Jennifer Wagner Cayemberg, MS, RD, LDN

A disease in which the body does not produce or

properly use insulin

25.8 million children and adults in the U.S., or 8.3% of

the population, have diabetes.

Estimated 18.8 million diagnosed with diabetes, 7.0

million people are unaware that they have the disease.

Centers for Disease Control and Prevention. National diabetes fact sheet: national estimates and general information on diabetes and prediabetes in the United States, 2011. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, 2011.

Number and Percentage of U.S. Population with Diagnosed Diabetes, 1958-2009

CDC’s Division of Diabetes Translation. National Diabetes Surveillance System available at http://www.cdc.gov/diabetes/statistics

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.

A gland that lies behind the stomach

Islets of Langerhans produces three hormones.

The islets contain 3 types of cells:

◦ Alpha, beta, and delta.

◦ Alpha cells produce glucagon.

◦ 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.

Glucagon : Hormone that increases the amount

of glucose in the blood when it is needed

(opposite of insulin).

Somatostatin: Hormone that can suppress both

glucagon and insulin when needed.

Insulin: Hormone that lowers blood glucose.

Insulin

A person normally secretes insulin in response to

an elevated blood sugar level.

It does this by accelerating blood sugar movement

out of the blood and into the cells.

Cells will not allow blood sugar in without insulin…

this can cause a problem.

Type 1: immune system has made a big mistake!

It attacks the beta cells and destroys them!

Type 2: pancreas is still making insulin, just not

enough to keep up, or their bodies have become

insulin resistant!

Screening for all patients at age 45. If results are normal, repeat every 3 years.

Screening at a younger age if patient meets following: ◦Obesity◦ First degree relative with diabetes◦Belongs to high-risk ethnic group◦Was diagnosed with gestational diabetes or delivered a

baby whose birth weight >9 lbs.◦Hypertension◦HDL level<35 or triglycerides >250◦ Found to have impaired glucose tolerance or impaired

fasting on a previous test.

Usually diagnosed in children and young adults.

Must take daily insulin shots to stay alive.

Type 1 accounts for 5-10% of the population with

diabetes.

Results from the body's failure

to produce insulin, the hormone

that "unlocks" the cells of the body,

allowing glucose to enter and fuel them.

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.

Results from insulin resistance (a condition in which the

body fails to properly use insulin), combined with relative

insulin deficiency.

Reported rates of gestational diabetes range from 2% - 10%.

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 as baby is receiving

glucose.

Women who have had gestational diabetes have a 35% - 60%

chance of developing diabetes in the next 10–20 years.

Centers for Disease Control and Prevention. National diabetes fact sheet: national estimates and

general information on diabetes and prediabetes in the United States, 2011. Atlanta, GA: U.S.

Department of Health and Human Services, Centers for Disease Control and Prevention, 2011.

Occurs when blood glucose levels are higher than normal, but

not high enough for a diagnosis of Type 2.

In 2005–2008, based on fasting glucose or Hgb A1c levels, 35%

of U.S. adults aged 20 years or older had prediabetes .

Increased risk of type 2 diabetes, heart disease, and stroke.

People with prediabetes who lose weight and increase their

physical activity can prevent or delay type 2 diabetes and in

some cases return their blood glucose levels to normal.

Centers for Disease Control and Prevention. National diabetes fact sheet: national estimates and general information on diabetes and prediabetes in the United States, 2011. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, 2011.

Some diabetes symptoms include:

Frequent urination: polyureaExcessive thirst : polydypsiaExtreme hunger: polyphasia

Unusual weight loss Increased fatigue

Irritability Blurry vision

Fasting blood glucose level between 100 - 125 mg/dl signals

pre-diabetes.

A person with a fasting blood glucose level of 126 mg/dl or

higher has diabetes.

In order to be diagnosed with diabetes person must have

symptoms of diabetes +

◦ Nonfasting plasma glucose >200

◦ Fasting blood glucose of >126 mg/dl

◦ 2-hour plasma glucose >200 mg/dl on oral glucose test

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.

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.

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.

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.

Especially beneficial in

type 2 diabetes.

Promotes weight loss

Increases insulin

sensitivity.

Must also be aware of

medication and intake to

prevent hypoglycemia.

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.

There are many new methods of controlling diabetes,

these are still the two most common.

Exchange Lists

Carbohydrate counting: basic, allows a little more

freedom and variety; eat at the same time everyday ,

at least within 1 hour of regular time.

◦ Eat about the same amount of carbohydrate with each

meal and snack.

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.

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.

DIET

Insulin / Insulin Pumps

Oral Medications

Alternative Therapies

Islet Cell Transplant

Pancreas Transplant

Type 1 and sometimes Type 2 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.

Used to treat Type 2 diabetics. There are four basic types:

Sulfonylurea: stimulates the body to make more insulin.

Metformin: lowers blood sugar by helping the insulin work better

Thiazolidinediones: increases muscle sensitivity to insulin.

Alpha-glucosidase inhibitors: slow the process of carbohydrate digestion.

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 is the leading cause of kidney failure, nontraumatic lower limb amputations, and new cases of blindness among adults; 7th leading cause of death in U.S.

◦Blindness: caused by diabetic retinopathy.

◦Kidney Disease: diabetic nephropathy

◦Heart Disease and Stroke

◦Nerve disease and amputationsCenters for Disease Control and Prevention. National diabetes fact sheet: national estimates and

general information on diabetes and prediabetes in the United States, 2011. Atlanta, GA: U.S.

Department of Health and Human Services, Centers for Disease Control and Prevention, 2011.

Control weight Eat a healthy well-balanced diet. Get regular exercise Have regular checkups Check feet everyday for cuts and

blisters Do not smoke! Keep blood sugar, BP, lipids

normal Avoid the 2 common diabetic

problems:hypoglycemia and hyperglycemia

Hypoglycemia: low blood sugar

Symptoms include shakiness, dizziness, sweating,

hunger, headache, pale skin, sudden moodiness,

clumsy or jerky movements, difficulty paying

attention, and tingling sensations around mouth.

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 minutes and test blood sugar again. If still low

repeat.

If hypoglycemia goes untreated, patient could get worse

and pass out!

Stress the importance of a night time snack in older

patients.

Ketoacidosis: Develops when the body does not have

enough insulin. The body can’t break down sugar so it

breaks down fat instead. Ketones build up in blood & urine.

Body does not tolerate ketones in high levels (poisonous).

Acidosis can lead to fluid buildup in brain, heart attack,

death of bowel tissue, kidney failure, severe illness or death.

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

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.

Be aware of risk factors and symptoms of

diabetes.

Prevention is key with changes in lifestyle.

American Diabetes Association: www.diabetes.org

CDC: http://www.cdc.gov/diabetes/