Nutrition for Diabetes

Aml Haddad –Pharmacy & Medical Sciences of Clinical Nutrition

Diabetes: is a group of metabolic disorders by
hyperglycemia

Idiopathic

Circulating Auto-antibodies Immunemediated (Autoimmunity) (viral infection, toxic

Type 1 Diabetes Mellitus (absolute insulin deficiency) 5-10 % of all cases

Genetic Factors

Risk Factors (physical inactivity, olderage, obesity) Type 2 Diabetes Mellitus (insulin resistance; insulin deficiency) 90 % all cases

Environmental factors

Intake of Excessive calories

• Gestational Diabetes GDM (specific types):
Diagnosed during Pregnancy results from:

Genetic Syndromes, malnutrition, infections, drugs, ↑ hormone---- insulin resistance ,7% of pregnancy
• Pre-Diabetes : Fasting or glucose tolerance test results above normal.

• Diagnosing Diabetes: Fasting blood glucose (mg/dl) 1. Normal ‹ 100 2. Pre-diabetes 100-125 3. Dm › 126 • 1. 2. 3. Random blood glucose: Normal ‹ 140 Pre -diabetes 140-190 Dm ›200

• Risk factors for diabetes: 1. Family history of type 2 2. Overweight , BMI ≥ 25 3. Cardiac Risk factors : ↑ LDL , ↑ Cholesterol ,↑hypertension ↓HDL.

• Protein glycosylation : When blood glucose remains elevated 1. Overtime, tissues become glycosylated. 2. Glucose (sticks) to tissue. • Glycosylation damages blood vessels and contributes to long-term complication associated with poorly controlled diabetes.

HEMOGLOBIN A1C LAB Test :
• • Measures the glycosylation of hemoglobin. Indicates average glycemic control over past 3 months. Recommended: ‹ 7

A1 C 5 6 7 8 9 10 11 12

BG 10 135 170 205 204 275 310 345

• 1. 2. 3. 4. 5.

Long term complication HBG conc.: Blood vessels (CVD) Eyes (retinopathy) Kidneys (nephropathy) Nerves (neuropathy) Noun-healing wounds.

Damage

Pieces of the diabetes Puzzle:
Food / CHO

insulin / medication

BG monitoring

Exercise

• Hypoglycemia: For BG ‹70 mg/dl

• Take 15g of CHO: 1cup juice, 1 Tbsp sugar ,jam, honey
• Recheck BG in 15 minutes.

• Don’t use items that contain fat delays absorption (no chocolate ,ice cream ,cookies).

Nutrition Management
• Type 1 Diabetes:

1. Depend in insulin injection with food intake , consistency in timing and amount of CHO eaten if on fixed insulin doses. • Adequate energy & nutrient in take to promote growth & development in children .
• Type 2 Diabetes: 1. lifestyle strategies (food /eating and physical activity ) that improve glycemia , dyslipidemia and blood pressure. 2. Nutrition education. 3. 5% -10 % weight loss 4. Blood glucose monitoring.

• NUTRITION THERAPY:
Balanced Diet
CHO Protein 45-65% Kcal 20-35% Kcal Starch ,milk, fruit ,Vega Meat , eggs, cheese

Fat

10-35% kcal

Oils, butter, nuts


LOW GI 55

TABLE GLYCEMIC INDEX:
Medium GI 65-69 Rice Honey HIGH GI 70 Dates White bread

Low-fat yoghurt with • sweetener Apples

Tomato soup, canned Nuts
Beans Fruits Vegetables Sweet potato Pasta Noodles

Cheese and tomato pizza Digestive biscuit
Ice cream Pineapple, fresh Table sugar Cake Raisins Potato, boiled

Watermelon Cornflakes
French fries Wafer biscuits Rice cakes Corn chips Watermelon Chips, potato

GLYCOMIC Effect of Food • Highest blood sugar is typically 1-2 hours after eating the meal. • However: 1. Liquids (juice)digest quicker. 2. High fat & fried foods digest slower 3. Highly refined grains & cereals digest quickly 4. High fiber foods (legumes & whole grains ) have glycemic response.

C

Supplementation for diabetes: Vit- B6,B12,B2 Calcium & D

Type 1 Diabetes Mellitus

Immune-mediated Circulating Auto-antibodies Type 1 Diabetes Melllitus (absolute insulin deficiency) Idiopathic (Autoimmunity) (viral infection,toxic chemicals, ect.)

Type 2 Diabetes Mellitus
Genetic Factors

Risk Factors
(physical inactivity, olderage, obesity)

Environmental factors

Type 2 Diabetes Mellitus
(insulin resitance;insulin deficiency)

Intake of
Excessive calories

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