Ketogenic Diet & Diabetes Management · •The ketogenic diet can be used for weight loss and...
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GOING KETO? ANTHC Diabetes Program February 2020 [email protected] https://www.surveymonkey.com/r/KETOHarper
Transcript of Ketogenic Diet & Diabetes Management · •The ketogenic diet can be used for weight loss and...
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GOING KETO?
ANTHC Diabetes Program
February 2020
https://www.surveymonkey.com/r/KETOHarper
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OBJECTIVES
1) Define Ketosis and the Ketogenic Diet
2) Discuss the ketogenic diet efficacy for weight loss and blood sugar control
3) Discuss therapeutic considerations for people maintaining a ketogenic diet
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PRETEST
Where do we make ketones?
a) The brain
b) The kidneys
c) The pancreas
d) The liver
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PRETEST
What organ can’t use ketones for fuel?
a) Heart
b) Kidney
c) Liver
d) Brain
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PRETEST
How long does it take to deplete glycogen stores?
a) 2 hours
b) 12 hours
c) 2 days
d) 2 weeks
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Insulin!
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Gluconeogenesis
& Glycogenolysis!
Glucagon!
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Gluconeogenesis
& Glycogenolysis!
Glucagon!
Ketosis!
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How to Deplete Glycogen Stores
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DEPLETE GLYCOGEN STORES
Muscle glycogen = 400g x ~4 kcal/g glycogen
= 1,600kcal
^can only be used by muscle
Liver glycogen = 100g x ~4 kcal/g glycogen
= 400 kcal available to burn
1)
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DEPLETE GLYCOGEN STORES
2) Muscle glycogen = 400g x ~4 kcal/g glycogen
= 1,600kcal
^can only be used by muscle
Liver glycogen = 100g x ~4 kcal/g glycogen
= 400 kcal available to burn
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DEPLETE GLYCOGEN STORES
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Ketone Bodies:
acetone, acetoacetate, and beta-hydroxybutyrate (BHB).
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Ketone Bodies:
acetone, acetoacetate, and beta-hydroxybutyrate (BHB).
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EPILEPSY
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KETOGENIC DIET EFFICACY
•Epilepsy
•Brain Tumor/cancer
•Alzheimer’s Disease
•Parkinson’s Disease
•Traumatic Brain Injury
•Mitochondrial Disease
•Autism
•ALS
•Brain Health
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WEIGHT MANAGEMENT?
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Comparison of Weight Loss Among Named Diet Programs in Overweight and Obese
Adults A Meta-analysis. JAMA 312(9):923-33 · September 2014. Johnston et. al.
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EFFECTIVENESS AND SAFETY OF A NOVEL CARE MODEL FOR THE MANAGEMENT OF TYPE 2 DIABETES AT 1 YEAR: AN OPEN-LABEL, NON-RANDOMIZED, CONTROLLED STUDY
N=349; people with type II diabetes; on DM medication
Continuous Care Intervention
(n=218)
Baseline, Day 70, 12 months
A1c, body weight, medications prescribed
Usual Care
(n=87)
Baseline, Day 70, 12 months
A1c, body weight, medications prescribed
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BODY WEIGHT
-13.8 +/- 0.71%
-1.11 +/- 1.06%
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A1C
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DIABETES MEDICATIONS
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DIABETES MEDICATIONS
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DIABETES MEDICATIONS
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KETOSIS?
mg/dL
20
16
11
8
4
0
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KETOGENIC DIET & DIABETES MANAGEMENT
“There is not a ‘one size fits all’ eating
plan for people with diabetes”
“A variety of eating patterns are
acceptable for the management of
diabetes.”
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Usual Dietary Recall
B – oatmeal, fruit, milk; coffee with cream and sugar
L – sandwich and soup; 12 ounces of orange juice
D – meat, rice, vegetable
Sn – popcorn
Beverages – coffee, 20 ounce Gatorade, orange juice
Planning to go keto for weight loss, on no medications for blood sugar or weight loss
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Has diabetes with an A1c of 7.9%
Takes Lantus 20u nightly
Metformin 500mg 4 tabs qam
Glipizide 5mg BID for blood sugar control
Usual diet
B – breakfast sandwich and fruit
Sn – trail mix
D – Stir fry OR tacos OR spaghetti
Beverages – water or black coffee
Plans to ‘go keto’ and just got a job working with heavy machinery
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PATTY
Current Meds:
Tresiba 62u daily
Novolog 4-30u with meals
Metformin 2000mg daily
Actos 30mg daily
A1c 12.4% (7/27/2018)
POC A1c 10.4% (11/8/2018)
Weight: 117.3kg
BMI: 39.65kg/m2
Plans to add Victoza today for bg control
Wants to go keto.
52yo female
seen 11/2018
Type II Diabetes
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PATTY
Current Meds:
Tresiba 62u daily
Novolog 4-30u with meals
Metformin 2000mg daily
Actos 30mg daily
A1c 12.4% (7/27/2018)
POC A1c 10.4% (11/8/2018)
Weight: 117.3kg
BMI: 39.65kg/m2
Plans to add Victoza today for bg control
Wants to go keto.
52yo female
seen 11/2018
Type II Diabetes
1:5gCHO,
education:
carbohydrate
counting
education – high fat
diets, slow GI emptying
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PATTY
Current Meds:
Tresiba 62u daily
Novolog 4-30u with meals
Metformin 2000mg daily
Actos 30mg daily
A1c 12.4% (7/27/2018)
POC A1c 10.4% (11/8/2018)
Weight: 117.3kg
BMI: 39.65kg/m2
Plans to add Victoza today for bg control
Wants to go keto.
A1c 8.1% (1/22/2019)
115.9kg
39.18kg/m2 (1/22/19)
20u TIDAC
(1/22/2019)
52yo female
seen 11/2018
Type II Diabetes
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TAKE HOME POINTS
•Consider use of dietary recall to assess actual intake
•The ketogenic diet can be used for weight loss and diabetes management, may be similar to other weight loss diets, but more long term research is needed
•When utilizing the ketogenic diet, it is important to have frequent contact with a health care team for nutrition and medication management
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POSTTEST
Where do we make ketones?
a) The brain
b) The kidneys
c) The pancreas
d) The liver
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POSTTEST
Where do we make ketones?
a) The brain
b) The kidneys
c) The pancreas
d) The liver
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POSTTEST
What organ can’t use ketones exclusively for fuel?
a) Heart
b) Kidney
c) Liver
d) Brain
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POSTTEST
What organ can’t use ketones for fuel?
a) Heart
b) Kidney
c) Liver
d) Brain
Greatist.com
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POSTTEST
How long does it take to deplete glycogen stores?
a) 2 hours
b) 12 hours
c) 2 days
d) 2 weeks
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POSTTEST
How long does it take to deplete glycogen stores?
a) 2 hours
b) 12 hours
c) 2 days
d) 2 weeks
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GOING KETO?
ANTHC Diabetes Program
February 2020
https://www.surveymonkey.com/r/KETOHarper
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DEPLETE GLYCOGEN STORES
