Lecture 10 - MNT for Diabetes Mellitus PDF

LECTURE 10- MNT FOR DIABETES MELLITUS Asst. Prof. Kristia Lei A. Reyes, RND, MSc ND 303 - Nutrition Therapy 1 DM  Definition of diabetes Characterized by hyperglycemia (high blood sugar) Defects in insulin production Autoimmune or other destruction of beta cells Insulin insensitivi...

LECTURE 10- MNT FOR DIABETES MELLITUS Asst. Prof. Kristia Lei A. Reyes, RND, MSc ND 303 - Nutrition Therapy 1 DM  Definition of diabetes Characterized by hyperglycemia (high blood sugar) Defects in insulin production Autoimmune or other destruction of beta cells Insulin insensitivity Impaired action of insulin on target tissues Slides current until 2008  Glucose ◻ essential nutrient that provides energy for proper functioning of the body cell. ◻ The major source of glucose is absorption of ingested food in the gastrointestinal tract to the blood and carried out to all the cells in the body. ◻ Glucose needs insulin to enter the cells.  Insulin Hormone produced by the pancreas (“lapay”) especially during meals. Controls the level of glucose in the blood by regulating the production and storage of glucose. Without insulin glucose can't enter the cells and remains on blood. PANCREAS ( “lapay” ) Types of Diabetes Type Deficient insulin production Requires daily insulin Unknown etiology, not preventable 1 Polyuria, polydipsia, hunger, weight loss, vision changes, fatigue Type Ineffective use of insulin Results of excess body weight and sedentary 2 lifestyle Types Hyperglycemia with onset or first recognition during pregnancy Diagnosed through prenatal screening GDM *Impaired glucose tolerance and Impaired fasting glycemia 🡪 causing large gestational-aged infants and HPN  CLASSIFICATION OF DIABETES MELLITUS 1. TYPE 1 DIABETES MELLITUS ß-cell dysfunction leading to absolute insulin deficiency 2. TYPE 2 DIABETES MELLITUS predominant insulin resistance with relative insulin deficiency or predominant secretory defect with insulin resistance 3. GESTATIONAL DIABETES MELLITUS 4. SECONDARY TYPES (Steroid-induced, stress-induced) Other specific types ◻ Genetic defects of beta-cell function ◻ Genetic defects in insulin action ◻ Disease of exocrine pancreas ◻ Endocrine gland disorders ◻ Drug of chemical-induced ◻ Infections ◻ Immune-mediated ◻ Genetic syndrome Features of Type 1 & Type 2 Type 1 Type 2 ◻ Viral infection, hereditary ◻ Obesity, hereditary, aging ◻ Insulin required ◻ Needed if extremely high ◻ Normal response to insulin ◻ Resistant to insulin ◻ Hyperglycemia with ◻ Hyperglycemia without ketoacidosis ketoacidosis ◻ Prevalence 5-10% ◻ Prevalence 90-95% ◻ IDDM, Juvenile, ◻ NIDDM, adult-onset, ketosis-prone, brittle ketosis-resistant, stable RISK FACTORS Hyperuricemia Microalbuminuria Dyslipidemia Previous IGT with oral glucose tolerance test 2-hour glucose value 140-199 mg/dl Previous gestational diabetes macrosomic or large gestational-age infant >3.7 kg birth weight; poor obstetric history Obesity; BMI > 23 kg/m2; waist-hip ratio >1; waist circumference >80 cm females, >90 cm males Family history of Type 2 diabetes Age Hypertension Coronary Heart disease Etiologic ◻ Type 1 - beta-cell destruction usually leading to absolute insulin deficiency - Autoimmune - Idiopathic - Etiologic ◻ Type 2 - Relative insulin deficiency - Secretory defect with or without insulin resistance Etiologic ◻ GDM - Pregnancy hormones (placental lactogen, cortisol, prolactin, progesterone) Characteristics ◻ Hyperglycemia ◻ Ketosis ◻ Polydipsia ◻ Glycosuria ◻ Polyuria ◻ Ketonuria ◻ Polyphagia ◻ Decreased capacity of ◻ Weakness/fatigues the tissues to heal ◻ Blurred vision ◻ Weight loss  CRITERIA FOR DIANOSIS OF DIABETES Fasting Plasma Post Prandial Glucose Plasma Glucose NORMAL < 100 MG/DL < 140 MG/DL IMPAIRED FASTING 100 - 125 MG/DL ------ GLUCOSE IMPAIRED GLUCOSE ------ 140 -199 MG/DL TOLERANCE DIABETES > 126 MG/DL > 200 MG/DL  CRITERIA FOR DIANOSIS OF DIABETES Fasting Plasma Post Prandial Glucose Plasma Glucose NORMAL < 100 MG/DL < 140 MG/DL IMPAIRED FASTING 100 - 125 MG/DL ------ GLUCOSE IMPAIRED GLUCOSE ------ 140 -199 MG/DL TOLERANCE DIABETES > 126 MG/DL > 200 MG/DL COMPLICATIONS Of Diabetes Mellitus 1. Macroangiopathies ◻ Damage to large blood vessels ◻ A. Diabetes increases risk of CHD by 300%. Atherosclerosis ◻ B. Foot ulceration 15%, recurrence 50% within 2 years, amputation 20% 2. Microangiopathies ◻ Damage to small blood vessels ◻ A. Retinopathy ◻ B. Neuropathy ◻ C. Nephropathy 3. DKA ◻ Uncontrolled production of ketones by the liver that leads to acidosis due to increased glucose production ◻ Characteristics: - hypoglycemia, metabolic acidosis, ketones in urine/blood - Often associated with Type 1 DM, may also occur in Type 2 if with an intercurrent illness 4. Nonketotic hyperosmolar coma ◻ Hyperglycemia and hyperosmolarity in the absence of ketosis ◻ Dehydration of brain cell because of osmotic pressure exerted by high glucose in blood that causes withdrawing out the water from the cell ◻ Insufficient/defective insulin Characteristics of Nonketotic Hyperosmolar coma: ◻ Elderly patients ◻ Associated with severe dehydration ◻ Polyuria, polydipsia ◻ Impaired renal function, preventing clearance of glucose in the liver ◻ No metabolic acidosis due to presence circulating insulin & lower levels of counterregulatory hormones 5. Gangrene ◻ Death of tissue due to loss of blood supply with or w/out bacterial infection 6. Insulin shock ◻ Overdose of insulin 7. Infection ◻ Depressed immune function  HYPERGLYCEMIA Define as elevated blood glucose level, caused by eating too much carbohydrates, not regularly taking medications, infection and stress. SIGNS and SYMPTOMS of HYPERGLYCEMIA Dry mouth Fatigue Excessive thirst Drowsiness Frequent urination (usually during the night) WHAT TO DO DURING HYPERGLYCEMIA? Check your sugar Drink lots of water Stick to your diet plan Consult your doctor if you need hospitalization  HYPOGLYCEMIA Defined as low blood glucose level (less than 50mg/dl or 2.7mmol/L), due to: - delayed or skipping of meals - eating too little food - too much exercise that has not been compensated with food - incorrect dosage of medications - drinking large amount of alcohol. SIGNS and SYMPTOMS OF HYPOGLYCEMIA Headache Seizure or coma Shakiness Weakness and fatigue Sweating Disorientation Numbness or tingling sensation of lips or finger WHAT TO DO DURING HYPOGLYCEMIA? Have a quick acting sugar (you need 15 grams of carbohydrate) 1/2 cup (4 oz) of any fruit juice 1/2 cup (4oz) regular soda 1 cup (8oz) milk glucose gel or tablet 1 or 2 teaspoon of sugar or honey 5-6 pieces of hard candy If found unconscious, bring to the nearest hospital for administration of Dextrose 50% via intravenous route. PREVENTION OF HYPOGLYCEMIA Take right dose of medications as prescribed all the time Keep a regular meal schedule Carry fast acting sugars all the time Avoid strenous activities after drug intake or insulin injection Carry any source of sugar during heavy exercise or activity Do not operate equipment or drive a car if you feel your sugar is low Carry an ID with your name and contact numbers in case of emergency. GUIDELINES TO FOLLOW DURING PERIODS OF ILLNESS (Sick Day Guide) ◻ Take insulin or oral anti diabetic agents as usual. ◻ If you have glucose meter, test sugar levels more frequent. Write down the results for future references. ◻ Report to your physician an elevated blood sugar levels (< 300mg/dl). ◻ Drink plenty of waters to avoid dehydration especially when you have vomiting or diarrhea. ◻ If you can't take the usual food, eat at least crackers or soup six to eight times per day. ◻ Consult your doctor if you have infection or your symptoms persist. Management of DM 1. Medical 2. Dietary 3. Behavior Modification 4. Pancreas transplant Medical Short-acting Intermediate Insulin Long-acting Sulphonylurea drugs (pancreas) Oral Biguanides (liver) hypoglycemic Metformin and Thioglitazones (fats, muscles) drugs Alpha glucosidase (gut) Dietary Management Fiber Low cholesterol Sodium controlled Type 1 & 2 20g CHO @ breakfast NSSS With snacks 30 kcal/kg GDM 35-45% CHO, 20-25% pro, 35-40% fats Behavior Modification ◻ Stress management ◻ Regular physical activity ◻ Avoid tobacco use ◻ Healthy, balanced diet ◻ Maintaining normal body weight Pancreas transplant ◻ Transplanted beta cell infused to the portal vein can attach to the blood vessels and function normally Monitoring and Control -Not only lowering blood glucose -But also other risk factors that damage blood vessels Monitoring and Control ◻ Moderate blood glucose control ◻ Blood pressure control ◻ Foot care ◻ Screening for retinopathy ◻ Blood lipid control ◻ Screening for early signs of diabetes-related kidney disease THANK YOU!