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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 Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Etiology • Cause of diabetes unclear, but may be caused by: – – – – Genetics Environmental factors Viruses Obesity Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Symptoms • Glycosuria – Glucose in urine • Polyuria – Excessive urination • Polydipsia – Excessive thirst (continues) Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Symptoms • Polyphagia – Excessive appetite • Weight loss • Weakness • Fatigue Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Classification • Prediabetes – Precursor to type 2 • Type 1 diabetes – Insulin-dependent diabetes mellitus (continues) Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Classification • Type 2 diabetes – Non-insulin-dependent diabetes mellitus • Gestational diabetes – Diabetes during pregnancy Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. 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 Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. 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 Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. 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) Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. 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 Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Treatment • Goals: – Control blood glucose levels – Provide optimal nourishment – Prevent symptoms • Delays complications • Normal blood glucose levels: – 70 to 100 mg per dL Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. 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 Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. 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) Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. 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 Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. 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 Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. 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) Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. 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) Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Stop and Share • Turkey ham: – Four meat exchanges • Mayonnaise: – One fat exchange • Two slices reduced-calorie bread: – One starch exchange (continues) Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. 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 Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Alternative Sweeteners • Approved and considered safe by FDA – Aspartame • Made from amino acids – Sucralose • Made from sugar molecule Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Dietetic Foods • Unnecessary and often misleading • Often contain same ingredients as foods prepared for general public – But at higher cost • Must read food labels Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. 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 Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. 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 Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. 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) Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Insulin Therapy • Human insulin – Most common – Preferred – Made synthetically • Classified by action – Very rapid-, rapid-, intermediate-, and long-acting (continues) Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Insulin Therapy • Often given in two or more injections daily • Insulin pumps now available for better glucose control Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. 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 Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. 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 Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. 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 Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. 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.