Course Outline
- What Is Diabetes?
- Types of Diabetes
- Treatment of Diabetes
- Impaired Glucose Tolerance and Impaired Fasting Glucose
- Prevention of Diabetes
- Prevention of Diabetes Complications
- Glucose Control
- Blood Pressure Control
- Control of Blood Lipids
- Preventive Care Practices For Eyes, Kidneys, and Feet
- Methods
- Prevalence of Diabetes
- Prevalence of Diabetes Among People Under 20 Years of Age
- Prevalence of Diabetes Among People 20 Years or Older
- Prevalence of Diabetes by Race/Ethnicity Among People 20 Years or Older
- Incidence of Diabetes
- Deaths Among People With Diabetes
- Complications of Diabetes
- Stroke
- High Blood Pressure
- Blindness
- Kidney Disease
- Nervous System Disease
- Amputations
- Dental Disease
- Complications of Pregnancy
- Other Complications
- Complications of Diabetes
- Stroke
- Acknowledgments
- How Many African Americans Have Diabetes?
- What Risk Factors Increase the Chance of Developing Type 2 Diabetes?
- Genetic Risk Factors
- Medical Risk Factors
- Figure 1. Prevalence of diagnosed and undiagnosed diabetes in African
- Americans, U.S., 1988-94.
- Gestational Diabetes (GDM)
- Hyperinsulinemia and Insulin Resistance
- Obesity
- Physical Activity.
- How Does Diabetes Affect African American Children?
- How Does Diabetes Affect African American Women During Pregnancy?
- Figure 2. Time trends in the percentage of adolescents and adults in the U.S. who are overweight, U.S., 1988-94
- How Do Diabetes Complications Affect African Americans?
- Eye Disease
- Kidney Failure
- Amputations
- Does Diabetes Cause Excess Deaths in African Americans?
- How Is NIDDK Addressing the Problem of Diabetes in African Americans?
- Prevention
- Figure 3. Mortality rates in African American and white diabetic men and women in a sample of the U.S. population, 1971-1993.
- National Diabetes Education Program
- Points to Remember
- Prevention
- References
- Major Studies of Diabetes in Hispanic Americans
- How Many Hispanic Americans Have Diabetes?
- Table 1. Hispanic American Populations in the United States and Percentage With Diabetes
- Figure 1. Prevalence of diagnosed and undiagnosed diabetes in Mexican Americans, U.S., 1988-94
- What Factors Increase the Chance of Developing Type 2 Diabetes?
- Genetic Risk Factors
- Figure 2. Genetic origins of the major Hispanic subgroups in the United States
- Medical and Lifestyle Risk Factors
- Prediabetes (Impaired Glucose Tolerance and Impaired Fasting Glucose)
- Gestational Diabetes
- Hyperinsulinemia and Insulin Resistance
- Obesity
- Physical Activity
- Figure 3. Prevalence of overweight individuals among whites, blacks, and Mexican Americans in the population, 1988-91
- Genetic Risk Factors
- How Does Diabetes Affect Hispanic Young People?
- How Does Diabetes Affect Hispanic Women During Pregnancy?
- How Do Diabetes Complications Affect Hispanic Americans?
- Eye Disease
- Kidney Disease
- Nerve Disease
- Peripheral Vascular Disease
- Heart Disease
- How Is NIDDK Addressing the Problem of Diabetes in Hispanic Americans?
- Diabetes Prevention Program
- National Diabetes Education Program
- Points to Remember
- References
- How Many American Indians and Alaska Natives Have Diabetes?
- Type 2 Diabetes
- Table 1. Age-adjusted prevalence of diagnosed diabetes among American Indians/ Alaska Natives, age 20 and older, by group of tribes– United States, 1997
- Table 2. Prevalence of diagnosed diabetes among American Indians/Alaska Natives and non-Hispanic whites, age 20 and older, by age and sex– United States, 1997.
- Type 1 Diabetes
- Type 2 Diabetes
- What Risk Factors Increase the Chance?
- Genetic Risk Factors
- Medical and Lifestyle Risk Factors
- Obesity
- Diet and Physical Inactivity
- Prediabetes (Impaired Glucose Tolerance and Impaired Fasting Glucose)
- Hyperinsulinemia and Insulin Resistance
- How Does Diabetes Affect American Indian and Alaska Native Women During Pregnancy?
- How Does Diabetes Affect Cardiovascular Health in American Indians and Alaska Natives?
- Ischemic Heart Disease
- Stroke
- Hypertension
- How Do Diabetes Complications Affect American Indians and Alaska Natives
- Diabetic Retinopathy
- Cataracts
- Diabetic Nephropathy
- Lower Extremity Amputation
- Periodontal Disease
- Infections
- Does Diabetes Cause an Inordinate Number of Deaths in American Indians and Alaska Natives?
- How Is NIDDK Addressing the Problem of Diabetes in American Indians?
- Diabetes Prevention Program
- Points to Remember
- References
- Table 1. Asian and Pacific Islander ethnicities in the United States.
- How Many Asian and Pacific Islander Americans Have Diabetes?
- Type 2 Diabetes
- Table 2. Prevalence of diabetes in the United States in non-Hispanic white people, Asian Americans, and Native Hawaiians.
- Type 1 Diabetes
- Type 2 Diabetes
- What Risk Factors Increase the Chance That Asian and Pacific Islander Americans Will Develop Type 2 Diabetes?
- Genetic Risk Factors
- Lifestyle and Medical Risk Factors
- Obesity
- Diet and Physical Inactivity
- Prediabetes (Impaired Glucose Tolerance and Impaired Fasting Glucose)
- Hyperinsulinemia and Insulin Resistance
- How Does Diabetes Affect Asian and Pacific Islander American Women During Pregnancy?
- How Does Diabetes Affect Cardiovascular Health in Asian and Pacific Islander Americans?
- How Do Diabetes Complications Affect Asian and Pacific Islander Americans?
- Diabetic Retinopathy
- Diabetic Nephropathy
- Lower Extremity Amputation
- Does Diabetes Cause an Inordinate Number of Deaths in Asian and Pacific Islander Americans?
- How Is NIDDK Addressing the Problem of Diabetes in Asian and Pacific Islander Americans?
- Diabetes Prevention Program
- Points to Remember
- References
- Questions to Ask Your Doctor About Blood Sugar
- How Do You Tell If You Have Pre-Diabetes?
- What You Can Do
- Frequently Asked Questions
- Q: What is pre-diabetes and how is it different from diabetes?
- Q: Is pre-diabetes the same as Impaired Glucose Tolerance or Impaired Fasting Glucose?
- Q: Why do we need to give it a new name? Has the condition changed?
- Q: How do I know if I have pre-diabetes?
- Q: How does the FPG test define diabetes and pre-diabetes?
- Q: How does the OGTT define diabetes and pre-diabetes?
- Q: Which test is better?
- Q: Why do I need to know if I have pre-diabetes?
- Q: Will my insurance cover testing and treatment?
- Q: What is the treatment for pre-diabetes?
- Q: Who should get tested for pre-diabetes?
- Q: How often should I be tested?
- Q: Could I have pre-diabetes and not know it?
- Q: Should children be screened for pre-diabetes?
- What Is Type 2 Diabetes?
- How Can Type 2 Diabetes Be Prevented?
- What Are the Signs and Symptoms of Type 2 Diabetes?
- Types of Diabetes
- Type 1 Diabetes
- Type 2 Diabetes
- Gestational Diabetes
- Should I Be Tested For Diabetes?
- What Does It Mean to Have Pre-Diabetes?
- Besides Age and Overweight, What Other Factors Increase My Risk For Type 2 Diabetes?
- What Can I Do About My Risk?
- Doing My Part: Getting Started
- Reach and Maintain a Reasonable Body Weight
- Make Wise Food Choices Most of the Time
- Be Physically Active Every Day
- Take Your Prescribed Medications
- How Does the Body Control Glucose?
- What Are the Symptoms of Hypoglycemia?
- Hypoglycemia in Diabetes
- Managing Hypoglycemia in Diabetes
- Other Causes of Hypoglycemia
- Diagnosis
- Reactive Hypoglycemia
- Rare Causes of Hypoglycemia
- Resources on Hypoglycemia
- Additional Readings
- How Food Affects Your Blood Glucose
- Blood-glucose Levels
- Noninvasive Blood Glucose Monitors
- How Can I Keep My Blood Glucose at a Health Level?
- Why Should I Eat About the Same Amount at the Same Times Each Day?
- Your Diabetes Medicines
- Your Exercise Plan
- Hypoglycemia
- The Food Pyramid
- Starches
- Vegetables
- Fruit
- Milk and Yogurt
- Meat and Meat Substitutes
- Fats and Sweets
- Alcohol
- Your Meal Plan
- Measuring Your Food
- When You Are Sick
- Points to Remember
- How to Find More Help
- Prevent Diabetes Problems: Keep Your Kidneys Healthy
- The Course of Kidney Disease
- Five Stages
- Effects of High Blood Pressure
- Preventing and Slowing Kidney Disease
- Blood Pressure Medicines
- Low-Protein Diets
- Intensive Management of Blood Glucose
- Dialysis and Transplantation
- Good Care Makes a Difference
- Looking to the Future
- References
- What are diabetes problems?
- What should I do each day to stay healthy with diabetes?
- What do my kidneys do?
- How can I prevent diabetes kidney problems?
- Is there a medicine to slow down kidney damage?
- How can my doctor protect my kidneys during special x-ray tests?
- How can diabetes hurt my kidneys?
- What can I do if I have diabetes kidney problems?
- How will I know if my kidneys fail?
- What happens if my kidneys fail?
- Will I know if I start to have kidney problems?
- How can I find out if I have kidney problems?
- Will my doctor do other kidney tests?
- When Your Kidneys Fail
- Treatment Choice: Hemodialysis
- Purpose
- How It Works
- Getting Ready
- Who Performs It
- The Time it Takes
- Possible Complications
- Your Diet
- Pros and Cons
- Working With Your Health-Care Team
- Treatment Choice: Peritoneal Dialysis
- Purpose
- How It Works
- Getting Ready
- Types of Peritoneal Dialysis
- Possible Complications
- Your Diet
- Pros and Cons
- Working With Your Health-Care Team
- Dialysis Is Not a Cure
- Treatment Choice: Kidney Transplantation
- Purpose
- How It Works
- Getting Ready
- The Time It Takes
- Possible Complications
- Your Diet
- Pros and Cons
- Working With Your Health-Care Team
- Conclusion
- Paying for Treatment
- Medicare
- Private Insurance
- Medicaid
- Veterans Administration (VA) Benefits
- Social Security Income (SSI) and Social Security Disability Income (SSDI)
- Organizations That Can Help
- Additional Reading
- Causes
- Symptoms
- Types of Diabetic Neuropathy
- Neuropathy Affects Nerves Throughout the Body
- Peripheral Neuropathy
- Autonomic Neuropathy
- Proximal Neuropathy
- Focal Neuropathy
- Peripheral Neuropathy
- Autonomic Neuropathy
- Unawareness of Hypoglycemia
- Heart and Circulatory System
- Digestive System
- Urinary Tract and Sex Organs
- Sweat Glands
- Eyes
- Proximal Neuropathy
- Focal Neuropathy
- Preventing Diabetic Neuropathy
- Diagnosis
- Treatment
- Foot Care
- Pain Relief
- Gastrointestinal Problems
- Dizziness and Weakness
- Urinary and Sexual Problems
- Points to Remember
- Hope Through Research
- For More Information
- What Is Gastroparesis?
- Symptoms
- Complications of Gastroparesis
- Major Causes of Gastroparesis
- Diagnosis
- Treatment
- Insulin For Blood Glucose Control in People With Diabetes
- Medication
- Meal and Food Changes
- Feeding Tube
- Parenteral Nutrition
- Points to Remember
- How Does an Erection Occur?
- What Causes Impotence?
- How Is Impotence Diagnosed?
- Patient History
- Physical Examination
- Laboratory Tests
- Other Tests
- Psychosocial Examination
- How Is Impotence Treated?
- Psychotherapy
- Drug Therapy
- Vacuum Devices
- Surgery
- What Will the Future Bring?
- Points to Remember
- Resources for More Information
- What Are Diabetes Problems?
- What Can I Do Each Day to Stay Healthy With Diabetes?
- What Can I Do to Prevent Diabetes From Damaging My Nervous System?
- What Can I Do to Take Care of My Feet?
- What Does My Nervous System Do?
- How Can Diabetes Hurt My Nervous System?
- How Can Diabetes Damage to The Peripheral Nerves Affect Me?
- How Can Diabetes Damage to the Autonomic Nerves Affect Me?
- How Can Diabetes Damage to the Cranial Nerves Affect Me?
- How Do I Know if I Have Nerve Damage?
- For More Information
- What Are Diabetes Problems?
- What Should I Do Each Day to Stay Healthy With Diabetes?
- What Do My Heart and Blood Vessels Do?
- What Damages My Heart and Blood Vessels?
- What Can I Do to Prevent Heart and Blood Vessel Problems?
- How Do My Blood Vessels Get Clogged?
- What Heart Problems Can Unhealthy Blood Vessels Cause?
- How Does Heart Disease Cause High Blood Pressure?
- What Are the Warning Signs of a Stroke?
- How Can Clogged Blood Vessels Hurt My Legs and Feet?
- What Can I Do to Prevent or Control Peripheral Vascular Disease?
- Which Medical Tests Will Help Me Keep Track of Any Heart or Blood Vessel Problems?
- For More Information
- What Are Diabetes Problems?
- What Should I Do Each Day to Stay Healthy With Diabetes?
- How Can Diabetes Hurt My Feet?
- What Can I Do To Take Care of My Feet?
- How Can I Get My Doctor to Help Me Take Care of My Feet?
- What Are Common Diabetes Foot Problems?
- How Can Special Shoes Help My Feet?
- How Can Diabetes Hurt My Skin?
- What Can I Do to Take Care of My Skin?
- Take Care of Your Feet for a Lifetime
- Tips For Proper Footwear
- Steps For Preventing Foot Problems
- Annual Comprehensive Diabetes Foot Exam
- What Are Diabetes Problems?
- What Should I Do Each Day to Stay Healthy With Diabetes?
- How Can Diabetes Hurt My Teeth and Gums?
- How Do I Know If I Have Damage to My Teeth and Gums?
- How Can I Keep My Teeth and Gums Healthy?
- How Can My Dentist Take Care of My Teeth and Gums?
- For More Information
- What Are Diabetes Problems?
- Will I Have Diabetes Problems?
- What Should My Blood Sugar Numbers Be?
- How Can I Find Out What My Average Blood Sugar Is?
- Check Your Hemoglobin Alc I.Q.
- Answers to the Hemoglobin A1c I.Q. Quiz
- What Should I Do About Blood Pressure?
- What Should I Know and Do About Smoking?
- What Else Can I Do to Prevent Diabetes Problems?
- Things to Check For Good Diabetes Care
- How to Use the Daily Diabetes Record Page
- Blood sugar checks
- Medicines
- Notes
- Introduction
- Principle 1: Screening High-Risk People and Diagnosing Diabetes
- Principle 2: On-Going Care
- Principle 3: Diabetes Education
- Principle 4: Treating Hyperglycemia
- Principle 5: Self-Monitoring of Blood Glucose Control and Hemoglobin A1c (HbA1c)
- Principle 6: Preventing and Diagnosing Long-Term Diabetes Problems
- Principle 7: Screening For and Treating Long-Term Diabetes Problems
- Do I Need to Take Diabetes Medicine?
- What if I have type 1 diabetes?
- What if I have type 2 diabetes?
- Why do I need medicines for type 1 diabetes?
- Specific insulin
- Why Do I Need Medicines for Type 2 Diabetes?
- What Do I Need to Know About Diabetes Pills?
- Specific Pills
- Oral Drugs
- What Do I Need to Know About Insulin?
- Can insulin be taken as a pill?
- How does insulin work?
- How often should I take insulin?
- When should I take insulin?
- Are there several types of insulin?
- Does insulin work the same all the time?
- Where on my body should I inject insulin?
- How should I store insulin?
- What are possible side effects of insulin?
- Might I Take More Than One Diabetes Medicine at a Time?
- What Should I Know About Hypoglycemia (low blood sugar)?
- How Do I Know If My Diabetes Medicines Are Working?
- Acupuncture
- Biofeedback
- Chromium
- Magnesium
- Vanadium
- Additional Information on Alternative Therapies for Diabetes
- What Is the DCCT?
- DCCT Study Findings
- How Did Intensive Treatment Affect Diabetic Eye Disease?
- How Did Intensive Treatment Affect Diabetic Kidney Disease?
- How Did Intensive Treatment Affect Diabetic Nerve Disease?
- How Did Intensive Treatment Affect Diabetes-Related Cardiovascular Disease?
- Elements of Intensive Management in the DCCT
- What Are the Risks of Intensive Treatment?
- Introduction
- Should We Attempt To Prevent Diabetes?
- Who Are Potential Candidates For Screening and Intervention?
- Choice of Screening Test
- Age Considerations and Screening Frequency
- How Should Diabetes Prevention Be Performed?
- Lifestyle Modification
- Pharmacological Interventions
- Lifestyle or Medication?
- How Do Strategies to Prevent Diabetes Differ From Those to Treat Diabetes?
- What Additional Research Is Needed?
- Conclusions
- References
Chapter 27: Diet and Exercise Delay Diabetes and Normalize Blood Glucose
- What Is Impaired Glucose Tolerance (IGT)?
- How does the fasting blood glucose test differ from the oral glucose tolerance test?
- For a person with IGT, what is the risk of developing type 2 diabetes?
- How many people in the U.S. have IGT? Would the DPP interventions benefit all of them?
- How do the DPP results compare to the findings of other type 2 diabetes prevention studies?
- How do diet and physical activity work to prevent diabetes?
- What were the goals of DPP’s lifestyle intervention arm?
- What dietary advice did participants receive?
- Lifestyle intervention more effectively reduced diabetes risk than metformin
- Within each arm, did certain groups of DPP participants benefit more from the intervention than other groups?
- Did the DPP volunteers in the lifestyle group benefit more from one lifestyle change than the other, e.g., more from exercise than from diet or vice versa?
- Lifestyle changes with diet and exercise reduced diabetes risk, as did treatment with metformin. By combining these interventions, could diabetes risk be reduced even further?
- Would the new formulation of metformin, Glucophage XR, be helpful to people with IGT?
- Do the DPP interventions affect the risk of cardiovascular disease, an important cause of mortality in people with type 2 diabetes?
- Are there any plans to get information about the DPP to the public and health- care professionals?
- What is the estimated cost of the DPP interventions?
- Were there any deaths or serious injuries in the study resulting from metformin treatment or the lifestyle changes?
- Were there adverse effects associated with the interventions?
- What will happen to the volunteers who took part in the DPP?
- What happened to the DPP volunteers who developed diabetes?
- Are diet and exercise beneficial even after diabetes develops?
- What is gestational diabetes and what causes it?
- How does gestational diabetes differ from other types of diabetes?
- Who is at risk for developing gestational diabetes and how is it detected?
- How does gestational diabetes affect pregnancy and will it hurt my baby?
- What can be done to reduce problems associated with gestational diabetes?
- Diet and Weight Gain
- Why is a special diet recommended?
- How much weight should I gain?
- How should I eat during my pregnancy?
- Other Nutritional and Nonnutritional Considerations
- Alcohol
- Salt
- Caffeine
- Megavitamins
- Smoking
- What food patterns help keep blood sugar levels normal?
- How do I plan meals?
- What can be done to slow weight gain during pregnancy?
- Is breastfeeding recommended?
- Glucose Monitoring
- What is self-blood glucose monitoring?
- How often and when should I test?
- How should I record my test results?
- Are there any other tests I should know about?
- How do I test for ketones?
- When do I test for ketones?
- Is it ever necessary to take insulin?
- Will my baby be healthy?
- Does gestational diabetes affect labor and delivery?
- Should I expect my baby to have any problems?
- Will I develop diabetes in the future?
- Exercise
- Should I exercise?
- What happens if diet and exercise fail to control my blood sugars?
- Can my blood sugar level go too low, and if so, what do I do?
- Glossary
- Pathophysiology of Diabetes Mellitus
- The Pancreas and Its Hormones
- Alcohol’s Effects on Blood Sugar Levels of Diabetics
- Effects of Alcohol Consumption in the Fed State
- Effects of Alcohol Consumption in the Fasting State
- Alcohol’s Effects on Complications of Diabetes
- Diabetic Ketoacidosis
- Alterations of Lipid Metabolism
- Elevated Triglyceride Levels.
- Reduced LDL Cholesterol Levels.
- Elevated HDL Cholesterol Levels.
- Cardiovascular Disease
- Peripheral Neuropathy
- Retinopathy
- Medication Interactions
- Summary
- References
Learning Objectives
Upon completing the course, you will be able to:
- Classify various types of diabetes and their prevalence in the general population.
- Describe the prevalence of diabetes among people under 20 years of age, among people 20 years or older, and in various ethnic population groups.
- Identify various complications of diabetes and cite mortality figures from the complications.
- Cite statistics illustrating the magnitude of diabetes among African Americans.
- Discuss genetics and medical and lifestyle risk factors that increase the chance of developing type 2 diabetes among African Americans.
- Describe how diabetes complications affect African Americans.
- Discuss various epidemiology studies about diabetes in Hispanic Americans.
- Discuss lifestyle and medical risk factors for diabetes in Asian and Pacific Islander Americans.
- Describe the new nomenclature and the criteria for the diagnosis of diabetes.
- Discuss with the patient how a diagnosis of diabetes is made.
- Identify 7 risk factors for diabetes.
- Define and answer prediabetes questions, such as the need for testing.
- Discuss the results of the Diabetes Prevention Program (DPP) study in preventing or delaying the development of type 2 diabetes.
- List 7 signs and symptoms of type 2 diabetes.
- Provide an overview of the three main kinds of diabetes–type 1, type 2 and gestational diabetes.
- Identify 7 factors that increase a person’s risk for type 2 diabetes
- Advise a patient on the steps he or she can take to reduce the risk of getting diabetes.
- Describe how the body controls glucose and list various symptoms of hypoglycemia.
- Describe certain rare causes of hypoglycemia.
- Describe the pancreatic islet transplantation and explain the benefits and risks of transplantation.
- Teach a patient about the importance of eating to control diabetes.
- Explain the food pyramid and prescribe proper servings of starches, vegetables, fruit, milk and yogurt, meat, and fats and sweets.
- Help a diabetic patient with his or her meal plan.
- Describe the course of kidney disease through five stages.
- Advise a patient in ways of preventing and slowing kidney disease.
- Teach a patient about kidney problems caused by diabetes.
- Explain to a patient three treatment choices when kidneys fail.
- Advise a patient who is on hemodialysis about proper diet.
- Describe for a patient hemodialysis and peritoneal dialysis and their relative advantages and disadvantages.
- Describe kidney transplantation as a treatment of choice for ESRD.
- Describe the causes, symptoms and types of diabetic neuropathy.
- Describe how autonomic neuropathy affects the nerves in lungs, heart, stomach, intestines, bladder, and sex organs.
- Explain to a patient various tests that are done to diagnose neuropathy.
- Describe gastroparesis, its symptoms, complications and treatment.
- Define impotence and explain what causes impotence.
- Explain how an erection occurs.
- Describe the treatment for impotence, including psychotherapy, drug therapy, and surgery.
- Teach a diabetic patient about keeping his heart and blood vessels healthy.
- Discuss with a patient the importance of keeping the hemoglobin A1c number under control.
- Enunciate 7 principles of quality diabetes treatment.
- Explain to a patient why he or she needs to take medicines for diabetes.
- List various types of diabetic pills that help lower blood glucose and identify their mode of action.
- Teach a patient how to recognize symptoms of hypoglycemia and what to do if the blood glucose is low.
- Discuss various alternative therapies, such as acupuncture, biofeedback, chromium, magnesium and vanadium for the treatment of diabetes.
- Discuss the findings of the Diabetes Control and Complications Trial (DCCT).
- Discuss various clinical studies initiated to determine the feasibility and benefit of various strategies to prevent or delay the onset of type 2 diabetes.
- On the basis of these clinical studies, identify potential candidates for screening and intervention, compare lifestyle modification with pharmacological interventions, and evaluate various strategies to prevent diabetes.
- Describe the results of the Diabetes Prevention Program (DPP) trial and compare the relative benefits of lifestyle modification, treatment with metformin and standard medical advice.
- Answer specific questions posed by a patient about diabetes: its prevalence, diagnosis, prevention, importance of diet and exercise.
- Describe the pathogenesis of gestational diabetes.
- List factors indicative of women who might develop gestational diabetes during pregnancy.
- Explain the 50-gram and 3-hour glucose tests for tolerance gestational diabetes.
- Explain how gestational diabetes affects pregnancy and how it may affect the baby.
- Answer the question often asked by pregnant women: How much weight should I gain?
- Provide guidance to a pregnant woman about the optimal intake of six food groups during pregnancy.
- Describe various tests done to assess the condition of the fetus before birth.
- Advise a pregnant woman about the importance of diet and exercise to control her blood sugars.
- Explain the pathophysiology of diabetes mellitus.
- Describe the blood glucose regulation by insulin in healthy people and in people with type 1 or type 2 diabetes.
- Describe the effects of alcohol consumption on blood sugar levels of diabetics.
- Contrast the effects of alcohol consumption in the fed and fasting states of diabetics.
- Describe the alcohol’s effects on complications of diabetes, such as diabetic ketoacidosis, lipid metabolism, cardiovascular disease, peripheral neuropathy and retinopathy.