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1. ADVANCED DIETETICS
PREPARED FOR YEAR 2&3
PREPARED BY MR. HABIIB WAHAB

2. DIABETES MELLITUS
Diabetes mellitus is a metabolic
disorder of glucose metabolism with
many causes and forms.

3. About Diabetes
 20.8 million Americans have diabetes (7%
of the population).
 54 million Americans have prediabetes.
 Diabetes is the seventh leading cause of
death from disease in the United States.

4. Continuation…
 People with diabetes either do not
produce insulin or cannot effectively use
it.
 Diabetes is characterized by
hyperglycemia.

5. Type 1 Diabetes Mellitus
 Accounts for 5% to 10% of cases
 Previously called insulin-dependent or juvenile-
onset diabetes
 Severe, unstable form
 Caused by autoimmune destruction of
pancreatic cells
 Can occur at any age
 Requires exogenous insulin

6. Type 2 Diabetes Mellitus
 Accounts for 90% to 95% of cases
 Previously called adult-onset or
non–insulin-dependent diabetes
 Initial onset usually after age 40 years
 Now being diagnosed in children
 Strong genetic link
 Prevalent in older, obese people
 Caused by insulin resistance or defect
 Usually treated with diet, exercise

7. Risk Factors for Type 2 Diabetes
Mellitus
 Family history of diabetes
 Age 45 years or older
 Overweight
 Not physically active
 Race/ethnicity (African American, Hispanic American, Native
American, Asian American, Pacific Islander)
 History of gestational diabetes
 Woman who has delivered infant weighing more than 9 pounds
 Identified impaired glucose tolerance

8. Gestational Diabetes
 Temporary form of disease occurring in
pregnancy
 Presents complications for mother and
fetus/infant
 Must be carefully monitored and
controlled

9. Symptoms of Diabetes
 Initial signs
Increased thirst
Increased urination
Increased hunger
Unusual weight loss (type 1)
Unusual weight gain (type 2)

10. Continuation…
 Laboratory test results
 Glycosuria (sugar in urine)
 Hyperglycemia (elevated blood sugar)
 Abnormal glucose tolerance tests
 Progressive results
 Water, electrolyte imbalance
 Ketoacidosis
 Coma

11. Metabolic Patterns of Diabetes
 Diabetes is especially related to metabolism of carbohydrate
and fat.
 It is important to control blood glucose within normal levels
of 70 to 110 mg/dl.
 If diabetes is uncontrolled and insulin is lacking:
 Glucose cannot enter the cells and builds up in the blood.
 Fat tissue breaks down.
 Protein breaks down, causing weight loss and nitrogen
loss.

12. Continuation…
Three basic stages of normal glucose
metabolism:
Initial interchange with glycogen and
reduction to smaller central compound
Joining with fat and protein
Common energy production

13.  Normal blood glucose balance
 Sources of glucose include glycogen, carbohydrate, fat, and
protein
 Uses:
Burned for energy needs
Changed to glycogen
Stimulate lipogenesis
Inhibit tissue fat breakdown
Promote amino acid uptake

14. Pancreatic Hormonal Control: Three
Key Hormones
Islets of Langerhans produce:
Insulin
Glucagon

16. Insulin
 Controls blood sugar
 Helps transport glucose into cells
 Helps change glucose to glycogen and store it in liver,
muscles
 Stimulates changes of glucose to fat for storage as body fat
 Inhibits breakdown of tissue fat and protein
 Promotes uptake of amino acids
 Influences burning of glucose for energy

17. Glucagon
Acts in a manner opposite to insulin
Breaks down stored glycogen and
fat
Raises blood glucose as needed to
protect brain during sleep or fasting

18. Long-Term Complications of Diabetes
 Retinopathy (diseases of retina which results in impairment or loss of vision)
 Nephropathy (kidney disease caused by diabetes)
 Neuropathy (damage or dysfunction of one or more nerves that may lead
to muscle pain)
 Heart disease
 Dyslipidemia(elevated LDL or bad cholesterol) makes up most of body's
cholesterol. High levels of low density lipoprotein (LDL) raise risk for heart
disease and stroke.
 Hypertension: condition characterized by high blood pressure.

19. Key concepts in management of
Diabetes Mellitus
 A consistent, sound diet is the keystone of diabetes
care and control.
 Daily self-care skills enable a person with diabetes to
remain healthy and reduce risks for complications.
 Blood glucose monitoring is a critical practice for
blood glucose control.
 A personalized care plan balancing food intake,
exercise, and insulin regulation is essential to
successful diabetes management.

20. COMPONENTS OF DIABETES MELLITUS
TREATMENT
The major components of the treatment of
diabetes are:
 Diet and Exercise
 Oral hypoglycemic therapy/oral anti diabetic
agents
 Insulin Therapy

21. Diet
 Diet is a basic part of management in every case.
 Dietary treatment should aim at:
• Ensuring weight control
• Providing nutritional requirements
• Allowing good glycaemia control with blood glucose
levels as close to normal as possible

22. DAILY FOOD PYRAMID

23. Recommended dietary guidelines for
people with diabetes:
The following principles are recommended as dietary guidelines for
people with diabetes:
 Dietary fat should provide 25-35% of total intake of calories but
saturated fat intake should not exceed 10% of total energy.
 Cholesterol consumption should be restricted and limited to 300 mg
or less daily
 Protein intake can range between 10-15% total energy (0.8-1 g/kg
of desirable body weight).
 Excessive salt intake is to be avoided. It should be particularly
restricted in people with hypertension and those with nephropathy.

24. Exercise
The following are some of the advantages that comes with
regular exercising;
 Physical activity promotes weight reduction and improves
insulin sensitivity, thus lowering blood glucose levels.
 Exercising also helps to provide physical fitness and
carbohydrate metabolism.
 It also helps reduce the risk factors for cardiovascular
diseases.
 Exercise also helps lower cardiac work and blood pressure.

25. Considerations during exercise
 Use proper footwear (shoes) during exercise
 Avoid exercise in extreme temperature
 Inspect your feet daily.
 Avoid exercise in periods of poor metabolic control
example when sick or not feeling well.
 Don’t exercise on an empty or full stomach.

26. Oral hypoglycemic therapy/oral anti
diabetic agents.
There are three functional types of Oral anti diabetic agents and
these are;
 Those that target insulin secretion; example sulphonylureas
which increase insulin secretion by pancreatic beta cells.
 Those that target insulin resistance; for example Biguanides
which inhibits glucose production by the liver and thus does not
produce weight gain, useful in obese clients.
 Those that target glucose absorption from the intestine;
example we have Alpha glucosidase inhibitors which Inhibit
carbohydrate absorption in the small intestine.

27. INSULIN THERAPY
This is especially used in the
treatment of type 1 diabetes and in
acute cases of type 2 diabetes
mellitus.

30. ASSIGNMENT/COURSE WORK
Read and make brief notes on the following Blood Sugar Test Methods.
 Fasting blood sugar test
 Post prandial blood sugar test
 HBAIC test
Instructions:
 Use font size of 12 and font style of New Times Roman.
 Please make sure your work is Justified
 Use line spacing of 1.5
 Use resources from the University Library and or the Internet