Diabetes Mellitus Types, Risk Factors, and Dietary Management

Diabetes Mellitus

- Chronic disease where individuals cannot regulate their blood glucose in the normal way

Characteristics of DM

- Elevated blood glucose concentration

- Inadequate or ineffective insulin

Canadian statistics of DM

Cases: 1.4M (2000) to 2.4M (2016) to 3.7M (2021)

What percentage of all diabetes cases is type 1 diabetes mellitus?

10%

What age group is primarily affected by type 1 diabetes mellitus?

Children & adolescence

What is another name for type 1 diabetes mellitus?

Juvenile-onset DM

What does the immune system attack in type 1 diabetes mellitus?

Pancreatic cells

What are some factors that can trigger the immune system to attack pancreatic cells in type 1 diabetes?

Genetics, viral infection, toxins, allergens, other diseases

What happens to insulin production in the pancreas in type 1 diabetes mellitus?

The pancreas makes too little or no insulin

What is another term for type 1 diabetes mellitus that emphasizes its dependence on insulin?

Insulin-dependent DM

What happens to blood glucose levels in individuals with type 1 diabetes mellitus?

Blood glucose remains elevated; body cells are starving for glucose

What is the underlying issue in type 1 diabetes mellitus?

The immune system attacks insulin-producing cells in the pancreas, causing a lifelong inability to regulate blood sugar properly

What percentage of diabetes mellitus cases are type 2?

90%

What happens to insulin in type 2 diabetes mellitus?

The pancreas makes plenty of insulin, but body cells resist its actions.

Is type 2 diabetes mellitus insulin-dependent?

No, it is considered non-insulin-dependent diabetes mellitus.

What happens to blood glucose and blood insulin levels in type 2 diabetes?

Both blood glucose and blood insulin levels rise.

Which age group is mostly affected by type 2 diabetes mellitus?

Adults.

What is another name for type 2 diabetes mellitus?

Adult-onset diabetes.

In recent years, who else has been increasingly diagnosed with type 2 diabetes mellitus?

Obese children.

What is a high health risk associated with type 2 diabetes mellitus?

Cardiovascular disease (CVD).

What are some risk factors for type 2 DM

Obesity (brings on insulin resistance), Genetics

- Greater risk if other family members have DM 2 and/ or of African, Hispanic, Native American, Asian, and Pacific Island descent

Prediabetes

- Impaired glucose tolerence

- Blood glucose higher than normal amount but not high enough

Prevention

- Healthy body weight

- Chose diet high in fruit and vegetables, fish, poultry and whole grains

- Exercise

- Limit alcohol

- dont smoke

Hypoglycemia

- low blood glucose

- There are two types: Reactive hypoglycemia & Fasting hypoglycemia

Reactive hypoglycemia

- Low blood glucose after a meal

- Body secretes too much insulin

What is fasting hypoglycemia?

Fasting hypoglycemia occurs when blood sugar drops after prolonged periods without eating.

What are some causes of fasting hypoglycemia?

Long time between food intake, cancer, pancreatic damage, uncontrolled diabetes, infection of the liver with hepatitis, and advanced alcohol-induced liver disease.

How does fasting hypoglycemia differ from reactive hypoglycemia?

Fasting hypoglycemia is associated with prolonged fasting and systemic illnesses, while reactive hypoglycemia occurs after meals.

Symptoms:

Fatigue, Weakness, Dizziness, Headache, Rapid heartbeat, Sweating, Trembling, Hunger, Anxiety, Irritability, Moodiness, confusion, Mental dullness

Extreme cases

Amnesia, Seizures, Unconsciousness

Glycemic response is defined as

- how quickly glucose is absorbed after ingestion

- how high blood glucose rises

- how quickly it returns to normal

Low glycemic response

- Slow absorption, modest rise, and smooth return to normal

High glycemic response

- Fast absorption, surge in blood glucose, possible plunge below normal

What is the Glycemic Index?

A method of classifying foods according to their potential for raising blood glucose.

What is the effect of foods with a high Glycemic Index?

They cause a high glycemic response (spike + crash).

What is the effect of foods with a low Glycemic Index?

They cause a low glycemic response (slow and steady rise).

Carb and sugar recommendation

Based on an average 2,000kcal/day diet and acceptable macro distribution of 45-65%.

Recommendation for total carbs

Canada's food guide

- ¼ plate whole grains

DRI

- RDA minimum 130g/d (glucose for nerves and bain)

ADMR

- 45-65% of total calories for CHO

Recommendations for dietary fiber

DRI (daily)

Men

- 14-50: 38g

- 51+: 30g

Women

- 19-50: 25g

- 51+:21g

WHO

>25g fiber a day from whole grains na dF&V

CFG

- Half your plate fruit and veg

- Choose whole grains

Recommended daily sugar

CFG

- Limit food and bev high in sugar to <10% total energy intake

DRI

- No UL published

- Committee suggests max of 25% or less total calories for people who meet their nutrient needs, maintain healthy BW and need additional energy

WHO

- Limit to <10% of total cals

- Aim to further reduce <5%

Diabetes

- Limit to 10% total calories

What does 1 table spoon of sugar equal?

4 grams of carbs

What are the two main types of sugars?

Monosaccharides and disaccharides

What is brown sugar?

White sugar with molasses added, 95% sucrose

What is concentrated fruit juice sweetener?

Sugar syrup from dehydrated fruit

What is confectioners sugar also known as?

Icing sugar, which is finely powdered sucrose

What is corn syrup derived from?

Cornstarch, mostly glucose, partly maltose

What does HFCS stand for?

High fructose corn syrup, mostly fructose with some glucose and maltose

What is granulated white sugar commonly known as?

Table sugar, which is crystalline sucrose

What are the main components of honey?

Glucose and fructose, made from enzymatic digestion of sucrose in nectar from bees

What is maple syrup derived from?

Sucrose from the sap of the sugar maple tree

What is molasses?

A thick brown syrup left over from refining sucrose from sugar cane

What should be included in front of package labeling for sugar?

Combine added sugar on ingredients list

What is added to food labels to indicate sugar content?

Added % daily value

What is the SSB tax?

Sugar-Sweetened Beverage tax

In which regions is the Sugar-Sweetened Beverage tax applied?

Some states in the USA, Mexico, France, Newfoundland and Labrador

What types of beverages are subject to the Sugar-Sweetened Beverage tax?

Beverages that contain added sugars, such as soda, energy drinks, and sweetened juices.

Goals for sugar

- reduce sugar consumption

- Promote healthy choices

- Improve public health

How does sugar added to high-fat foods affect consumption?

It may trigger overconsumption.

What do high sugar foods often contain?

Extra empty calories.

Give examples of sweet-flavored high-fat treats.

Cakes, candies, chocolate bars, cookies, doughnuts, ice cream, muffins.

What is the association between sugar-sweetened beverage consumption and body weight?

Increased energy intake and body weight.

What health risks are linked to added sugar intake?

Obesity, diabetes, inflammation, cancers, hypertension, and heart disease.

What is high fructose corn syrup (HFCS)?

A sweetener made from corn that is high in fructose.

Evidence on health and sugar: Sugar and diabetes

- Sugar alone is not culpable in causing Type 2 DM

- If a high energy intake from added sugars causes gains of excess body fat, then

sugar elevates risk for Type 2 DM

- A diet high in whole-grain foods and dietary fiber could predict a reduced risk of Type 2 DM

Evidence on health and sugar: Sugar and heart disease

- Average intake of sugar does not adversely affect heart health in healthy persons

-High sugar diet increases triglyceride levels (lipid levels) → because excess sugar is converted to fat

- High saturated fat produced in response to dietary sugar is the major culprit in heart disease susceptibility

Evidence on health and sugar: Sugar and behaviour in children and adults

- Research suggest sugar is NOT linked to behaviour

What is an energy source for bacteria that cause tooth decay?

Sugar

What factors affect the risk of dental decay from sugar?

Length of time food stays in the mouth, how sticky it is, how often you eat it, and whether you brush your teeth right after eating.

What percentage of calories from sugar is associated with a lower prevalence of dental caries?

No more than 10%

What are sugar alcohols also known as?

Polyols

Where do sugar alcohols occur naturally?

In fruits and vegetables

What is a common use for sugar alcohols?

Added to many processed foods

How do the calories in sugar alcohols compare to sugar?

Fewer calories per gram than sugar

How are sugar alcohols digested?

Slowly digested and partially absorbed

What gastrointestinal issues can sugar alcohols cause?

Commonly lead to GI issues (restricted in Low FODMAP diet)

What are artificial sweeteners also known as?

Non-nutritive sweeteners

What is the calorie content of artificial sweeteners?

Calorie-free

What do artificial sweeteners provide?

A sweet flavour

Are artificial sweeteners typically toxic?

Typically not toxic at 'usual' levels, but some have been banned

Which artificial sweetener is best for baked goods?

Sucralose

Are there artificial sweeteners considered safe during pregnancy?

A handful are considered safe

Is Stevia approved for use in Canada?

Approved to be used as a food additive and as a tabletop sweetener

What is monk fruit extract approved for?

Approved as a tabletop sweetener only

Lipids

- organic (carbon-containing) compounds

- soluble in organic solvents

- not soluble in water

- most are a mixture of SAFA, MUFA, PUFA

What do Lipids include?

- Triglycerides

- Phospholipids

- Sterols

- Fats: lipids that are solid at room temperature (25C or 70F)

- Oils: lipids that are liquid at room temp.

What is a fatty acid?

A fatty acid is an organic chain of carbon atoms with hydrogens attached.

What functional groups are present in a fatty acid?

A fatty acid contains a methyl group (CH3) on one end and an acid group (COOH) on the other.

What does the structure of a fatty acid indicate about its carbon atoms?

Every point in the structure indicates a carbon atom, and each line symbolizes the bonds between carbons (1 bond each).

How many bonding spots do carbon atoms have in fatty acids?

Carbon atoms have 4 bonding spots, with the remaining bonds being between hydrogen and carbon.

What are the names of the ends of a fatty acid?

The left end is the methyl end, and the right end is the carboxyl end (acid group).

What is the most abundant fatty acid in nature?

18-carbon fatty acid

What is the simplest fatty acid?

Stearic acid

What is the common range of carbon chains in fatty acids found in meats, seafood, and vegetable oils?

14-18 carbon chains

What carbon chain length is commonly found in fatty fish like salmon?

20-24 carbon chains

What are fatty acids with 6-12 carbon chains referred to as?

Medium-chain fatty acids

What are fatty acids with 4 or fewer carbon chains referred to as?

Short-chain fatty acids

Which oil is an example of a medium-chain fatty acid?

Coconut oil

Which food products are examples of short-chain fatty acids?

Dairy products

What are saturated fatty acids (SAFA)?

Saturated fatty acids have each carbon fully bonded to hydrogen atoms and contain only single bonds (not including the acid group).

What defines unsaturated fatty acids?

Unsaturated fatty acids contain a double bond between two carbons.