Download Fundamentals of Nutrition

Chapter 17
Diet and Diabetes Mellitus
Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Objectives
• Describe diabetes mellitus and identify types
• Describe symptoms of diabetes mellitus
• Explain relationship of insulin to diabetes
mellitus
• Discuss appropriate nutritional management of
diabetes mellitus
Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Diabetes Mellitus
• Group of serious and chronic disorders
affecting metabolism of carbohydrates
• Glucose
– Primary source of energy for body
– Transported by blood
– Entry into cells controlled by insulin
Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Insulin
• Secreted by beta cells of islets of Langerhans
in pancreas gland
• Hyperglycemia can result from the following:
– Inadequate production of insulin
– Inability of body to use insulin
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Etiology
• Cause of diabetes unclear, but may be caused
by:
–
–
–
–
Genetics
Environmental factors
Viruses
Obesity
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Symptoms
• Glycosuria
– Glucose in urine
• Polyuria
– Excessive urination
• Polydipsia
– Excessive thirst
(continues)
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Symptoms
• Polyphagia
– Excessive appetite
• Weight loss
• Weakness
• Fatigue
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Classification
• Prediabetes
– Precursor to type 2
• Type 1 diabetes
– Insulin-dependent diabetes mellitus
(continues)
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Classification
• Type 2 diabetes
– Non-insulin-dependent diabetes mellitus
• Gestational diabetes
– Diabetes during pregnancy
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Prediabetes
• Improper use of insulin by cells of body
• Fasting blood glucose > 110 mg per dL but
< 126 mg per dL
• May advance to type 2 diabetes
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Type 1 Diabetes
• Immune response that prevents insulin
secretion by pancreatic beta cells
• 5 to 10 percent of all new diabetes cases
• Risk factors:
– Genetics, autoimmune status, and environment
• Requires insulin therapy
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Type 2 Diabetes
• Previously called adult-onset diabetes
• Used to occur after age 40, but now found in
teens and young adults
– Due to obesity
• Risk factors:
– Family history, old age, history of gestational diabetes,
physical inactivity, and race or ethnicity
(continues)
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Type 2 Diabetes
• Often asymptomatic at beginning
• Treatment:
– Diet, exercise, and oral diabetes medication
– May or may not need insulin
• Goals of medical nutrition therapy:
– Maintain healthy glucose, blood pressure, and lipid levels
– Reduce weight
Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Gestational Diabetes
• Occurs between 16th and 28th week of
pregnancy
• Insulin required if not responsive to diet and
exercise
• Usually disappears after infant born
• Type 2 diabetes can develop five to 10 years
after pregnancy
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Treatment
• Goals:
– Control blood glucose levels
– Provide optimal nourishment
– Prevent symptoms
• Delays complications
• Normal blood glucose levels:
– 70 to 100 mg per dL
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Treatment Regimes
• Diet alone
• Diet combined with glucose-lowering
medication
• Diet combined with insulin
• Exercise in addition to any of the above
• Regular monitoring of blood glucose levels in
addition to any of the above
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Nutritional Management
• Calorie needs depend on age, activities, lean
muscle mass, size, and REE
• Recommended:
– 50 to 60 percent from carbohydrates
– 40 to 50 percent from complex carbohydrates
– 10 to 20 percent from simple sugars
(continues)
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Nutritional Management
• Total amount of carbohydrates eaten affects
blood sugar levels
– Rather than type
• Limit fats to 30 percent of total calories
• Have proteins provide 15 to 20 percent of total
calories
• Eat nutrient-dense diet
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Carbohydrate Counting
• Newest method for teaching diabetic client
how to control blood sugar with food
• Three food groups have been put under
heading of carbohydrates:
– Starches and breads, milk, and fruits
– Can be interchanged within one meal
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Diets Based on Exchange Lists
• Most commonly used method of diet therapy
• Developed by American Diabetes Association
in conjunction with American Dietetic
Association
• Foods within each list contain approximately
equal amounts of calories, carbohydrates,
proteins, and fats
(continues)
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Diets Based on Exchange Lists
• Foods can be substituted within one list and
still provide prescribed types and amounts of
nutrients and calories
– However, amounts of nutrients and calories on one list not
same as those on any other list
• Diet given in terms of exchanges
– Rather than as particular foods
Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Stop and Share
• Consider the following question:
– Using the exchange lists in your text, identify the number of
each exchange in the following meal.
•
•
•
•
•
Sandwich made with 4 oz of extra-lean turkey ham
1 tbsp reduced-calorie mayonnaise
Reduced-calorie bread
1.5 oz of pretzels
Iced tea
(continues)
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Stop and Share
• Turkey ham:
– Four meat exchanges
• Mayonnaise:
– One fat exchange
• Two slices reduced-calorie bread:
– One starch exchange
(continues)
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Stop and Share
• Pretzels:
– Two starch exchanges
• Iced tea
– Free
• Total = three starch, four meat, and one fat
exchange
Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Fiber
• High-fiber intake:
– 25 to 35 g per day
– Reduces amount of insulin needed by lowering blood
glucose
– Lowers blood cholesterol and triglyceride levels
– Water needs increase
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Alternative Sweeteners
• Approved and considered safe by FDA
– Aspartame
• Made from amino acids
– Sucralose
• Made from sugar molecule
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Dietetic Foods
• Unnecessary and often misleading
• Often contain same ingredients as foods
prepared for general public
– But at higher cost
• Must read food labels
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Alcohol
• Not recommended for diabetic clients
• Limited use sometimes allowed if approved by
physician
• Some diabetic clients who use hypoglycemic
agents cannot tolerate alcohol
• If used, must be included in diet plan
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Exercise
• Helps body use glucose
• Lowers cholesterol, blood pressure, body fat,
and stress level
• Important for management of type 2 diabetes
• Must be carefully discussed and planned in
type 1 diabetes to avoid hypoglycemia
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Insulin Therapy
• Clients with type 1 diabetes must have
injections of insulin every day to control blood
glucose levels
• Once initiated, usually continued throughout
life
(continues)
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Insulin Therapy
• Human insulin
– Most common
– Preferred
– Made synthetically
• Classified by action
– Very rapid-, rapid-, intermediate-, and long-acting
(continues)
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Insulin Therapy
• Often given in two or more injections daily
• Insulin pumps now available for better glucose
control
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Insulin Reactions
• Also known as hypoglycemic episode
• Can result from too much insulin
• Symptoms:
– Headache, blurred vision, tremors, confusion, poor
coordination, and eventually unconsciousness
• Can result in brain damage, coma, or death
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Treatment for Insulin Reactions
• For conscious clients, oral form of glucose
• For unconscious clients, IV treatment with
dextrose and water
• Diabetic clients should carry identification
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Considerations for the
Health Care Professional
• If diet followed, medication taken, and time
allowed for sufficient exercise and rest, client
can live near-normal life
• Emphasize importance of eating all prescribed
food
• Meals should be eaten at regular times
• Clients should read labels
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Conclusion
• Diabetic diet used in treating diabetes mellitus
– Metabolic disease caused by improper functioning of
pancreas
• Serious complications can occur if left untreated
– Including death
• Treatment:
– Diet, medication, and exercise
Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.