chapter 020
TRANSCRIPT
Williams' Basic Nutrition & Diet Therapy
Chapter 20
Diabetes Mellitus
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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.
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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
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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
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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
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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
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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
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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
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Gestational Diabetes (p. 402)
Temporary form of disease occurring in pregnancy Presents complications for mother and fetus/infant Must be carefully monitored and controlled
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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
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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
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Symptoms of Diabetes (p. 404)
Initial signs Increased thirst Increased urination Increased hunger Unusual weight loss (type 1) Unusual weight gain (type 2)
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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
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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
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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.
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Case Study (cont’d)
List Mr. Jones’ risk factors for type 2 diabetes.
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Case Study (cont’d)
What other screening tools could be used for diabetes?
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Case Study (cont’d)
What are some signs and symptoms that Mr. Jones may be experiencing?
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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
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Pancreatic Hormone Control(p. 405)
Islets of Langerhans produce: Insulin Glucagon Somatostatin
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Islets of Langerhans (p. 407)
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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
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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
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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)
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Abnormal Metabolism in Uncontrolled Diabetes (p. 407)
When insulin activity insufficient, imbalances occur in: Glucose Fat Protein
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Glucose (p. 407)
Glucose normally absorbed into pancreatic cells, triggering secretion of insulin
Glucose taken up into cells Without insulin, cells starved for glucose
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Fat (p. 407)
Without insulin, fat tissue formation decreases Fat tissue breakdown increases Intermediate products of fat breakdown, ketones,
accumulate in body
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Protein (p. 408)
Without insulin, protein also broken down to secure energy
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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
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General Management of Diabetes (p. 409)
Early detection Prevention of complications Glucose tolerance test Goals of care
Maintaining optimal nutrition Avoiding symptoms Preventing complications
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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
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Special Objectives During Pregnancy (p. 411)
Usually involves team of specialists Careful monitoring of mother with diabetes Preventing fetal damage
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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.
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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
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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
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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
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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
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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
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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
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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
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Daily Activity Schedule (p. 414)
Food distribution must be adjusted to activities Especially important for children and adolescents Stressful event can counteract insulin activity
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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
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Drug Therapy (p. 415)
Affects food distribution Patient must adjust diet, medications, exercise as
needed
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Diet Management (p. 415)
General planning according to type of diabetes Develop plan to meet individual needs: living
situation, background, food habits
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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
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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
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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
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Necessary Skills (p. 419)
Healthy eating Being active Monitoring Medications
Insulin Oral hypoglycemic agents
Problem-solving Health coping Reducing risk
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Case Study (cont’d)
The physician sends Mr. Jones for nutritional counseling.
What are your recommendations for him?
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Resources (p. 422)
American Diabetes Association American Dietetic Association American Association of Diabetes Educators
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Staff Education (p. 422)
Success of diabetes education programs depends on sensitivity and training of staff
Continuing education essential
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