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Nutrition and Diabetes Mellitus


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Type I Diabetes
Insulin Deficiency
Autoimmune disease
Type II Diabetes
Insulin Resitence
80-90% are Obese
Diagnosing Diabetes
Fasting Glucose >126mg/dl
2hr Post meal glucose >200mg/dl
Random Glucose >200mg/dl
Symptoms of Diabetes
Unexplained weight loss
Goals of Diabetes Therapy 5
Optimal BG
Optimal blood lipid levels
BP control
Healthy Body Weight
Prevent Acute Complications
Diabetic Nutritional Breakdown
No Different from the general public.
HTN- Lower Na and EtOH; Increase weight loss, fruits and vegs, excercise, LF dairy.

Elevated TG: Increase % kcal from fat; decrease % from CHO
Dietary CHO in DM
60-70% of energy from CHO and MUFA.
50% CHO alone
High Fiber meals rather than highly processed starchy foods
10-17% Energy from sugar.
Macronutrient intake in DM
Supplements 2
Folate during pregnancy
Calcium in adults to Reduce osteoporosis
Chromium not recommended
Carb Counting in DM
Patient is given daily allowance of carbs broken into snacks and meals
Patient is encouraged to make healthy food choices (whole grain bread, etc)
Advanced Carb Counting in DM
Patients determine the specific dose of insulin needed to cover the amount of carbs consumed
Insulin Therapy
Necessary for people who cannot produce there enough insulin to meet their metabolic needs
Ideal treatment is one that mimics insulin secretion as closely as possible
Two Approaches to insulin therapy
Conventional "fixed" insulin Approach
Intensive "flexible" insulin therapy
Conventional Insulin Therapy
A combination of rapid and intermediate acting insuloin twice daily
Set dose; set time
Conventional Insulin Therapy
Diet Importance
Consistent daily carbohydrate intake is important.
Can change regimen is hyper/hypo glycemic during different times of the day
Conventional Insulin Therapy
High Risk Behavoir
Skipping Meals
Altering CHO intake at meals
Sleeping late
Vigorous excercise
Skipping a dose
Intensive Insulin Therapy
Basal insulin levels maintained while pre-mealtime insulin levels can be adjusted based on meal.
Multiple Injections and frequent BG monitoring
Less Hyperglycemia present
Intensive Insulin Therapy
Potential Problems
- Most common problem in insulin therapy
- 15g of carbs will releive in 10-20 minutes
Weight Gain
Total Daily insulin dose
0.6U per KG of BW
Intensive Insulin Therapy
Breakdown Rapid V.s Long Acting
1/2-2/3 Long Acting

1/2-1/3 Rapid Acting

0.6U per kg

0.2U LA x kg before brkfst; 0.1U x kg at bedtime

1U rapid acting for every 10-15 carbs consumed
Conventional Insulin Therapy
Breakdown of Dose
0.6U per kg per BW

2/3 Daily dose at Breakfast
- 1:2 bolus/basal ratio

1/3 Daily dose at dinner
- 1:1 bolus/basal ratio
Type II DM
Glycemic Progression 4steps
Diet and Lyestyle changes
- Excercise
- Modest Weight loss (5-10%)
Oral anti-diabetics
Eventually lose their ability to secrete enough insulin
Execercise in DM 3
Enhances insulin sensitivity post exercise
- Lowers insulin needs
- Improves Glycemic control in type II
Decrease CV risk factors
- Blood Lipids
Improves weight maintenance
Metabolic Syndrome
A group of disorders that substantially increase the risk of developing CVD
Charecteristics of Metabolic Syndrome
Abdominal obesity
Insulin resistence
High blood pressure
Abnormal blood pressure
Metabolic Syndrome
Treatment Recomendations
Weight Management
Reduce intake of sugars
Intake of whole grains
Reduce Na
Treatment Recommendations
Physical Exercise
Drug Therapy

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