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Chapter 20 Chapter 20 Diabetes Mellitus

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Chapter 20Chapter 20

Lesson 20.1Lesson 20.1

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Key ConceptKey Concept

• Diabetes mellitus is a metabolic disorder of glucose metabolism with many causes and forms.

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About DiabetesAbout Diabetes

• Seventeen million Americans have diabetes (6.2% of the population).

• Diabetes is the sixth leading cause of death from disease in the U.S.

• People with diabetes either do not produce insulin or cannot effectively use it.

• Diabetes is characterized by hyperglycemia.

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Word OriginsWord Origins

• Diabetes from Greek “to pass through”

• Mellitus from Latin for “honey”

• Insulin from Latin for “island”

• Islets of Langerhans—clusters of pancreatic cells named for discoverer

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Type 1 Diabetes MellitusType 1 Diabetes Mellitus

• Accounts for 5% to 10% of cases

• Previously called insulin-dependent or juvenile-onset diabetes

• Severe, unstable form

• Caused by autoimmune destruction of pancreatic cells

• Can occur at any age

• Requires exogenous insulin

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Type 2 Diabetes MellitusType 2 Diabetes Mellitus

• Accounts for 90% to 95% of cases

• Previously called adult-onset or non-insulin-dependent diabetes

• Initial onset usually after age 40

• Now being diagnosed in children

• Strong genetic link

• Prevalent in older, obese people

• Caused by insulin resistance or defect

• Usually treated with diet, exercise

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Risk Factors for Type 2 Risk Factors for Type 2 Diabetes MellitusDiabetes Mellitus

• Family history of diabetes• Age 45 years or older• Overweight• Not physically active• Race/ethnicity (African American, Hispanic American,

Native American, Asian American, Pacific Islander)• History of gestational diabetes• Woman who has delivered infant weighing more than

9 pounds• Identified impaired glucose tolerance

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Gestational DiabetesGestational Diabetes

• Temporary form of disease occurring in pregnancy

• Presents complications for mother and fetus/infant

• Must be carefully monitored and controlled

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Other Types of DiabetesOther Types of Diabetes(Secondary)(Secondary)

• Causes Genetic defect Pancreatic conditions or disease Endocrinopathies—imbalance with other

hormones in the body Drug/toxin- or chemical-induced

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Impaired Glucose ToleranceImpaired Glucose Tolerance(IGT)(IGT)

• Above normal fasting blood glucose but not high enough to be diabetes

• A risk factor for type 2 diabetes

• Underlying conditions often present

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Symptoms of DiabetesSymptoms of Diabetes

• Initial signs Increased thirst Increased urination Increased hunger Unusual weight loss (type 1) Unusual weight gain (type 2)

(Cont'd…)

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Symptoms of DiabetesSymptoms of Diabetes(…Cont’d)

• Laboratory Test Results Glycosuria (sugar in urine) Hyperglycemia (elevated blood sugar) Abnormal glucose tolerance tests

• Progressive Results Water, electrolyte imbalance Ketoacidosis Coma

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Chapter 20Chapter 20

Lesson 20.2Lesson 20.2

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Key ConceptKey Concept

• Diabetes mellitus is a metabolic disorder of glucose metabolism with many causes and forms.

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Metabolic PatternsMetabolic Patterns

• Diabetes is especially related to metabolism of carbohydrate and fat.

• It is important to control blood glucose within normal levels of 70 to 110 mg/dl.

• If diabetes is uncontrolled and insulin is lacking: Glucose cannot enter the cells and builds up in the

blood. Fat tissue breaks down. Protein breaks down, causing weight loss and

nitrogen loss.

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Three Key HormonesThree Key Hormones

• Islets of Langerhans produce: Insulin Glucagon Somatostatin

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InsulinInsulin

• Controls blood sugar Helps transport glucose into cells Helps change glucose to glycogen and store it

in liver, muscles Stimulates changes of glucose to fat for

storage as body fat Inhibits breakdown of tissue fat and protein Promotes uptake of amino acids Influences burning of glucose for energy

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GlucagonGlucagon

• Acts in a manner opposite of insulin

• Breaks down stored glycogen and fat

• Raises blood glucose as needed to protect brain during sleep or fasting

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SomatostatinSomatostatin

• A “referee” for several other hormones

• Inhibits secretion of insulin, glucagon, and other hormones

• Also produced in other parts of the body (e.g., hypothalamus)

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Long-Term Complications of Long-Term Complications of DiabetesDiabetes

• Retinopathy

• Nephropathy

• Neuropathy

• Heart disease Dyslipidemia—elevated triglyceride,

decreased HDL cholesterol Hypertension—a major comorbid condition

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Chapter 20Chapter 20

Lesson 20.3Lesson 20.3

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Key ConceptsKey Concepts

• A consistent, sound diet is the keystone of diabetes care and control.

• Good self-care skills practiced daily enable a person with diabetes to remain healthy and reduce risks for complications.

• A personalized care plan, balancing food intake, exercise, and insulin regulation, is essential to successful diabetes management.

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Criteria for Diagnosis of Criteria for Diagnosis of Diabetes MellitusDiabetes Mellitus

• Symptoms of diabetes plus casual (any time) plasma glucose concentration greater than or equal to 200 mg/dl

• Fasting plasma glucose greater than or equal to 126 mg/dl

• Two-hour plasma glucose greater than or equal to 200 mg/dl during an oral glucose tolerance test

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Management of DiabetesManagement of Diabetes

• Early detection

• Glycemic control

• Prevention of complications

• Glucose tolerance test

• Goals of Care Maintaining optimal nutrition Avoiding symptoms Preventing complications

(Cont'd…)

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Management of DiabetesManagement of Diabetes(…Cont’d)

• Elements of therapy plan Diet Exercise Ensuring adequate insulin activity Controlling stress

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Diet TherapyDiet Therapy

• Weight reduction (type 2)

• Sufficient energy intake

• Balance of energy intake and output

• Balance of carbohydrate, fat, protein

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Core Focus: Glycemic Core Focus: Glycemic ControlControl

• Nutrition therapy Total energy balance Nutrient balance Food distribution balance

• Personal diet Total kcalories of energy balance Ratio of carbohydrate, fat, protein Daily food distribution pattern

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Energy BalanceEnergy Balance

• Carbohydrate Should provide 60% of energy intake Starch and sugar—complex and simple

carbohydrates Fiber Sugar substitutes—nutritive and nonnutritive

• Protein About 15% to 20% of total energy

• Fat No more than 25% to 30% of kcalories

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Food Distribution BalanceFood Distribution Balance

• Eat even amounts of food at regular intervals.

• Maintain even blood glucose supply.

• Snacks may be needed.

• Adjust eating according to activity level and stress.

• Regulate glycemic response according to physical activity/exercise.

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Diet ManagementDiet Management

• Develop plan to meet individual needs.

• Consult clinical dietician.

• Use the food exchange system. Foods grouped into “exchange lists” Foods selected to meet energy needs, balance

ratio of nutrients

• Limit processed foods.

• Limit alcohol; plan carefully.

• Avoid hypoglycemia.

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Symptoms of HyperglycemiaSymptoms of Hyperglycemia

• Extreme thirst (polydipsia)

• Frequent urination (polyuria)

• Excessive hunger (polyphagia)

• Dry skin

• Blurred vision

• Drowsiness

• Nausea

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Person-Centered Self-CarePerson-Centered Self-Care

• Persons with diabetes need essential skills/knowledge. Understand nature of diabetes Nutrition—develop sound food plan Insulin—know type, duration of action,

combinations Monitor glucose levels Control emergencies, illness Identification bracelet

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ResourcesResources

• American Diabetes Association

• American Heart Association

• “Light” cookbooks