KNES 337 - Unit 13 Diabetes

diabetes types

gestational, type I, type II

gestational diabetes

• only during pregnancy

• Is a resistance to insulin that develops during pregnancy, resistance is too great, so blood glucose not regulated properly → hyperglycemia

percent of gestational diabetes

5-6% of women develop gestational diabetes 

higher risk for gestational diabetes

• women over 35 years old

• women with obesity

• women from a high-risk group (African, Arab, Asian, Hispanic, Indigenous, South Asian)

gestational diabetes treatment

• Control blood glucose levels with an individualized diet and exercise plan 

  • Some women require daily insulin injections for blood glucose control 

macrosomia

large baby more than 4 kg (8 lb. 13 oz), Issues with delivery - c-section

can be due to high blood glucose in mother → brings extra glucose to baby → high insulin in baby → causes baby to put on extra weight and body fat 

infants from gestational diabetes

• may have increased body fat at birth and have blood glucose control problems after delivery

  • May produce excess insulin which may lead to hypoglycemia - monitor closely after birth 

  • At greater risk for diabetes later in life 

  • 6-20% will have a physical abnormality that may threaten survival or a high quality of life - e.g. cleft palate, club foot, heart defects 

    • Can correct cleft palate and club foot with surgery, and some heart defects can be corrected 

• Disappears after delivery - but type II diabetes may appear later in life in the mother

• Exercise, maintenance of normal weight, and a healthy diet reduce the risk that diabetes will return 

type I diabetes

• Autoimmune - attack on pancreatic beta cells (produce insulin)

• Deficiency of insulin

percent of type I diabetes

Accounts for 5-10% of all diabetes and is increasing yearly 

type I diabetes onset

• Typically diagnosed in children or at least before 40 years old, onset is abrupt

  • Diagnosis peaks around the ages of 11-12 years 

treatment of type I diabetes

• Treatment is with insulin, diet, and exercise 

• continuous glucose monitoring

• Before insulin was discovered (which was discovered in Toronto)

  • Starve to death - no way to get glucose into tissues from the blood

  • Insulin injections are life-saving

• Insulin!!!! - injections, pump, islet transplant 

insulin pump

Insulin is injected into the subcutaneous tissue automatically by the pump

islet transplant

done everything else, but still not enough control, get new healthy pancreatic cells - brittle diabetes 

glucose monitoring

• probe that constantly samples glucose levels in interstitial fluid - good indication of blood glucose 

  • Dexcom and Libre - can see blood glucose levels over the whole day and during meals 

  • Before, they’d have to prick their finger multiple times a day 

environmental triggers of Type I

associations:

• Early exposure to cow’s milk proteins - immune system may get these proteins mixed up with pancreatic beta cells (shown in mice, but not yet humans)

• Vitamin D deficiency

• Early exposure to gluten

• Certain viruses (rubella, rotavirus, mumps, cytomegalovirus, enteroviruses)

• Gut microbiota - leaky gut, immune system confused

breastfeeding

if for the first 4 months, may protect infants against type I diabetes

immune system

• Expose kids to a wide variety of microbes - kids should go outside to develop their immune system well 

  • Better at telling self vs. outside bacteria 

  • Less allergies as well 

  • E.g. growing up on a farm, with older siblings, with pets, even eating dirt, can be beneficial to early immune development 

• Certain bacteria, when present in early life can strengthen immune response and prevent T1D

glycemic index

foods that affect blood glucose are given a glycemic index value

• Blood glucose elevation caused by 50 grams of food → compare to elevation caused by eating 50 g of glucose → assign a glycemic index value

• foods that elevate blood glucose require more insulin to move glucose into cells 

• Low-glycemic index foods decrease blood triglyceride levels and insulin requirements in type 2 diabetes

• High-glycemic foods good to promote glycogen formation - but don’t want to become insulin resistant

potato and glucose

overshoot the baseline (lower blood glucose after a spike) - may feel angry, shaky, not good

potatoes

• Russet (baked potatoes usually) and instant mashed potatoes higher GI than red potatoes 

  • Boiling and then cooling starches is better 

pasta

low GI food

• curve is gentler 

  • Cooked al dente (slightly hard) - slower glucose absorption 

  • Sourdough pasta - used bacterial culture to make it, good for gut microbiota - can change how body metabolizes carbs and starches 

oatmeal

• Instant oatmeal (rolled oats) - GI = 79 - will raise blood glucose the most

• Quick oatmeal - GI = 65

• Steel cut oats, large flake oats, muesli/granola (baked) - GI = 55

GI of glucose

GI = 100

GI of french bread

GI = 95

GI of rice krispies

GI = 82

Gi of sticky rice

GI = 86

GI of all-bran

GI = 42

GI of yogurt

GI = 35

GI of milk

GI = 31

GI of hummus

GI = 6

prediabetes

• Elevated fasting blood glucose levels below the cut off point used to diagnose type 2 diabetes (6.1-6.9 mmol/L) = prediabetic

• Prediabetes is a major risk factor for type 2 diabetes

• Once you have type 2 diabetes - it’s irreversible 

  • Try and reverse it in the prediabetes stage

insulin resistance risk factors

• Obesity

• Low levels of physical activity

• Genetics

When blood glucose levels become high, the pancreas secretes more insulin to keep glucose levels under control

Pancreas becomes exhausted from over work and insulin production slows or stops

7 mmol/L

or higher = the fasting blood glucose levels at which type 2 diabetes has developed

type II diabetes 

• lifestyle related, most cases, treatment is weight reduction and medications

• Occurs in individuals with overweight or obesity and a sedentary lifestyle

• Most common in people over 40 - but increasingly seen in young children and adolescents

• Strong genetic component

  • Runs in families (Black, Hispanic, Indigenous, Asian), associated with apple obesity 

• Individuals with type 2 diabetes are insulin resistant

managing type II diabetes

• Can be managed with diet and exercise - most of the time

  • If not, there are 8 different classes of diabetes medications that can be prescribed to manage diabetes (including Ozempic)

• Manage with diet and exercise

  • Weight loss alone significantly improves blood glucose control - even 5% weight loss

  • Proper diets are crucial 

    • Complex carbohydrates - whole-grain breads, cereals, high-fiber foods, vegetables, fruits, low-fat milk and meats, and fish (low glycemic foods)

    • Healthy fats

    • Regular meals and snacks

    • Protein at every meal - particularly bedtime - helps liver to not overproduce glucose during overnight fasting period 

symptoms of diabetes

applies to all types if poorly controlled/untreated

• High glucose levels

• Frequent urination

• Increased thirst and hunger

  • But not gaining weight 

  • Energy trapped in blood

• Unusual fatigue

• Weight loss - without trying

  • Big sign in children - if they plateau or lose weight, immediately check for diabetes (key symptom)

• Blurred vision - High glucose can affect retina

• Increased susceptibility to infection

• Slow healing sores - Especially on feet

health consequences

over long term

• Heart disease and stroke

• Kidney damage (nephropathy)

  • Lead to dialysis requirement 

  • Can’t clear out waste other wise 

• Blindness (retinopathy)

  • High blood glucose → can attach to proteins (glycation) in the retina → lead to blindness 

• Nerve damage (neuropathy)

  • Loss of sensation, not healing

  • Can’t feel feet, if injured, you might not feel it and not know it’s there - wounds can get infected if not treated 

• Loss of limbs due to poor circulation 

  • Amputations - mostly foot, toes 

• Alzheimer's Disease / dementia

alzheimers disease

• Can be known as “type III diabetes” 

• May be linked to type II - common pathways of insulin resistance and inflammation 

• Control diabetes as best as possible to avoid developing dementia