1. Nutrition Medical Therapy
Nutrition Medical Therapy
Diabetes Mellitus
© 2007 Thomson - Wadsworth

2. 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).

3. 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
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4. 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
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6. 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
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7. Type 2 Diabetes Hyperosmolar hyperglycemic state Fluid losses
Blood volume depletion
Electrolyte imbalances
> mg/dL
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8. Chronic Complications
Large blood vessels
Accelerated atherosclerosis
Impaired circulation
Foot ulcers
Small blood vessels
Retinopathy
Nephropathy
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9. Chronic Complications
Nerve damage
Pain & burning
Numbness & tingling
Loss of sensation
Delayed stomach emptying
Sexual dysfunction
Constipation
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10. Treatment Type 1 Type 2 Requires lifelong treatment Insulin therapy
Diet therapy
Exercise
Oral medications or insulin
Requires lifelong treatment
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11. 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
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12. Insulin Therapy For people that can’t produce enough insulin
Type 1 diabetes
Some persons with type 2
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14. Insulin Delivery Injection with syringes Injection ports Insulin pumps
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15. Insulin Therapy & Hypoglycemia
Most common complication
Need immediate intake of glucose or CHO food
15-20 grams
Relieves in 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
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16. Oral Antidiabetic Management
Modes of action:
Improves insulin secretion
Reduces liver glucose production
Improves glucose use by tissues
Delays CHO absorption
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18. 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
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19. 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
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20. 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
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21. 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.

22. 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%.

23. 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.

24. 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.
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26. 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
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