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Diabetes 2012

Diabetes 2012. Janie Berquist, RN, BSN, MPH, CDE Children’s Mercy Hospitals and Clinics Kansas City, MO. Everything You Want to Know (and More) About Diabetes. What is Diabetes? What are the Symptoms? What is the Treatment? Nutritional Guidelines for Diabetes

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Diabetes 2012

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  1. Diabetes 2012 Janie Berquist, RN, BSN, MPH, CDE Children’s Mercy Hospitals and Clinics Kansas City, MO

  2. Everything You Want to Know (and More) About Diabetes • What is Diabetes? • What are the Symptoms? • What is the Treatment? • Nutritional Guidelines for Diabetes • How Can I prevent Diabetes (in myself and other people)? • Is Research being done to stop Diabetes?

  3. What is DIABETES? Diabetes is a chronic disease that affects the way the body uses food for energy Insulin (hormone made in the pancreas) helps the body change food into energy

  4. Symptoms of Diabetes • Being very thirsty • Urinating a lot—often at night • Having blurry vision from time to time • Feeling very tired much of the time • Losing weight without trying • Having very dry skin • Having sores that are slow to heal

  5. Symptoms of High Blood Glucose

  6. How does my body use insulin? Insulin allows blood sugar (glucose) to move from the bloodstream into cells to be used as fuel INSULIN Glucose = CELLS

  7. Diabetes Blood sugar (glucose) cannot move into the cells without insulin. This creates a high blood sugar level. Glucose = Its getting crowded in here Cells

  8. Type 1 Diabetes Without insulin, glucose cannot move from the bloodstream into cells to be used as energy GLUCOSE IN BLOODSTREAM We’re hungry Glucose = CELLS

  9. What is happening in the body? The glucose in the blood goes up with Eating food containing CHO Stress Infection/Fever Medications When Glucose goes up, Pancreas produces insulin which is secreted into the blood stream and acts like a key to unlock the door of the cell to allow glucose to enter the cell. When glucose goes down or the muscle stores are low, theLiver converts fat to glucose when which results in glucose rising in the blood even when not eating.

  10. Dr. Banting and Dr. BestDiscovered Insulin - 1922

  11. Insulin Hexamer

  12. Insulin Role in Glucose Transport

  13. Types of Diabetes Type 1- “Juvenile Diabetes” • body does not make any insulin • Sudden onset • Autoimmune process • treatment includes: • healthy eating plan • activity plan • must take insulin shots

  14. Types of Diabetes Type 2 – Formerly “Adult” Diabetes • body does not make enough insulin to overcome insulin resistance • insulin not working well • Initial treatment includes (in children): • healthy eating plan • activity plan • Metformin (Glucophage)

  15. Type 2 diabetes In type 2 the body produces insulin, but not all of it goes to the proper sites to allow glucose into the cells INSULIN Glucose = CELLS

  16. Types of Diabetes • Gestational diabetes is diagnosed in some women during pregnancy. It is a temporary form of glucose intolerance. But women who develop gestational diabetes in pregnancy may develop type 2 diabetes later in life.

  17. Diagnosing Diabetes (Type 1 or Type 2-ADA) • Normal – Fasting Plasma Glucose < 100 • “Pre-diabetes” – 100-125 • Diabetes - 126 or over • After two hours (Oral Glucose Tolerance) • “Pre-diabetes” – 140-199 • Diabetes - >200

  18. A1C--your “average” blood sugar When your A1Cis:Youraverage blood sugar is: 4%---70 5%-----80 6%-------120 7%------150 8%------------180 9%--------------210 10%----------------250 11%-------------------280 12%----------------------310 13%-------------------------350

  19. Blood Sugar Meters

  20. For Patients Needing Insulin

  21. DIABETES IS NOT JUST ABOUT WHAT YOU EAT IT IMPACTS ALL THE MAJOR ORGANS OF THE BODY Macrovascular Microvascular • Brain • Cerebrovascular disease • Transient ischemic attack • Cerebrovascular accident • Cognitive impairment Eye Retinopathy Cataracts Glaucoma • Heart • Coronary artery disease • Coronary syndrome • Myocardial infarction • Congestive heart failure • Kidney • Nephropathy • Microalbuminuria • Gross albuminuria • Kidney failure • Extremities • Peripheral vascular disease • Ulceration • Gangrene • Amputation • Nerves • Neuropathy • Peripheral • Autonomic

  22. Long-term Complications Why do complications occur? • The tissues in the body are damaged because of long term exposure to high blood glucose and highly variable blood glucose. • How do I avoid complications? • Work to keep blood glucose in control over the long term and reduce widely fluctuating blood glucoses

  23. Prevention of Complications • Preventive care practices like foot exams, eye exams, dental exams, and flu and pneumonia shots. • Factors that can be controlled like weight, exercise, and foods eaten.  • Maintain blood glucose in desirable range – A1C <6.5%-7%

  24. What Can I Do to Help? • Healthy Eating • Activity • Medications, Glucose testing? – Remind • Watch for Complications – feet, etc. • Safety Issues – Low Vision, lack of Mobility

  25. Symptoms of hypoglycemia

  26. Treatment of hypoglycemia • Check blood glucose. Treat if <70 • Give 15 grams quick-acting carbohydrate, such as 4-8 oz. skim milk or 4 crackers • Recheck blood glucose in 15-30 minutes • Retreat with another 15 grams of carbohydrate if blood glucose is still low What should I choose?

  27. “Metabolic Syndrome” • Overweight, specifically waist circumference larger than hips • Hypertension (high blood pressure) • Hepatic steatosis (Excess fat in the liver) • Dyslipidemia (High Triglycerides and Low HDL cholesterol) • Polycystic ovarian syndrome (condition in which cysts on the ovaries produce male hormones)

  28. Types of Nutrients • Carbohydrate – 4 calories per gram • Protein – 4 calories per gram • Fats, Oils – about 9 calories per gram • Vitamins – 0 calories per gram • Minerals – 0 calories per gram

  29. Reading Food Labels Food labels contain the most accurate carbohydrate information • Check the Serving Size • Not the gram weight of the serving located by serving size • 253g is the weight of 1 cup of chili

  30. % Daily Value (RDA) • A percent listed on the food label for certain nutrients • It is based on a 2000 calorie daily diet for the amount of nutrients a person should get each day Labels require the following nutrient information *Vitamin A *Vitamin C *Calcium *Iron • 10-20% good source • >20% excellent source

  31. Carbohydrate- usually about 50-60%% of total calories • Carbohydrate has the greatest effect on blood glucose (BG) • 100% of carbohydrate turns to glucose after eating • It is the first source of energy and important in a healthy diet • Higher carbohydrate foods are not ‘bad’

  32. Carbohydrate • Usually 40-50% of food consumption • Main sources include: • Breads, Cereals, Grains, Starchy Veggies • Fruit and Juice • Milk and Yogurt • Sweets and Desserts

  33. Carbohydrates • Sweetened beverages, either natural or artificially, are not recommended due to rapid spikes in blood glucose • 100% fruit juice and fruit flavored drinks • Regular soda pop • Sport drinks • Kool Aid • Other sweetened beverages

  34. Fiber • Desirable fiber intake – soluble fiber • Adults: 25-35 grams per day • Best sources of Soluble Fiber: Fruits and vegetables, oat bran, barley, beans and peas, prunes. • These types of fiber can give a feeling of fullness and help lower cholesterol • Foods with Zero Fiber: • Dairy Products (Milk, Cheese,etc.) • Meats, poultry, fish, eggs • Fats/oils, sugar/syrups

  35. Protein – About 20% of calories • Does not affect blood glucose as much as carbohydrate • Excessive protein will not build bigger muscles • Meat, poultry, fish, and beans • Milk, yogurt, cheese and Eggs • Choose low-fat sources

  36. Fats/Oils – About 20-30%% of Calories • Remember – Fats have twice as many calories as carbohydrate and protein • Know your fats – • Saturated fats – Animal fats – whole milk, butter, fatty meats and sausages, processed foods. • Trans fats - They are found in commercial baked and fried foods, and come from hydrogenated vegetable oils

  37. Fats/Oils • Monounsaturated fats tend to lower LDL, but only if they replace saturated. Sources are canola and olive oils, peanuts. • Polyunsaturated fats – Omega -6 and Omega -3. A balance of both is most helpful. Omega-3’s can can help lower triglycerides, and are often taken as fish or flaxseed oils.

  38. Nutrition Tips • Avoid sugary drinks (juice, flavored milk, sweetened tea, Gatorade/PowerAde, Kool-aid, soda, etc.) • Eat 5 fruits/vegetables per day • Eat mostly whole grains • Have 3 servings of fat free/low fat dairy products daily • Measure foods for 1-2 weeks using measuring cups, spoons, and food scale • Read labels and count carbohydrate grams, “carb units” or calories at all meals and snacks

  39. Nutrient Dense Foods: • Do have substantial amounts of vitamins and minerals • Relatively few calories • Fruits, vegetables, low fat dairy, whole grains

  40. Foods to INCREASE • Fruits and Vegetables • Eat a RAINBOW of colors especially dark greens, red, orange veggies/fruits and legumes • Include at least 1 at every meal! • Whole Grains • Make at least ½ of your grains whole • Lowfat milk • 2-3 servings per day of reduced fat dairy products • More is not necessarily better • Variety of proteins • include more seafood – 6-8 ounces per week • Lean and less processed choices • Oils • Replace solid fats (animal fats) with more oils (plant and seafood fats) • Potassium, Fiber, Calcium and Vitamin D

  41. Nutrient Poor Foods: • Do not provide substantial amounts of vitamins and minerals • Often have a lot of calories • Chips, cookies, granola bars, crackers

  42. Foods to REDUCE • Sodium • 1500 mg – 2300 mg per day *that’s less than 1 teaspoon per day! • Saturated Fat • Aim for <10% of calories from these solid animal fats • Cholesterol • Aim for <300 mg per day • Trans Fat • Aim for 0.00000!!!!! of these man-made harmful fats • Added Sugars and Solid Fats • Contribute 35% of the calories per day for Americans • Should be closer to 5-15% • Do not contribute to overall health or provide nutrients • Refined Grains • Especially cookies, cakes, donuts and other desserts! • Should only be ~3 oz per day or less.

  43. “FA(S)T FOOD” Quarter Pounder w/cheese (510 cal/25g fat) + large fry (520 cal/25g fat) + large soda (310 cal /0g fat) Total: 1340 cal/ 50g fat

  44. How to be Successful • Make a Plan • Get structured support or program • www.mypyramid.gov • Applications for phones • www.fatsecret.com/ for calorie counter on Android phones

  45. Benefits of Exercise • More energy • Feel good about yourself ( hormones called “endorphins” are responsible ) • Better sleep • Increase endurance, strengthens heart and lungs • Builds strength – bones and muscles • Decreases body fat • Improves brain function

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