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Diabetes MellitusChapter 20

11Objectives:Identify the nature of diabetesIdentify metabolic patterns of diabetesDescribe general management of diabetesDefine diet therapy based on the balance conceptDefine diet therapy based on exchange systemDescribe a diabetes education program22Key ConceptsDM is a metabolic disorder of glucose metabolism with many causes and forms

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

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

3Key ConceptsBlood glucose monitoring is a critical practice for blood glucose controlA personalized care plan, balancing food intake, exercise, and insulin regulation, is essential to successful diabetes management

4DefinitionA group of metabolic diseases characterized by hyperglycemia resulting from defects in insulin secretion, insulin action, or both.

5Nature of DiabetesFor glucose to be used by the cells in the body, it first has to be taken out of the blood and transported to the cells.For this to happen, the hormone insulin- has to be presentWithout insulin, glucose accumulates in the blood stream66Classification of Diabetes Mellitus And Glucose IntoleranceTYPE 1 DMPreviously called insulin-dependent or juvenile diabetesSevere, unstable formCaused by autoimmune destruction of the beta cells in the pancreatic cellsCan occur at any age usually before 30Requires exogenous insulin77Classification of Diabetes Mellitus And Glucose IntoleranceTYPE 2 DMPreviously called adult-onset or non-insulin-dependent diabetesInitial onset usually after age 40Now being diagnosed in childrenStrong genetic link

88Classification of Diabetes Mellitus And Glucose IntoleranceType II: Prevalent in older, obese peopleUsually treated with diet, exercise, sometimes oral hypoglycemic medication

Classification of Diabetes Mellitus And Glucose IntoleranceTYPE 2 DM cont.Caused by insulin resistance or defectThe body is either not producing enough insulin or the insulin it is producing cannot be used.1011

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15Risk Factors for Type 2 DMFamily history of diabetesAge 45 years or olderOverweightNot physically activeRace/ethnicity (African American, Hispanic American, Native American, Asian American, Pacific Islander)

1616Risk Factors for Type 2 DMHistory of gestational diabetesWoman who has delivered infant weighing more than 9 poundsIdentified impaired glucose tolerance

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18Gestational DiabetesTemporary form of disease occurring in pregnancyPresents complications for mother and fetus/infant including macrosomia i.e. abnormally large infantScreening for GDM at 24-28 wks. GestationOral glucose tolerance test (OGTT)Must be carefully monitored and controlled

1919Other Types of Diabetes(Secondary)CausesGenetic defect in the beta-cells of the pancreas or insulin actionPancreatic conditions or disease Endocrinopathiesimbalance with other hormones in the body Eg. Cushings SyndromeDrug/toxin- or chemical-induced DM impair insulin secretion or action2020Impaired Glucose Tolerance(IGT)Above normal fasting blood glucose but not high enough to be diabetes (= or >110mg/dl and