Post on 07-Jan-2016
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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