.  Results from insulin resistance (a condition in which the body fails to properly use insulin), combined with relative insulin deficiency.

13.  Reported rates of gestational diabetes range from 2% - 10%.  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 as baby is receiving glucose.  Women who have had gestational diabetes have a 35% - 60% chance of developing diabetes in the next 10–20 years. Centers for Disease Control and Prevention. National diabetes fact sheet: national estimates and general information on diabetes and prediabetes in the United States, 2011. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, 2011.

14.  Occurs when blood glucose levels are higher than normal, but not high enough for a diagnosis of Type 2.  In 2005–2008, based on fasting glucose or Hgb A1c levels, 35% of U.S. adults aged 20 years or older had prediabetes.  Increased risk of type 2 diabetes, heart disease, and stroke.  People with prediabetes who lose weight and increase their physical activity can prevent or delay type 2 diabetes and in some cases return their blood glucose levels to normal. Centers for Disease Control and Prevention. National diabetes fact sheet: national estimates and general information on diabetes and prediabetes in the United States, 2011. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, 2011.

15. Some diabetes symptoms include: Frequent urination: polyurea Excessive thirst : polydypsia Extreme hunger: polyphasia Unusual weight loss Increased fatigue Irritability Blurry vision

16.  Fasting blood glucose level between 100 - 125 mg/dl signals pre-diabetes.  A person with a fasting blood glucose level of 126 mg/dl or higher has diabetes.  In order to be diagnosed with diabetes person must have symptoms of diabetes + ◦ Nonfasting plasma glucose >200 ◦ Fasting blood glucose of >126 mg/dl ◦ 2-hour plasma glucose >200 mg/dl on oral glucose test

17.  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.

18.  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.

19.  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.

20.  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.

21.  Especially beneficial in type 2 diabetes.  Promotes weight loss  Increases insulin sensitivity.  Must also be aware of medication and intake to prevent hypoglycemia.

22.  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.

23. There are many new methods of controlling diabetes, these are still the two most common.  Exchange Lists  Carbohydrate counting: basic, allows a little more freedom and variety; eat at the same time everyday, at least within 1 hour of regular time. ◦ Eat about the same amount of carbohydrate with each meal and snack.

24.  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.

25.  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.

26.  DIET  Insulin / Insulin Pumps  Oral Medications  Alternative Therapies  Islet Cell Transplant  Pancreas Transplant

27.  Type 1 and sometimes Type 2 patients need to be treated with insulin.  There are more than 20 types.  They differ in how they are made, how they work in the body and their cost.

28. Used to treat Type 2 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.

29.  Main goal is to normalize blood sugar.  Realistic goals for diabetics are 70-140 mg/dl before meals, <180 mg/dl after and a glycosolated hemoglobin within 1% of normal.  Need good blood glucose control to avoid complications.

30. Diabetes is the leading cause of kidney failure, nontraumatic lower limb amputations, and new cases of blindness among adults; 7 th leading cause of death in U.S. ◦ Blindness: caused by diabetic retinopathy. ◦ Kidney Disease: diabetic nephropathy ◦ Heart Disease and Stroke ◦ Nerve disease and amputations Centers for Disease Control and Prevention. National diabetes fact sheet: national estimates and general information on diabetes and prediabetes in the United States, 2011. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, 2011.

31.  Control weight  Eat a healthy well-balanced diet.  Get regular exercise  Have regular checkups  Check feet everyday for cuts and blisters  Do not smoke!  Keep blood sugar, BP, lipids normal  Avoid the 2 common diabetic problems: hypoglycemia and hyperglycemia

32.  Hypoglycemia: low blood sugar  Symptoms include shakiness, dizziness, sweating, hunger, headache, pale skin, sudden moodiness, clumsy or jerky movements, difficulty paying attention, and tingling sensations around mouth.

33.  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 15 minutes and test blood sugar again. If still low repeat.  If hypoglycemia goes untreated, patient could get worse and pass out!  Stress the importance of a night time snack in older patients.

34.  Ketoacidosis: Develops when the body does not have enough insulin. The body can’t break down sugar so it breaks down fat instead. Ketones build up in blood & urine. Body does not tolerate ketones in high levels (poisonous).  Acidosis can lead to fluid buildup in brain, heart attack, death of bowel tissue, kidney failure, severe illness or death.

35.  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

36.  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.

37.  Be aware of risk factors and symptoms of diabetes.  Prevention is key with changes in lifestyle. American Diabetes Association: www.diabetes.orgwww.diabetes.org CDC: http://www.cdc.gov/diabetes/http://www.cdc.gov/diabetes/