DIET AND

DIABETES
MELLITUS
 DIABETES MELLITUS
 Diabetes mellitus is the name for a group of serious and chronic (long
standing) disorders affecting the metabolism of carbohydrates.
 characterized by hyperglycemia
 The distribution of glucose must be carefully managed for the
maintenance of good health. Glucose is transported by the blood, and
its entry into the cells is controlled by hormones. The primary hormone
is insulin
HORMONES INVOLVED
 Insulin is secreted by the beta cells of the islets of Langerhans in
the pancreas.
 Glucagon, which is secreted by the alpha cells of the islets of
Langerhans, helps release energy when needed by converting
glycogen to glucose.
 Somatostatin is a hormone produced by the delta cells of the islets
of Langerhans and the hypothalamus (inhibitory)
SYMPTOMS
 Glycosuria
 Polyuria
 Polydypsia
 Polyphagia
 Ketonemia
 Ketonuria
 Diabetic Coma
DIET MANAGEMENT
 It is recommended that carbohydrates provide 50% to 60%
of the calories. Approximately 40% to 50% should be
from complex carbohydrates (starches). The remaining
10% to 20% of carbohydrates could be from simple
sugar
 Fats should be limited to 30% of total calories, and
proteins should provide from 15% to 20% of total calories.
Lean proteins are advisable because they contain limited
amounts of fats.
TYPE I DIABETES
 The client with type 1 diabetes needs a nutritional plan that
balances calories and nutrient needs with insulin therapy
and exercise.
 It is important that meals and snacks be composed of
similar nutrients and calories and eaten at regular times
each day.
 Small meals plus two or three snacks may be more helpful
in maintaining steady blood glucose levels for these clients
than three large meals each day
TYPE II DIABETES
 The client with type 2 diabetes may be overweight.
 The nutritional goal for this client is not only to keep blood
glucose levels in the normal range but to lose weight as
well.
 Exercise can help attain both goals
 SPECIAL
CONSIDERATION
FOR DIABETIC
CLIENT
FIBER
 High-fiber intake appears to reduce the amount of insulin needed
because it lowers blood glucose.
 It also appears to lower the blood cholesterol and triglyceride levels.
High-fiber may mean 25 to 35 grams of dietary fiber a day. Such high
amounts can be difficult to include. High-fiber foods should be
increased very gradually, as an abrupt increase can create intestinal gas
and discomfort.
 When increasing fiber in the diet one must also increase intake of
water. An increased fiber intake can affect mineral absorption.
ALTERNATIVE SWEETENERS
 Sucralose is the newest sweetener to gain approval by the
FDA. Sucralose is made from a sugar molecule that has
been altered in such a way that the body will not absorb it
 Aspartame is the generic name for a sweetener composed
of two amino acids: phenylalanine and aspartic acid.
INSULIN THERAPY
 Exogenous insulin is a protein. It must be injected because, if
swallowed, it would be digested and would not reach the
bloodstream as the complete hormone. After insulin treatment is
begun, it is usually necessary for the client to continue it throughout
life.
 Human insulin is the most common insulin given to clients. This
insulin does not come from humans but is made synthetically by a
chemical process in a laboratory. Human insulin is preferred
because it is very similar to insulin made by the pancreas.
 DIET AND
CARDIOVASCUL
AR DISEASE
CARDIOVASCULAR DISEASE
(CVD
Cardiovascular disease (CVD) affects the heart and blood vessels.
 risk factors have been identified and are known as the metabolic
syndrome
1. Abdominal obesity
2. High blood lipids such as high triglycerides, low HDL, and high
LDL
3. High blood pressure
4. Insulin resistance
5. Elevated highly sensitive C-reactive protein in the blood
ATHEROSCLEROSIS
 Arteriosclerosis is the general term for vascular disease in
which arteries harden (become thickened), making the
passage of blood difficult and sometimes impossible
 Atherosclerosis affects the inner lining of arteries (the
intima), where deposits of cholesterol, fats, and other
substances accumulate over time, thickening and weakening
artery walls
ATHEROSCLEROSIS
 Hyperlipidemia, hypertension (high blood pressure), and
smoking are major risk factors for the development of
atherosclerosis.
 A fat-restricted diet can be difficult for the client to accept.
A diet very low in fat will seem unusual and highly
unpalatable (unpleasant-tasting) to most clients. It takes
approximately 2 or 3 months to adjust to a low-fat diet.
 CONGESTIVE HEART FAILURE
 Heart failure is caused by conditions that damage the heart muscle,
including coronary artery disease (CAD), heart attack, cardiomyopathy,
valve disease, heart defects present at birth, diabetes mellitus, and
chronic renal disease
 With the inadequate circulation, body tissues do not receive sufficient
amounts of nutrients. This insufficiency can cause malnutrition and
underweight, although the edema can mask these problems. In some
cases a fluid restriction may be ordered
 USE OF DIURETICS
 Diuretics to aid in the excretion of water and sodium and a sodium-
restricted diet are typically prescribed.
 Diuretics can cause an excessive loss of potassium, the client’s blood
potassium should be carefully monitored to prevent hypokalemia, which
can upset the heartbeat.
 Fruits, especially oranges, bananas, and prunes, can be useful in such
a situation because they are excellent sources of potassium and
contain only negligible amounts of sodium