Diet and Diabetes
Created by:
Tricia Fleming, University of Kansas Dietetic Intern
Tammy Beason, MS, RD, Nutrition Education
Specialist, Family Nutrition Education Program
December 2001
Diabetes- What is it?
• Body is not producing or has lost
sensitivity to insulin.
• Insulin is a hormone that is needed to
convert sugar, starches and other food
into energy.
• Insulin is produced in the body by the
pancreas.
Types of Diabetes
There are several types of diabetes:
• Type I - body does not produce any
insulin.
• Type II- body is not making enough or is
losing sensitivity to insulin made.
Types of Diabetes
• Secondary - a consequence from
another disease. For example,
pancreatitis or cystic fibrosis.
• Gestational Diabetes- diabetes during
pregnancy.
• Impaired Glucose Tolerance- an
intermediate between normal and
diabetes.
Quick Review-Anatomy of the
Pancreas
• A gland that lies behind the stomach
• Clusters of cells inside the pancreas
known as the islets of Langerhans
produces three hormones.
• The islets contain 3 types of cells:
• Alpha, beta, and delta.
• Alpha cells produce glucagon.
Pancreas contd.
• Beta cells- produce insulin
• Delta cells- produce somatostatin
• These cells have special sensors that
monitor levels of blood sugar and
stimulate the release of the correct
hormone.
Insulin and the other
hormones
• Glucagon - Hormone that increases the
amount of glucose in the blood when it
is needed.
• Somatostatin - Hormone that can
suppress both glucagon and insulin
when needed.
• Insulin- Hormone that lowers blood
glucose.
How Does Insulin Work?
• A person normally secretes insulin in
response to an elevated blood sugar
level.
• It does this by accelerating blood
sugars movement out of the blood and
into the cells.
• Cells will not allow blood sugar in
without insulin. - this can cause a
problem.
Why isn’t the body making
insulin?
• In people with Type I, the immune
system has made a big mistake!
• It attacks the beta cells and destroys
them!
• In people with Type II, the pancreas is
still making insulin, just not enough to
keep up, or their bodies have become
insulin resistant!
Type I
• Usually diagnosed in children and
young adults.
• Must take daily insulin shots to stay
alive.
• Type I accounts for 5-10% of the
population with diabetes.
Type II
• The most common form of the disease.
• Approximately 50% of men and 70% of
women are obese at the time of
diagnosis.
• Nearing epidemic proportions, due to
increase # of older Americans, greater
occurrence of obesity and sedentary
lifestyles.
Gestational Diabetes
• Pregnant women have a higher insulin
level.
• If woman has hyperglycemia, her blood
glucose crosses the placenta but her
insulin does not.
• This can cause a high birth weight for
baby.
What are the Symptoms?
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Polyphasia- excessive eating
Polyurea- excessive urination
Polydypsia-excessive fluid intake
Blurred vision
Poor wound healing
Irritability
How are you diagnosed with
diabetes?
• In June 1997, the ADA redefined it’s
criteria for diagnosing diabetes.
• Normal fasting blood glucose is <110
mg/dl.
• Impaired fasting glucose is >110 and
<126 mg/dl.
• Provisional diagnosis for diabetes>126
mg/dl
Diagnosis contd.
• In order to be diagnosed with diabetes:
• Person must have symptoms of
diabetes +
• Causal plasma glucose >200
• Fasting blood glucose of >126 mg/dl
• 2-hour plasma glucose >200 mg/dl on
oral glucose test
Who’s at risk?
ADA now recommends that screening
for diabetes should be considered for all
patients at age 45. If the results are
normal it should be repeated every 3
years.
Screening should be considered at a
younger age if patient meets following
risk factors:
Who’s at risk?
•
•
•
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Obesity
First degree relative with diabetes
Belongs to a high-risk ethnic group
Was diagnosed with gestational
diabetes or delivered a baby whose
birth weight >9 lbs.
• Hypertension
Who’s at risk?
• HDL level<35 or triglycerides >250
• Found to have impaired glucose
tolerance or impaired fasting on a
previous test.
I’ve got Diabetes, now what?
• After diagnosis, there is a great need
for education.
• A diabetic diet is no different from
anyone else’s but they must keep track
of what they eat.
• A food diary is a great start!
• Serving sizes must be emphasized.
Treatment Goals for Type I
• Match insulin to food intake.
• Type I’s are encouraged to be precise
and regular from day to day with food
intake, insulin regimen, and activity.
Exercise and Type I’s
• Increases flexibility, muscular strength ,
and well being.
• Must monitor insulin and food intake to
match exercise regimen.
• Increases insulin effectiveness and
sensitivity in the body.
Treatment Goals for Type II
• Achieve normal or near-normal blood
glucose levels.
• Provide adequate calories for
reasonable body weight.
• Prevent, delay or treat nutrition related
complications.
• Improve health through optimal
nutrition.
Exercise and Type II
•
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•
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Especially beneficial in type II diabetes.
Promotes weight loss
Increases insulin sensitivity.
Must also be aware of medication and
intake to prevent hypoglycemia.
Treatment of Diabetes
• Diet plays a major role.
• Carbohydrates are the component of
food that causes an increase in blood
sugar.
• Diabetics are encouraged to keep track
of the amount of CHO they eat.
Methods of Carbohydrate
Control
There are many new methods of
controlling diabetes, these are still the
two most common.
• Exchange Lists
• Carbohydrate counting- Very basic,
allows a little more freedom and variety.
Blood Glucose Monitoring
• All diabetics must keep track of blood
glucose levels.
• This is the only way to know if the treatment
is effective.
• Gives the diabetic a good indication of what
affects their blood sugar level.
• Must check at least 2 times a day and four
times a day for at least 3 days a week.
Hemoglobin A1c
• A good indicator of blood glucose
control.
• Gives a % that indicates control over
the preceding 2-3 months.
• Performed 2 times a year.
• A hemoglobin of 6% indicates good
control and level >8% indicates action
is needed.
Dietary Guidelines
• Eat a diet low in saturated and total fat.
• Eat a diet moderate in sodium and
sugar.
• Eat 5 or more fruits and vegetables a
day.
• Choose a diet rich in whole grains.
• Moderate use of alcohol
Dietary Guidelines
• Eat at the same time everyday , at least
within 1 hour of regular time.
• Eat about the same amount of
carbohydrate with each meal.
Other Treatments
• Type I and sometimes Type II patients
need to be treated with insulin.
• There are more than 20 types.
• They differ in how they are made, how
they work in the body and their cost.
Oral Medications
Used to treat Type II diabetics. There are
four basic types:
• Sulfonylurea-stimulates the body to
make more insulin.
• Metformin-lowers blood sugar by
helping the insulin work better
Oral medications
• Thiazolidinediones- increases muscle
sensitivity to insulin.
• Alpha-glucosidase inhibitors- slow the
process of carbohydrate digestion.
Treatment Goals
• The main goal is to normalize blood
sugar. Realistic goals for diabetics are
70-140 mg/dl before meals, <180 mg/dl
after and a glycosolated hemoglobin
within 1% of normal.
• Need good blood glucose control to
avoid complications.
Diabetes Complications
Diabetes complications are the seventh
leading cause of death. They include:
• Blindness- caused by diabetic
retinopathy.
• Kidney Disease- diabetic nephropathy
• Heart Disease and Stroke
Complications contd
• Nerve disease and amputations
• Impotence
How to Avoid Complications
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Control weight
Eat a healthy well-balanced diet.
Get regular exercise
Have regular checkups
Check feet everyday for cuts and
blisters
• Do not smoke!
How to Avoid Complications
• Keep blood sugars normal
• Avoid the 2 common diabetic problems,
hypoglycemia and hyperglycemia
Hypoglycemia
• Hypoglycemia- low blood sugar
• Happens to everyone with diabetes
• Symptoms include shakiness,
dizziness, sweating, hunger, headache,
pale skin, sudden moodiness, clumsy or
jerky movements, difficulty paying
attention, and tingling sensations
around mouth.
Hypoglycemia
How to treat Hypoglycemia:
• Quickest way to raise blood glucose is
with some form of sugar.
• 3 glucose tablets, 1/2 cup of fruit juice,
5-6 pieces of candy.
• Wait 15-20 minutes and test blood
sugar again. If still low retreat.
Hypoglycemia
• If hypoglycemia goes untreated, patient
could get worse and pass out!
• Stress the importance of a night time
snack in older patients.
Hyperglycemia
Ketoacidosis: Develops when the body
does not have enough insulin. The body
can’t break down sugar so it breaks
down fat instead. Ketones are what is
left from this process.The body does
not tolerate ketones and tries to pass
them out of the body.
Hyperglycemia
Symptoms that may result in ketoacidosis
occur when:
• Too little insulin has been ejected, or insulin
is not effective.
• Consumed more food and/or exercised less
than expected.
• High blood sugar, high levels of sugar in the
urine, frequent urination, and increased thirst
How to treat Hyperglycemia
• Usually can lower it by exercising, or
injecting more insulin, be careful of the
somogyi effect.
The somogyi effect is the condition of
hypoglycemia resulting from the
treatment of hyperglycemia.
Conclusion
Diabetes is a very complicated disease.
For more information: www.diabetes.org