Nutrition and Diabetes Mellitus
Terms
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- Type I Diabetes
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Insulin Deficiency
Autoimmune disease - Type II Diabetes
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Insulin Resitence
80-90% are Obese - Diagnosing Diabetes
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Fasting Glucose >126mg/dl
2hr Post meal glucose >200mg/dl
Random Glucose >200mg/dl - Symptoms of Diabetes
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Polyuria
Polydipsia
Unexplained weight loss - Goals of Diabetes Therapy 5
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Optimal BG
Optimal blood lipid levels
BP control
Healthy Body Weight
Prevent Acute Complications - Diabetic Nutritional Breakdown
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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
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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
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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
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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
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Conventional "fixed" insulin Approach
Intensive "flexible" insulin therapy -
Conventional Insulin Therapy
Dosage -
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
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Basal insulin levels maintained while pre-mealtime insulin levels can be adjusted based on meal.
Multiple Injections and frequent BG monitoring
Flexibility
Less Hyperglycemia present -
Intensive Insulin Therapy
Potential Problems -
Hypoglycemia
- 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
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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
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Enhances insulin sensitivity post exercise
- Lowers insulin needs
- Improves Glycemic control in type II
Decrease CV risk factors
- Blood Lipids
- HTN
Improves weight maintenance - Metabolic Syndrome
- A group of disorders that substantially increase the risk of developing CVD
- Charecteristics of Metabolic Syndrome
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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
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Physical Exercise
Drug Therapy