Let’s Take a Closer Look at Blood Sugar

Amy Wourms RD, LD

Objectives

Define diabetes and name the different types

Identify signs and symptoms of diabetes

Discuss risk factors for the disease and ways to lower your risk of developing diabetes

Fact or Fiction

The main problem in Diabetes is blood sugar?

Definition

Diabetes Mellitus, or simply, diabetes, is a group of diseases characterized by high blood glucose levels that result from defects in the body’s ability to produce and/or use insulin.

http:// www.diabetes.org

Types

Type I DiabetesType II Diabetes

Pre-DiabetesGestational Diabetes

Type I Diabetes

The body does not produce the hormone insulin◦Only 5% of all people with diabetes have this

form of the disease◦Usually diagnosed in children and young adults

(previously known as juvenile diabetes)◦Can be managed by insulin therapy and other

treatments

Not enough insulin to unlock cells to use glucose in muscle

Type I Diabetes

Blood Sugar Balance

Type II Diabetes

The body either does not produce enough insulin or the cells ignore the insulin (insulin resistant).◦Most common form of diabetes◦When glucose builds up in the blood instead of

going into the cells, it can lead to diabetes complications

◦Typically diagnosed in adults◦Recently being diagnosed in young children and

adolescents

Cell is resistant to insulin so does not unlock muscle cell to let glucose in

Type II Diabetes

Statistics

Total Prevalence of diabetes◦ Total: 25.8 million children & adults in the US (or

8.3% of the population) Diagnosed: 18.8 million people Undiagnosed: 7 million people

◦ Pre-diabetes: 79 million people◦ New Cases: 1.9 million people, aged 20 years or

older, were diagnosed in 2010

Total Costs of diabetes◦ $174 billion in the US in 2007 for diabetics◦ $25 billion for American adults with Pre-diabetes◦ $18 billion for people with undiagnosed diabetes

National Diabetes Fact Sheet 2011 – www.diabetes.org

Fact or Fiction?

You have to loose a lot of weight for your diabetes to improve.

Is There a Link Between Obesity and Diabetes?

Of the people diagnosed with type II diabetes, about 80 to 90 percent are also diagnosed as obese. This fact provides an interesting clue to the link between diabetes and obesity. Understanding what causes the disease will hopefully allow us to prevent diabetes in the future.

Being overweight places extra stress on your body in a variety of ways, including your body’s ability to maintain proper blood glucose levels. In fact, being overweight can cause your body to become resistant to insulin. If you already have diabetes, this means you will need to take even more insulin to get sugar into your cells. And if you don’t have diabetes, the prolonged effects of the insulin resistance can eventually cause you to develop the disease.

Obesity Trends* Among U.S. AdultsBRFSS, 1994-2008

(*BMI 30, or about 30 lbs. overweight for 5’4” person)

Signs & Symptoms (Type I & II)

Frequent urinationIncreased thirst or hungerExtreme tirednessWeight loss (without loss of appetite)Blurred visionFrequent infectionsSlow wound healingPain, numbness or tingling in the feetStomach pain/vomitingSexual dysfunction

Pre-Diabetes

Blood glucose levels that are higher than normal but not yet high enough to be diagnosed with diabetes

Types◦Impaired fasting glucose – before a meal◦Impaired glucose tolerance – after a meal

Signs & Symptoms (Pre-Diabetes)

You may not have symptomsMay experience “low blood sugar”

symptoms a few hours after meals◦Weakness, dizziness, sweating

Without good blood glucose control, pre-diabetes will become type II diabetes

Blood Sugar Balance

The body works to maintain blood sugar in a narrow range

Insulin and Glucagon control this range◦When blood sugar is high, Insulin

is released Released by the pancreas

◦When blood sugar is low, Glucagon is released Released by the pancreas, this

hormone stimulates the liver to release glucose from storage (glycogen stores)

Fact or Fiction?

Diabetes is not a serious disease.

Impact of Uncontrolled Blood Sugars

The heart and blood vessels

Kidney Disease (Nephropathy)

The Eyes Decreases ability to

fight off infection Slow wound healing Autonomic neuropathy

If not controlled, diabetes can put you at risk for a host of complications that can affect nearly every organ in the body. They include:

Heart disease and blood vessel disease

Heart disease and blood vessel disease are the biggest complications that people with uncontrolled diabetes face.In Diabetic patients these diseases are caused by:Damage to small blood vessels and

capillary circulation. Damage to the inner or outer lining of

blood vessels.

Kidney Disease (Nephropathy)

Diabetes can damage the way the kidneys work in our body.

High levels of blood sugar make the kidneys filter too much blood. After a long period of time the kidneys start to leak and useful protein is lost in the urine.

In time, the stress of overwork causes the kidneys to lose their filtering ability. Waste products then start to build up in the blood. Finally, the kidneys fail.

Diabetic kidney disease can be prevented by keeping blood sugar in your target range.

Slow wound healing

Wound healing can be slowed when the patient is diabetic. An important point to remember about a diabetic patient wound is that it heals slowly and can worsen rapidly, so requires close monitoring. There are several factors that influence wound healing in a diabetic patient, and may include:

Blood Glucose Levels An elevated blood sugar level stiffens the arteries and causes narrowing of

the blood vessels. The effects of this are far-reaching and include the origin of wounds as well as risk factors to proper wound healing.

Poor Circulation Narrowed blood vessels lead to decreased blood flow and oxygen to a

wound. An elevated blood sugar level decreases the function of red blood cells that carry nutrients to the tissue. This lowers the efficiency of the white blood cells that fight infection. Without sufficient nutrients and oxygen, a wound heals slowly.

Decreases ability to fight off infection

Immune System Deficiency Diabetes lowers the efficiency of the immune system, the

body's defense system against infection. A high glucose level causes the immune cells to function ineffectively, which raises the risk of infection for the patient. Studies indicate that particular enzymes and hormones that the body produces in response to an elevated blood sugar are responsible for negatively impacting the immune system.

Infection With a poorly functioning immune system, diabetics are

at a higher risk for developing an infection. Infection raises many health concerns and also slows the overall healing process.

The Eyes

Diabetes is the leading cause of new blindness in the U.S. In adults ages 20-74. It can cause a number of eye problems, some of which can lead to blindness, The eye disorders include:

GlaucomaCataractsDiabetic retinopathy

Autonomic neuropathy

Autonomic Neuropathy is damage to the nerve supply of the internal organs of the body.

Damage to the nerve supply of the heart affects the regulation of the pulse rate. In the blood vessels, manifestations such as a fall in blood pressure.

Loss of the nerve supply to small blood vessels can also impair the regulation of blood flow.

Fact or Fiction?

Smoking increases the risk of the complications of diabetes?

Risk Factors

Family HistoryAge over 45 yearsBeing Overweight or obese (BMI of 25kg/(m^2) or higher)

Not getting enough physical activity ( < 150min/week)

Low HDL (good) cholesterol (< 40mg/dL for men and <50mg/dL for women)

High Triglycerides ( > 150 mg/dL)

High blood pressure ( > 120/80mg/dL)

Race/Ethnicity (African American, Latino, Native American, Asian American,

Pacific Islanders)

Women◦ Polycystic ovarian syndrome◦ Diabetes during pregnancy (gestational diabetes)

Testing Blood Glucose

Fasting plasma glucose test◦Blood test done after overnight

fast (or nothing to eat or drink, except water, for 10-12 hours.)

Results◦Normal = < 100mg/dL◦Pre-diabetes = 100-126mg/dL◦Diabetes = > 126mg/dL

Hgb A1c

Hemoglobin is found in red blood cellsThey carry oxygen from the lungs to the

rest of the bodyGlucose can also attached to hemoglobin,

forming glycated hemoglobin◦Hgb A1c is a type of this

Related to the average blood glucose over the last 3 months

Hgb A1c

How does Hgb A1c work?◦Too much sugar in the

blood stream◦Extra sugar links up

with hemoglobin◦The more sugar in

your blood the more hemoglobin gets saturated

◦HgbA1c test is elevated

Prevention Goals

To prevent diabetesTo prevent complications of high blood

sugars and diabetesTo maintain a healthy lifestyle through

diet and exercise

Prevention Options

Lifestyle Modifications◦Dietary ◦Physical activity

Weight managementScreenings

Fact or Fiction?

You can lower high blood glucose with high-fiber foods.

Lets talk about ways to lower and maintain a good/low blood glucose

(blood sugar) level through:1. Food/diet

2. Exercise/Physical Activity

Take control of your Blood sugar!

Diabetics must monitor their diet to prevent their blood sugar from running dangerously high. Pre-diabetics or those with a genetic disposition to the disease can keep blood sugar levels low by being careful with their diet, possibly reducing the risk of needing medication. Food, if carefully chosen, can cause a gradual rise in blood sugar levels (which is good) or it can cause the levels to rise too quickly

Two ways to help decrease and control blood sugar through diet:1. Choose healthy carbohydrates2. Eat more fiber

Carbohydrates and Blood Sugar

When you eat carbohydrates, either simple or complex, your body breaks them down into sugars, which are absorbed into the bloodstream. The sugar level rises, and in response, your pancreas releases the hormone insulin. Insulin helps take the sugar from the blood and put it into the cells, where it can be used as energy to fuel your body.

Some carbohydrates affect blood sugar more than others. For example processed grains like white flour and white rice raise blood sugar more quickly than whole wheat or brown rice.

A good starting place for people with diabetes is to have roughly 45 to 60 grams of carbs per meal and 15 to 30 grams for snacks

Good sources of carbohydrates:o Fruits (2-3servings per day)o Vegetables (4-5 servings per day)o Whole grainso Legumes (beans, peas and lentils) o Low-fat dairy products (Milk and yogurt)

How does fiber affect Blood Sugar?

Fiber is a good thing for people with diabetes!o Fiber does not raise blood glucose levels, because it is not

broken down by the body.o Foods that contain fiber (fruits, vegetables, whole grain

breads, cereals, and pastas) also contain other types of non-fiber carbohydrate (sugar, starch) that must be accounted for in your meal plan.

Other Fiber-rich foods Include:o Oatmealo Nutso Legumes (beans, peas and lentils)o whole-wheat flouro Wheat bran.

Best choice Vs. Bad Choice

Best Choices Worst Choices

• 1% or skim milk • Whole milk

• Reduced-fat mayonnaise• Light salad dressings

• Regular mayonnaise• Regular salad dressings

• Whole-grain flours, such as whole wheat flour

• White flour

• Whole grains, such as brown rice • Processed grains, such as white rice

• Cereals containing whole-grain ingredients and little added sugar

• Cereals with little whole grain and lots of sugar

Baked or stewed beans Beans prepared with lard

• Whole-grain bread • White bread

Baked, broiled, steamed, or grilled fish Fried fish

Baked, broiled, grilled, or stewed meats Fried meats

Lets exercise a little!

“You don’t need to run a marathon to get results,” says Dawn Sherr, RD, of the American Association of Diabetes Educators. “

Lets take a look at three steps to maintain and decreasing your blood sugar through exercise:Step 1: Make a PlanStep 2: Set a ScheduleStep 3: Get Ready

Step 1: Make a Plan If you're just starting, ask your doctor which exercise is right for you.

Ask if you need to adjust your diabetes medicine before you hit the trail or the pool.

Step 2: Set a Schedule The best time to exercise may be after a meal. Ask your doctor what

time of day is best for you. Take the dog for a walk after breakfast and dinner. Or schedule a yoga class or a round of tennis after lunch.

Step 3: Get Ready Stay motivated, ask a friend or family member to come along, or join

a class. You won't skip an outing when other people are counting on you!

Check your blood sugar before a brisk walk or workout. If it's below 100, check with your doctor to see if you need to eat a snack first.

Carry a snack or glucose tablets in case your blood sugar gets low. Drink plenty of water before, during and after your workout.

How will exercising lower my Blood sugar?

When you do moderate exercise, like walking, that makes your heart beat a little faster and breathe a little harder. Your muscles use more glucose, the sugar in your blood stream.  Over time, this can lower your blood sugar levels. It also makes the insulin in your body work better. You'll get these benefits for hours after your walk or workout. Try incorporating exercises such as:1. Aerobic Exercise2. Strength Training

Aerobic Exercise

Aerobic exercise helps your body use insulin better. It makes your heart and bones strong, relieves stress, improves blood circulation, and reduces your risk for heart disease by lowering blood glucose and blood pressure and improving cholesterol levels.We Recommend: Aiming for 30 minutes of moderate-to-vigorous intensity aerobic exercise at least 5 days a week or a total of 150 minutes per week.

Examples of aerobic activities: Brisk walking (outside or inside on a treadmill) Bicycling/Stationary cycling indoors Dancing Low-impact aerobics  Swimming or water aerobics Playing tennis Stair climbing Jogging/Running Hiking Rowing Ice-skating or roller-skating Cross-country skiing Moderate-to-heavy gardening

Strength Training

Strength training (also called resistance training) makes your body more sensitive to insulin and can lower blood glucose.We Recommend: doing some type of strength training 2-3 days each week in addition to aerobic activity.

Examples of strength training activities: Weight machines or free weights at the gym Using resistance bands Lifting light weights or objects like canned goods or water

bottles at home Exercises that use your own body weight to work your muscles

(examples are pushups, sit ups, squats, lunges, wall-sits, and planks)

Classes that involve strength training

Fact or Fiction?

Insulin is a cure for diabetes.

Treatment Goals

To achieve better blood sugar controlTo prevent complications of high blood

sugars and diabetesImprove your body’s ability to use insulinWork towards decreasing the need for

diabetic and blood pressure medication

Treatment Options

Lifestyle Modifications◦Physical activity and dietary changes

Oral Medication◦Many different kinds◦Ex: Metformin

Injection Medications◦Required for type I◦Allows muscles to uptake insulin◦Short and Long acting

Insulin Pump

Questions

Sources

http://www.diabetes.org/living-with-diabetes/complications/kidney-disease-nephropathy.html

http://www.cvd.idf.org/Double_Jeopardy/How_does_Diabetes_Lead_to_CVD_/

http://www.woundcarecenters.org/living-with-wounds/how-diabetes-affects-wound-healing.html

http://www.diabeticcareservices.com/diabetes-education/diabetes-and-obesity

http://www.diabetes.org/living-with-diabetes/complications/eye-complications/

http://www.diabetes.org/diabetes-basics/diabetes-myths/?loc=DropDownDB-myths

http://diabetes.webmd.com/diabetic-food-list-best-worst-foods?page=2 http://

www.joslin.org/info/how_does_fiber_affect_blood_glucose_levels.html http://

highered.mcgraw-hill.com/sites/dl/free/0078022584/947562/SampleChapter08.pdf

http://www.webmd.com/healthy-aging/nutrition-world-2/exercise-lower-blood-sugar