Lesson 20.1 Diabetes Mellitus as Metabolic disorder

Insulin

-Controls blood sugar -Helps transport glucose into cells -Helps change glucose to glycogen and store it in liver, muscles (glycogenesis) -Stimulates changes of glucose to fat for storage as body fat (lipogenesis) -Inhibits breakdown of tissue fat (lipolysis) and protein -Promotes uptake of amino acids by skeletal muscles -Influences burning of glucose for energy

Carbohydrate counting

-Count carbohydrates within a meal -Inject appropriate amount of insulin to process glucose -1 serving = 15 g carbohydrate

Care for person with DM

-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 effective glycemic control. -A personalized care plan that balances food intake, exercise, and insulin regulation is essential to successful diabetes management.

nephropathy

-Diabetes is the leading cause of end-stage renal disease -Primary symptom is microalbuminuria

Sources of blood glucose

-Dietary intake -Glycogen from liver and muscles

Heart disease/Cardiovascular disease

-Dyslipidemia: Elevated triglyceride, decreased HDL -Hypertension: A major comorbid condition

General management of diabetes

-Early detection and monitoring -Prevention of complications -Glucose tolerance test -Basic goals of care -Glycemic control and medication -Insulin and oral hypoglycemic agents -Optimal nutrition -Physical activity: minimum of 150 min/week moderate aerobic activity and 2x/week resistance training -Diabetes self-management education/support -Psychosocial assessment and care

Metabolic pattern of diabetes

-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.

Without insulin

-Fat tissue formation decreases -Fat tissue breakdown increases -Intermediate products of fat breakdown, ketones, accumulate in body -The ketone acetone in the urine is one indicator of poor glycemic control and of the adverse development of ketoacidosis.

Daily activity schedule

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

Uses of blood glucose

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

Additional considerations

-For youth with type 1 or type 2 diabetes, and older adults with diabetes, to meet the nutrition and psychosocial needs of these times in the life cycle -Careful team monitoring of the mother's diabetes management (whether GDM or preexisting) is essential to ensure her health and the baby's health. -Provide self-management training for safe conduct of exercise, including the prevention and treatment of hypoglycemia and diabetes treatment during acute illness

Gestational Diabetes

-Form of diabetes occurring in pregnancy Risk factors are the same as for DM -Screening during pregnancy, earlier for high-risk women -One-step and two-step procedures check postprandial glucose levels -Presents complications for mother and fetus/infant -Must be carefully monitored and controlled -Persistent hyperglycemia is associated with an increased risk of intrauterine fetal death and macrosomia.

Diet management

-General planning according to type of diabetes -Develop plan to meet individual needs: living situation, background, food habits

Causes of 2ndary diabetes

-Genetic defects -Pancreatic conditions or disease -Endocrinopathies: imbalance with other hormones in the body (e.g., Cushing's syndrome, pheochromocytoma, aldosteroma) -Drug/toxin induced or chemical induced

When insulin activity insufficient, imbalances occur in:

-Glucose -Fat -Protein

Nature of Diabetes

-Glucose is primary source of energy for the body. -Insulin, produced by the β cells of the pancreas, is needed in order for glucose to be taken out of blood and transported into cells. -People with diabetes do not produce insulin or cannot effectively use insulin produced. -Diabetes: group of metabolic diseases characterized by hyperglycemia

Glucose

-Glucose normally absorbed into pancreatic cells, triggering secretion of insulin -Insulin is required for glucose to be taken up into cells -Without insulin, cells starved for glucose as glucose remains circulating in the blood

Monitor food and fluid intake.

-Consume added carbohydrates as needed to avoid hypoglycemia. -Keep carbohydrate-based foods available during and after activity. -Ensure adequate fluid intake.

Intro to DM

-11.7% of U.S. adults have diabetes -Seventh leading cause of death in the United States -Historically, victims died at a young age -With proper care, people with diabetes can live long, fulfilling lives

Somatostatin

-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)

impaired glucose tolerance

-Above normal fasting blood glucose but not high enough to be diagnosed as diabetes -A risk factor for type 2 diabetes Also called "prediabetes" -Underlying conditions often present

Type 1 diabetes mellitus

-Accounts for 5% to 10% of cases Previously called insulin-dependent or juvenile-onset diabetes -Caused by the autoimmune destruction of the β cells in the pancreas -People with type 1 diabetes mellitus must rely on exogenous sources of insulin. -Can occur at any age

type 2 diabetes mellitus

-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 -Results from insulin resistance or insulin defect: Either the body is not producing enough insulin or the insulin that is being produced cannot be used. -Diet, exercise, and oral medications for disease management

Glucagon

-Acts in a manner opposite to insulin -Breaks down stored glycogen and fat -Raises blood glucose as needed to protect brain and other tissues during sleep or fasting

Drug therapy

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

Energy intake

-Balances with needs for growth/development, physical activity, desirable lean weight -Negative balance if weight loss is goal

Lab tests result

-Glycosuria (sugar in urine) -Hyperglycemia (elevated blood sugar) -Abnormal glucose tolerance tests -Elevated glycosylated hemoglobin A1c

Individuals with diabetes

-Healthy eating patterns -Recommended blood glucose and lipid profiles -Ideal body weight -Blood pressure levels -Prevent or slow the rate of chronic complications -Individualize nutrition plans -Maintain the pleasure of eating -Provide practical tools for meal planning

Monitor blood glucose before + after physical activity.

-Identify when changes to insulin or food intake are needed. -Learn glycemic response to activities.

Protein

-If normal kidney function, the usual amount of kilocalories as protein is adequate. -High protein not recommended for patients with diabetic nephropathy because it stresses the kidneys.

Symptoms of diabetes

-Increased thirst = polydipsia -Increased urination = polyuria -Increased hunger = polyphagia -Unintentional weight loss (type 1 only) -Additional signs: blurred vision, dehydration, skin irritation or infection, and general weakness and loss of strength

Islets of Langerhans produce:

-Insulin: major hormone controls blood glucose -Glucagon: acts opposite insulin, to keep blood glucose in balance

Glycemic index

-Measure of a food's ability to raise blood glucose level -Carbohydrates differ from each other -Conflicting evidence of its effectiveness

neuropathy

-Nervous system damage most commonly in legs and feet -Can lead to cellulitis

Food exchange system

-Organizes food into groups -Patients select a variety of foods from the various food groups in accordance with their own diet plan -Amounts of nutrients/serving used Choose Your Foods: Exchange Lists for Diabetes

Food distribution

-Plan food distribution based on oral hypoglycemic agents and long-acting insulin as warranted -Adjust to pt daily schedule -Use blood glucose monitoring to make adjustments -Maintain even blood glucose level; avoid hypoglycemia -Balance distribution of food and snacks especially important for children and adolescents to coordinate with growth spurts and pubertal hormones -Regulate glycemic response according to physical activity and exercise and stress

Patients with pre-diabetes

-Promote healthy food choices: same guidelines as provided for those with type 2 diabetes -Increase physical activity -Limit saturated and trans fat intake, and sugar- sweetened beverage intake

SPECIAL CONCERNS

-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 self-management education/support

-To improve clinical outcomes, health status, and quality of life -Diet and lifestyle Monitoring -Medications -Problem-solving (recognize early symptoms of hypoglycemia) -Reducing risk -Resource awareness

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

Achieve metabolic control before activity.

-Use caution if hyperglycemic and avoid vigorous activity if ketosis is present -Ingest additional carbs if glucose is <100 mg/dL

Progressive results (if untreated)

-Water, electrolyte imbalance -Ketoacidosis -Coma

Protein

-Without insulin, protein is also broken down to secure energy by making glucose. -This causes weight loss, muscle weakness, and urinary nitrogen loss

Diabetes Mellitus

-is a metabolic disorder of glucose metabolism that has many causes and forms. -A consistent and sound diet is a major keystone of diabetes care and control.

Fat

-quality appears to be more important than fat quantity. -Omega-3 fatty acids, saturated fat, dietary cholesterol, and trans fat recommendations identical to those for the general public

Carbohydrates

Complex and simple carbohydrates (starches and sugars)

Responds to hypoglycemia

Somatostatin: acts as referee for other hormones that affect blood glucose

Fat

Insulin promotes lipogenesis and inhibits lipolysis.

Fiber

Normal consumption encouraged

Sugar substitutes and sweeteners

Nutritive and nonnutritive safe in moderation

Retinophathy

diabetic retinopathy is the #1 cause of blindness in adults