323-glucose regulation

glucose regulation definition

the process of maintaining optimal blood glucose levels

glucose regulation

• nutrient intake

  • eat food: blood glucose rises

• hormones

  • insulin is released in response to rising blood sugars (produced in the beta cells of islets of Langerhans in pancreas

  • responsible for binding to cells and helping to facilitate glucose to enter cells

• cellular uptake

normal glucose and insulin metabolism

1. eat food

2. blood sugar rises

3. insulin secreted by beta cells in response to rising blood sugars

4. insulin binds to cell membranes to tell GLUT4 to help glucose get into cells by facilitated diffusion

5. once into cells: cells break down glucose and make energy → blood sugar stabilized and insulin secretion goes down

6. extra glucose→ stored in liver and muscles as glycogen

counterregulatory hormones

• maintain blood glucose levels within normal levels by regulating release of glucose for energy during food intake and periods of fasting

  • glucagon, epinephrine, growth hormone, cortisol

  • stimulate glucose production and release by the liver

  • decrease movement of glucose into cell

normal glucose levels

• fasting: 74-106

• after eating: 100-140

pre-diabetic fasting glucose level

100-125

hypoglycemia

less than 70

• very severe is less than 50

• nutrition: malnutrition causes body to start to break down glucose stores; fatty acids and ketones are produced (signals life-threatening hypoglycemia)

• medication reactions → too much insulin or wrong insulin

• over exercising→ not taking enough time for body to recover with exercise

hyperglycemia

• insufficient insulin production/secretion:

  • because glucose can’t get into cell, so blood sugar stays high

• deficient hormone signaling:

  • insulin resistant→ producing enough but cells are not responding how they should

  • decrease in insulin receptors and/or glucose transporter cell

• excessive counterregulatory hormone secretion:

  • too much glucagon and too much cortisol→ gluconeogenesis (glucose made from non-carb sources and blood sugars are raised

pathophysiology of type 1 diabetes

beta cells in pancreas are destroyed

symptoms of type 1 diabetes

3 P’s

• polyuria

• polydipsia

• polyphagia

treatment for type 1 diabetes

insulin

diabetes mellitus

• chronic multisystem disease characterized by hyperglycemia related to abnormal insulin production, impaired insulin utilization, or btoh

• affects 29.1 million people

• seventh leading cause of death

diabetes mellitus is the leading cause of

• adult blindness

• end-stage renal disease

• nontraumatic lower limb amputation

major contributing factors for diabetes mellitus

• heart disease

• stroke

type 2 diabetes

• most prevalent type (90-95%)

• many risk factors: overweight, obesity, advanced age, family history

• increasing prevalence in children

type 2 diabetes etiology and pathophysiology

• pancreas continues to produce some endogenous insulin but

  • not enough insulin is produced OR

  • body does not use insulin effectively

• big difference in type 1 vs type 2: in type 1 there is an absence of endogenous insulin

type 2 diabetes onset

• onset is gradual

• very often asymptomatic

• often discovered with routine lab testing

  • 50-80% of B cells are no longer secreting insulin

  • average person has had diabetes for 6.5 years

• can be managed initially with healthy eating, exercise, and glucose monitoring

• eventually will need medication

diagnosis for diabetes

• hemoglobin A1C of 6.5% or higher

• fasting glucose greater than or equal to 126

• 2 hour plasma glucose level greater than or equal to 200 after 75 mg glucose ingestion

pre-diabetes

• increased risk for developing type 2 diabetes

• usually asymptomatic

• impaired glucose tolerance, impaired fasting glucose, or both

• fasting blood glucose levels 100-125 mg/dL

• prevention is key in this phase

  • diet and exercise, lose weight, patient education, given metformin (SE: weight lose)

gestational diabetes

• fetal nutrient requirements

• insulin resistance

• 9.2% of all pregnancies

• more likely in people who are Hispanic, African-American, Native American, Asian, and Pacific Islander

• more likely to develop type 2 diabetes later in life

• mom is eating more and eating more frequently → blood sugars are high

• placenta makes hormones, such as cortisol that produces insulin and increases blood sugar

• insulin needs can be up to 3x more production

pregnancy screening for diabetes

• all pregnant people are screened between 24-28 weeks

• oral glucose tolerance test (OGTT)

• step 1:

  • drink 50 g of sugary drink very quickly then get blood drawn 1 hour after

  • 130-140 is considered positive and can go to step 2

• step 2:

  • blood drawn when fasting before drinking drink

  • drink 100 g of sugary drink

  • blood drawn at 1, 2, and 3 hours after

  • 2 values are abnormal: gestational diabetes

treatment for gestational diabetes

• diet-consult with a dietician

• exercise-moderate exercise

• glucose monitoring

• pharmacologic therapy

macrosomia

• baby that is bigger than it is supposed to be

  • because there is an increase in blood sugar→ the pancreas is bigger in a fetus, so it produces more insulin→ grows fat diposits→ bigger baby

why is there a risk for hypoglycemia in babies from gestational diabetes

• used to a lot of sugar in mom’s belly

• when born→ not receiving that sugar anymore

• baby’s blood sugar drops quickly

• baby needs blood glucose testing and IV glucose

goals of diabetes treatment

• decrease symptoms

• promote well-being

• prevent acute complications

• delay onset and progression of long-term complications

patient teaching for diabetes

• nutritional therapy

• drug therapy

• exercise

• self-monitoring of blood glucose

  • ***diet, exercise, and weight loss may be sufficient for patients with type 2 diabetes

  • ***all patients with type 1 require insulin

diabetes nutritional therapy: type 1

• meal planning

  • based on usual food intake and preferences

  • balanced with insulin and exercise patterns

• day-to-day consistency makes it easier to manage blood glucose levels

• more flexibility with rapid-acting insulin, multiple daily injections, and insulin pump

diabetes nutritional therapy: type 2

• emphasis on achieving glucose, lipid, and BP goals

• weight loss

  • nutritionally adequate meal plan with decreased fat and CHO

  • spacing meals

  • regular exercise

carb nutrition for diabetes

• minimum of 130g/day

• fruits, veggies, whole grains, legumes, low-fat dairy

• fiber-25-30 grams

fat nutrition for diabetes

• limited saturated fats to <7% of total calories

• limit cholesterol to <200 mg/day

• minimize trans fat

• healthy fat come from plants

  • olive, nuts, avocados

protein nutrition for diabetes

• should make up 15-20% of total calories

• high protein diets not recommended

  • because it takes too long and has to be sustained→ have to be on it forever

alcohol nutrition for diabetes

• limit to moderate amount

  • 1 drink/day for women; 2 drinks/day for men

• inhibits gluconeogenesis by liver

  • can cause severe hypoglycemia

• blood glucose levels must be monitored

exercise therapy for diabetes

• ADA recommends 150 min/wk

• moderate-intensity

• type 2-resistance training 3x/week