Kharadar General Hospital

School Of Nursing
GENERIC BSN, 1ST YEAR,2ND SEMESTER
APPLIED NUTRITION
1-CREDIT HOUR

SUNNIA ROBINSON
RN,RM,BSN
Nursing Instructor
Kharadar General Hospital School of Nursing
UNIT VIII: Nutritional consideration in the
prevention and management of type II Diabetes
Mellitus:
LEARNING OBJECTIVES:-
• Describe the prevalence of type II DM in Pakistan.
• Describe dietary factors associated with the diseases.
• Explain the role of weight gain in the Etiology of type II DM.
• Identify the role of the nurse in prevention and management
of type II DM.
 
 DIABETES MELLITUS
• Diabetes mellitus (DM),
commonly known as
diabetes, is a group of
metabolic disorders
characterized by a high
blood sugar level over a
prolonged period of time.
SYMPTOMS
 TYPES OF DIABETES MELLITUS
• 1. Diabetes mellitus Type I
Once known as juvenile diabetes or insulin-dependent diabetes, is a chronic
condition in which the pancreas produces little or no insulin
• 2. Diabetes mellitus Type II
 A condition in which the cells cannot use blood sugar efficiently to meet the body's
needs. 
• 3. Gestational diabetes mellitus
Any degree of glucose intolerance with onset or first recognition during pregnancy
CAUSES OF DM TYPE II
• Genetics
• Type 2 diabetes can be hereditary. That doesn’t mean that if your
mother or father has (or had) type 2 diabetes, you’re guaranteed to
develop it; instead, it means that you have a greater chance of
developing type 2.
•  Obesity
•  The person who is overweight and inactive is much more likely to
develop type 2 diabetes
CAUSES
• Lack of exercise: Physical activity has many benefits—one of them
being that it can help you avoid type 2 diabetes, if you’re susceptible.
• Unhealthy meal planning choices: A meal plan filled with high-fat
foods and lacking in fiber (which you can get from grains, vegetables,
and fruits) increases the likelihood of type 2.
CAUSES
• Overweight/Obesity: Lack of
exercise and unhealthy meal
planning choices can lead to
obesity, or make it worse. Being
overweight makes it more likely
that you’ll become insulin resistant
and can also lead to many other
health conditions.
• Insulin Resistance
LINKS BETWEEN OBESITY AND TYPE
2 DIABETES
• For type 2 diabetes, this includes being overweight or obese (having a
body mass index – BMI – of 30 or greater).
• Recent research suggests that obese people are up to 80 times more
likely to develop type 2 diabetes than those with a BMI of less than 22
.
• INFLAMMATORY RESPONSE
• Studies suggest that abdominal fat causes fat cells to release ‘pro-
inflammatory’ chemicals, which can make the body less sensitive to
the insulin it produces by disrupting the function of insulin responsive
cells and their ability to respond to insulin.
LINKS BETWEEN OBESITY AND TYPE
2 DIABETES
• DISRUPTION IN FAT METABOLISM
• Obesity is also thought to trigger changes to the body’s 
metabolism These changes cause fat tissue (adipose tissue) to
release fat molecules into the blood, which can affect insulin
responsive cells and lead to reduced insulin sensitivity.
Risk Factors
• Weight. The more fatty tissue you have, the more resistant your cells
become to insulin.
• Family history. Your risk increases if a parent or sibling has type 2 diabetes.
• Age. Your risk increases as you get older.
• Polycystic ovary syndrome. For women, having polycystic ovary syndrome
— a common condition characterized by irregular menstrual periods, and
obesity — increases the risk of diabetes.
• High blood pressure
• Cholesterol and triglyceride levels. If you have low levels of high-density
lipoprotein (HDL), or "good," cholesterol, your risk of type 2 diabetes is
higher.
The prevalence of type II DM in Pakistan
• The prospective cross-sectional
studies reporting the prevalence
of diabetes in Pakistan has
reached 17.1 per cent, now.
• The prevalence of diabetes is on
the rise in the adult population of
Pakistan both in urban and rural
areas.
• The urban areas are more
affected than the rural areas.
Dietary factors associated with DM
CARBOHYDRATES AND DM

• Complex Carbohydrates and

fiber diet is recommended.
• Adult with DM should eat no
more than 200 grams per day.
PROTIEN
• A protein intake of 0.8-1
g/kg should be
recommended only for
patients with diabetes.
FATS
• Eating too much fat can lead to
you taking in more calories than
your body needs which causes
weight gain which can affect
your diabetes control and overall
health.

• In diabetic diet, the total fat

should be 20 to 30 per cent of the
total energy
Vitamins and Minerals
• Vitamins and minerals play an
important role in glucose
metabolism
•  vitamin B complex, antioxidants
(vitamin A, C, E and
carotenoids), calcium, vitamin D,
vitamin K, magnesium, sodium,
and potassium – and glucose
metabolism
Fiber and DM
• All fibers can slow the
absorption of sugar and fat from
food, and therefore help prevent
spikes in blood sugar and blood
fat after eating.
• typical recommendation to
patients is 35-40 grams of fiber
per day ideally
Water and DM
• Drinking enough water can help
your body eliminate excess
glucose through urine. The
Institute of Medicine
recommends men drink about
10-12 cups of day and
women drink about 8-10 cups .
Role of nurse in Prevention and Management of type II
DM.

• Screening, prevention and early detection of type 2 diabetes

• Describe the risk factors for type 2 diabetes
• explain the importance of prevention or delay of onset of type 2
diabetes in individuals at risk
• explain the role that exercise plays in the prevention of, or delay in
progression to, type 2 diabetes
• explain the importance of weight control and the role that diet plays in
the prevention of, or delay in progression to, type 2 diabetes.
Continued
• Promoting self-care
• support the patient and help them develop their own self-care with guidance
• observe and report any concerns that you may have about a patient that would
affect their ability to self-care
• Mental health
• have an understanding and awareness of how mental health issues, such as
depression and anxiety, can affect people with diabetes
• report any changes that you notice in the patient’s normal mental health, 
Continued
• Nutrition
• identify foods and drinks with high sugar content
• follow the nutritional plan and report any related problems
• measure and record the waist circumference, height and weight of
your patient accurately
• report if meals are not eaten, especially carbohydrates, if the patient is
using insulin or blood glucose lowering therapies.
Continued
• Urine monitoring
• document and report the results.
• Blood glucose monitoring
• document and report the result.
• recognize and follow local quality assurance procedure, including
disposal of sharps
• recognize hypoglycemia and be able to administer glucose
• Understand the normal range of glycaemia and report any readings
outside this range to the appropriate person.
Continued
• Oral therapies
• Injectable therapies
• Hypoglycemia- blood sugar is less than 70 mg/dL.
• Hyperglycaemia-fasting and 2-hour postprandial blood glucose levels
of more than 125 mg/dl and 180 mg/dl, respectively. 
Treatment
• Healthy diet
• Taking regular exercise
• Keeping their blood glucose levels within an agreed target range
• Medication such as metformin
• Insulin therapies.
•  Healthy targets for HbA1c, blood pressure and cholesterol levels.
• Normal Range HbA1c—6.5% in DM patients
• Cholesterol levels-----less than 200mg\dl
PREVENTION
•  Lifestyle changes 
• Increase physical activity 
• Maintaining a balanced diet
•  Living up smoking and alcohol consumption
Complications
• Neuropathy: These changes in
the nerves involve injury and
disease in the peripheral nervous
system, especially in the legs and
feet. It results in sensory loss and
causes numbness .
Continued
• Nephropathy: The thickening of
capillaries in the glomerulus
leads to nephropathy, later to
renal failure, which is the lead
continued
• Retinopathy: The changes in the
eyes include thickening of
capillaries with small
hemorrhages from broken
arteries in the retina, with yellow
waxy discharge or retinal
detachment. This complication
can eventually cause blindness.
continued
• Atherosclerosis: Another
complication is the development
of fibrous plaques on the inside
lining of major blood vessels,
which thickens gradually,
narrowing the interior part of the
blood vessel and restricts blood
flow
 REFERENCES
1. Ruth A. Roth (2011).Nutrition and Diet Therapy (10th edition):
Maxwell drive Clifton park USA.
2. S.R. Mudambi, M.V. Raja Gopal (2006). Fundamental of Food,
Nutrition and Diet Therapy (fifth edition): New age international
Publisher India.