Metabolic Syndrome

a cluster of the most dangerous heart attack risk factors: diabetes and raised fasting plasma glucose,
abdominal obesity, high cholesterol and high blood pressure.

Metabolic Risk Factors

A large waistline; abdominal obesity or "having an apple shape."

Excess fat in the stomach area is a greater risk factor for heart disease than excess fat in
other parts of the body, such as on the hips.

A high triglyceride level

A low HDL cholesterol level or "good" cholesterol.

High blood pressure

High fasting blood sugar

Insulin Resistance

Metabolic Risk Factors

The risk of having metabolic syndrome is closely linked to overweight and obesity and a lack of physical
activity.

Nutrition for Persons with

Diabetes Mellitus

Diabetes Mellitus

Condition characterized by either relative or complete lack of insulin secretion by the beta-cells of the
pancreas or by defects of insulin cell receptors

result in disturbances in CHO, CHON and lipid metabolism and elevated blood glucose level

Coal Stove Analogy:

Type 1 versus Type 2

Body cells (mitochondria) = coal stove

Carbohydrate = coal

Insulin = coal shovel

Type 1 vs Type 2 DM

Type 1 diabetes

What goes wrong in Type 1 ?

Destruction of the pancreatic beta cells causing impairment in insulin production

Gestational Diabetes

Occurs during pregnancy after placenta is formed and is caused by placental hormones working in
opposition to insulin.

Temporary but increases the risk to develop type 2 DM later in life

Hormones Involved in
Blood Glucose Management

INSULIN: lowers BG by allowing cell uptake

COUNTER-REGULATORY HORMONES—

“stress hormones”: raise BG levels by allowing stored glycogen to be released as BG

Glucagon: first hormone released to raise BG; in excess can cause nausea and vomiting (as in injectable
form to treat severe low BG w/ unconsciousness

Epinephrine, or adrenalin: causes increased heart rate, physical tremors

Cortisol: causes warm, sweaty feeling

Growth hormone

Blood Glucose Issues

Dawn phenomenon:

increased release of counter regulatory hormones (cortisol and growth hormone) decrease insulin’s
effectiveness

Occurs at dawn for those with normal nighttime sleep pattern; Fasting BG will rise naturally as a result of
release of glycogen stores from cortisol and/or growth hormone production

Somogyi effect:

a high BG always follows a low BG because of release of glycogen stores from liver

Since this is a temporary rise of BG, avoid overcorrection of hyperglycemia to inhibit a continued cycle of
low and high BG readings (will only occur if insulin injection is used)

Management of Diabetes Mellitus?

GOALS:

to normalize blood glucose levels and decrease complications

Improve health through healthy food choices & physical activity

Address individual nutritional needs taking into consideration personal and cultural preferences &
lifestyle while respecting individual’s wishes and willingness to change

Management of Diabetes Mellitus?

STRATEGY:

1. Medications

2. Lifestyle Changes:

Diet

Exercise

Lifestyle Modification

Exercise:
 *In type 1 – doesn’t improve glycemic control but prevents CV complications

*In type 2- improves glucose tolerance

- makes body cells more sensitive to insulin

- maintains weight

- prevent cardiovascular diseases

#advise the client to warm up before exercise & cool down afterwards

#exercise 5 days per week

#30 minutes/day

TIPS FOR DIABETIC PATIENTS

TYPE 1:

Eat a light CHO snack about 30 minutes prior to exercise

Carry fast-acting CHO foods

Consume an additional 10 to 15 g of CHO for each hour of moderate exercise & an extra 20 to 30 g for
each hour of vigorous exercise

Time exercise sessions so it won’t coincide w/ peak insulin effects

Exercise w/in 2 hours of eating

Check CBG level before & after exercise

Avoid exercise if fasting glucose exceeds 300 mg/dl

TIPS FOR DIABETIC PATIENTS

Exercise for 20 to 45 minutes atleast 3x/week

If taking an oral antidiabetic or insulin, exercise within 2 hours of eating

Stop exercising if hypoglycemia signs or symptoms occur

Treatment for Acute Complications

DKA and HHNK

Insulin administration

IV fluid administration

Correction of electrolyte imbalance

Hypoglycemia

If unconscious, glucagon is injected

If conscious, glucose-containing products must be squeezed in to the mouth

Rule of 15

Rule of 15:

If the BG level is below 70mg/dl,

eat 15g of an easily absorbable CHO

If BG level is below 50 mg/dl,

ingest 30 g of CHO

Wait 15 minutes, then recheck CBG

NO CHANGE=repeat the process, then recheck CBG after 15 minutes. Continue until CBG is normal

Preventing Long Term Complications

For CV diseases:

Control BP and cholesterol level

Maintain normal weight

Exercise daily

Eat heart-healthy diet

For Retinopathy:

Annual eye exam

Dental Complications
Regular dental check ups

Brush teeth after every meal, floss daily, report bleeding gums, soreness, pain in teeth & gums

Nephropathy

Keep BG level under control

Prompt treatment of UTI

Dermopathy

Check skin daily for cuts or irritated areas

Bathe daily with warm water and mild soap, apply lanolin-prevent dryness

Pat skin dry thoroughly esp. in between toes, and skinfolds

Neuropathy

Proper foot care: wash feet daily w/ warm water & soap, dry thoroughly; trim toenails to match the
shape of the toes; wear soft,clean & absorbent socks;

avoid tight-fitting shoes

Avoid temperature extremes

GLYCEMIC RESPONSE

AFTER MEALS – Glucose rises followed by an increase in insulin levels

INSULIN – Promotes glucose uptake & utilization. As a result, glucose levels decrease

PROTEIN – Raises insulin secretion

FATS – Raises insulin secretion and delays digestion and absorption of dietary carbohydrates

NORMAL FBS;

NORMAL POST PRANDIAL BLOOD GLUCOSE > 140 mg/dl

Glycemic Index

Predicts the effect of carbohydrate-containing food on postprandial glycemia

Does not account for the variability of the test food and considers food item in isolation

High Glycemic Index Foods:

Bread, Pasta, Rice, Cereal, Baked Goods

Low Glycemic Index Foods:

Fruits, Vegetables, Whole Grains, Legumes

MEAL PLANNING

Carbohydrate Counting

Emphasizes eating a consistent amount of CHO rather than restricting the type of CHO

All forms of CHO basically affects BG levels similarly when eaten in the same amount

Nutritional Guidelines for Diabetic Patients

(American Diabetes Association 2013)

consider individual metabolic goals:

Glucose, lipid levels, blood pressure

Carbohydrates should come from vegetables, whole grains, fruits, legumes and dairy products over
those that contain sugar, fat and sodium

Fat quality is more important than quantity. Take it from monounsaturated and polyunsaturated fats,
avoid trans-fats and saturated fats.

*Although those working to manage their weight should still even eat good fats in
moderation.

Nutritional Guidelines for Diabetic Patients

(American Diabetes Association 2013)

Limit or avoid intake of sugar-sweetened beverages

Reduce sodium to less than 2300mg per day

with additional reductions for those with hypertension

Eat fatty fish at least 2 times (2 servings) per week

People with diabetes do not benefit from use of omega-3 (EPA/DHA) Supplements for the
prevention or treatment of CV disease

There is no clear evidence of benefit from vitamin or mineral supplements for people with diabetes who
do not have underlying vitamin or mineral deficiencies. Nor is there evidence to support the use of
cinnamon or other herbs or supplements for the treatment of diabetes.

Self Monitoring of Blood Glucose Level

To determine if he needs to adjust his medication, diet or exercise

Usually taken before meals & at bedtime

FILIPINO PROFILE

Revels in rice,

Has sweet tooth,

Likes to order “

Meal a, with extra fries,

Go large”,

Remote control lifestyle,

Masters of manyana

Therefore,

Filipinos are at high risk for diabetes!

GUIDELINES FOR

MACRONUTRIENT DISTRIBUTION

CHO - DRI 40-65%

CHON - DRI 10-35%

ADA 15-20% (TOTAL CAL)

FATS - DRI 20-35%

SATURATED FAT - <7% (TOTAL CAL)

CHOLESTEROL - <200 MG/DL

DIETARY FIBERS – 15g/1000cal RENI