Diet and Health Guidelines to Lower Risk of Diabetes

1. Diet and Health Guidelines to Lower Risk of Diabetes Presented by Janice Hermann, PhD, RD/LD OCES Adult and Older Adult Nutrition Specialist

2. Carbohydrates • Body breaks down carbohydrates (complex and simple) into monosaccharides • Maltose = glucose + glucose • Surcrose = glucose + fructose • Lactose = glucose + galactose • Fructose and galactoseconverted in the body to glucose • Glucose is form body uses for energy

3. Blood Glucose Regulation • Blood glucose level must be closely regulated • Hormones control blood glucose levels: • Insulin • Glucagon

4. Blood Glucose Regulation • When blood glucose levels are high • Pancreatic beta cells release insulin which helps glucose enter body cells so glucose can be: • Used for energy • Stored as glycogen in liver • Converted into triglycerides for storage When blood glucose levels low • Pancreatic alpha cells release glucagon: • Signals liver to release glucose from liver glycogen

5. Blood Glucose Regulation: Insulin Figure 4.8a

6. Blood Glucose Regulation: Glucagon Figure 4.8b

7. Blood Glucose Regulation

8. What Is Diabetes • Diabetes is a condition that results in high blood glucose levels • When someone has diabetes the body: • Makes little or no insulin, • Doesn’t use insulin properly, or • Both • As a result, body cells don’t get energy they need, and blood glucose levels stay high

9. Diabetes Symptoms • Symptoms are caused by high blood glucose, may include: • Frequent urination • Increased hunger • Increased thirst • Blurred vision • Feeling tired • Irritability

10. Types of Diabetes • Pre diabetes • Type 1 (5-10%) • Body doesn’t make insulin • Must take insulin • Develops rapidly • Type 2 (90-95%) • Body doesn’t make enough insulin, or the body doesn’t respond to insulin • Weight control may help • May still need medication • Develops slowly • Gestational

11. Types of Diabetes • Pre Diabetes • Overweight increases risk of developing type 2 diabetes by decreasing body's ability to use insulin • Insulin resistance • Body produces insulin; however, body cells resist action of insulin • Blood glucose levels begin to increase • Impaired glucose tolerance and/or impaired fasting glucose

12. Types of Diabetes • Pre Diabetes • At first, body responds to insulin resistance by having beta cells produce more insulin to keep blood glucose levels down • Can lead to high blood insulin levels • Body may be able to keep blood glucose levels down by producing extra insulin for several years • Eventually beta cells begin to wear out and produce less insulin, which can potentially lead to development of type 2 diabetes

13. Types of Diabetes • Pre Diabetes • Where extra weight is carried is a factor in insulin resistance • Upper body fat cells are more likely to be large insulin resistant fat cells • Lower body fat cells are more likely to be smaller and respond normally to insulin

14. Types of Diabetes • Type 1 (5-10%) • Autoimmune disorder: defect in which immune cells attack and destroy the insulin producing pancreatic beta cells • Symptoms • High blood glucose • Increased urination • Increased thirst • Weight loss • Dehydration • Feeling tired • Irritability

15. Types of Diabetes • Type 2 (90-95%) • Usually develops after 40 years of age as the pancreatic beta cells progressively lose function with age • Most people with type 2 diabetes are overweight • However, type 2 diabetes is also being seen in overweight children • Closely related to overweight and inactivity • Estimates are 30 to 50 percent of people with type 2 diabetes are undiagnosed

16. Types of Diabetes • Gestational Diabetes • Glucose intolerance that develops during pregnancy (usually 2-3 trimester) • 7% of all pregnancies • Insulin antagonist hormone levels increase and insulin resistance occurs • Blood glucose control usually returns to normal after delivery

17. Diabetic Complications • High blood glucose can damage: • Nerves, eyes, kidneys, heart, and blood vessels • This damage can lead to: • Blindness, high blood pressure, heart disease, kidney disease, and amputations • Keeping blood glucose in control can stop or prevent development of diabetic complications

18. Screening Recommended • People with impaired glucose tolerance and/or impaired fasting glucose • People over age 45 • People with a family history of diabetes • People who are overweight • People who do not exercise regularly • People with low HDL cholesterol or high triglycerides, high blood pressure • Certain racial/ethnic groups (Non-Hispanic Blacks, Hispanic/Latino Americans, Asian Americans, Pacific Islanders, and American Indians and Alaska Natives) • Women who had gestational diabetes, or who have had a baby weighing 9 pounds or more at birth

19. Screening Recommended • Children and Adolescents should be screen if overweight or at-risk-for-overweight and if have two of the following risk factors: • Family history of diabetes • Low HDL cholesterol or high triglycerides, high blood pressure • Certain racial and ethnic groups (e.g., Non-Hispanic Blacks, Hispanic/Latino Americans, Asian Americans and Pacific Islanders, and American Indians and Alaska Natives) • Signs of insulin resistance (acanthosisnigricans – gray/brown skin pigmentation)

20. Preventing Diabetes • Type 1 Diabetes • No nutritional recommendations can be made for prevention of type 1diabetes • Research is investigating if breast feeding over bottle feeding may be beneficial

21. Preventing Diabetes • Type 2 Diabetes • Weight management (diet and physical activity) • Diabetes Prevention Program (oral medication vslifestyle intervention) • 31% decrease in progression to diabetes in medication group • 58% decrease in progression to diabetes in lifestyle group • Modest weight loss (5-10%) • Modest physical activity (30 minutes daily)

22. Diabetes Treatment • Goals of diabetes treatment are to achieve: • Control blood glucose • Control blood lipids • Control blood pressure • Prevent or delay large and small blood vessel and nerve damage • Diabetes Control and Complications Trials have shown controlling blood glucose is effective in preventing or delaying diabetic complications

23. Diabetes Treatment • The goal of diabetes treatment is to keep blood glucose in control through: Diabetic Meal Physical Activity Plan Medication

24. Diabetes Health Care Team • People with diabetes should receive medical care from a physician-coordinated team. Such teams may include, but are not limited to: Physician Mental Health Professional Nurse Ophthalmologist/Optometrist Dietitian Podiatrist Pharmacist Dentist Diabetes Educator Dermatologist Exercise Physiologist

25. Diabetes Health Care Team • Most important person on a diabetes health care team is the person with diabetes • A lot of diabetes care is self-care. The person with diabetes is the one who knows: • How feels • If following meal plan • If physically active • If taking medication • If testing blood glucose and • If problems start to occur

26. Standards of Care • Taking care of diabetes will allow people with diabetes to enjoy life with few complications • The American Diabetes Association provides standards of care for people with diabetes • For detailed information on standards of diabetes care contact local American Diabetes Association at www.diabetes.org

27. Standards of Care • After being diagnosed with diabetes, people with diabetes should work with their physician and health-care team to make a diabetes care plan • A diabetes care plan needs to be individualized to fit the person’s lifestyle

28. Standards of Care • A diabetes care plan should be individualized and include information on: Visiting your doctor Eye care Management goals Foot care Medications Dental care Diabetic meal plan Other professionals Physical activity Sick day plan Glucose testing Stress management

29. Standards of Care • Visiting doctor • Every 3- 6 months • Review blood glucose records • A1c • Blood pressure • Weight • Foot check

30. Blood Glucose Goals Normal Goal* Fasting or before meals <100 mg/dl 70-130 mg/dl 2 Hr Post Meal <140 mg/dl <180 mg/dl HbA1c <6% <7% *varies

31. Standards of Care • Visiting doctor • Every year • Total cholesterol, LDL cholesterol, HDL cholesterol, triglycerides • Kidneys (urine analysis for protein in urine) • Dilated eye exam • Review meal plan • Flu shot • Update with diabetes educator

32. Blood Lipid and Blood Pressure Goals Lipids Cholesterol < 200 mg/dl LDL Cholesterol < 100 mg/dl HDL Cholesterol > 40 mg/dl (men) > 50 mg/dl (women) Triglycerides < 150 mg/dl Blood Pressure Systolic <130 mm Hg Diastolic < 80 mm Hg

33. Standards of Care • Diabetes management goals • Both short and long-term goals • Diabetes management goals are individualized depending on diabetes control and other health conditions

34. Standards of Care • If need medications, education needed to: • Learn how to use them • How they work with diet and physical activity • What to do if blood glucose goes too high or low

35. Medication • Insulin • Oral mediations • Taking medication does not replace healthful habits, still need to follow diabetic meal plan and participate in physical activity

36. Standards of Care • A diabetic meal plan individualized to fit person’s lifestyle, diabetes, and other health conditions - education is needed to: • Know how the diet works with medication and physical activity • How to follow the diabetic meal plan at home, at work, and when eating out • Know whether alcohol fits into the meal plan • What to eat when sick, on how being sick affects blood glucose

37. Diabetic Meal Plan • A diabetic meal plan focuses on providing a healthy diet that: • Controls blood glucose and • Prevents diabetic complications

38. Diabetic Meal Plan • There is no one specific diabetic meal plan, a diabetic meal plan is developed to meet your own special needs: • Individual food likes • Daily schedule • Medications used • Other health issues: • Glucose control • Weight • Blood lipids • Blood pressure

39. Diabetic Meal Plan • A healthy diet includes a variety of foods from all the food groups. In general, a diabetic meal plan is: • Low in fat • Moderate in protein • Highs in complex carbohydrates like beans, vegetables and grains (such as breads, cereals, noodles, and rice)

40. Consistency • A diabetic meal plan provides a consistent amount of carbohydrate from day to day, spaced evenly throughout the day to prevent wide changes in blood glucose • Some methods used to provide the consistency of a diabetic meal plan are: • Plate method • Diabetic pyramid • Diabetic exchange system • Carbohydrate counting

41. Consistency • Eating too much carbohydrate at one time can raise blood glucose too high. • Eating too little carbohydrate can lead to hypoglycemia, especially for people taking oral diabetic medication or insulin.

42. Consistency • To be consistent, it's best to: • Eat about the same number of calories each day • Eat meals and snacks about the same time each day • Spread meals and snacks throughout the day • Never skip meals • Watch portion sizes

43. Individual Considerations • Weight loss • Carbohydrate • Alcohol • Fat • Sodium • Protein

44. Weight Loss • For many people with type 2 diabetes losing weight is a big part of diabetes treatment • Losing weight can help body cells use insulin better • For people who are trying to lose weight their diabetic meal plan will be moderately lower in calories and fat to help with weight loss • Losing weight and lowering fat intake can also help lower blood cholesterol and blood pressure

45. Weight Loss • The best way to lose weight is to: • Follow a healthy eating plan, moderately lower in calories (about 500 calories less per day) and • Increase physical activity (60 minutes per day) • Healthy weight loss is slow • Maximum recommended weight loss is 1 to 2 pound per week • Many times, just a 10% weight loss can bring blood glucose into control for people with type 2 diabetes

46. Carbohydrate • Dietary carbohydrates include: • Simple Sugars • Complex Carbohydrates • Grains, Fruits, Milk and Vegetables • Fiber • During digestion all carbohydrates except fiber break down into simple sugars

47. Carbohydrate • In the past, people with diabetes were told to avoid sugar • Now known that complex carbohydrates and sugars have a similar effect on blood glucose levels • The total amount of carbohydrate is the issue, not just sugar • People with diabetes can have sugar, but the carbohydrate from foods containing sugar must be worked into the meal plan

48. Carbohydrates • There are some problems with foods high in sugar • Foods high in sugar often don't provide other important nutrients needed every day • Foods high in sugar are also often high in fat

49. Glycemic Index • Glycemic index is the blood glucose response to a food, this varies based on: • Amount of carbohydrate • Nature of the starch • Cooking and processing • Food form and particle size • Severity of glucose intolerance • Fasting and pre-meal glucose concentration

50. Glycemic Index • However, although different carbohydrates have different glycemic responses (glycemic index), there is limited long-term benefits of low glycemic index diets on blood glucose control (A1c). • Therefore there is insufficient evidence to recommend low glycemic index diets as a strategy in diabetes meal planning.