nutrition medical therapy diabetes mellitus © 2007 thomson - wadsworth

Nutrition Medical TherapyDiabetes Mellitus

© 2007 Thomson - Wadsworth

Therapeutic Diets

are modifications of the normal diet made in order to meet the

altered needs resulting from disease.

Therapeutic diet is planned to meet or exceed the dietary allowances

of a normal person as the aim of diet therapy is to maintain health

and help the patient to regain nutritional wellbeing.

In certain ailments it may be necessary to restrict intake of calories (as

in weight reduction diets)

or sodium (as in heart ailment).

Type 1 Diabetes

• 5-10% of cases• Autoimmune destruction of

beta cells• May be inherited or

environmental• Insulin therapy needed• Usually occurs in childhood or

adolescence• Ketosis may be the first sign


Type 2 Diabetes

• 90-95% of cases• Often asymptomatic• Some insulin is

produced– Insulin resistance &

relative insulin deficiency

– Beta cells get exhausted

• Risk increased with:– Obesity– Age– Decreased physical activity– Genetics

• Prevalence is increasing in children


Type 1 Diabetes

• Ketoacidosis – Ketosis (acetone breath)– Acidosis

(hyperventilation)– Hyperglycemia (polyuria)– Causes

• Missed insulin, illness, alcohol abuse, physiological stressors

• Hypoglycemia– Inappropriate

management– Excessive insulin or

antidiabetic drugs– Prolonged exercise– Skipped/delayed meals


Type 2 Diabetes

• Hyperosmolar hyperglycemic state– Fluid losses– Blood volume depletion– Electrolyte imbalances– >600-2000 mg/dL


Chronic Complications

• Large blood vessels– Accelerated

atherosclerosis– Impaired circulation – Foot ulcers

• Small blood vessels– Retinopathy– Nephropathy


Chronic Complications

• Nerve damage– Pain & burning– Numbness & tingling– Loss of sensation– Delayed stomach emptying– Sexual dysfunction– Constipation


Treatment

• Type 1– Insulin therapy

• Type 2– Diet therapy– Exercise – Oral medications or

insulin• Requires lifelong

treatment


Evaluating Treatment

• Self-monitored glucose testing– Type 1: 3 or more

times/day

• Long-term– Glycated hemoglobin

(HbA1c)

– Measures glycemic control in past 2-3 months

• Routine blood pressure checks

• Lipid screening• Urinary protein

screening• Ketone testing


Insulin Therapy

• For people that can’t produce enough insulin

• Type 1 diabetes• Some persons with

type 2


Insulin Delivery

• Injection with syringes

• Injection ports• Insulin pumps


Insulin Therapy & Hypoglycemia

• Most common complication

• Need immediate intake of glucose or CHO food

• 15-20 grams• Relieves in 10-20

minutes

• 15 grams CHO– 2-3 glucose tablets– 4 tsp table sugar– 1 tbs honey– 15 small jellybeans– ½ cup unsweetened

grape juice– ½ cup canned orange

juice


Oral Antidiabetic Management

• Modes of action:– Improves insulin secretion– Reduces liver glucose production– Improves glucose use by tissues– Delays CHO absorption


Physical Activity

• Central feature of management for type 2

• Improves insulin sensitivity

• Improves lipid levels• Lowers blood pressure• Promotes weight loss

• Physical activity & insulin therapy– Doses need to be

reduced– Check blood sugar

before & after

• Type 2– Medical evaluation

needed before starting


Pregnancy & Type 1 & 2 Diabetes

• Need glycemic control– At conception & during 1st

trimester to reduce risks of birth defects

– 2nd & 3rd trimesters to minimize risks of large babies & infant mortality


Gestational Diabetes

• Risk factors– Family history of

diabetes– Obesity– Certain ethnic groups– Delivered babies

weighing over 9 pounds

• May need to restrict carbohydrates to 40-50% total kcalories

• Space carbohydrates throughout the day

• Regular aerobic activity• May need insulin


The primary dietary goals for people with type 1/2 diabetes are the:

maintenance of optimal metabolic outcomes and blood glucose levels

reduction of the risk of complications of diabetes (e.g. macrovascular disease,

vascular disease) and to treat them

improvement of general health, through healthy food choices and physical

activity

coverage of the individual’s nutritional needs, according to personal and cultural

preferences and lifestyle and their energy and nutritional needs

maintenance of normal body weight.

Nutrient Recommendations

• Carbohydrates: 50% of kcal– Low Glycemic index

• Fiber

– Same as general population

– mainly soluble fiber from oats,

barley, legumes can reduce

serum cholesterol by 5–10%.

• Fat– Same as general population

unless have increased LDLs• Protein

– 15-20% of kcal – about 0.8–1 g/kg per day

• Micronutrients• Same as general population• Sugar

– Minimize foods & drink with added sugars /sugar alternatives

Total dietary fibre intake of at least 25–35 g/d from a variety of sources

is advised for adults.

In diabetic nephropathy the protein allowance is less than 0.8 g/kg/day

For children, 5 g plus 1 g per year of age is suggested as a general guide.

Including more foods and food combinations that combine cereal fibre

with low GI may be helpful to optimise health outcomes for people with

diabetes. Sodium: A moderate sodium intake of 1 gram/1,000 calories is

recommended, because many diabetics are hypertensive or have hypertension.

Lipids: In diabetic diet, the total fat should be 20 to 30 per cent of the total energy.

Of these saturated fats contribute about a fourth (7-10%), monounsaturated half (10-13%) and polyunsaturated about a fourth (8-10%) of the total energy.

Cholesterol content of the diet should be less than 300 mg per day.

Omega-3 polyunsaturated fatty acids seem to have a cardioprotective role and can lower the plasma levels of triglycerides.


Meal-Planning Strategies

• Carbohydrate counting– Person given a daily

carbohydrate allowance

– Divided into pattern of meals & snacks

• Exchange lists– More complex & difficult to

learn– Sorts foods according to

their proportions of CHO, fat, & protein

– Each food has similar macronutrient & energy content


nutrition medical therapy diabetes mellitus © 2007 thomson - wadsworth

Documents

thomson wadsworthtype

thomson wadsworth0

insulin therapytype

glucose testingtype

normal diet

aim of diet therapy

intake of calories

cho food15