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8/7/2019 24 Carbohydrate Modified Diets for Diabetes
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Slide preparation: Lowery, Mendel, Berardi and Miracle Copyright 2003 Wadsworth/Thomson Learning, Inc.
Nutrition & Diet TherapyCataldo, Debruyne & Whitney
CHAPTER 24:CARBOHYDRATE-
MODIFIED DIETS
FOR DIABETES
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Slide preparation: Lowery, Mendel, Berardi and Miracle Copyright 2003 Wadsworth/Thomson Learning, Inc.
What Is Diabetes Mellitus?
Diabetes (dye-uh-beet-eez) mellitus (MELL-ih-tus or mell-eye-tus):
a group of metabolic disorders of glucose regulation and utilization
Diabetes = passing through (the body)
Mellitus = honey-sweet (sugar)
Type 1 diabetes: the less common type of diabetes in which the
person produces no insulin at all
Type 2 diabetes: the more common type of diabetes that develops
gradually and is associated with obesity and insulin resistance
Insulin resistance: the condition in which the cells fail to respond to
insulin as they do in healthy people
Impaired glucose tolerance: inability to maintain normal blood
glucose levels without excessive insulin production
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Slide preparation: Lowery, Mendel, Berardi and Miracle Copyright 2003 Wadsworth/Thomson Learning, Inc.
What Is Diabetes Mellitus?
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Slide preparation: Lowery, Mendel, Berardi and Miracle Copyright 2003 Wadsworth/Thomson Learning, Inc.
What Is Diabetes Mellitus?
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Slide preparation: Lowery, Mendel, Berardi and Miracle Copyright 2003 Wadsworth/Thomson Learning, Inc.
Untreated or Uncontrolled Diabetes
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Slide preparation: Lowery, Mendel, Berardi and Miracle Copyright 2003 Wadsworth/Thomson Learning, Inc.
Untreated or Uncontrolled Diabetes
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Slide preparation: Lowery, Mendel, Berardi and Miracle Copyright 2003 Wadsworth/Thomson Learning, Inc.
Acute Complications of Diabetes
Symptoms of
hyperglycemia:
Intense thirst and,
sometimes, hunger Increased urination
Blurred vision
Fatigue
Acetone breath
Labored breathing
Symptoms of
hypoglycemia:
Hunger
Headache
Sweating
Shakiness
Nervousness
Confusion
Disorientation
Slurred speech
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Slide preparation: Lowery, Mendel, Berardi and Miracle Copyright 2003 Wadsworth/Thomson Learning, Inc.
Acute Complications of Diabetes
Reminder: Ketone bodies are
produced by the incomplete
breakdown of fat when glucose
is not available to the cells.
When counterregulatoryhormone levels rise, they
cause insulin resistance and
signal the liver to mobilize
glycogen and protein to
provide glucose.
counterregulatory
hormones: hormones
that oppose insulin
actions. The
counterregulatory
hormones include
glucagon, epinephrine,
norepinephrine, cortisol,
and growth hormone.
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Slide preparation: Lowery, Mendel, Berardi and Miracle Copyright 2003 Wadsworth/Thomson Learning, Inc.
Chronic Complications of Diabetes
Reminder: the damaging effects of insulin
resistance and impaired glucose tolerance on
the blood vessels and nerves may begin before
a diagnosis of diabetes is made.
A heart attack that goes unrecognized is called a
silent heart attack.
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More About Diabetes
glycated proteins: proteins that have glucose
attached to them.
Metabolic syndrome: the combination of
insulin resistance, hyperinsulinemia, obesity,hypertension, elevated LDL and triglycerides,
and reduced HDL that is frequently associated
with type 2 diabetes and cardiovascular
disease; Also called syndrome Xand insulin-
resistance syndrome.
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Slide preparation: Lowery, Mendel, Berardi and Miracle Copyright 2003 Wadsworth/Thomson Learning, Inc.
Treatment of Diabetes Mellitus
Treatment goals
Maintain blood glucosewithin a fairly normal range
Achieve optimal blood lipidlevels
Control blood pressure
Support health and well-being
Prevent and treatcomplications
The most important goal isblood glucose control
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Slide preparation: Lowery, Mendel, Berardi and Miracle Copyright 2003 Wadsworth/Thomson Learning, Inc.
Diabetes Therapy Comparison
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Slide preparation: Lowery, Mendel, Berardi and Miracle Copyright 2003 Wadsworth/Thomson Learning, Inc.
Evaluating Diabetes Control
glycated (GLIGH-kate-id)hemoglobin: hemoglobin withglucose molecules attached to itsamino acids; Also calledglycosylated hemoglobin. The
most common is hemoglobin a1c(HbA1c), orA1C for short
The American College ofEndocrinologyand the AmericanAssociation ofClinicalEndocrinologists recommend thatHbA1c be called simply A1C and
also recommend that clients knowtheir A1C level and their targetA1C level.
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Slide preparation: Lowery, Mendel, Berardi and Miracle Copyright 2003 Wadsworth/Thomson Learning, Inc.
Medical Nutrition
Therapy for Diabetes Exchange lists The exchange system sorts
foods into three main
groups by their proportions
of carbohydrate, fat, andprotein
The foods in these three
groupsthe carbohydrate
group, the fat group, and
the meat and meatsubstitutes group
(protein)are then
organized into several
exchange lists
Carbohydrate counting
Carbohydrate counting allows
clients more flexibility in
adjusting their diets
Clients may first learn theexchange list system to help
them establish healthy eating
habits, understand portion
sizes, control their intake of
energy and energy nutrients,and learn to eat consistent
amounts of carbohydrates at
regular times
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Examples of Exchanges
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Slide preparation: Lowery, Mendel, Berardi and Miracle Copyright 2003 Wadsworth/Thomson Learning, Inc.
Examples of Exchanges
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Slide preparation: Lowery, Mendel, Berardi and Miracle Copyright 2003 Wadsworth/Thomson Learning, Inc.
Examples of Exchanges
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Slide preparation: Lowery, Mendel, Berardi and Miracle Copyright 2003 Wadsworth/Thomson Learning, Inc.
Exchange List: Nutrients/serving
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Slide preparation: Lowery, Mendel, Berardi and Miracle Copyright 2003 Wadsworth/Thomson Learning, Inc.
Drug Therapy for Diabetes
Medications do not replace diet and physical
activity in the management of diabetes
Oral Antidiabetic agents
Insulin and insulin analogs
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Slide preparation: Lowery, Mendel, Berardi and Miracle Copyright 2003 Wadsworth/Thomson Learning, Inc.
Diabetes Management
in Pregnancy Preexisting diabetes
Women with diabetes who arecontemplating pregnancy needto receive preconception care,which aims to achieve the best
possible blood glucose controlbefore pregnancy
Gestational diabetes
Women who have never haddiabetes may be diagnosed withdiabetes during pregnancy
(gestational diabetes).Gestational diabetes is the mostcommon medical complication ofpregnancy
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Slide preparation: Lowery, Mendel, Berardi and Miracle Copyright 2003 Wadsworth/Thomson Learning, Inc.
Summary
Diabetes develops when little or no insulin is produced (type 1
diabetes) or when insulin is ineffective (type 2 diabetes).
In either case, undiagnosed or uncontrolled diabetes can lead to
acute complications, including hyperglycemia and hypoglycemia. Ifleft untreated, both of these complications can lead to coma and
death. The chronic complications of diabetes include repeated
infections, cardiovascular diseases, kidney disease, loss of vision,
and neuropathy.
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Slide preparation: Lowery, Mendel, Berardi and Miracle Copyright 2003 Wadsworth/Thomson Learning, Inc.
Summary
The goals of diabetes management are to control blood glucose,
blood lipids, and blood pressure; Support health; And prevent and
treat complications.
Tight control of blood glucose levels reduces the complicationsassociated with diabetes.
Clients monitor blood glucose (and sometimes urinary ketones), and
clinicians monitor A1C to evaluate treatment plans and determine
when adjustments are necessary.
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Slide preparation: Lowery, Mendel, Berardi and Miracle Copyright 2003 Wadsworth/Thomson Learning, Inc.
Summary
The diet for diabetes parallels a healthy diet for all people, but emphasizes aconsistent intake of carbohydrate spaced evenly throughout the day. Clients needto adjust their diets when they engage in physical activity, miss meals, or becomeill.
Although all people with type 1 diabetes eventually need insulin to treat diabetes,
some people with type 2 diabetes can manage their blood glucose with diet andphysical activity alone. Others with type 2 diabetes can be managed with oralantidiabetic agents, insulin, insulin analogs, or a combination of these.
Careful management of blood glucose levels before and during pregnancy helpswomen with diabetes limit the risks of complications to mother and infant.
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Slide preparation: Lowery, Mendel, Berardi and Miracle Copyright 2003 Wadsworth/Thomson Learning, Inc.
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