Blood Glucose / Diabetes

Cost of Diabetes - direct medical costs

$176 billion

Cost of Diabetes - total (direct & indirect)

$245 billion

Cost of Diabetes - indirect costs (disability, work loss, premature mortality)

$69 billion

Blood glucose level 110-125 is considered

'impaired fasting glucose*

Type 1 diabetes

(ß-celltext annotation indicator destruction, usually leading to absolute insulin deficiency) This form of diabetes, which accounts for only 5-10% of those with diabetes, has been previously referred to as insulin-dependent diabetes, type I diabetes, and juvenile-onset diabetes. The treatment consists of long-acting and short-acting insulin injected multiple times daily.

Blood glucose in the fed state: Digestion to monosaccharides - Liver conversion of monosaccharides to glucose results in:

- Increased blood glucose which leads to: - Increased Insulin resulting in: - Increased cellular uptake and storage of glucose, leading to: - Decreased Blood glucose

How is the Glycemic Index calculated?

- Subjects consume enough food to ingest about 50 g of available CHO. - This is compared to a control of 50 g glucose - blood glucose levels are measured over the next 2 hours

Sources of blood glucose:

- derived from dietary CHO - glycogen stored in the liver - non-CHO sources such as amino acids, lactic acid, and glycerol

What supplies glucose between meals?

- glucose stored as glycogen in the liver - amino acids, lactic acid, and glycerol can all be repackaged as glucose for use by the body

Over time, continuing high levels of blood glucose will damage both small and large blood vessels which contributes to some of diabetes' most serious complications, including:

- heart disease - adults with diabetes have heart disease death rates about 2 to 4 times higher than adults without diabetes; heart disease and stroke account for about 65 percent of deaths in people with diabetes - blindness - diabetes is the leading cause of new cases of blindness among adults - limb amputations - more than 60 percent of nontraumatic lower-limb amputations occur among people with diabetes - kidney failure -diabetes is the leading cause of kidney failure - nervous system - about 60 to 70 percent of people with diabetes have mild to severe forms of nervous system damage

A random blood glucose level of 200 mg/dL or more, plus presence of the following symptoms, can mean that you have diabetes:

- increased urination (polyuria) - increased thirst (polydypsia) - increased hunger (polyphagia) - unexplained weight loss Other symptoms include fatigue, blurred vision, and sores that do not heal.

Screening for GDM

- screen all women between 24-28 wks of pregnancy - screen high risk women in first trimester (previous hx GDM, previous birth of baby 9#+, member of ethnic group at high risk, obesity)

The Glycemic Index gives a value of

0-100 with pure glucose being the reference food and having a glycemic index (GI) of 100.

GI of glucose

100

Fasting Plasma Glucose Test results for Pre-diabetes (impaired fasting glucose) are

100 to 125

The American Diabetes Assoc. has defined impaired fasting glucose as

100-125 a range not yet adopted by all

Fasting Plasma Glucose Test results for diabetes are

126 and above Confirmed by repeating the test on a different day

Oral Glucose Tolerance Test results for normal are

139 and below

Oral Glucose Tolerance Test results for pre-diabetes are

140 - 199

GI of fructose

20

Oral Glucose Tolerance Test results for diabetes are

200 and above Confirmed by repeating the test on a different day

HgAlc for prediabetes

5.7-6.4%

GI Classification Range for - Low GI

55 or less

GI Classification Range for - Medium GI

56 - 69

GI of sucrose

59

A1C # for Level of control - normal

6 or less

Diabetes prevalence: In general, people aged _____+ years had the highest prevalence, followed by persons ______ years, and persons less than ____ years of age.

65 + most prevalent 45 - 64 years next most < 45 least prevalent

A1C # for Level of control - take action

7 or more An A1C greater than 7 means increased risk for complications of diabetes

GI Classification Range for - High GI

70 or more

Normal fasting glucose levels are typically:

70-109 mg/dl

Diabetes was _______ leading cause of death in US

7th

GI of honey

87

Type 2 diabetes accounts for approximately ______% of those with diabetes and was previously referred to as non-insulin-dependent diabetes, type II diabetes, and adult-onset diabetes.

90 - 95%

Fasting Plasma Glucose Test results for normal are

99 and below

A1C # for Level of control - goal

< 7 (ADA) < 6.5 (AACE)

HgAlc for diabetes

> 6.5%

Summary of Diagnostic Criteria for Diabetes (3 tests)

Acute symptoms plus casual plasma glucose >200 mg/dl or Fasting plasma glucose >126 mg/dl or 2-hr plasma glucose >200 mg/dl during oral glucose tolerance test or HgAlc > 6.5% criteria must be confirmed by repeat testing on a subsequent day unless obvious signs of dm exist

Summary of Diagnostic Criteria for Prediabetes (2 tests)

Fasting Plasma Glucose 100 mg/dl to 125 mg/dl or 2-hr plasma glucose 140-199 mg/dl during oral glucose tolerance test HgAlc: 5.7-6.4%

Importance of Glucose

Glucose is a major source of energy in the body's cells. When glucose can't be transferred into the cells from the bloodstream, those cells can 'starve'. As a result, glucose can build up in the blood and is known as 'high blood sugar'.

Hormonal effects - Epinephrine:

It is typically secreted in response to stress. It increases blood glucose by increasing catalysistext annotation indicator of glycogen to glucose in the liver. It can also be producted in response to exercise.

Glucose goals - before meals

Plasma Values 80 - 130 Whole Blood Values 70 - 120

Glucose goals - 1-2 hrs. after meals

Plasma Values less than 180 (ADA) < 140 (AACE) Whole Blood Values less than 130

Factors affecting blood glucose control - Stress

Stress has a direct effect on blood glucose levels. Prolonged or excessive stress can cause the body to produce hormones that prevent insulin from working properly which increases blood glucose levels. Stress hormones tell your liver to release glucose; it's your body's natural way of thinking it is helping you.

Factors affecting blood glucose control - FOOD

The total amount of CHO consumed at one time strongly affects blood glucose levels. Also, the type of CHO consumed, such as glucose vs. fructose, will affect glucose levels. Other factors, such as delayed gastric empyting, will affect blood glucose levels.

T/F In diabetes testing, positive test results should be confirmed by a 2nd test on a different day unless obvious signs of diabetes present themselves.

True

T/F Diabetes is likely to be underreported as a cause of death.

True Studies have found that only about 35 to 40 percent of decedents with diabetes have diabetes listed anywhere on the death certificate and only about 10 to15 percent had it listed as the underlying cause of death. Overall, the risk for death among people with diabetes is about twice that of people without diabetes of similar age.

Glycated hemoglobin is hemoglobin that has

a blood sugar molecule attached to it, which happens when blood sugar levels are higher than they should be.

Type 1 diabetes results from

a cellular-mediated autoimmune destruction of the ß-cells of the pancreas. This has a genetic predisposition and is also related to environmental factors that are poorly defined.

The glycemic index is

a ranking system for carbohydrates based on their immediate effect on blood glucose levels. It compares carbohydrates gram for gram in individual foods, providing a numerical index of post-meal glycemia.

Gestational Diabetes (GDM) is

any degree of glucose intolerance with onset or first recognition during pregnancy. It complicates approximately 7% of all pregnancies in the U.S. (range 1-14%). GDM represents 90% of all pregnancies complicated by diabetes.

When are self tests usually done?

before meals, after meals, and/or before bed. People who take insulin usually need to test more often than those who don't.

The prevalence of diagnosed diabetes was higher for what ethnic groups vs. whites?

blacks and hispanics

The HgAlc represents

blood glucose levels over the past 2-3 months

High GI food examples

corn flakes, baked potato, jasmine rice, white bread

Blood glucose level >126 and confirmed on a 2nd occasion is considered

diabetes

Diabetes is a disease characterized by

elevated blood glucose levels.

Factors affecting blood glucose control - EXERCISE

exercise and other forms of physical activity will typically lower blood glucose levels, with the effects lasting for several hours.

Blood glucose is typically measured in a

fasting state, 1-2 hrs after a meal, or after a known amount of carbohydrate has been administered.

In the normal 120-day lifespan of the red blood cell, glucose molecules react with hemoglobin, forming

glycatedtext annotation indicator hemoglobin

Carbohydrate foods that break down more quickly during digestion have higher / lower glycemic indices

higer These foods require less energy to be converted into glucose which results in faster digestion and a quicker increase in blood glucose.

In individuals with poorly controlled diabetes, the quantities of these glycated hemoglobins are much higher / lower than in healthy people.

higher

Diabetes mellitus is a group of metabolic diseases characterized by

hyperglycemiatext annotation indicator resulting from defects in insulin secretion, insulin action, or both.

Type 2 diabetes

insulin resistance and some insulin deficiency. Initially, and often throughtout their lifetime, these individuals do not need daily insulin injections to survive.

Type 2 diabetes is not the result of ß-cell destruction. Most of the patients are obese which causes

insulin resistance. Patients are treated either with a diet/exercise combination, or the addition of medications that lower blood glucose. With disease progression, some type 2 patients will require daily insulin to control blood glucose.

Carbohydrate foods that break down more slowly have a high / low glycemic index

low This suggests a slower rate of digestion and absorption resulting in better controlled blood glucose.

Blood glucose level <70 is considered

low - hypoglycemia

Factors affecting blood glucose control - DRUG

many drugs may influence blood glucose levels. The most common group is steroids (ex: Prednisone), usually prescribed for inflammation. Other drugs to be aware of: diurectics, oral contraceptives, alcohol, caffeine, some anti-depressants, and glucagon.

In actuality, the GI of foods may / may not have little impact on glucose levels because foods are typically not consumed individually, but as part of a total meal.

may have little impact The mixed components of the meal blunt the GI response of individual foods. This will be discussed more in Clinical Nutrition 1.

oral glucose tolerance test

measures your blood glucose after you have gone at least 8 hours without eating and 2 hours after you drink a glucose-containing beverage. This test can be used to diagnose diabetes or pre-diabetes.

fasting plasma glucose test

measures your blood glucose after you have gone at least 8 hours without eating. This test is used to detect diabetes or pre-diabetes.

Research concludes what can prevent or delay Type 2 diabetes?

modest weight loss and regular exercise

Oral Glucose Tolerance Test (OGTT)

more sensitive than the FPG test for diagnosing pre-diabetes, but it is less convenient to administer. The OGTT requires you to fast for at least 8 hours before the test. Your plasma glucose is measured immediately before and 2 hours after you drink a liquid containing 75 grams of glucose dissolved in water.

Low GI food examples

most fruit and vegetables (but not potato), basmati rice, oats, All-bran, skim milk

Medium GI food examples

sucrose, Mars bar

Hemoglobin A1C Test: reflects

the blood glucose average level over the past 3 months

The A1C measures the % of hemoglobin (the main component of red blood cells) in

the blood that is glycated.

Type 2 diabetes may go undiagnosed for up to 7-10 years because

the hyperglycemia develops gradually and at the earlier stages, the symptoms are not severe enough to be noticed by the patient.

Hormonal effects - Glucagon:

to protect from hypoglycemia, glucagon signals the liver to release glucose into the bloodstream. This can occur when there is potential of hypoglycemia due to fasting or exercise, as examples.

HbA1C is usually checked how often?

twice per year or more often for individuals who have continually high blood glucose levels.

random plasma glucose test

your doctor checks your blood glucose without regard to when you ate your last meal. This test, along with an assessment of symptoms, is used to diagnose diabetes but not pre-diabetes.