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Type 2 Diabetes Mellitus


Medications used for control of Diabetes, cont d Oral Hypoglycemic Agents (OHAS): Taken by mouth (not the same as insulin) Types: sulfonylurea and metformin drugs – PowerPoint PPT presentation

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Title: Type 2 Diabetes Mellitus

Medications used for control of Diabetes, contd
Oral Hypoglycemic Agents (OHAS)
  • Taken by mouth (not the same as insulin)
  • Types sulfonylurea and metformin drugs
  • Action Increase use and effectiveness of insulin
    present in blood
  • Enhance insulin production by pancreas

Other Management Methods
  • Training in self-management
  • Home testing of blood glucose level
  • Individualized treatment addressing medical,
    psychosocial, and lifestyle issues

Does Insurance pay for Diabetes Education?
  • Findings of the Diabetes Control and Complication
    Trial (DCCT) and subsequent effort of American
    Diabetes Association and American Dietetic
    Association, federal legislation passed covering
    medical nutrition therapy for diabetes
    (reimbursed by Medicare and Medicaid)
  • As of July 1998, services of Certified Diabetes
    Educators (CDE) or Registered Dietitians (RD)
    covered in medical treatment of diabetes

Effective management of Type 2 Diabetes includes
  • Control of food intake
  • Increased physical activity
  • Use of oral medication and/or
    insulin in some cases
  • Weight loss and maintenance of weight at a
    reasonable level - A mild to moderate weight loss
    of 10 to 20 pounds has been shown to improve
    diabetes control

National Diabetes Education Program (NDEP)
Initiated in 1997 by NIH and CDCP
4 Objectives Are To
Increase public awareness of diabetes and risk
factors and educate public and professionals on
strategies for prevention of complications
Improve understanding of diabetes and its control
and promote self-management
Improve health care professionals understanding
of diabetes and its control and promote an
integrated (team) approach
Promote health care policies that improve quality
and access to diabetes care
Recommended Eating Patterns for those with Type 2
Maintenance of near-normal blood glucose levels
and optimal blood lipid levels Normal fasting
blood glucose level 70 mg/dl to 115
mg/dl Normal glucose levels may rise to 180
mg/dl after consumption of food or sugar solution.
Recommended Eating Patterns for those with Type 2
Diabetes (contd)
Adequate calorie intake to maintain or attain
reasonable weight - defined as a weight that is
achievable and maintainable, both in short-term
and long-term.
Prevention and treatment of acute problems and
long-term complications of diabetes
Improvement of overall health through optimal
Recommended Levels/Ratios of various food
  • Protein 10 to 20 of calories. Lower level
    recommended if there is evidence of kidney
    (renal) disease.
  • Fat 30 of calories or less. If person has a
    problem with elevated blood lipids, recommended
    level may be as low as 20 or 25 of calories

Example 7 saturated fat 10 polyunsaturated
fat 13 as monounsaturated fat
Carbohydrates and sweeteners
  • Carbohydrates include starches, sugars, syrups
    and sweeteners.
  • Glycemic effect of food foods containing sugars
    and syrups may not raise blood sugar levels any
    more than some other carbohydrate foods.

Sweet intake Moderate intake considered
acceptable for those with diabetes.
Carbohydrates and sweeteners, contd
Other sugars
  • There seems to be little proven value of
    substituting sugars such as fructose or honey for
  • Sweeteners such as sorbitol, mannitol, xylitol
    have less effect on blood sugar, but cause
  • Total amount of carbohydrates is more important
    than source.
    Recommended that Carbohydrates
    Fats 75 of total calories

Non-caloric sweeteners approved by FDA are
considered safe for people with diabetes.
Recommended level is 20- 35 g per day
No more than 3,000 mg/day for those without high
blood pressure. For those with
mild to moderate high blood pressure, 2,400 mg
sodium per day or less is generally recommended.
Same precautions as for others (as in Dietary
Guidelines for Americans)
If you drink alcoholic beverages, do so in
  • 2 drinks or less/daily of alcoholic beverages
    will normally not cause a problem.
  • 1 alcoholic beverage 12 oz beer, 5 oz wine, 1
    1/2 oz liquor, gin, etc.
  • Count alcohol similar to fat 1 alcoholic
    beverage 2 fat exchanges.

Vitamins Minerals
  • Vitamin and mineral needs can be met by a
    balanced food intake (e.g. Food Guide Pyramid)
  • Vitamin and mineral supplements not necessarily
  • Increasing evidence supports supplementation with
  • Chromium supplementation not currently

Vitamins Minerals, contd
  • Adequate intakes of calcium, magnesium, and
    potassium needed for control of blood pressure
    and other functions.
  • Adequate intakes of low-fat milk products, fruits
    and vegetables are especially important.

Eating Guides for those with Diabetes
Recommended guides/methods
  • Food Guide Pyramid (especially for borderline
    diabetics and those with Type 2 Diabetes not on
  • Dietary Guidelines for Americans (principles are
    generally incorporated in all types of eating
  • Carbohydrate Counting Careful attention to total
    carbohydrate quantity and distribution during
  • Individualized eating plans designed by
    Registered Dietitians and Certified Diabetes

Situational Obstacles to Dietary Adherence
Negative emotions
Strong temptation (such as being near large
amounts of food or being offered food by others)
Time pressures
Eating Out
Feeling deprived
Social events involving food
Having competing priorities
Lack of family support
Food refusal (food rejection or aversions, such
as in children)
Friends Lack of support of patients dietary
Recommended Lifestyle Practices for those with
Type 2 Diabetes
  • Control psychological stress
  • See a doctor for regular checkups
  • Follow doctors recommendations on medications
  • Take steps to control high blood pressure
  • Participate in Physical Activity
    Exercise increases the muscle cells ability to
    take up the insulin that is present in the blood

Recommended Physical Activity (in absence of
  • 30 minutes per day of moderately vigorous aerobic
    exercise, on most days of the week, but at least
    every other day.
  • Can be done in three 10 - minute sessions or two
    15 - minute sessions.
  • Weight resistance training has
    beneficial effects, if done properly.

Issues and Recommendations for PAs Work with
Limited-Resource and Elderly Clients with Type 2
  • Limited-resource and elderly individuals often
  • Cannot afford recommended food.
  • Lack transportation to grocery store, or to
    doctor or dietitian.
  • Misunderstand doctors recommendations.
  • Have difficulty translating dietary
    recommendations into actual foods at the grocery
    store or in cooking.

Elderly may have limited mobility, hearing loss,
chewing difficulty, and problems brought on by
multiple diseases/conditions.
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