DIABETES MELLITUS | Type2 Diabetes | Eat Well | Carbohydrate Counting
DIET AND DIABETES MELLITUS – Diabetes mellitus is the name for a group of serious and chronic (longstanding) disorders affecting the metabolism of carbohydrates.
These disorders are characterized by hyperglycemia (abnormally large amounts of glucose in the blood). The amount of glucose in the blood normally rises after a meal. The pancreas reacts by providing insulin. As the insulin circulates in the blood, it binds to special insulin receptors on cell surfaces.
This binding causes the cells to accept the glucose. The resulting reduced amount of glucose in the blood in turn signals the pancreas to stop sending insulin.
The etiology (cause) of diabetes is not confirmed. Although it appears that diabetes may be genetic, environmental factors also may contribute to its occurrence. For example, viruses or obesity may precipitate the disease in people who have a genetic predisposition.
DIABETES MELLITUS SYMPTOMS:
When hyperglycemia exceeds the renal threshold, the glucose is excreted in the urine (glycosuria). With the loss of
the cellular fluid, the pateint experiences
- Polyuria (excessive urination),
- and polydipsia (excessive thirst) typically results.
- The inability to metabolize glucose causes the body to break down its own tissue for protein and fat. This response causes polyphagia (excessive appetite),
- but at the same time a loss of weight, weakness, and fatigue occur.
- The body’s use of protein from its own tissue causes it to excrete nitrogen. Because the untreated diabetic client cannot use carbohydrates for energy, excessive amounts of fats are broken down, and consequently the liver produces ketones from the fatty acids.
- Ketones collect in the blood (ketonemia) and must be excreted in the urine (ketonuria). Ketones are acids that lower blood pH, causing acidosis. Acidosis can lead to diabetic coma, which can result in death if the pateint is not treated quickly with fluids and insulin.
- Nerve damage (neuropathy) is also common.
DIABETES MELLITUS CLASSIFICATION:
The types of diabetes are prediabetes, type 1, type 2, and gestational.
It means that the cells in the body are not using insulin properly. The diagnosis is made by a fasting blood glucose, which is more than 110 but less than 126 mg/dl. One’s lifestyle will determine when prediabetes will advance to type 2.
Type 1 diabetes:
It develops when the body’s immune system destroys the pancreatic beta cells. These are the only cells in the body that make the hormone insulin that regulates blood glucose. Type 1 diabetes is usually diagnosed in children and young adults. It can account for 5% to 10% of all cases of newly diagnosed diabetes. Some risk factors include genetics, autoimmune status, and environmental factors.
Type 2 diabetes:
It was previously called adult-onset diabetes because it usually occurred in adults over the age of 40 onset is gradual and production of insulin gradually diminishes; can usually be controlled by diet and exercise. Type 2 is associated with obesity, and obesity has become an epidemic, which has drastically increased the incidence of type 2 diabetes among adolescents and young adults.
A family history of diabetes, prior history of gestational diabetes, impaired glucose tolerance, older age, physical inactivity, and race and ethnicity can predispose one to type 2 diabetes.
In type 2 diabetes, hypertension may be present as part of the metabolic syndrome (i.e., obesity, hyperglycemia,
and dyslipidemia) that is accompanied by high rates of cardiovascular disease. The American Diabetes Association recommends that blood pressure be controlled at >130/80 mm Hg for diabetics.
Types of Oral Diabetes (Glucose-Lowering) Medications:
- Meglitinide- Repaglinide (Prandin) Nateglinide (Starlix)
- Thiazolidinedione- Pioglitazone (Actos) Rosiglitazone (Avandia)
- Combination drugs– Glyburide and metformin (Glucovance) Glipizide and metformin (Metaglip)
- Nonsulfonylurea- Metformin (Glucophage) Melformin and a time-released controlling polymer (Glucophage XR)
- Alpha-glucosidase– inhibitor Acarbose (Precose) Miglitol (Glycet) Second-generation sulfonylureas- Glyburide (DiaBeta, Micronase, Glynase Prestabs) Glipizide (Glucotrol, Glucotrol XL) Glimepride (Amaryl)
can occur between the sixteenth and twenty-eighth week of pregnancy. If it is not responsive to diet and exercise, insulin injection therapy will be used (Figure 17-1). It is recommended that a dietitian or a diabetic educator be consulted to plan an adequate diet that will control blood sugar for mother and baby. Concentrated sugars should be avoided. Weight gain should continue, but not in excessive amounts. Usually, gestational diabetes disappears after the infant is born. However, diabetes can develop 5 to 10 years after the pregnancy.
TREATMENT: The treatment of diabetes is intended to do the following:
- Control blood glucose levels
- Provide optimal nourishment for the client
- Prevent symptoms and thus delay the complications of the disease
Treatment is typically begun when blood tests indicate hyperglycemia or when other previously discussed symptoms occur. Normal blood glucose levels (called fasting blood sugar, FBS) are from about 70 to 100 mg/dl.
Treatment can be by diet alone or by a diet combined with insulin or an oral glucose-lowering medication plus regulated exercise and the regular monitoring of the client’s blood glucose levels.
The physician and dietitian can provide essential testing, information, and counseling and can help the client delay potential damage. The ultimate responsibility, however, rests with the client. When a person with diabetes uses nicotine, eats carelessly, forgets insulin, ignores symptoms, and neglects appropriate blood tests, he or she increases the risk of developing permanent tissue damage.
The dietitian will need to know the client’s diet history, food likes and dislikes, and lifestyle at the onset. The client’s calorie needs will depend on age, activities, lean muscle mass, size, and REE.
It is recommended that carbohydrates provide 50% to 60% of the calories. Approximately 40% to 50% should be from complex carbohydrates (starches). The remaining 10% to 20% of carbohydrates could be from simple sugar.
It is the total amount of carbohydrates eaten that affects blood sugar levels rather than the type. Being able to
substitute foods containing sucrose for other carbohydrates increases flexibility in meal planning for the diabetic.
Fats should be limited to 30% of total calories, and proteins should provide from 15% to 20% of total calories. Lean proteins are advisable because they contain limited amounts of fats.
The client with type 1 diabetes should anticipate the possibility of missing meals occasionally and carry a few crackers and some cheese or peanut butter to prevent hypoglycemia, which can occur in such a circumstance.
The client with type 2 diabetes may be overweight. The nutritional goal for this client is not only to keep blood glucose levels in the normal range but to lose weight as well. Exercise can help attain both goals.
Carbohydrate counting is the newest method for teaching a diabetic client how to control blood sugar with food. The starch and bread category, milk, and fruits have all been put under the heading of “carbohydrates.” This means that these three food groups can be interchanged within one meal.
One would still have the same number of servings of carbohydrates, but it would not be the typical number of starches or fruits and milk that one usually eats.
For example, one is to have four carbohydrates for breakfast (2 breads, 1 fruit, and 1 milk). If there is no milk available, a bread or fruit must be eaten in place of the milk. Protein, approximately 3 to 4 ounces, is eaten for lunch and dinner. One or two fat exchanges are recommended for each meal. Two carbohydrates should be eaten for an evening snack. These are only beginning guidelines.
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