Nutritional Management of T2DM - Nov 1-2018.pptx -...

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Nutritional Management of Type 2 Diabetes in Children and Adolescents Jennifer Bewza, RD CDE Diabetes Education Resource for Children & Adolescents (DER-CA)
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Outline About the DER-CA Diabetes defined Type 2 Diabetes in Children – screening and diagnosis Type 2 Diabetes in Children – the Manitoba Experience Treatment What Barriers Exist?
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About the DER-CA D iabetes E ducation R esource for C hildren and A dolescents Established 1985 Part of provincial diabetes education network Specialized education, care and support for children, adolescents and their families affected by diabetes Doctors, nurses, dietitians, social worker, psychologists & support staff
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See patients from Manitoba, northwestern Ontario, and southeastern Saskatchewan 800 children from MB, SK, NW Ontario 500 Type 1 (~ 2 newly diagnosed/week) 280 Type 2 (~1-3 newly diagnosed/week) 50 with secondary diabetes
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Different Types of Diabetes TYPE 1 DIABETES IDDM childhood or juvenile diabetes TYPE 2 DIABETES NIDDM adult onset diabetes Secondary Diabetes eg. cystic fibrosis, drug-induced MODY (Maturity Onset Diabetes of the Young) HNF1-alpha, HNF4-alpha, HNF1-beta, Glucokinase Very rare and often misdiagnosed as Type 1 or Type 2
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DM - definition Fasting plasma glucose > _________ mmol/L OR 2 hour plasma glucose in a 75 g oral glucose tolerance test > _____________mmol/L OR Random plasma glucose of > __________mmol/L *A1C alone is not recommended for diagnostic purposes in those <18 yrs old* In the absence of symptoms, two abnormal glucose values are required for the diagnosis of diabetes. In the presence of symptoms, such as polyuria and polydipsia, only one abnormal glucose value is required. For type 2 diabetes: recommend using a combination of A1C and fasting or random blood glucose to screen for type 2 diabetes in children and youth with risk factors. Diabetes Canada Clinical Practice Guidelines 2018 6
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Prediabetes Impaired Fasting Glucose (IFG) ________________mmol/L Impaired Glucose Tolerance (IGT) _________________mmol/L 7
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Acanthosis Nigricans 9
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Type 1 vs. Type 2 Diabetes Type 1 Diabetes ____% of diabetes population _______________ No insulin produced Insulin injections are required Cannot be prevented by lifestyle Type 2 Diabetes _____% of diabetes population ________________ Variety of treatment options Family history/ethnicity Inactivity and obesity 10
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Signs and Symptoms of Diabetes Polyuria Polydipsia Acanthosis nigricans Fatigue/lack of energy Blurred vision Weight loss Nausea/vomiting or abdominal pain Loss of appetite Frequent infections (yeast in the genital area) Tingling/numbness in hands or feet Lab findings: hyperglycemia, ketonuria, acidemia 11
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Type 2 diabetes mellitus NORMOGLYCEMIA Insulin Secretion Insulin Sensitivity 12
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Type 2 diabetes mellitus INSULIN RESISTANCE Insulin Secretion Insulin Sensitivity NORMOGLYCEMIA 13
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Type 2 diabetes mellitus INSULIN RESISTANCE Insulin Secretion Insulin Sensitivity IMPAIRED GLUCOSE TOLERANCE 14
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