Diabetes. management through Nutrition and Exercise. Presented by Buvi Duration of Diabetes. Lack of Blood Glucose Control. Cardiovascular Risk Factors …
Get YOUR Game Plan against Diabetes
management through Nutrition and Exercise
Presented by Buvi Burugapalli
Outreach team Community Center for Vital Aging
Diabetes Over 16 million people in the US 8 million Diagnosed, 8 million undiagnosed 6 of total population 10 with Type I and 90 with type II
Prevalence
Increases with age Gender Difference Racial, Ethnic Disproportionate prevalence among African Americans, Hispanic Americans and American Indian
Increase in Overall Prevalence Increasing Age of US population Reduction in Mortality Rate Increase in Risk Factors such as
Obesity Physical Inactivity
Mortality Risk
Duration of Diabetes Lack of Blood Glucose Control Cardiovascular Risk Factors such as
Smoking High blood pressure Abnormal Lipid Levels Physical Inactivity Central Obesity
What causes Diabetes?
Obesity Sedentary Lifestyle Aging Genes
Classification Diabetes Mellitus DM type- type- Impaired Glucose Tolerance Gestational DM
Types of DM Type I DM Insulin Dependent Type II DM Non-Insulin Dependent Secondary/other types of diabetes associated with certain conditions Malnutrition related DM
Type I DM
Presence of ketosis Almost complete
lack of insulin or severe lack of Autoimmune Cause Patients commonly lean
Type II DM
Most Common Strong Genetic Basis Absence of Ketosis Inadequate Insulin Secretion Obesity a strong factor
Secondary/Other Type
Related to certain diseases, conditions or drugs Known or probable cause Treatment of underlying disorder may ameliorate the diabetes Hyperglycemia present at level diagnostic of diabetes
Malnutrition Related Diabetes Mellitus
Mostly in developing countries Among 10 to 40 year olds Hyperglycemia present without ketoacidosis Role of malnutrition as a causal factor is unknown
Impaired Glucose Tolerance
Higher than normal plasma glucose but lower than the diagnostic values for DM Precursor for Type II Only about 25 develop into type II and rest go back to normal Patients are more susceptible to macrovascular diseases
Gestational DM
2-4 during second or third trimester Onset of DM with pregnancy More common in older women with family history of dm Higher chance of developing NIDDM and IGT
Diagnosis of Diabetes
Increased thirst Increased frequency of urination Increased Fatigue Blurred Vision Increased occurrence of infections Abnormal
Healing
Risk Factors for Non-Diabetic Patients
Strong Family History Obesity Certain Races Women with previous GDM High Blood pressure hypertriglyceridemia 40 years old with any of the above
Nutrition
Nutrition Therapy The Most Fundamental Component of the Diabetes Treatment Plan Goals:
Near Normal Glucose Levels Normal Blood Pressure Normal Serum Lipid Levels Reasonable Body Weight Promotion of Overall Health
Nutrition Consult
Conduct Initial Assessment of Nutritional Status Diet History, Lifestyle, Eating Habit Provide Patient Education Regarding Basic principles of diet therapy Meal planning Problem solving Developing individualized meal plan Emphasize one or two priorities Minimize changes from the patients
Nutrition Therapy
Provide Follow-up assessment of the meal plan to
Determine effectiveness in terms of glucose and lipid control and weight loss Make necessary changes based on weight loss, activity level, or changes in medication Provide ongoing patient education and support
Advantages of Losing Weight
Improves Glucose Control Increases Sensitivity to insulin Lower lipid levels and blood pressure Corresponding lowering of the dosage of
pharmacologic agents
For a Successful Outcome
Modest Caloric Restrictions Spreading caloric intake throughout the day Increased Physical Activity Behavior Modification Psychosocial Support
Caloric Intake
Women: 100 for the first 5 ft of height plus 5 for each additional inch over 5 ft Men: 106 for the first 5 ft of height plus 6 for each additional inch over 5 ft Add 10 for larger body build, Subtract 10 for smaller body builds Multiply resulting weight by:
Men and Physically Active Women: 15 Most Women, Sedentary Men, and Adults over 55: 13 Sedentary Women, Obese Adults over age 55: 10
Nutrient Components
Protein Fat CHO Sucrose and Fructose Nutritive Sweeteners Fat Replacements Vitamins and Minerals Alco 
hol Intake
Protein Intake
Small to medium portion of protein once daily 12-20 of daily calories From both animal and vegetable sources Vegetable source less nephrotoxic than animal protein 3-5oz of meat, fish or poultry daily Patient with nephropathy should limit to less than 12 daily
Fat Intake
35 of total calories Saturated fat 10 of total calories Polyunsaturated fats 10 of total calories Cholesterol consumption 300 mg Moderate increase in
monounsaturated fats such as canola oil and olive oil up to 20 of total calories
CHO Intake
CHO intake determined after protein and fat intake have been calculated Emphasize on whole grains, starches, fruits, and vegetables Fiber same as for nondiabetics 20g to 35g Rate of digestion related to the presence of fat, degree of ripeness, cooking method, and preparation
Nutritive Sweeteners and Fat Replacements
Nutritive Sweeteners: corn syrup, fruit juice concentrate, honey, molasses,dextrose, and maltose have same impact on calorie and glycemic response Fat substitutes are derived from CHO or protein sources So, CHO and Protein content should be reviewed before using
Nutrition
Individualized Diet Treatment Plan Diet changes do not have to be dramatic Regular monitoring of blood glucose, glycated hemoglobin, lipid levels, blood pressure, and body weight
Exercise
Potential Benefits
Improved Glucose tolerance Weight loss or maintenance or desirable weight Improved cardiovascular risk factors Improved response to pharmacologic therapy Improved energy level, muscular strength, flexibility, quality of life, and sense of well being
Precautions and Considerations
Consult
a physician Rule out significant cardiovascular diseases or silent ischemia Prevent hypoglycemia with selfmonitoring of capillary blood glucose SMCBG both before and after exercising Strenuous exercise not recommended for people with poor metabolic control and significant complications
Exercise Prescription
Interest Capacity Motivation Physical status Individualized approach
Types of exercise
Walking Biking and stationary cycling Lap swimming and water aerobics Weight lifting At least 3-4 times a week, 30-40 minutes per session, 50 to 70 of maximum oxygen uptake
Acute Complications
Metabolic
Diabetic Ketoacidosis DKA Hyperosmolar Hyperglycemis Nonketotic Syndrome HHNS Hypoglycemia
Infection Quality of Life
Hypoglycemia
Factors Attributing to Hypoglycemia:
Exercise Alcohol Intake Other Drugs Decreased Liver or Kidney Function
Signs of Hypoglycemia
Glucose level 60 mg/dL Mild Hypoglycemia:
Pallor, Diaphoresis, Tachycardia, Palpitations, Hunger, Paresthesias, Shakiness
Moderate Hypoglycemia
Inability to Concentrate, Confusion, Slurred Speech, Irrational or uncontrolled behavior, slowed reaction time, blurred vision, somnolence, extreme
fatigue
Signs of Hypoglycemia
Severe Hypoglycemia
Completely automated/disoriented behavior Loss of Consciousness Inability to arouse from sleep seizures
Treatment
Goal is to normalize the plasma glucose level as quickly as possible Mild Hypoglycemia: 3 glucose tablets, cup fruit juice, 2 tablespoon rains, 5 lifesavers candy, to cup regular soda, 1 cup milk Moderate Hypoglycemia: Larger amount of CHO that are rapidly absorbed Severe Hypoglycemia: IV glucose or Glucagon 1mg, Glucose gel, Honey, syrup, jelly
Prevention
Know the signs and symptoms of hypoglycemia Try to eat regular meals Carry a source of CHO Perform SMCBG regularly Use regular insulin 30 minutes before eating Schedule exercise appropriately, adjust meal times, calorie intake, insulin dosing Check blood glucose before sleeping
Long-term Complications of DM
Macrovascular Diseases
Hypertension Dyslipidemia Myocardial Infarction Stroke
Microvascular Complications
Diabetic Retinopathy, Diabetic Nephropathy, Diabetic Neuropathy, Diabetic Diarrhea, Neurogenic Bladder, Impaired Cardiovascular Reflexes, Sexual Dysfunction
Diabetic Foot Disorders
Quality of life
Patients with blood glucose
values consistently greater than 200 mg/dL will have a reduced quality of life Poor work performance, infections, periodontal diseases, blurred vision, and among elderly, higher incidence of falls
Source:mindanews.com
