chapter 020

Williams' Basic Nutrition & Diet Therapy

Chapter 20

Diabetes Mellitus

Copyright © 2013 Mosby, Inc., an imprint of Elsevier Inc. All rights reserved. 1

14th Edition

Lesson 20.1: Diabetes Mellitus as a Metabolic Disorder

Diabetes mellitus is a metabolic disorder of glucose metabolism with many causes and forms.

A consistent, sound diet is a major keystone of diabetes care and control.

2Copyright © 2013 Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.

Introduction (p. 400)

11% of U.S. adults have diabetes Seventh leading cause of death in the United States Historically, victims died at young age With proper care, people with diabetes can live long,

fulfilling lives


Nature of Diabetes (p. 400)

Defining factor Glucose is primary source of energy for the body Insulin is needed to be taken out of blood and

transferred into cells People with diabetes either do not produce insulin

or cannot effectively use insulin produced Diabetes: group of metabolic diseases

characterized by hyperglycemia


Classification of Diabetes Mellitus and Glucose Intolerance (p. 400)

Type 1 diabetes mellitus Accounts for 5% to 10% of cases Previously called insulin-dependent or juvenile-

onset diabetes Severe, unstable form


Classification of Diabetes Mellitus and Glucose Intolerance (cont’d) (p. 401)

Type 1 diabetes mellitus (cont’d) Caused by autoimmune destruction of pancreatic

cells Can occur at any age Requires exogenous insulin


Type 2 Diabetes Mellitus (p. 401)

Accounts for 90% to 95% of cases Previously called adult-onset or non–insulin-

dependent diabetes Initial onset usually after age 40 years Now being diagnosed in children


Type 2 Diabetes Mellitus (cont’d) (p. 402)

Strong genetic link Prevalent in older, obese people Caused by insulin resistance or defect Usually treated with diet, exercise


Gestational Diabetes (p. 402)

Temporary form of disease occurring in pregnancy Presents complications for mother and fetus/infant Must be carefully monitored and controlled


Other Types of Diabetes (p. 404)

Causes Genetic defect Pancreatic conditions or disease Endocrinopathies: imbalance with other hormones

in the body Drug/toxin induced or chemical induced


Impaired Glucose Tolerance(p. 404)

Above normal fasting blood glucose but not high enough to be diabetes

A risk factor for type 2 diabetes Underlying conditions often present


Symptoms of Diabetes (p. 404)

Initial signs Increased thirst Increased urination Increased hunger Unusual weight loss (type 1) Unusual weight gain (type 2)


Symptoms of Diabetes (cont’d) (p. 405)

Laboratory test results Glycosuria (sugar in urine) Hyperglycemia (elevated blood sugar) Abnormal glucose tolerance tests

Progressive results Water, electrolyte imbalance Ketoacidosis Coma


The Metabolic Pattern of Diabetes (p. 405)

Energy supply and control of blood glucose Diabetes is especially related to metabolism of

carbohydrate and fat It is important to control blood glucose within

normal levels of 70 to 110 mg/dl


Case Study

Mr. Jones is a 45-year-old black male. He is 25 lbs overweight. He also has a family history of diabetes. His most recent lab work reveals an elevated fasting blood sugar, elevated total cholesterol, and low HDL level.


Case Study (cont’d)

List Mr. Jones’ risk factors for type 2 diabetes.



What other screening tools could be used for diabetes?



What are some signs and symptoms that Mr. Jones may be experiencing?


The Metabolic Pattern of Diabetes (cont’d) (p. 405)

Sources of blood glucose Dietary intake Glycogen from liver and muscles

Uses of blood glucose For immediate energy needs: glycolysis Change to glycogen for storage: glycogenesis Convert to fat for longer-term storage: lipogenesis


Pancreatic Hormone Control(p. 405)

Islets of Langerhans produce: Insulin Glucagon Somatostatin


Islets of Langerhans (p. 407)


Insulin (p. 405)

Controls blood sugar Helps transport glucose into cells Helps change glucose to glycogen and store it in

liver, muscles Stimulates changes of glucose to fat for storage

as body fat Inhibits breakdown of tissue fat and protein Promotes uptake of amino acids by skeletal

muscles Influences burning of glucose for energy


Glucagon (p. 407)

Acts in a manner opposite to insulin Breaks down stored glycogen and fat Raises blood glucose as needed to protect brain

during sleep or fasting


Somatostatin (p. 407)

A “referee” for several other hormones Inhibits secretion of insulin, glucagon, and other GI

hormones Also produced in other parts of the body (e.g.,

hypothalamus)


Abnormal Metabolism in Uncontrolled Diabetes (p. 407)

When insulin activity insufficient, imbalances occur in: Glucose Fat Protein


Glucose (p. 407)

Glucose normally absorbed into pancreatic cells, triggering secretion of insulin

Glucose taken up into cells Without insulin, cells starved for glucose


Fat (p. 407)

Without insulin, fat tissue formation decreases Fat tissue breakdown increases Intermediate products of fat breakdown, ketones,

accumulate in body


Protein (p. 408)

Without insulin, protein also broken down to secure energy


Long-Term Complications(p. 408)

Retinopathy: leading cause of new cases of blindness age 20 to 74

Nephropathy: leading cause of end-stage renal disease

Neuropathy: nervous system damage in legs and feet

Heart disease Dyslipidemia: Elevated triglyceride, decreased

high-density lipoprotein cholesterol Hypertension: A major comorbid condition


General Management of Diabetes (p. 409)

Early detection Prevention of complications Glucose tolerance test Goals of care

Maintaining optimal nutrition Avoiding symptoms Preventing complications

Copyright © 2013 Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.

General Management of Diabetes (cont’d) (p. 411)

Self-care skills People with diabetes must treat themselves

Basic elements of diabetes management Healthy diet Physical activity Ensure adequate insulin


Special Objectives During Pregnancy (p. 411)

Usually involves team of specialists Careful monitoring of mother with diabetes Preventing fetal damage


Lesson 20.2: Care for the Person with Diabetes Mellitus

Daily self-care skills enable a person with diabetes to remain healthy and reduce risks for complications.

Blood glucose monitoring is a critical practice for blood glucose control.

A personalized care plan balancing food intake, exercise, and insulin regulation is essential to successful diabetes management.


Medical Nutrition Therapy for Individuals with Diabetes (p. 411) Individuals with prediabetes

Promote healthy food choices Increase physical activity Achieve and maintain moderate weight loss


Medical Nutrition Therapy for Individuals with Diabetes (cont’d) (p. 411)

Individuals with diabetes Blood glucose levels as safely as possible Lipid and lipoprotein profile Blood pressure levels Prevent, or at least slow, the rate of chronic

complications Address individual nutrition needs Maintain the pleasure of eating


Additional Considerations(p. 411)

Additional considerations For youth with type 1 diabetes, youth with type 2

diabetes, pregnant and lactating women, and older adults with diabetes, to meet the nutrition needs of these unique times in the life cycle

Provide self-management training for safe conduct of exercise, including the prevention and treatment of hypoglycemia and diabetes treatment during acute illness


Total Energy Balance (p. 411)

Normal growth and weight management Type 1 in childhood: use normal height/weight

charts Type 2 in adulthood: major goal is often weight

reduction/control Energy intake

Balances with needs for growth/development, physical activity, desirable lean weight

Negative balance if weight loss is goal


Nutrient Balance (p. 412)

Carbohydrate Starch and sugar: Complex and simple

carbohydrates Glycemic index Fiber Sugar substitutes: Nutritive and nonnutritive

Glycemic index Measure of a food’s ability to raise blood glucose

level Carbohydrates differ


Nutrient Balance (cont’d) (p. 412)

Fiber Normal consumption encouraged

Sugar substitute sweeteners Nutritive and nonnutritive allowed in moderation

Protein About 10% to 35% of total energy

Fat No more than 7% of kilocalories from saturated fat


Food Distribution (p. 414)

Eat even amounts of food at regular intervals Maintain even blood glucose supply Snacks may be needed Adjust eating according to activity level and stress Regulate glycemic response according to physical

activity and exercise Drug therapy


Daily Activity Schedule (p. 414)

Food distribution must be adjusted to activities Especially important for children and adolescents Stressful event can counteract insulin activity


Exercise (p. 414)

Recommendation: 150 min/week of moderate-intensity aerobic activity

Helps those with type 2 DM control blood glucose and prevent cardiovascular disease, other risks

For those using insulin, energy needs of exercise must be covered in food distribution plan


Drug Therapy (p. 415)

Affects food distribution Patient must adjust diet, medications, exercise as

needed


Diet Management (p. 415)

General planning according to type of diabetes Develop plan to meet individual needs: living

situation, background, food habits


Diet Management (cont’d)(p. 415)

Carbohydrate counting Count carbohydrates for a meal Inject appropriate amount of insulin to process

glucose Food exchange system

Organizes food into groups


Special Concerns (p. 416)

Special diet food items: usually not needed Alcohol: occasional cautious use allowed Hypoglycemia: prepare for possibility Illness: adjust food and insulin accordingly Travel: consult with dietitian first Eating out: plan ahead and choose restaurants wisely Stress: antagonistic to insulin


Diabetes Education Program(p. 419)

Goal: person-centered self-care Patients taking more active role in their care Diabetes requires daily survival skills

Diabetes Self-Management Education (DSME) Support informed decision-making Self-care behaviors Problem-solving Active collaboration with health care team


Necessary Skills (p. 419)

Healthy eating Being active Monitoring Medications

Insulin Oral hypoglycemic agents

Problem-solving Health coping Reducing risk



The physician sends Mr. Jones for nutritional counseling.

What are your recommendations for him?


Resources (p. 422)

American Diabetes Association American Dietetic Association American Association of Diabetes Educators


Staff Education (p. 422)

Success of diabetes education programs depends on sensitivity and training of staff

Continuing education essential


chapter 020

Health & Medicine

diabetes mellitus copyright

imprint of elsevier

diabetes mellitus contd

gestational diabetes

types of diabetes

nature of diabetes

symptoms of diabetes

diabetes mellitus accounts