Chapter 20
Nutrition &
Diabetes
Mellitus
© 2007 Thomson - Wadsworth
Diabetes Mellitus
• Metabolic disorders
characterized by:
 Elevated blood
glucose
 Disordered insulin
metabolism
• May have:
 Impaired insulin
secretion
 Cells that do not
respond to insulin
normally
• Results in
hyperglycemia
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Symptoms
• Classic symptoms
 Glycosuria
 Polydipsia
 Polyuria
 Polyphagia
• Other
 Blurred vision
 Increased
infections
 Loss of weight
 Constant fatigue
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Diagnosis of Diabetes
• Non-fasting
plasma glucose
200 mg/dL or > &
classic symptoms
• Fasting glucose
level 126 mg/dL
or >
• Plasma glucose 2
hours after a 75
gm glucose load
= 200 mg/dL or >
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© 2007 Thomson - Wadsworth
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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Type 2 Diabetes
• 90-95% of cases
• Risk increased with:
 Obesity
• Often asymptomatic
 Age
• Some insulin is
 Decreased physical
produced
 Insulin resistance &
relative insulin
deficiency
 Beta cells get
exhausted
activity
 Genetics
• Prevalence is
increasing in children
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Acute Complications
• Disturbances in energy
metabolism
• Fluid & electrolyte
imbalances
• Hyper- & hypoglycemia
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Type 1 Diabetes
• Ketoacidosis
 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
 Alcohol without food
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Type 2 Diabetes
• Hyperosmolar
hyperglycemic state
Fluid losses
Blood volume depletion
Electrolyte imbalances
>600-2000 mg/dL
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Chronic Complications
• Large blood vessels
Accelerated
atherosclerosis
Impaired circulation
Foot ulcers
• Small blood vessels
Retinopathy
Nephropathy
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Chronic Complications
• Nerve damage
Pain & burning
Numbness & tingling
Loss of sensation
Delayed stomach
emptying
Sexual dysfunction
Constipation
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Treatment
• Type 1
Insulin therapy
• Type 2
Diet therapy
Exercise
Oral medications or
insulin
• Requires lifelong
treatment
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Treatment Goals
• Desirable blood glucose
levels
• Healthy blood lipid
concentrations
• Control blood pressure
• Manage weight
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Evaluating Treatment
• Self-monitored
glucose testing
 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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Body Weight Concerns
• Type 1
• Type 2
 Newly diagnosed
are thin
 Usually gain
weight with insulin
therapy
 Newly diagnosed
usually overweight
 Worsens insulin
resistance
 Weight loss
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Nutrient Recommendations
• Carbohydrates: 50% • Fat
total kcalories
 Same as general
 High fiber, whole
grain
• Fiber
population unless have
increased LDLs
• Protein
 15-20% of kcalories
 Same as general
population
• Alcohol
• Sugar
 Use with food
 Minimize foods &
drink with added
sugars
• Micronutrients
 Same as general
population
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Meal-Planning Strategies
• Carbohydrate
counting
• Exchange lists
 Simpler & more
flexible than other
methods
 Person given a
daily carbohydrate
allowance
 Divided into
pattern of meals &
snacks
 More complex &
difficult to learn
 Sorts foods according
to their proportions of
CHO, fat, & protein
 Each food has similar
macronutrient &
energy content
© 2007 Thomson - Wadsworth
© 2007 Thomson - Wadsworth
Insulin Therapy
• For people that
can’t produce
enough insulin
• Type 1 diabetes
• Some persons
with type 2
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© 2007 Thomson - Wadsworth
Insulin Delivery
• Injection with
syringes
• Injection ports
• Insulin pumps
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Insulin Regimen
• Type 1
• Type 2
 Multiple daily
injections
 Several types of
insulin
 Insulin pump
 30% of persons
need insulin
 Insulin alone
 Insulin with oral
agents
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Insulin Therapy & Hypoglycemia
• Most common
complication
• Need immediate
intake of glucose
or CHO food
• 15-20 grams
• Relieves in 10-20
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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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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© 2007 Thomson - Wadsworth
Physical Activity
• Central feature of
• Physical activity &
management for
insulin therapy
type 2
 Doses need to be
reduced
• Improves insulin
 Check blood sugar
sensitivity
before & after
• Improves lipid levels
• Type 2
• Lowers blood
 Medical evaluation
pressure
needed before
starting
• Promotes weight loss
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Sick-Day Management
• Type 1 diabetes
Illness increases ketoacidosis risk
• Recommendations
Frequent blood glucose testing
Regular CHO intake: 45-50 g every
3-4 hours
Fluids to avoid dehydration
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Diabetes Management & Pregnancy
• Pregnancy
• Uncontrolled diabetes
increases insulin
 Miscarriages
resistance & need
 Birth defects
for insulin
 Fetal deaths
• Glycemic control • Type 2 diabetes
more difficult
 Deliver large babies
 May need C-section
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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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Gestational Diabetes
• Risk factors
 Family history of
diabetes
 Obesity
 Certain ethnic
groups
 Delivered babies
weighing over 9
pounds
• May need to restrict
carbohydrates to 4050% total kcalories
• Space carbohydrates
throughout the day
• Regular aerobic
activity
• May need insulin
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Nutrition in Practice
Metabolic Syndrome
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Prevalence of Metabolic
Syndrome in the U.S.
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Metabolic Syndrome
• Insulin resistance is a • Risk increases with
age
central feature
• Increases risk of CVD • Main cause
 Obesity
• 3 of the following:
 Central abdominal fat
 Insulin resistance
 Obesity
 Hypertriglyceridemia
 Reduced HDLs
 Hypertension
• Treatment
 Dietary & lifestyle
changes
 Reduce sugar &
refined grains
© 2007 Thomson - Wadsworth
© 2007 Thomson - Wadsworth