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HAPPY MONDAY

DIABETES • Diabetes mellitus (DM) is a group of diseases characterized by high levels of blood glucose resulting from defects in insulin

production, insulin action, or both.

• When you eat, your body breaks food down into glucose. Glucose is a type of sugar that is your body’s main source of energy.

HOW DOES IT WORK?

As blood glucose rises, the body sends a signal to the pancreas, which releases insulin.

Insulin is a hormone. It makes our body's cells absorb glucose from the blood.

• Acting as a key, insulin binds to a place on the cell wall (an insulin receptor), unlocking the cell so glucose can pass into it. There, most of the glucose is used for energy right away.

• Blood glucose goes up and down throughout the day:

• As your blood glucose rises (after a meal), the pancreas releases insulin.

• Your pancreas may not produce enough insulin (insulin deficiency).

• Your cells don’t use insulin properly. The insulin can’t fully “unlock” the cells to allow glucose to enter (insulin resistance).

TYPES OF DIABETES• Type 1 Diabetes Mellitus

• Type 2 Diabetes Mellitus• Other types:

• Gestational Diabetes

• LADA (Latent autoimmune diabetes of adults)

• MODY (maturity-onset diabetes of youth)

• Secondary Diabetes Mellitus

TYPES 1 DIABETES• Was previously called insulin-dependent diabetes mellitus (IDDM) or

juvenile-onset diabetes.

• Type 1 diabetes develops when the body’s immune system destroys pancreatic beta cells, the only cells in the body that make the hormone insulin that regulates blood glucose.

• This form of diabetes usually strikes children and young adults, although disease onset can occur at any age.

• Type 1 diabetes may account for 5% to 10% of all diagnosed cases of diabetes.

• Risk factors for type 1 diabetes may include autoimmune, genetic, and environmental factors.

TYPE 2 DIABETES• Was previously called non-insulin-dependent diabetes mellitus (NIDDM) or adult-onset

diabetes.

• Type 2 diabetes may account for about 90% to 95% of all diagnosed cases of diabetes.

• It usually begins as insulin resistance, a disorder in which the cells do not use insulin properly. As the need for insulin rises, the pancreas gradually loses its ability to produce insulin.

• Type 2 diabetes is associated with older age, obesity, family history of diabetes, history of gestational diabetes, impaired glucose metabolism, physical inactivity, and race/ethnicity.

• African Americans, Hispanic/Latino Americans, American Indians, and some Asian Americans and Native Hawaiians or Other Pacific Islanders are at particularly high risk for type 2 diabetes.

• Type 2 diabetes is increasingly being diagnosed in children and adolescents.

26 million with Diabetes

79 millionwith Pre-Diabetes

SYMPTOMS• Frequent urination

• Excessive thirst

• Extreme hunger or constant eating

• Unexplained weight loss

• Presence of glucose in the urine

• Tiredness or fatigue • Changes in vision • Numbness or tingling in

the extremities• Slow-healing wounds or

sores • Abnormally high

frequency of infection • Many people have no

symptoms

DIABETES MEANS:• 2 x the risk of high blood pressure• 2 to 4 x the risk of heart disease• 2 to 4 x the risk of stroke• #1 cause of adult blindness • #1 cause of kidney failure• Causes more than 60% of non-traumatic

lower-limb amputations each year

COMPLICATIONS• Eyes

• Kidneys

• Nerves

• Cardiovascular disease and stroke

• Randomly controlled studies show that these complications can be prevented or controlled with good blood sugar control but this might involve multiple shots etc

• More shots does not mean “worse diabetes”!

WHO IS AT RISK?• Age 45 or older

• Overweight

• Inactive

• Ethnic or minority population

• Family history of diabetes

• Excess abdominal fat

• High blood pressure

• Pre-diabetes

• High blood fats

• Darkening of the skin

• Polycystic ovary syndrome

• History of Gestational Diabetes or large baby

MANAGEMENT OF DIABETES

• Diet and ExerciseA

• Oral hypoglycaemic therapyB

• Insulin TherapyC

DIET• Diet is a basic part of management

in every case. Treatment cannot be effective unless adequate attention is given to ensuring appropriate nutrition.

EXERCISE•Physical activity promotes

weight reduction and improves insulin sensitivity, thus lowering blood glucose levels.

ORAL ANTI-DIABETIC AGENTS

• There are currently four classes of oral anti-diabetic agents:

• Biguanides

• Insulin Secretagogues – Sulphonylureas

• Insulin Secretagogues – Non-sulphonylureas

• α-glucosidase inhibitors

• Thiazolidinediones (TZDs)

INSULIN THERAPY• Short-term use:

• Acute illness, surgery, stress and emergencies

• Pregnancy

• Breast-feeding

• Insulin may be used as initial therapy in type 2 diabetes

• in marked hyperglycaemia

• Severe metabolic decompensation (diabetic ketoacidosis, hyperosmolar nonketotic coma, lactic acidosis, severe hypertriglyceridaemia)

• Long-term use:

• If targets have not been reached after optimal dose of combination therapy or BIDS, consider change to multi-dose insulin therapy. When initiating this,insulin secretagogues should be stopped and insulin sensitisers e.g. Metformin or TZDs, can be continued.

Key pieces of diabetes self-management:

Monitoring blood glucose

Taking medication

Following a meal plan

Getting regular exercise

GOOD NEWS FOR TYPE 1 DIABETES

GOOD NEWS FOR TYPE 2 DIABETES

WHAT IS A FOOD ALLERGY?

Immunological response to food (allergic reaction) Body protecting itself – release of

histamine Affects multiple body systems:

GI Respiratory Skin Cardiovascular

Exposure can cause serious problems or death

INTOLERANCE VS. ALLERGY

• Intolerance• Reaction to the chemicals in food• No immune system response• No serious (life-threatening) side-

effects •Bloating, gas, abdominal

discomfort

FOOD ALLERGY FACTSWHAT THE EXPERTS SAY

• Doubling of food allergy over the past 10 years, particularly peanut allergy. • Latest statistics show continual increase with peanut allergy as

the leading cause

• 12 million Americans affected (4%)• ½ are peanut and/or tree nut

• 3 million school aged children (8%)

• Onset at any age

FOOD ALLERGY FACTSWHAT THE EXPERTS SAY

• Eight foods account for 90% of all reactions

POSSIBLE EXPOSURES

• Ingestion

• Contact

• Inhalation

• Eating, Mucus Membranes, Eczema

SIGNS OF AN ALLERGIC REACTION

• Hives

• Difficulty Breathing

• Vomiting

• Diarrhea

• Eczema Flare

• Lightheadedness

• Swelling

WHAT SOMEONE MAY SAY

• I think I am going to throw up• My mouth/tongue itches• My chest feels tight• I feel itchy• My tongue feels hot/burning/tingling/heavy• There’s something in my throat• My lips feel tight• My tongue feels like there is hair on it• Feels like bugs are in my ears

WHAT CAN BE DONE???

• GIVE EPINEPHRINE!!! (Epi-pen)

ADMINISTERING AN EPI-PEN

Hold 15 seconds

Jab black end into outer thigh Use enough force to make a bruise This can be done through clothing

Remove grey activation cap

Keep patient lying down

FOOD ADDITIVES• Additives that can cause allergic

reactions:

• Sulfites: food additives used to prevent discoloration, mold and spoiling in foods such as grapes, some beverages, and processed foods.

• Monosodium Glutamate: people who are sensitive to MSG may experience tightness in the chest, a headache, and a burning sensation in the neck and shoulders.

11.2 REVIEW QUESTIONS1. Identify and describe the effects of the substance

released by the cells that causes the symptoms of a food allergy.

2. What are the two most important dietary factors for an athlete?

3. Nutritional needs differ throughout the life cycle. Discuss the ways calorie intake should vary as a person grows from infancy to old age.