Nutrition Medical Therapy Nutrition Medical Therapy Diabetes 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 © 2007 Thomson - Wadsworth

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 © 2007 Thomson - Wadsworth

Type 1 Diabetes Ketoacidosis Hypoglycemia 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 © 2007 Thomson - Wadsworth

Type 2 Diabetes Hyperosmolar hyperglycemic state Fluid losses Blood volume depletion Electrolyte imbalances >600-2000 mg/dL © 2007 Thomson - Wadsworth

Chronic Complications Large blood vessels Accelerated atherosclerosis Impaired circulation Foot ulcers Small blood vessels Retinopathy Nephropathy © 2007 Thomson - Wadsworth

Chronic Complications Nerve damage Pain & burning Numbness & tingling Loss of sensation Delayed stomach emptying Sexual dysfunction Constipation © 2007 Thomson - Wadsworth

Treatment Type 1 Type 2 Requires lifelong treatment Insulin therapy Diet therapy Exercise Oral medications or insulin Requires lifelong treatment © 2007 Thomson - Wadsworth

Evaluating Treatment Self-monitored glucose testing Long-term 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 © 2007 Thomson - Wadsworth

Insulin Therapy For people that can’t produce enough insulin Type 1 diabetes Some persons with type 2 © 2007 Thomson - Wadsworth

© 2007 Thomson - Wadsworth

Insulin Delivery Injection with syringes Injection ports Insulin pumps © 2007 Thomson - Wadsworth

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 © 2007 Thomson - Wadsworth

Oral Antidiabetic Management Modes of action: Improves insulin secretion Reduces liver glucose production Improves glucose use by tissues Delays CHO absorption © 2007 Thomson - Wadsworth

© 2007 Thomson - Wadsworth

Physical Activity Physical activity & insulin therapy Doses need to be reduced Check blood sugar before & after Type 2 Medical evaluation needed before starting Central feature of management for type 2 Improves insulin sensitivity Improves lipid levels Lowers blood pressure Promotes weight loss © 2007 Thomson - Wadsworth

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 © 2007 Thomson - Wadsworth

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 © 2007 Thomson - Wadsworth

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 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 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%.

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.

Cholesterol content of the diet should be less than 300 mg per day. 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. © 2007 Thomson - Wadsworth

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 © 2007 Thomson - Wadsworth

© 2007 Thomson - Wadsworth

© 2007 Thomson - Wadsworth

© 2007 Thomson - Wadsworth