Transcript Diabetes and Nutrition

Joyce B. Patterson, MPH, RDN, BC-ADM
University of Michigan Adult Diabetes Education Program
Objectives
 Identify risk factors for insulin resistance and describe the
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progression from prediabetes to type 2 diabetes
Describe The Plate Method, Carbohydrate Counting, and
portion control and know when to use which approach
Briefly review various drug classifications and their
mechanisms of action
Describe the treatment and prevention of hypoglycemia
and identify which patients are most at risk
Discuss physical activity recommendations
List strategies for preventing Type 2 Diabetes and locate
Diabetes Prevent Programs in your area.
The ADA Standards
 Classification/Diagnosis
 Care Management
 MNT
 Pharmacotherapy
 Complications and Risk
Reduction
 Special populations
 Diabetes Ed/Support
 Prevention
 And more!
Available online
National Standards for DSME/S
 Designed to define quality DSME and support and to assist diabetes
educators in providing evidence-based education and selfmanagement support.
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Internal Structure
External Input from stakeholders and experts
Access
Program Coordination
Instructional Staff (multidisciplinary approach)
Written curriculum reflecting current guidelines
Individualization
Ongoing Support
Patient Progress
Quality Improvement, systematic review of process and outcomes
Diabetes Care, Volume 37, Supplement 1, January 2014
Risk factors for Pre-DM/T2DM
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Age
CVD or Family History of CVD
Overweight/obese
Sedentary Lifestyle
Poor diet
Ethnicity (Asian/Pacific Islander, African American, Native
American, Hispanic)
Low HDL and/or high trigs
History of IGT, PCOS, Metabolic Syndrome, GDM
Some medications (antipsychotics, glucocorticoids)
Sleep disorders (OSA, night-shift workers)
The Plate Method, Carbohydrate Counting, Portion Control,
Balanced Meal Planning
Explain Carbohydrate Metabolism
and Insulin Resistance
“Oh, now it makes
sense! Nobody ever
explained that to me
before.”
http://youtu.be/m6rHYc0X0jw
How many carbs should I eat?
 About half of total calories from carbs
 In a 1400 calorie diet, that is about 50-75g
Carbs PER meal. (if 3 meals per day)
 In a 2000 calorie diet it’s more like 60g-100g
of CHO 3-4x/day, potentially.
 Or about 30g CHO 6x/day or 40g CHO
6x/day.
1400 calories x 50% = 700 calories
700/4 calories per gram = 175g per day
Carb Counting with insulin therapy
http://www.med.umich.edu/pdf/Diabetes-101-Taking-Charge.pdf
Carb Counting with insulin therapy
Carb Counting with insulin therapy
Blood sugar and food
 After eating carbohydrates alone, peak
blood sugar occurs about an hour later.
Blood Sugar
 Fat slows down this curve, causing blood
sugar to peak 1.5-4 hours later.
Time
For T2DM without insulin
 Teach The Plate Method
 Recommend portion
control and healthy food
choices
 Emphasize balanced meal
planning
 Discuss eating patterns,
e.g. The Mediterranean
Diet
http://www.diabetes.org/food-and-fitness/food/planning-meals/create-your-plate/
Discuss Timing of Meals and Snacks
Blood Sugar
Snack Mountain
Time meals and snacks
approximately 3-4 hours apart.
breakfas snack lunch
snack dinner
snack
Drug classifications, Mechanisms of Action
Explain their medications
Algorithm for
Progression of DM
Treatment
Standards of Medical
Care in Diabetes – 2016
p. S54
Explain their medications
Drug classifications,
mechanisms of action,
advantages and
disadvantages
Standards of Medical
Care in Diabetes – 2016
pp. S55-56
Insulin Action Times
Insulin Regimens
 Basal only, sometimes combined with oral medications
 Basal/Bolus
 Set doses
 Sliding Scale
 Carb Ratios
 Pump Therapy
Lots of variation, individualization, and patient/doctor
preferences!
Insulin pump
 What does it do?
 Delivers continuous (basal) insulin via small catheter placed
into fatty tissue.
 Delivers bolus (meal or correction) insulin by a button push.
 Can be more convenient
 What doesn’t it do?
 It does not monitor your blood sugar.
 It does not “sense” when you have eaten
 It is NOT an external pancreas.
 It is not for everyone
 Risks involved?
 DKA
CGMS: Continuous Glucose Monitors and
Vgo insulin delivery device
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CGMS: What is it? How does it work? How does it
help our patients?
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Vgo Insulin delivery device: It’s new, who should
think about it?
Breaking News!
 Automatically
adjusts the
delivery of your
basal insulin
Inhaled insulin
 Afrezza
 Limited dosing options
 Not for use in patients
with asthma or other
respiratory conditions, or
smokers or recent exsmokers.
Treatment and Prevention
Why Hypoglycemia?
Remember, it depends on the medication regimen.
 Too much insulin
 Exercise/physical activity within last 24 hours up to
48 hours – may need to reduce insulin with increased
exercise
 Inconsistent meal times
 Skipping meals
 Skipping carbs at meals
 Taking oral medications incorrectly
 Recent dietary changes
 Alcohol consumption
Some symptoms of hypoglycemia
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Sweaty
Shaky
Nervous
Grouchy
Hungry
Tired
Mouth sensations
Tearful
 Slurred
speech
 Stumbling
 Headache
 Unable to complete
simple tasks (easy math)
 Difficulty with recall
 Giggly
How to treat hypoglycemia?
 Rule of 15: Check BG
 Consume 15g of simple carbs
 3-4 glucose tabs
 4oz juice or ½ can regular pop
 Sugary candies like jellybeans (not Snickers
bar, remember the curve!)
 RE-check BG after 15 minutes, if not
>70mg/dL, repeat.
Protein stimulates insulin
release
 Do not use protein to treat hypoglycemia or
prevent recurrence
 Follow treatment with balanced meal or
snack that includes CHO and healthy fat
(e.g. fruit and nuts)
Helps to lower blood sugar and improve insulin sensitivity.
Physical Activity Guidelines
 At least 150 min/week of moderate-intensity aerobic
physical activity (50–70% of maximum heart rate)
 Reduce sedentary time, particularly by breaking up
extended amounts of time (90 min) spent sitting.
 Resistance training at least twice per week.
Locate a Diabetes Prevention Program in Your Area
Strategies to Prevent T2DM
 5-10% weight loss
 At least 150 minutes of physical activity each week
 Healthy food choices
 Participation in intensive lifestyle change programs
Intensive Lifestyle Change
Programs
 The CDC-led Diabetes Prevention Program was designed
for patients with prediabetes
 Completers reduced their risk for developing T2DM by
58%
 The 1-year program emphasizes weight loss through
healthy eating, physical activity, and stress management
 16 weekly sessions followed by bi-weekly and monthly
sessions
Video: https://www.youtube.com/watch?v=XxFpUYli2Vc
CDC Info and Curriculum:
http://www.cdc.gov/diabetes/prevention/index.html
Medicare and the DPP
 In 2016, Medicare announced expansion of coverage to
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include DPP
The benefit will be available January 2018.
DPP providers must have CDC recognition to
participate in the Medicare program
Learn more about Medicare and DPP at
https://innovation.cms.gov/initiatives/medicarediabetes-prevention-program/
Learn more about developing a DPP program at
https://www.cdc.gov/diabetes/prevention/index.html
SE Michigan DPP locations
 http://bit.ly/SEMDPPmap
 http://bit.ly/SEMDPPlist
 https://nccd.cdc.gov/DDT_
DPRP/Programs.aspx
 Search by State and City
Other References
 AACE/ACE Clinical Practice Guidelines for Developing
a Diabetes Mellitus Comprehensive Care Plan –2015
 The Art & Science of Diabetes Self-Management
Education Desk Reference, 3rd Edition, AADE
 American Diabetes Association, diabetes.org
Thank You!
Joyce B. Patterson, MPH, RDN, BC-ADM
University of Michigan Diabetes Education Program
[email protected]