MANAGING DIABETES Cassie Alvarado, MS Dietetic Intern, CSULB 2nd Floor DGC – September 16, 2011

OBJECTIVES

  Clients who attend the session will be able to define diabetes.

  Clients who attend the

session will be able to identify 3 signs or symptoms of diabetes.

  Clients who attend the

session will be able to describe 2 methods for managing diabetes.

WHAT IS DIABETES?3

American Diabetes Association definition:

  “A group of diseases characterized by high blood glucose levels that result from defects in the body's ability to produce and/or use insulin.”

WHAT IS INSULIN?1

  Regulates/controls blood glucose   Pancreas produces insulin hormone   If the pancreas makes too little or no insulin,

the food you eat cannot be turned into energy in the body.

TYPES OF DIABETES1, 3

 Type I – Insulin Dependent   Pancreas is damaged and cannot make

insulin   Need to get insulin from shots or a pump

everyday

 Type II   Pancreas can make some insulin, but not

enough for what your body needs OR

  Body ignores pancreas

 Gestational – During Pregnancy

BLOOD GLUCOSE LEVELS

 Fasting ranges are as follows:   Normal

 70-100 mg/dL

  Pre-Diabetes  100-125mg/dL

  Diabetes  Equal to or over 126mg/dl

RISK FACTORS1

 Sedentary lifestyle   Not physically active

 Family history  Overweight/Obese  Cultural/Ethnic Groups

  American Indians   Alaska Natives   African Americans   Hispanics/Latinos   Asian Americans   Pacific Islanders

HIV AND DIABETES5

 Immune Recovery   The body destroys some of the

insulin creating cells in the pancreas when CD4 cells increase

DIABETES AND HIV6

 One study found that the whole body inflammation occurring in some patients using ART may add to the possibility of getting diabetes.

HIV MEDICATIONS AND DIABETES

 Certain protease inhibitors (PIs) can make your body not use it’s own insulin correctly.  Crixivan  Kaletra  Norvir

 Certain nucleoside reverse transcriptase inhibitors (NRTIs) have effects on how your body breaks down glucose.   Combivir, Retrovir   Zerit

SIGNS/SYMPTOMS3

COMPLICATIONS OF DIABETES – WHY CONTROLLING IT IS IMPORTANT3

 Heart Disease and Stroke   Risk of death due to heart

disease and risk of stroke are 2-4 times more likely in people with diabetes

 High Blood Pressure   In 2008, 67% of people with

diabetes had blood pressure over 140/90 mmHg

COMPLICATIONS OF DIABETES – WHY CONTROLLING IT IS IMPORTANT3

 Blindness   Diabetes is the leading

cause in new cases of blindness

 Kidney Disease   Diabetes is the leading

cause of kidney failure, making up 44% of the cases.

 Neuropathy   60-70% of people with

diabetes have some sort of nerve damage.

MANAGING DIABETES

OPTIONS FOR MANAGING DIABETES1

 Option #1 – Exercise

TYPES OF EXERCISE

  Riding your bike   Walking   Swimming   Dancing   Gardening   Running   Just move your body!

OPTIONS FOR MANAGING DIABETES1

 Option #2 – Medication

(Checking your blood

glucose is important.)

OPTIONS FOR MANAGING DIABETES1

 Option #3 – Diet   My Plate   Carb Counting *We will focus on this

option for today*

Foods to limit:   White bread   Pasta   Rice   Low-fiber cereals   Baked goods   Starchy foods – Potatoes

Foods to emphasize:   Fruits   Vegetables   Whole and minimally processed grains   Legumes

FOOD SOURCES2

Diabetics do not need special foods… in fact, you are eating foods that are healthy for everyone.

 Whole grains  Non-fat or low-fat milk  Fresh fruits  Vegetables  Lean proteins

MY PLATE  Half of your plate should be

protein and grains, half of your plate fruits and vegetables

 Focus on the veggies for diabetics

MIX IT UP!

 Variety is key for not getting bored with the same foods…get creative!

COUNTING CARBOHYDRATES2

 Keeping track of carbohydrates   Starches (grains, beans, starchy vegetables)   Fruit and fruit juice   Milk and yogurt

 One serving of these foods will equal one “carb serving” or “exchange” which is 15g of carbohydrates.

 Easy way to keep track…

PORTION SIZE

 Portioning your food is necessary when you are trying to keep track of calories and how much food you are eating.

PORTION SIZES – USDA4

The Bread, Cereal, Rice, and Pasta Group

  1 pancake is a compact disc (CD)

 ½ cooked cup rice, pasta is a cupcake wrapper full or a rounded handful

  1 slice of bread is an audiocassette tape

  1 roll is a bar of soap

PORTION SIZES – USDA4

The Vegetable Group   1 cup green salad is a fist

or a tennis ball   1 baked potato is a fist or

a tennis ball  ½ cup cooked broccoli is a

scoop of ice cream or a light bulb

PORTION SIZES – USDA4

The Fruit Group  ½ cup of fresh fruit is 7 cotton balls   1 medium size fruit is a fist or a tennis ball   1 cup of cut-up fruit is a fist or a tennis ball  ¼ cup raisins is a large egg or a golf ball

PORTION SIZES – USDA4

The Milk, Yogurt, and Cheese Group

  1½ ounces cheese is a 9-volt battery or your index and middle fingers

  1 ounce of cheese is a pair of dice or your thumb

  1 cup of ice cream is a large scoop the size of a tennis ball

PORTION SIZES – USDA4

The Meat, Poultry, Fish, Dry Beans, Eggs, and Nuts Group

  2 tablespoons peanut butter is a Ping-Pong ball   3 ounces cooked meat, fish, poultry is a palm, a

deck of cards or a cassette tape   3 ounces grilled/baked fish is a checkbook   1 cup cooked dried beans is a fist or a tennis ball

PORTION SIZES – USDA4

Fats, Oils and Sweets   1 teaspoon butter, margarine is the size of a stamp

the thickness of your finger   2 tablespoons salad dressing is a Ping-Pong ball   1 ounce of chocolate is one package of dental floss   1 ounce of small candies is one handful   1 ounce of chips or pretzels is two

handfuls

CLOSING TIPS FOR MANAGING DIABETES2

 Exercise!

 Snack throughout the day  Make all meals complete  Choose diet sodas, calorie-free

drinks, or water instead of sugary drinks

REFERENCES 1.  National Diabetes Education Program. What is Diabetes? US

Department of Health and Human Services, 2009. Retrieved from: http://ndep.nih.gov/media/Youth_Tips_Diabetes.pdf

2.  Eating Well with Diabetes and Carbohydrate Basics Handout. The Permanente Medical Group, 2006.

3.  American Diabetes Association. Diabetes Basics. 2011. Retrieved from: http://www.diabetes.org/diabetes-basics/symptoms/

4.  USDA. What is a Serving Size? Retrieved from: www.fns.usda.gov/tn/healthy/portions_kit/serving_size.pdf

5.  Takarabe, D., Rokukawa, Y., Takahashi, Y., Goto, A., Takaichi, M., et al. Autoimmune diabetes in HIV-infected patients on highly active antiretroviral therapy. The Journal of Clinical Endocrinology & Metabolism, 2010;95(8):4056-4060.

6.  Brown, T., Tasiopoulos, K., Bosch, R., Shikuma, C., McComsey, G. Association between systemic inflammation and indicent diabetes in HIV-infected patients after initiation of antiretroviral therapy. American Diabetes Association - Diabetes Care, 2010;33(10):2244-2249.