DIABETES

TYPES
• A blood sugar level less than 140 mg/dL (7.8
mmol/L) is normal.
• A reading of more than 200 mg/dL (11.1
mmol/L) after two hours indicates diabetes.
• A reading between 140 and 199 mg/dL (7.8
mmol/L and 11.0 mmol/L) indicates
prediabetes.
GLYCEMIC LOAD & INDEX
 Carbs required per day
• Most people with diabetes can control their
blood sugar by limiting carbohydrate servings
to 2-4 per meal and 1-2 per snack.
• That is 200-225 g per day.
 COMPLICATIONS
• ACUTE COMPLICATIONS (Hypoglycemia and diabetic ketoacidosis)
• LONG-TERM COMPLICATIONS (Long-term complications of diabetes
include macrovascular diseases, microvascular diseases, and
neuropathy.)
• Macrovascular diseases involve diseases of large blood vessels;
microvascular diseases associated with diabetes involve the small
blood vessels and include nephropathy and retinopathy.
• In contrast, diabetic neuropathy is a condition characterized by
damage to the nerves. MNT is important in managing several long-
term complications of diabetes.
• Nutrition therapy is also a major component in reducing risk factors
for chronic complications, especially those related to macrovascular
disease.
 ACUTE (HYPOGLYCEMIA)
• A low blood glucose, or hypoglycemia (or
insulin reaction), is a common side effect of
insulin therapy.
• symptoms include shakiness, sweating,
palpitations, anxiety, and hunger
• In general, a blood glucose of 70 mg/dl (3.9
mmol/L) or lower should be treated
immediately. Treatment of hypoglycemia
requires ingestion of glucose or carbohydrate-
containing food. Although any carbohydrate
will raise glucose levels, glucose is the
preferred treatment.
 DIABETIC KETOACIDOSIS
• Hyperglycemia can lead to diabetic
ketoacidosis (DKA), a lifethreatening but
reversible complication characterized by
severe disturbances in carbohydrate, protein,
and fat metabolism.
• DKA is always the result of inadequate insulin
for glucose use. As a result, the body depends
on fat for energy, and ketones are formed.
• DKA is characterized by elevated blood glucose
levels (>250 mg/dl but generally <600 mg/dl) and
the presence of ketones in the blood and urine.
• Symptoms include polyuria, polydipsia,
hyperventilation, dehydration, the fruity odor of
ketones, and fatigue. SMBG, testing for ketones,
and medical intervention can help prevent DKA.
If left untreated, DKA can lead to coma and
death.
• Treatment includes supplemental insulin, fluid and
electrolyte replacement, and medical monitoring.
Acute illnesses such as flu, colds, vomiting, and
diarrhea, if not managed appropriately, can lead to
the development of DKA.
• During acute illness, oral ingestion of about 150 to
200 g of carbohydrates per day (45-50 g every 3-4
hr) should be sufficient, along with medication
adjustments, to keep glucose in the goal range and
to prevent starvation ketosis.
 Long term ( macrovascular)
• Macrovascular diseases, including
atherosclerotic cardiovascular disease
(ASCVD), peripheral vascular disease (PVD),
and cerebrovascular disease are more
common, tend to occur at an earlier age, and
are more extensive and severe in people with
diabetes.
• Dislipidimia
• Hypertension
 Microvascular Diseases
• Diabetic Kidney Disease
• Retinopathy: Diabetic retinopathy is estimated
to be the most frequent cause of new cases of
blindness among adults 20 to 74 years of age.
Glaucoma, cataracts, and other disorders of
the eye also occur earlier and more frequently
with diabetes
 Neuropathy
• Chronic high levels of blood glucose also are
associated with nerve damage, and 60% to
70% of people with diabetes have mild to
severe forms of nervous system damage.
 MNT
• VEGETABLES: avoid starchy vegetables
including yam, potatoes, corn and green peas
etc.
• Increase intake of non starchy vegetables eg
carrots, green leafy veg, tomatoes, onion,
cucumber etc
• Avoid processed and fatty meats
• Limit intake of red meat to once a week
• Increase intake of lean meat
• Avoid intake of refined or white flour, white
bread, white rice or pasta.
• Paneer doodha: soak 10-15 piece overnight
squeeze and extract its water and drink it.
• Fenugreek: put 1tbsp in glass of water and
leave it overnight filter and drink on empty
stomach.
• Eat small, regular meals
• Have a small snack between meals. You can keep
your blood glucose levels within the target range by
spreading the carbohydrates that you eat evenly
throughout the day.
• Reduce the amount of fats, salt and sugary foods in
your diet.
• Eat more foods that are high in fibre, including
wholegrain products.
• Match your mealtimes to your medication timings.
 Treatment of Hypoglycemia
• Immediate treatment with carbohydrates is essential.
• If the blood glucose level falls below 70 mg/dL (3.9
mmol/L), treat with 15 g of carbohydrates, which is
equivalent to:
• 15 g carbohydrate from glucose tablets (4) or glucose
gel
• 4-6 ounces of fruit juice or regular soft drinks
• 6 ounces (1/2 can) of regular soda pop (not sugar free)
• 8 ounces (1 cup) of sports drink (not sugar free)
• 1 tablespoon of sugar, syrup or honey