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Bodys response to glucagon blocks gluconeogenesis can

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Unformatted text preview: l lifestyle/diet changes • those with combination diabetes o have type 1 diabetes and then become insulin resistant need oral medications so that body can use insulin Types of Oral Agents • Increase Insulin Sensitivity – help with insulin resistance: o metformin increases insulin sensitivity decreases glucose release by the liver o TZDs enhances glucose and fatty acid uptake in skeletal muscle • Increase Insulin Secretion – help with beta cell dysfunction o sulphonureas stimulate pancreas to secrete insulin at lower glucose levels o non- sulphonurea insulin secretagogues simulate pancreas to secrete insulin Medications in Type 2 Diabetes • usually start with metformin • if glycemic targets are not achieved, other oral agents or insulin might be added • insulin for type 2 diabetes o start with a basal dose – long acting or premixed with fast acting or short acting o move up to multiple dose if required • want to get glucose under control as quickly as possible o if drugs don’t work – move to insulin – usually only need a little bit of insulin to start o most people with type 2 – diabetes gets worse over time Physical Activity • increases insulin sensitivity • especially beneficial for type 2 • key part of diabetes treatment • potential risks increase with DM: o ischemic events, foot injuries Exercise Recommendations • minimum of 150 minutes of moderate- vigorous aerobic activity/week o spread over a minimum of three days o no more than two consecutive days without exercise • resistance exercise three times per week • proper foot wear o check for foot injury due to neuropathy Exercise with Insulin • exercise uses glucose quickly o at risk for hypoglycemia following exercise o directly after or hours later (even in the night) concern for parents of children with type 1 • adjustments to CHO intake or insulin injections needed o need to monitor glucose before, during and after exercise o take additional 10- 15g CHO per 0.5 – 1 hour of planned activity o OR decrease insulin dose • children: increase CHO – more straightforward • most people start off by adjusting carb intake Diet • cornerstone of management • type 2 and GDM – may be only management required • for all types – sustained CHO delivered throughout day – primary goal • avoid complications (cardiovascular) – secondary goal • goals of diet vary depending on type of DM – tertiary goals o DM1 – growth, weight regain o DM2 – weight loss o GDM – successful pregnancy, slowed/stopped weight gain don’t want to cut diet too far – fetus needs nutrients don’t want weight loss in women with GDM Practice Guidelines • Canadian Diabetes Association Clinical Practice Guidelines o developed by Canadian experts o based on most current literature o evidence is rated 2008 CDA Guidelines for Nutrition Therapy in Diabetes • nutrition counselling by a RD • small group or one- on- one setting similar • follow Eating Well with Canada’s Food Guide • healthy eating to avoid complications • type 1 diabetes match insulin to carbohydrate OR maintain consistency in carbohydrate intake • type 2 diabetes maintain regularity in timing and spacing of meals • choose food with a lower glycemic index • sucrose in mixed meals up to 10% energy • <7% of total daily energy from saturated fats • trans fatty acids to a minimum • type 1 diabetes – risk of delayed hypoglycemia from alcohol AND should adjust carbohydrate intake and/or insulin, increase blood glucose monitoring Macro...
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