Type 2 Diabetes Mellitus

1
Medications used for control of Diabetes, contd
Oral Hypoglycemic Agents (OHAS)

• Taken by mouth (not the same as insulin)
• Types sulfonylurea and metformin drugs
• Action Increase use and effectiveness of insulin
  present in blood
• Enhance insulin production by pancreas

2
Other Management Methods

• Training in self-management
• Home testing of blood glucose level
• Individualized treatment addressing medical,
  psychosocial, and lifestyle issues

3
Does Insurance pay for Diabetes Education?
Insurance

• Findings of the Diabetes Control and Complication
  Trial (DCCT) and subsequent effort of American
  Diabetes Association and American Dietetic
  Association, federal legislation passed covering
  medical nutrition therapy for diabetes
  (reimbursed by Medicare and Medicaid)
• As of July 1998, services of Certified Diabetes
  Educators (CDE) or Registered Dietitians (RD)
  covered in medical treatment of diabetes

4
Effective management of Type 2 Diabetes includes

• Control of food intake
• Increased physical activity
• Use of oral medication and/or
  insulin in some cases
• Weight loss and maintenance of weight at a
  reasonable level - A mild to moderate weight loss
  of 10 to 20 pounds has been shown to improve
  diabetes control

5
National Diabetes Education Program (NDEP)
Initiated in 1997 by NIH and CDCP
4 Objectives Are To
Increase public awareness of diabetes and risk
factors and educate public and professionals on
strategies for prevention of complications
Improve understanding of diabetes and its control
and promote self-management
Improve health care professionals understanding
of diabetes and its control and promote an
integrated (team) approach
Promote health care policies that improve quality
and access to diabetes care
6
Recommended Eating Patterns for those with Type 2
Diabetes
Maintenance of near-normal blood glucose levels
and optimal blood lipid levels Normal fasting
blood glucose level 70 mg/dl to 115
mg/dl Normal glucose levels may rise to 180
mg/dl after consumption of food or sugar solution.
7
Recommended Eating Patterns for those with Type 2
Diabetes (contd)
Adequate calorie intake to maintain or attain
reasonable weight - defined as a weight that is
achievable and maintainable, both in short-term
and long-term.
Prevention and treatment of acute problems and
long-term complications of diabetes
Improvement of overall health through optimal
nutrition
8
Recommended Levels/Ratios of various food
components

• Protein 10 to 20 of calories. Lower level
  recommended if there is evidence of kidney
  (renal) disease.
• Fat 30 of calories or less. If person has a
  problem with elevated blood lipids, recommended
  level may be as low as 20 or 25 of calories

Example 7 saturated fat 10 polyunsaturated
fat 13 as monounsaturated fat
9
Carbohydrates and sweeteners

• Carbohydrates include starches, sugars, syrups
  and sweeteners.
• Glycemic effect of food foods containing sugars
  and syrups may not raise blood sugar levels any
  more than some other carbohydrate foods.

Sweet intake Moderate intake considered
acceptable for those with diabetes.
10
Carbohydrates and sweeteners, contd
Other sugars

• There seems to be little proven value of
  substituting sugars such as fructose or honey for
  sucrose.
• Sweeteners such as sorbitol, mannitol, xylitol
  have less effect on blood sugar, but cause
  diarrhea.
• Total amount of carbohydrates is more important
  than source.
  Recommended that Carbohydrates
  Fats 75 of total calories

Non-caloric sweeteners approved by FDA are
considered safe for people with diabetes.
11
Fiber
Recommended level is 20- 35 g per day
Sodium
No more than 3,000 mg/day for those without high
blood pressure. For those with
mild to moderate high blood pressure, 2,400 mg
sodium per day or less is generally recommended.
12
Alcohol
Same precautions as for others (as in Dietary
Guidelines for Americans)
If you drink alcoholic beverages, do so in
moderation

• 2 drinks or less/daily of alcoholic beverages
  will normally not cause a problem.
• 1 alcoholic beverage 12 oz beer, 5 oz wine, 1
  1/2 oz liquor, gin, etc.
• Count alcohol similar to fat 1 alcoholic
  beverage 2 fat exchanges.

13
Vitamins Minerals

• Vitamin and mineral needs can be met by a
  balanced food intake (e.g. Food Guide Pyramid)
• Vitamin and mineral supplements not necessarily
  recommended.
• Increasing evidence supports supplementation with
  antioxidants.
• Chromium supplementation not currently
  recommended.

14
Vitamins Minerals, contd

• Adequate intakes of calcium, magnesium, and
  potassium needed for control of blood pressure
  and other functions.
• Adequate intakes of low-fat milk products, fruits
  and vegetables are especially important.

15
Eating Guides for those with Diabetes
Recommended guides/methods

• Food Guide Pyramid (especially for borderline
  diabetics and those with Type 2 Diabetes not on
  insulin)
• Dietary Guidelines for Americans (principles are
  generally incorporated in all types of eating
  plans)
• Carbohydrate Counting Careful attention to total
  carbohydrate quantity and distribution during
  day.
• Individualized eating plans designed by
  Registered Dietitians and Certified Diabetes
  Educators.

16
Situational Obstacles to Dietary Adherence
Negative emotions
Strong temptation (such as being near large
amounts of food or being offered food by others)
Time pressures
Eating Out
Feeling deprived
Social events involving food
Having competing priorities
Lack of family support
Food refusal (food rejection or aversions, such
as in children)
Friends Lack of support of patients dietary
goals
17
Recommended Lifestyle Practices for those with
Type 2 Diabetes

• Control psychological stress
• See a doctor for regular checkups
• Follow doctors recommendations on medications
• Take steps to control high blood pressure
• Participate in Physical Activity
  Exercise increases the muscle cells ability to
  take up the insulin that is present in the blood

18
Recommended Physical Activity (in absence of
contraindications)

• 30 minutes per day of moderately vigorous aerobic
  exercise, on most days of the week, but at least
  every other day.
• Can be done in three 10 - minute sessions or two
  15 - minute sessions.
• Weight resistance training has
  beneficial effects, if done properly.

19
Issues and Recommendations for PAs Work with
Limited-Resource and Elderly Clients with Type 2
Diabetes

• Limited-resource and elderly individuals often
• Cannot afford recommended food.
• Lack transportation to grocery store, or to
  doctor or dietitian.
• Misunderstand doctors recommendations.
• Have difficulty translating dietary
  recommendations into actual foods at the grocery
  store or in cooking.

Elderly may have limited mobility, hearing loss,
chewing difficulty, and problems brought on by
multiple diseases/conditions.