persistent hyperglycemia; affects 8.3% of the US
type 1 diabetes
autoimmune disease; Dx in childhood/teens; no insulin produced; no signal telling cells to take up glucose in the blood stream
type 2 diabetes
cells are resistant to insulin; Dx throughout lifespan; signal to take up glucose in blood stream is present, but cells do not respond
complications arising from diabetes
damage to large blood vessels leads to increased risk of stroke; damage to small blood vessels leads to bleeding in the retinas and possibly blindness; high blood pressure and increased risk of heart attack; excretion of protein in the urine and eventually kidney failure; nerve damage that causes numbness and pain; blocked arteries in the legs, reduced blood flow to the feet, causing sores that heal slowly or not at all; numbness that affects balance and increases the risk of accidental injury
signs and symptoms of diabetes
frequent urination; excessive hunger; weight loss, fatigue/irritability; infections; blurred vision; tingling in hands/feet; nausea/vomiting; however, can be asymptomatic
blood test levels for diagnosis of diabetes
A1C – 6.5% or above; fasting plasma glucose – 126 mg/dL or above; oral glucose tolerance test – 200 mg/dL or above
blood test levels for diagnosis of pre-diabetes
A1C – 5.7-6.4%; fasting plasma glucose – 100-125 mg/dL; oral glucose tolerance test – 140-199 mg/dL
normal blood test levels
A1C – about 5%; fasting plasma glucose – 99 mg/dL or below; oral glucose tolerance test – 139 mg/dL or below
why use the exchanges?
groups together food with similar nutritional values; functions as both planning and educational tool
why is the exchange good to use with diabetes?
blood glucose control is affected by food choices; also by exercise and insulin medication; use of exchanges can help prevent complications
what does the exchange system facilitate?
general meal planning and healthy eating involving calorie control and appropriate distribution of macronutrients/food groups
food lists in the exchange system
foods of about the same nutritional value grouped together; grouped by content of kcals, CHO, fat, protein
what do the individualized meal plans do?
outline # of exchanges (servings) from each group for every meal/snack
what things do the tips in the guide highlight?
high in fiber, extra fat, high in sodium
where does the nutrient data for the exchange system come from?
USDA Food and Nutrient Database – database of almost 700 foods; averages of food labels – generic or national brands; occasionally from recipes
patient requirements to use the exchange system
thorough knowledge of foods; good memory; intelligence; motivation; self-efficacy
how does the exchange system function as a tool for dietitians?
quick assessment of dietary intake; meal planning guide; diabetes and weight management; calorie counts