NUR INTERNATIONAL UNIVERSITY
LAHORE
ASSIGNMENT NO. 2
Name: Muhammad Sadiq Naseer
Registration no.: 3008-MSFND-F22
Submitted to: Ms. Laraib Sheikh
Course Name & Code: FND 702 Advanced Medical Nutrition Therapy
Dated: 06/06/2023
Food, Nutrition and Dietetics Program
Department of Clinical Nutrition
NUR International University,
Lahore.
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Question 1: Pathophysiology
A) Type 1 Diabetes
The immune system launches an autoimmune attack on the insulin-producing beta cells in
the pancreas. The beta cells are progressively destroyed, leading to an absolute insulin
deficiency. Without insulin, glucose cannot enter cells, causing hyperglycemia.
B) Type 2 Diabetes
Type 2 diabetes is primarily characterized by insulin resistance, where the body's cells
become less responsive to the effects of insulin. This resistance is linked to obesity,
increased free fatty acids, and chronic low-grade inflammation.
C) Latent Autoimmune Diabetes Mellitus (LADA)
It begins as an autoimmune attack on beta cells, similar to type 1 diabetes, but progresses
more slowly. The gradual destruction of beta cells leads to a progressive decline in insulin
production. Initially, there may be some degree of insulin resistance.
Question 2: Diagnostic Criteria
A) Type 1 Diabetes
The classical symptoms of Type 1 diabetes include polyuria, polydipsia, unexplained weight loss,
and fatigue. Hyperglycemia can be confirmed by random plasma glucose levels ≥200 mg/dL,
fasting plasma glucose levels ≥126 mg/dL, or 2-hour plasma glucose levels ≥200 mg/dL during an
oral glucose tolerance test (OGTT). Additionally, the detection of autoantibodies such as antiglutamic acid decarboxylase (GAD) antibodies, islet cell antibodies (ICA), and insulin
autoantibodies (IAA) supports the diagnosis of type 1 diabetes.
B) Type 2 Diabetes
Hyperglycemia can be confirmed by fasting plasma glucose levels ≥126 mg/dL, HbA1c levels
≥6.5%, or 2-hour plasma glucose levels ≥200 mg/dL during an OGTT. Unlike type 1 diabetes,
autoantibodies are typically not present in type 2 diabetes.
C) Latent Autoimmune Diabetes Mellitus (LADA)
LADA is characterized by the presence of autoantibodies associated with beta cell destruction,
similar to type 1 diabetes. The most commonly detected autoantibodies include GAD antibodies.
LADA is typically diagnosed in adults over the age of 30 and shows a slower progression
compared to type 1 diabetes. Initially, individuals with LADA may be misdiagnosed with type 2
diabetes due to its atypical presentation. However, as beta cell function declines over time, insulin
therapy becomes necessary.
Question 3: Complications of Hyperglycemia
Hyperglycemia, a state of elevated blood glucose levels, can give rise to acute complications such
as diabetic ketoacidosis (DKA) and hyperosmolar hyperglycemic state (HHS).
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A) Diabetic Ketoacidosis (DKA)
DKA primarily affects individuals with type 1 diabetes, although it can also occur in those with
type 2 diabetes.
Key characteristics include:



a)
Hyperglycemia: Blood glucose levels typically exceed 250 mg/dL (13.9 mmol/L).
Ketosis: Ketones are present in the blood and urine.
Acidosis: The blood becomes acidic due to the buildup of ketones.
Medical management
i.
Hospitalization: Immediate hospitalization is imperative to provide meticulous
monitoring and appropriate treatment for DKA.
ii.
Fluid replacement: Intravenous administration of fluids is employed to restore proper
hydration and correct electrolyte imbalances resulting from excessive urination and
dehydration.
iii.
Insulin therapy: Regular insulin is administered intravenously to lower blood glucose
levels and suppress the production of ketones. Insulin facilitates the uptake of glucose
by cells for energy and inhibits the breakdown of fats.
b) Nutritional care
i.
In the beginning, oral intake may be restricted until ketosis and acidosis are effectively
controlled. Once the patient stabilizes, a gradual transition to a regular diabetic meal
plan is recommended. This entails emphasizing a balanced intake of macronutrients,
consistent carbohydrate counting, and portion control.
B) Hyperosmolar Hyperglycemic State (HHS)
Key features include:



Severe hyperglycemia: Blood glucose levels often surpass 600 mg/dL (33.3 mmol/L).
Hyperosmolarity: Increased blood osmolarity due to elevated glucose levels.
Dehydration: Profound fluid depletion and electrolyte imbalances resulting from
excessive urination and inadequate fluid intake.
a) Medical management
i.
Hospitalization: HHS necessitates immediate hospitalization for intensive care and
meticulous monitoring.
ii.
Fluid replacement: Intravenous administration of fluids is emp loyed to rectify
dehydration and restore electrolyte balance. Adequate fluid replacement is critical for
replenishing blood volume and enhancing tissue perfusion.
iii.
Insulin therapy: Insulin may be administered gradually to progressively lower blood
glucose levels, thereby enabling cells to utilize glucose more effectively.
b) Nutritional care
i.
Initially, oral intake may be restricted until hydration and electrolyte imbalances are
corrected. Once stabilized, a gradual transition to a regular diabetic meal plan is
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recommended, focusing on balanced macronutrient intake, consistent carbohydrate
counting, and portion control.
Question 4: Nutrition Care Plan
Nutrition Care Plan for Type 1 Diabetes Mellitus in
Adults:
A) Nutrition Diagnosis: Inadequate Carbohydrate
Counting Skills
i.
Goal: Accurately count carbohydrates for
80% of meals and snacks.
ii.
Interventions: Educate on carbohydrate
counting techniques, including reading food
labels and using measuring tools.
iii.
Monitoring and Evaluation: Monitor
carbohydrate counting through selfreporting and food diaries. Conduct regular
follow-up sessions to assess progress and
address challenges.
B) Nutrition Diagnosis: Uncontrolled Blood
Glucose Levels
i.
Goal: Maintain target blood glucose levels
within the recommended range.
ii.
Interventions: Encourage regular selfmonitoring of blood glucose levels and
keeping a log. Provide education on the
impact of food choices, portion sizes, and
meal timing on blood glucose control.
iii.
Monitoring and Evaluation: Monitor selfreported blood glucose levels and review
logs during follow-up visits. Assess HbA1c
levels to evaluate long-term blood glucose
control.
Question 5: Carbohydrate-to Insulin Ratios
and Correction Dosages
The integration of an insulin regimen with nutrition Figure 1: Advanced Carbohydrate Counting
therapy plays a pivotal role in the comprehensive
management of Type 1 Diabetes Mellitus (T1DM) in adults. This symbiotic approach facilitates
the achievement of glycemic control, optimal insulin dosing, and overall metabolic well-being
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Insulins are categorized into basal and bolus therapies. Basal insulins are long-acting (16-24 hours)
and provide day-long replacement, curbing excessive liver glucose secretion. Typically, they are
injected once or twice in the morning, dinner, or bedtime. Bolus insulins, fast-acting, address postmeal glucose spikes and correct imbalances like the dawn effect (early morning glucose rise due
to hormone release). Insulin delivery options include vials/syringes, pens, pumps, and hybrid
devices. Basal bolus regimens are commonly initiated for individuals with type 1 diabetes.
Here are some recommendations for carbohydrate-to-insulin ratios and correction dosages specific
to adults with T1DM:
a) Carbohydrate-to-Insulin Ratios
The ICR denotes the amount of insulin required to cover a specific quantity of carbohydrates. For
instance, an ICR of 1:10 signifies that 1 unit of insulin is administered for every 10 grams of
carbohydrates ingested.
b) Correction Dosages
Determine an individualized correction factor, also known as the sensitivity factor or insulin
sensitivity factor. This factor represents how much one unit of insulin is expected to lower blood
sugar. For example, a correction factor of 1:50 means that one unit of insulin is expected to reduce
blood sugar by 50 mg/dL (2.8 mmol/L).
Question 6: Interpret Laboratory Parameters
Ref.
Range
Result Rationale
Fluid balance
Osmolality
(285-295)
306
In type 1 diabetes, high blood sugar levels can contribute
to an increase in osmolality.
Electrolyte balance
Sodium
136-145
130
Diabetic ketoacidosis (DKA) can lead to fluid and
electrolyte imbalances, including low sodium levels.
Potassium
Acid-base balance
3.5-5.5
3.6
pH
7.35-7.45
7.31
pCO2 (mm Hg)
35-45
35
HCO3 - mEq/L
24-28
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In type 1 diabetes, high blood sugar levels can lead to an
accumulation of acidic ketones, resulting in a condition
called diabetic ketoacidosis (DKA).
In type 1 diabetes, especially during DKA, there can be
a decrease in bicarbonate levels as a result of increased
production of acidic ketones.
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Question 7: Essential Skills and Educational Requirements
Optimal prioritization of essential skills and educational requirements for a recently diagnosed
adult with type 1 diabetes mellitus:
1. Proficiency in blood glucose monitoring techniques: It is of paramount importance to
provide comprehensive education on sophisticated blood glucose monitoring
methodologies, encompassing the utilization of cutting-edge glucometers or continuous
glucose monitoring (CGM) systems.
2. Acumen in managing hypoglycemia: Equipping the individual with the ability to
promptly recognize and address signs and symptoms of hypoglycemia is imperative.
3. Skillful management of hyperglycemia: Comprehensive education on recognizing
symptoms of hyperglycemia and employing appropriate management strategies is vital.
4. Diabetes education program: Encouraging active participation in diabetes education
programs, workshops, or online resources fosters continuous acquisition of knowledge and
skills to empower individuals in managing their condition effectively.
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