24 Carbohydrate Modified Diets for Diabetes

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Slide preparation: Lowery, Mendel, Berardi and Miracle Copyright 2003 Wadsworth/Thomson Learning, Inc.

Nutrition & Diet TherapyCataldo, Debruyne & Whitney

CHAPTER 24:CARBOHYDRATE-

MODIFIED DIETS

FOR DIABETES


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What Is Diabetes Mellitus?

Diabetes (dye-uh-beet-eez) mellitus (MELL-ih-tus or mell-eye-tus):

a group of metabolic disorders of glucose regulation and utilization

Diabetes = passing through (the body)

Mellitus = honey-sweet (sugar)

Type 1 diabetes: the less common type of diabetes in which the

person produces no insulin at all

Type 2 diabetes: the more common type of diabetes that develops

gradually and is associated with obesity and insulin resistance

Insulin resistance: the condition in which the cells fail to respond to

insulin as they do in healthy people

Impaired glucose tolerance: inability to maintain normal blood

glucose levels without excessive insulin production


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Untreated or Uncontrolled Diabetes


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Untreated or Uncontrolled Diabetes


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Acute Complications of Diabetes

Symptoms of

hyperglycemia:

Intense thirst and,

sometimes, hunger Increased urination

Blurred vision

Fatigue

Acetone breath

Labored breathing

Symptoms of

hypoglycemia:

Hunger

Headache

Sweating

Shakiness

Nervousness

Confusion

Disorientation

Slurred speech


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Acute Complications of Diabetes

Reminder: Ketone bodies are

produced by the incomplete

breakdown of fat when glucose

is not available to the cells.

When counterregulatoryhormone levels rise, they

cause insulin resistance and

signal the liver to mobilize

glycogen and protein to

provide glucose.

counterregulatory

hormones: hormones

that oppose insulin

actions. The

counterregulatory

hormones include

glucagon, epinephrine,

norepinephrine, cortisol,

and growth hormone.


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Chronic Complications of Diabetes

Reminder: the damaging effects of insulin

resistance and impaired glucose tolerance on

the blood vessels and nerves may begin before

a diagnosis of diabetes is made.

A heart attack that goes unrecognized is called a

silent heart attack.


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More About Diabetes

glycated proteins: proteins that have glucose

attached to them.

Metabolic syndrome: the combination of

insulin resistance, hyperinsulinemia, obesity,hypertension, elevated LDL and triglycerides,

and reduced HDL that is frequently associated

with type 2 diabetes and cardiovascular

disease; Also called syndrome Xand insulin-

resistance syndrome.


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Treatment of Diabetes Mellitus

Treatment goals

Maintain blood glucosewithin a fairly normal range

Achieve optimal blood lipidlevels

Control blood pressure

Support health and well-being

Prevent and treatcomplications

The most important goal isblood glucose control


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Diabetes Therapy Comparison


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Evaluating Diabetes Control

glycated (GLIGH-kate-id)hemoglobin: hemoglobin withglucose molecules attached to itsamino acids; Also calledglycosylated hemoglobin. The

most common is hemoglobin a1c(HbA1c), orA1C for short

The American College ofEndocrinologyand the AmericanAssociation ofClinicalEndocrinologists recommend thatHbA1c be called simply A1C and

also recommend that clients knowtheir A1C level and their targetA1C level.


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Medical Nutrition

Therapy for Diabetes Exchange lists The exchange system sorts

foods into three main

groups by their proportions

of carbohydrate, fat, andprotein

The foods in these three

groupsthe carbohydrate

group, the fat group, and

the meat and meatsubstitutes group

(protein)are then

organized into several

exchange lists

Carbohydrate counting

Carbohydrate counting allows

clients more flexibility in

adjusting their diets

Clients may first learn theexchange list system to help

them establish healthy eating

habits, understand portion

sizes, control their intake of

energy and energy nutrients,and learn to eat consistent

amounts of carbohydrates at

regular times


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Examples of Exchanges


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Exchange List: Nutrients/serving


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Drug Therapy for Diabetes

Medications do not replace diet and physical

activity in the management of diabetes

Oral Antidiabetic agents

Insulin and insulin analogs


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Diabetes Management

in Pregnancy Preexisting diabetes

Women with diabetes who arecontemplating pregnancy needto receive preconception care,which aims to achieve the best

possible blood glucose controlbefore pregnancy

Gestational diabetes

Women who have never haddiabetes may be diagnosed withdiabetes during pregnancy

(gestational diabetes).Gestational diabetes is the mostcommon medical complication ofpregnancy


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Summary

Diabetes develops when little or no insulin is produced (type 1

diabetes) or when insulin is ineffective (type 2 diabetes).

In either case, undiagnosed or uncontrolled diabetes can lead to

acute complications, including hyperglycemia and hypoglycemia. Ifleft untreated, both of these complications can lead to coma and

death. The chronic complications of diabetes include repeated

infections, cardiovascular diseases, kidney disease, loss of vision,

and neuropathy.


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Summary

The goals of diabetes management are to control blood glucose,

blood lipids, and blood pressure; Support health; And prevent and

treat complications.

Tight control of blood glucose levels reduces the complicationsassociated with diabetes.

Clients monitor blood glucose (and sometimes urinary ketones), and

clinicians monitor A1C to evaluate treatment plans and determine

when adjustments are necessary.


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Summary

The diet for diabetes parallels a healthy diet for all people, but emphasizes aconsistent intake of carbohydrate spaced evenly throughout the day. Clients needto adjust their diets when they engage in physical activity, miss meals, or becomeill.

Although all people with type 1 diabetes eventually need insulin to treat diabetes,

some people with type 2 diabetes can manage their blood glucose with diet andphysical activity alone. Others with type 2 diabetes can be managed with oralantidiabetic agents, insulin, insulin analogs, or a combination of these.

Careful management of blood glucose levels before and during pregnancy helpswomen with diabetes limit the risks of complications to mother and infant.


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24 Carbohydrate Modified Diets for Diabetes

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