MNT-mnt mnt mnt mnt mnt mntDiabetes.pptx

Mnt for diabetes

1. MNT---Diabetes Dr. K. S. Abbasi INSTITUTE OF FOOD & NUTRITIONAL SCIENCES

2. Mechanism Diabetes results from the body’s inability to use and store food properly. During normal digestion, foods are broken down into nutrients which the body uses for energy. These particular nutrients are: protein (which is broken down into amino acids), carbohydrate (broken down into glucose), and fat (broken down into fatty acids). Insulin, a hormone produced by the pancreas, regulates the body’s use of these nutrients. It is released into the bloodstream when glucose increases and binds itself to cells at sites called receptors. Once bound to receptors, insulin allows glucose from food to move from the bloodstream into the cells where it is broken down for energy. The cells use glucose as their main energy source. Persons with diabetes either make little or no insulin or are unable to use insulin properly. As a result, glucose stays in the blood instead of entering cells, and the cells starve. High levels of glucose in the blood are characteristic of uncontrolled diabetes.

3. Classification Type 1 is insulin dependent, juvenile onset, immune-mediated, diabetes is a complete or near-complete inability of the body to make insulin, usually referred to as insulin deficiency. It results from an autoimmune destruction of the beta cells of the pancreas. To survive, persons with this type of diabetes depend on multiple daily injections of insulin. The person with type 1 diabetes may have wide daily swings in blood sugar levels and is prone to two very different disorders: ketoacidosis and hypoglycemia . Ketoacidosis is marked by high levels of glucose and ketoacids (fat breakdown products, also called ketones) in the blood, caused by a lack of insulin. Hypoglycemia is, simply, low blood sugar. Type 1 diabetes is usually characterized by an abrupt onset of symptoms commonly referred to as the “ 3Ps”: Polyphagia (increased hunger), Polydipsia (increased thirst) & Polyuria (increased urination). Number of medical risks are associated with type 1 diabetes. like, diabetic retinopathy (eyes), diabetic neuropathy( nerves), diabetic nephropathy (kidneys) heart failure & stroke.

4. Type 2 diabetes called adult onset diabetes is a term used for persons who have insulin resistance and usually have relative, rather than absolute, insulin deficiency. It is a condition in which the body still makes insulin, but either cannot produce an adequate supply or cannot use the insulin properly, the latter deficiency typically referred to as insulin resistance Gestational diabetes mellitus is used to describe glucose intolerance that has its onset or is first detected during pregnancy. Women with known diabetes mellitus before conception are not part of this class. The risk of developing GDM is influenced by excess body weight, inactivity, older age, history of GDM, previously large-for-gestation-age infant, family history of diabetes, and high-risk ethnicity. Risk estimates for developing diabetes (usually type 2 diabetes) after GDM vary widely from 2 to 70 percent , depending on the population studied, the criteria used for diagnosis, and the length of follow-up. Prediabetes is a term used for those who are at increased risk of developing diabetes. Risk factors involve obesity, high triglyceride levels, low HDL cholesterols etc. They have impaired fasting glucose (IFG), impaired glucose tolerance (IGT), elevated HbA1C or in combinations.

5. DIAGNOSIS AND TESTING Glycated Hemoglobin (HbA1C) above 6.5%. Fasting plasma glucose (FPG) above 126 mg/dL. Fasting is defined as “no caloric intake for at least eight hours.” Two-hour postprandial glucose (PG) above 200 mg/dL during an oral glucose tolerance test (OGTT). This test should be performed using a 75 gm glucose load. Symptoms of diabetes, plus random plasma glucose levels above 200 mg/dL. Classic symptoms include polyuria, polydipsia, and unexplained weight loss. The onset of gestational diabetes is usually without symptoms, so maternal screening during pregnancy is necessary for diagnosis and treatment. GDM is usually diagnosed between the 24th and 28th week of gestation, but high-risk individuals should be screened during the first trimester, preferably at the first pre-natal visit.

6. Medical Nutrition Therapy Nutritional counseling for optimal diabetes medical nutrition therapy (MNT) are: To achieve optimal metabolic outcomes (blood glucose, lipids, hypertension) To Modify nutrient intake to prevent and slow development of complications To Consider lifestyle, personal and cultural preferences and willingness to change To maintain the pleasure of eating by only limiting food choices when indicated by scientific evidence (Diabetes Care, 2006). Major interventions which are used to manage diabetes are: Meal planning to promote healthy eating, Physical activity Medication (if necessary) Self-monitoring of blood glucose Education Monitoring and evaluation is carried out by: Blood glucose, Lipid Profile& Blood pressure responses to therapy

7. A- Nutritional Therapy 1. Ensure appropriate macronutrient intake: Carbohydrate (CHO) : 50 to 55% kcal intake Protein : 20-25 % kcal intake Fat : 25-30% kcal intake CHO are an important dietary source of energy CHO is the main nutrient that affects postprandial glucose levels. 2. Controlling the CHO intake : controlling the total amount of CHO distribution of CHO over several meals and snacks type of CHO

8. 3. Add food with known Glycemic index (GI) Foods with a low GI (<55) produce a lower postmeal glucose elevation Foods with a high GI (>70) show higher postprandial glucose values. 4. Add ample Fiber source : Soluble (legumes, oats, fruits) & Insoluble (whole grain breads, cereals and some vegetables) Both results in increased satiety, slowing absorption time and lower glycemic index. 5. Carbohydrate Counting Works as follows: a dietitian determines a person’s dietary needs the individual is given a daily CHO allowance divided into a pattern of meals & snacks according to individual preferences the carbohydrate allowance can be expressed in grams or as the number of carbohydrate portions allowed per meals

9. Carbohydrate Counting is done by emphasis is given to spreading the dietary intake over six meals daily : General reduction in simple carbohydrates and fat intake is advisable 3 main meals 3 snacks meals Breakfast Snack1 Lunch Snack2 Dinner Snack3 CHO% 15% 10% 30% 10% 20% 15% 6. Minimize Fat intake as under: less than 10 % SFA, up to 10 % PUFA , the remainder derived from MUFA

10. B: PHYSICAL ACTIVITY/EXCERCISE Advantages: Maintain or improve cardiovascular fitness in order to prevent or minimize the long-term cardiovascular complications of diabetes. Improve flexibility, which decreases with aging because of changes in the elasticity of soft tissue. Improve muscle strength, which may deteriorate as a result of neuropathy. Allow persons with type 1 diabetes to safely participate in and enjoy physical and/or sport activities. Assist in weight control and management in persons with type 2 diabetes Allow persons with diabetes to experience the same benefits and enjoyment that those without diabetes gain from a regular exercise program.

11. Possible Risks: Hypoglycemia during or after exercise in persons taking insulin. Increased hyperglycemia in poorly controlled persons and under insulinized persons with pre-exercise blood glucose levels of 250 to 300 mg/dL. Myocardial infraction or arrhythmia in persons with diabetes who also have atherosclerotic cardiovacular disease, especially if exercise is not properly paced. Damage to soft tissue and joints, especially with peripheral neuropathy. Precautions: Receive a complete medical evaluation or medical clearance from a physician. Monitor blood glucose before and after exercise. Self-monitoring of blood glucose (SMBG) is important in deciding when to exercise as well as identifying potential hypoglycemia. Exercise may require a decrease in insulin dose. Ingest adequate fluids, use proper footwear, inspect feet after exercise, avoid exercise in extreme heat or cold, avoid exercise during periods of poor glucose control, carry identification and a source of carbohydrate (for persons taking insulin or oral diabetes agents).