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Diabetes Mellitus - Mgt

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.

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Diabetes Mellitus - Mgt

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  1. Diabetes Mellitus - Mgt • Calculate and define diets for diabetes mellitus. • Integrate physiological functions of organ systems and effects of disease on MNT.

  2. DCCT • 10 year study • 1,400 subjects • Decreased risk of complications by 70% if blood glucose as near normal as possible

  3. Management of DM • MNT • Medications • Exercise • SMBG and Pattern Management • Self-management education

  4. Goals of MNT • Near-normal blood glucose • Optimal blood lipid levels • Provide adequate kcal

  5. Goals of MNT • Prevent, delay, treat nutrition-related risk factors or complications • Improve or maintain overall health through optimal nutrition

  6. Role of CHO • CHO = CHO = CHO • Scientific evidence does not support the restriction of sucrose in an overall healthy diet

  7. Role of CHO • Sucrose and sucrose-containing foods can substitute for other CHO foods in the total meal plan

  8. Next 2 slides research by Bantle and Laine in Type 1 diabetes mellitus and varying % kcal from sucrose

  9. Mg% glu Sucrose & blood glucose values in Type 1 diabetes mellitus

  10. Mg% glu Sucrose & blood glucose values in Type 2 diabetes mellitus

  11. 15 g CHO • 2 small cookies • 1/2 donut • 1/2 cup ice cream • 1 tbsp syrup • 3 cups popcorn

  12. How much fat in each item on previous slide? • How may kcal?

  13. 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

  14. 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

  15. Will work with meal plan approaches in a case study format • Please read in ADA Clinical Manual & text

  16. Medications • Www.niddk.nih.gov/health/diabetes/pubs/med/index • Medicines for People with Diabetes

  17. Medication - Insulin • Handout of insulin types and oral hypoglycemic agents • Next slide lispro or Humalog

  18. Lispro - fastest acting human insulin

  19. 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

  20. Medication - Oral agents • Sulfonylureas • Biguanides • Thiazolidinedione • Meglitinides • Alhpa-glucosidase inhibitors

  21. Sulfonylureas • Stimulate pancreas to make insulin • Can result in hypoglycemia • Do not take with alcohol • Wt gain • Orinase, Tolinase • DiaBeta, Amaryl, Glucotrol

  22. Biguanides • Antihyperglycemic in effect • Not at risk for hypoglycemia • Enhances peripheral glucose uptake • Do not take with alcohol • Metallic taste • Glucophage

  23. Thiazolidinedione • Helps cells to take in more glucose • Monitor liver function • Gain wt • Risk of anemia & edema • Actos • Avandia

  24. Meglitinides • Repaglinide • Helps pancreas make more insulin right after meals • Can get hypoglycemia • Gain wt

  25. Alpha-glucosidase inhibitor • Gas, bloating, diarrhea if dose to high • Take with first bite or 30 min before meal • Glyset • Precose

  26. Exercise • Glucose will enter muscle cell without insulin • What might be potential problems?

  27. Exercise Guidelines • SMBG before and after ex. • Adjust food intake or insulin dose • 1 hr increased ex need additional 15 g cho

  28. Hypoglycemia hunger shakiness cold sweats palpitations Hypoglycemia headache confusion lack of coordination anger seizures, coma , death Acute Complications

  29. Acute Complications • Hypoglycemia • Why these symptoms? • What are the causes of hypoglycemia?

  30. Acute Complications • Hypoglycemia • treatment • 15 g CHO • SMBG • more 15 g CHO if not increasing

  31. Long Term Monitoring • Glycosylated hemoglobin • glucose attaches to hemoglobin non-enzymatically • normal 6%

  32. Long Term Monitoring • Glycosylated hemoglobin • Next slide the relation between average blood glucose & HbA1c

  33. HbA1c and average blood glucose

  34. Long Term Monitoring • Ketones in urine • important during illness • check if blood glucose consistently over 240 mg%

  35. Long Term Monitoring • Triglycerides • Blood cholesterol

  36. End lecture on management • Questions • Now to work on case studies and do the work

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