DIABETES MELLITUS

Introduction:

Diabetes mellitus is a chronic metabolic disorder that prevents the body to utilize glucose completely or
partially. It is characterized by raised glucose concentration in the blood and alterations in carbohydrates, protein
and fat metabolism.

Causes of diabetes mellitus:

TYPE 1: The immune system of the body attacks and destroys the cells that produce insulin. As no insulin is
produced, glucose levels further increases, which can seriously damage the body’s organs. Type 1 diabetes is often
known as insulin-dependent diabetes. It is also sometimes known as juvenile diabetes or early- onset diabetes
because it usually develops before the age 40, often during the teenage years. Type 1 diabetes is less common than
type 2 diabetes.

TYPE 2: Type 2 diabetes is where the body does not produce enough insulin or the body’s cells do not respond
to insulin. This is known as insulin resistance. Type 2 diabetes is far more common than type 1 diabetes.

GESTATIONAL DIABETES: Some women tend to experience high levels of blood glucose as during
pregnancy due to reduced sensitivity of insulin receptors.

Ranges of diabetes mellitus:

Diabetes diagnostic criteria

Condition 2 hour* plasma glucose Fasting plasma glucose HbA1C

RANGES mmol/l(mg/dl) mmol/l(mg/dl) %

Normal <7.8 (<140) <6.1 (<110) <6.0

Impaired Fasting Glucose <7.8 (<140) ≥6.1(≥110) &<7.0(<126) 6.0–6.4

Impaired Glucose
≥7.8 (≥140) <7.0 (<126) 6.0–6.4
Tolerance

Diabetes mellitus ≥11.1 (≥200) ≥7.0 (≥126) ≥6.5

Symptoms of diabetes mellitus:

The main symptoms are:

 Polyuria : urinating frequently

 Polydipsia: feeling very thirsty
 Polyphagia: feeling hungry frequently
 Weakness
 Weight loss and loss of muscle bulk
 Frequently episodes of thrush
 Cuts or wounds that heal slowly
 Blurred vision

Diagnosis

 Impaired glucose tolerance test

 Glycosuria
 Ketonuria
 Random blood sugar
 Glucose tolerance test

Principles of the diet

Normal Carbohydrates, Normal Protein, Low Calorie (1g/kg), High Fiber (40g/ day), Normal vitamins and
minerals, Normal Fluids.

Foods to be included

Green leafy vegetables, wheat bran, oats, bran, brown rice, tofu, lentils, low fat foods and plantain stem.

Foods to be avoided

Simple sugars, Jaggery, alcohol, nuts, cake, fried foods, candy, dried fruits, roots and tubers.

Nutritional requirement:

High carbohydrate and high fibre diet improve insulin. Binding and increase in monotype insulin receptor
binding. Carbohydrate is maintained to about 60-65 per cent of total calories.
Protein: A diet high in protein is good for the health of diabetes because it supplies essential amino acid needed for
tissue repair.

Fat: Low fat diet increase insulin binding and also reduces LDL and VLDL levels.

Vitamin and Minerals: Normal intake of vitamin and minerals is recommended.

Dietary Fiber:

 Insulin requirements

 Increase peripheral tissue insulin

 Sensitivity

 Decrease serum cholesterol and triglyceride value

CASE STUDY -1

GENERAL INFORMATION
Name : Mrs.DHANALAKSHIMI
Gender :Female
Age :68
Religion : HINDU
Occupation : HOUSE WIFE
Date of admission :

HOSPITAL DETAILS
MRD No :10729564
Ward No :126

MEDICAL HISTORY
Past Medical History: Diabetes mellitus, Parabinsonism
Present Complaints : lower limb swelling, chest pain, Feaver, cold, cough, bleeding manifestation and
abdominal pain
Diagnosis : Diabetes mellitus

NUTRITIONAL STATUS EVALUATION

 1] Anthropometric Assessment
PARAMETE ASSESSMENT
RS
Height 160cm
Weight 75Kg
BMI 29.3
IBW Weight in kg/height in m^2=28

NUTRITIONAL SCREENING ON ADMISSION

 Social history: House wife so she carried out normal day to day tasks
 Family history: Few family members having diabetes mellitus
 Diet history:Non vegetarian and doesn’t have any form of food allergy
 Allergy:No food allergy
 Activity: Regular household activity,no other form of physical exercise or yoga
 Sleep pattern: difficulty in falling asleep
2] Biochemical Assessment
TE VALUE REFERENCE RANGE
ST
Hemoglobin 11.3mg/dl 12-16g/dl
Blood sugar 253mg/dl 99mg/dl
Blood urea 22mg/dl 6-24mg/dl
Serum creatinine 0.7mg/dl 0.5-1.1mg/dl
sodium 129meq/l 136-145meq/l

3] Biophysical Assessment
DATE BLOODPRESSUR PULSE RATE RESPIRATION
E RATE
100/70mmhg 94/min 26/min
25/min

4] Clinical Assessment
ORGA OBSERVATION
NS
GENERAL APPEARANCE NORMAL
EYE NORMAL
MOUTH NORMAL
BEHAVIOUR NORMAL
 TONGUE NORMAL
EAR NORMAL
NAIL NORMAL

6] DietaryAssessment
Food Habit:non vegetarian
Food Allergy: no

FOOD FREQUENCY RECORD

FOOD REQUENCY RECORD
FOOD ITEMS DAILY WEEKLY MONTHLY OCCASIONALLY

Cereals 

Pulses 

Green Leafy 
Vegetable

Roots tubers 

Other vegetables 

Fats and oils 

Sugar and Jaggery 

Fish and poultry 

Tinned junk foods 

Deep fried foods 

Others 

24 HOURS RECALL

TIME MENU SERVING SIZE

6:00am Tea 100ml
 8:00am Upma/idly 1 cup/ 3no's
Sambar
Chutney 1 katori
1 katori
10:00am Tea 100ml
1:00pm Rice 1 cup
Sambar
Rasam 1 katori
Fish 1 katori
2pcs
4:00pm Tea Oil 100ml 1
snack cup
8:00pm Chappath 3no's 1
katori
Vegetable
kuruma
10:00pm Turmeric Milk 100ml

NUTRIENTCALCULATION:

FOODITEMS QUANTITY ENERGY PROTEIN CHO(g) FAT(g)

(g) (kcal) (g)

Skimmed Milk, liquid 150 43.5 3.75 6.9 0.15

Parboiled rice 60 207.6 3.84 46.9 0.3

Green gram dal 20 69.6 4.8 11.8 0.24

Broad beans 20 9.6 0.9 1.44 0.02

Red gram dal 25 83.75 5.57 14.4 0.42

Onion 10 5 0.12 1,11 0.01

Apple 100 59 0.2 13.4 0.5

Parboiled rice 100 346 6.4 79 0.4

Wheat flour 80 272.8 9.68 55.52 1.36

Bengal gram ,whole 25 90 4.27 15.22 1.32

Brinjal 50 12 0.7 2 0.15

 Tomato 25 5.75 0.47 0.9 0.025

Onion 25 12.5 0.3 2.77 0.025

Red gram dhal 20 67 4.46 11.52 0.34

Onion 20 10 0.24 2.22 0.02

Chow Chow 50 13.5 0.35 2.85 0.05

Onion 10 5 0.24 1.11 0.01

Green gram 40 133.6 9.6 22.6 0.52

Onion 10 5 0.12 1.11 0.01

Rice 60 207 4.08 46.92 0.3

Black gram dhal 20 69.4 4.8 11.92 0.28

Mint leaves 25 30 0.72 7.2 0.09

Garlic 5 7.25 0.31 1.49 -

Ginger 5 3.35 0.11 0.615 0.04

Total 1767.8 70.8 360.9 6.59

APROXIMATELY NUTRITIVE VALUE

 Energy : 1724.8kcal
 Protein : 58.8g
 Fat : 24.8g
 Carbohydrate : 348.54g

MEDICATIONS
DRUGS DOSAGE
T. ECOSPRIN 1-1-0-1
SYP.ASCORIL-D 1-1-1-1
T.PAN 1-1-0-1
T.DOLO 1-1-0-1
T.ROSUVAS 0-0-0-1
SYP.LUPITUSS 1-1-0-1

NUTRITIONAL STATUS OF THE PATIENT

 DIET PRESCRIBED: Oral- low fat diabetic diet and iron rich diet.
 PRINCIPLE OF DIET: High fluid, high protein, high fibre, moderate carbohydrate, low
fat, liberal vitamins and minerals, low calorie

DIET ORDER
DATE DIET ORDER
DAY1
 DAY2
DAY1

DIET PRESCRIBED IN HOSPITAL

DAY 1
TIME MENU SERVING SIZE
6:00am Skimmed milk 100 ml
8:00am Chappath 3 no's
i
1 katori
Vegetable
kuruma
10:00am Vegetable soup 100ml
1:00pm Rice 1 cup
Dhal
1 katori
sambar Egg
white 2 no's
Beans
poriyal 1 katori

Rasam 1 katori
Butter 100ml
milk
4:00pm Skimmed milk 100ml
Marie biscuit 2 no's
8:00pm Wheat rava upma 1 cup
Onion chutney 1 katori
10:00pm Milk 100 ml

CALCULATION

TIME MENU QUANTIT ENER PROTEI CH F

Y GY N O A
 (g) (g) (g) T
(g)
6:00am Skimm 100ml 30 2.6 4.8 0.1
ed
milk
8:00am Chappat 3 no's 256 9.1 52.1 1.3
hi
Vegetab 1 katori 52 1.0 4.5 3.5
le
kuruma
10:00a Vegetab 100ml 35 1.0 5.8 1.0
m le soup
1:00pm Rice 1 cup 281 6.1 61.2 0.8
Dhal 1 katori 69 4.6 11.5 0.7
sambar
Egg 2 no's 34 7.2 0.5 0.1
white
Beans 1 katori 41 1.3 3.9 2.3
poriyal
Rasam 1 katori 33 1.8 4.6 0.8
Butter 100 ml 18 0.9 0.9 1.2
milk
4:00pm Skimm 100 ml 30 2.6 4.8 0.1
ed
milk
Marie 2no's 45 0.8 7.9 1.1
biscuit
8:00pm Whe 1 cup 75 2.4 14.2 1.4
at
rava
upma
Onio
n 1 katori 67 1.4 10.0 2.4
chutn
ey
10:00p Milk 100 63.6 3.10 5.35 4.6
m
TOTAL 1129.6 45.9 193. 21.
05 4

Day 2

TIME MENU SERVING SIZE

6:00am Skimmed milk 100ml
8:00am Idli 3 no's
Sam
1 katori
bar
1 katori
Tomato chutney
10:00am Pineapple 1 cup
1:00pm Rice 1 cup
Garlic
1 katori
kulambu
Cabbage 1 katori
poriyal
2 pcs
Breast
Chicken 1 katori
Rasa 100 ml
m
Butter
milk
4:00pm Green gram sundal 1 cup
8:00pm Wheat 3 no's
dosa Tomato
1 katori
chutney
10:00pm Skimmed milk 100 ml

NUTRITIVE VALUE CALCULATION

TIME MENU QUANTI ENER PROTEI CH F

TY GY N O A
 (g) (g) (g) T
(g)
6:00a Skimm 100 ml 30 2.6 4.8 0.1
m ed
milk
8:00a Idli 3 no's 156 5.0 30. 1.7
m 2
Sambar 1 katori 69 4.6 11. 0.7
5
Tomato 1 katori 50 1.1 5.0 3.2
chutney

10:00a Pineapp 1 cup 103 0.9 25. 0.2

m le 2
1:00p Rice 1cup 281 6.1 62. 0.8
m 2
Garlic 1 katori 74 1.2 6.7 5.0
kulamb
u
Cabbag 1 katori 79 1.8 5.6 5.5
e
poriyal
Breast 2 pcs 119 22.0 1.2 1.8
chicken
Rasam 1 katori 33 1.8 4.6 0.8
Butter 100 ml 18 0.9 0.9 1.2
milk
4:00p Gre 1 cup 51 3.6 8.8 0.2
m en
gra
m
sun
dal
8:00p Whe 3 no's 143 2.9 16. 7.5
m at 1
dosa
Tom
 ato 1 katori 50 1.1 5.0 3.2
chutn
ey
10:00p Skimm 100 ml 30 2.6 4.8 0.1
m ed
milk
TOTA 1286 4.8 191 32
L .6

NUTRITIVE VALUE CALCULATION

TIME MENU QUANTIT ENERG PROTEI CH FAT

Y Y N O
(g)
(g) (g) (g)
6:00am Skimm 100 ml 30 2.6 4.8 0.1
ed
milk
8:00am Ava 1 cup 152 2.8 2.4 4.8
l
upma
Onio 1 katori 73 2.5 8.1 3.5
n
chutn
ey
10:00am Apple 1 cup 44 0.2 10.0 0.4
(witho
ut
skin)
1:00pm Rice 1 cup 281 6.1 61.2 0.8
Chicken 1 katori 91 6.3 4.5 5.4
kulamb
u
Rasam 1 katori 33 1.8 4.6 0.8
Butter 100 ml 18 0.9 0.9 1.2
milk
Egg 2 no's 34 7.2 0.5 0.1
 white
4:00pm Blac 1 cup 82 3.9 13.9 1.2
k
chan
na
8:00pm Kamb 3 no's 321 9.1 41.8 13.0
u
dosa
Onio 1 katori 67 1.5 10.0 2.4
n
chutn
ey
10:00pm Skimm 100 ml 30 2.6 4.8 0.1
ed
milk
TOTAL 1256 47.4 168. 27.6
5

SUMMARY
The patient Mrs.DHANALAKSHIMI age was 68 years old admitted in the hospital with the
present complaints the h/o pruritus, abdominal pain, worsening in the night. She has the past
history of Diabetes mellitus for 5 years. The BMI (29.3) shows that the patient is obese. The
biochemical assessment shows that the hemoglobin is low. The clinical assessment shows that
the patient was normal. On assessing the dietary habit, it was noticed that the calorie intake was
high. The food frequency shows that the patient's diet included all the food groups. On diagnosis
of the disease and nutritional assessment the patient was given drug and dietary treatment. Drugs
were prescribed by the physician and the diet order prescribed by the dietitian.Oral- low fat
diabetic diet and iron rich diet.