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Diabetes Mellitus Mgt

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Diabetes Mellitus - Mgt. Calculate and define diets for diabetes mellitus. ... Sucrose & blood glucose values in Type 2 diabetes mellitus. 15 g CHO. 2 small cookies ... – PowerPoint PPT presentation

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Learn more at: http://www.okstate.edu
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Title: Diabetes Mellitus Mgt


1
Diabetes Mellitus - Mgt
  • Calculate and define diets for diabetes mellitus.
  • Integrate physiological functions of organ
    systems and effects of disease on MNT.

2
DCCT
  • 10 year study
  • 1,400 subjects
  • Decreased risk of complications by 70 if blood
    glucose as near normal as possible

3
Management of DM
  • MNT
  • Medications
  • Exercise
  • SMBG and Pattern Management
  • Self-management education

4
Goals of MNT
  • Near-normal blood glucose
  • Optimal blood lipid levels
  • Provide adequate kcal

5
Goals of MNT
  • Prevent, delay, treat nutrition-related risk
    factors or complications
  • Improve or maintain overall health through
    optimal nutrition

6
Role of CHO
  • CHO CHO CHO
  • Scientific evidence does not support the
    restriction of sucrose in an overall healthy diet

7
Role of CHO
  • Sucrose and sucrose-containing foods can
    substitute for other CHO foods in the total meal
    plan

8
  • Next 2 slides research by Bantle and Laine in
    Type 1 diabetes mellitus and varying kcal from
    sucrose

9
Mg glu
Sucrose blood glucose values in Type 1 diabetes
mellitus
10
Mg glu
Sucrose blood glucose values in Type 2 diabetes
mellitus
11
15 g CHO
  • 2 small cookies
  • 1/2 donut
  • 1/2 cup ice cream
  • 1 tbsp syrup
  • 3 cups popcorn

12
  • How much fat in each item on previous slide?
  • How may kcal?

13
Food Myths
  • 50 60 of protein becomes glucose
  • Eating a protein with a cho snack slows
    absorption of cho
  • Bedtime snack needs protein
  • Eating too much protein can damage kidneys

14
Food Myths
  • Protein foods are like meat, cheese, and peanut
    butter.
  • Look up kcal from pro, fat cho of shrimp,
    extra-lean ground beef, Am cheese, bologna, 2
    milk, lentils
  • Look up kcal from pro fat of sirloin, mozerella
    cheese, almonds, p butter, hot dog

15
  • Will work with meal plan approaches in a case
    study format
  • Please read in ADA Clinical Manual text

16
Medications
  • Www.niddk.nih.gov/health/diabetes/pubs/med/index
  • Medicines for People with Diabetes

17
Medication - Insulin
  • Handout of insulin types and oral hypoglycemic
    agents
  • Next slide lispro or Humalog

18
Lispro - fastest acting human insulin
19
Peak Effect of Insulin
  • At your tables draw what the blood glucose might
    be at the peak times of Humalog, Humulin N,
    Humulin U
  • Blood glucose starts at 100mg
  • All taken at 8am

20
Medication - Oral agents
  • Sulfonylureas
  • Biguanides
  • Thiazolidinedione
  • Meglitinides
  • Alhpa-glucosidase inhibitors

21
Sulfonylureas
  • Stimulate pancreas to make insulin
  • Can result in hypoglycemia
  • Do not take with alcohol
  • Wt gain
  • Orinase, Tolinase
  • DiaBeta, Amaryl, Glucotrol

22
Biguanides
  • Antihyperglycemic in effect
  • Not at risk for hypoglycemia
  • Enhances peripheral glucose uptake
  • Do not take with alcohol
  • Metallic taste
  • Glucophage

23
Thiazolidinedione
  • Helps cells to take in more glucose
  • Monitor liver function
  • Gain wt
  • Risk of anemia edema
  • Actos
  • Avandia

24
Meglitinides
  • Repaglinide
  • Helps pancreas make more insulin right after
    meals
  • Can get hypoglycemia
  • Gain wt

25
Alpha-glucosidase inhibitor
  • Gas, bloating, diarrhea if dose to high
  • Take with first bite or 30 min before meal
  • Glyset
  • Precose

26
Exercise
  • Glucose will enter muscle cell without insulin
  • What might be potential problems?

27
Exercise Guidelines
  • SMBG before and after ex.
  • Adjust food intake or insulin dose
  • 1 hr increased ex need additional 15 g cho

28
Acute Complications
  • Hypoglycemia
  • hunger
  • shakiness
  • cold sweats
  • palpitations
  • Hypoglycemia
  • headache
  • confusion
  • lack of coordination
  • anger
  • seizures, coma , death

29
Acute Complications
  • Hypoglycemia
  • Why these symptoms?
  • What are the causes of hypoglycemia?

30
Acute Complications
  • Hypoglycemia
  • treatment
  • 15 g CHO
  • SMBG
  • more 15 g CHO if not increasing

31
Long Term Monitoring
  • Glycosylated hemoglobin
  • glucose attaches to hemoglobin non-enzymatically
  • normal 6

32
Long Term Monitoring
  • Glycosylated hemoglobin
  • Next slide the relation between average blood
    glucose HbA1c

33
HbA1c and average blood glucose
34
Long Term Monitoring
  • Ketones in urine
  • important during illness
  • check if blood glucose consistently over 240 mg

35
Long Term Monitoring
  • Triglycerides
  • Blood cholesterol

36
  • End lecture on management
  • Questions
  • Now to work on case studies and do the work
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