NUTRITION FOR DIABETES MELLITUS
Diabetes mellitus is a group of conditions characterized by either a relative or complete lack of insulin secretion by the beta cells of the pancreas or by defects of cell insulin receptors, which result in disturbances of carbohydrate, protein, and lipid metabolism.
Role in wellness
The number of persons diagnosed with diabetes is at epidemic proportions in the United States, and it is estimated that more than 5 million people with the disease have not been diagnosed. As a chronic disorder, diabetes mellitus requires long-term lifestyle changes of both dietary intake and physical activity. Approaching this disorder in a proactive manner by maintaining blood glucose levels as near normal as possible can lessen the negative impact of diabetes and achieve a higher level of wellness.
A way to achieve a proactive approach is to consider diabetes through the five dimensions of health. Long-term serious physical health complications may be avoided if hyperglycemia is controlled through dietary and lifestyle modifications to maintain the physical dimension of health. The ability of the individual to understand the condition; to be compliant on a regular basis regarding insulin injections, if required; and to follow dietary and exercise recommendations may depend on the intellectual health dimension. Emotional health may be tested. Not only must the individual deal with a chronic lifelong condition but also changes in dietary intake may necessitate the loss of symbolic foods, which may be emotionally upsetting.
Support, especially by family members and friends, is crucial. Social health may be pivotal in adjustment to this disorder. If one is already secure in social relationships, adaptations in social situations will be easier and more acceptable. People who eat special diets based on their religious or spiritual beliefs may need special adaptations of the diabetic diet to sustain their spiritual dimension of health.
Diabetes mellitus
Diabetes mellitus is a group of conditions characterized by either a relative or complete lack of insulin secretion by the beta cells of the pancreas or by defects of cell insulin receptors, which result in disturbances of carbohydrate, protein, and lipid metabolism and elevated blood glucose.
Diabetes is usually diagnosed and characterized by elevated fasting blood glucose (>126 mg/dl if found on at least two occasions) or hyperglycemia. The main goal of treatment is maintenance of insulin/ glucose homeostasis.
In addition to everyday maintenance necessary to control blood glucose levels, diabetes mellitus is associated with disability and premature death because of the disease’s effect on structural and functional alterations in many body systems, especially macrovascular and microvascular damage. Ranked as one of the most costly health problems in America, diabetes mellitus is often called a “silent killer. “7 All persons with diabetes mellitus are vulnerable to long-term complications and premature death, which is associated with all types of diabetes.
Manifestation of these complications may be preempted with control of hyperglycemia.
Macrovascular complications increase risk of coronary artery disease, peripheral vascular disease, and cerebrovascular accidents.
Microvascular effects include nephropathy (kidney disorder) and retinopathy (eye disorder from blood vessel changes).
As a result of nephropathy, approximately half of all individuals with type 1 diabetes mellitus (type 1 DM) develop chronic renal failure and end-stage renal disease (ESRD). Retinopathy is the leading cause of blindness in North America. In addition, neuropathy complications affect peripheral circulation, causing decreased sensations in extremities that may result in injury without the patient’s knowledge. Healing is impaired because of the effects of diabetes on the circulatory system; gangrene may develop, and amputation may be necessary.
Autonomic effects of diabetes may include orthostatic hypotension, persistent tachycardia, gastroparesis, neurogenic bladder (urinary bladder dysfunction from neurologic damage), impotence, and impaired visceral pain sensation that can obscure symptoms of angina pectoris or myocardial infarction.
Development of these long-term complications is believed to be correlated to the level and frequency of hyperglycemia experiences throughout the life span of a per son who has diabetes. Results of the Diabetes Control and Complications Trial6 indicate that intensive therapy is more effective than conventional therapy in delaying and slowing the progression of retinopathy by 75%, nephropathy by 50%, and neuropathy by 60% in patients with type 1 DM. Results of the U.K.’s Prospective Diabetes Study indicate that better blood glucose control reduces risk of retinopathy by 25% and nephropathy by 30% and possibly reduces neuropathy.
Glucose intolerance can be classified into two primary categories: type 1 diabetes mellitus (type 1 DM) and type 2 diabetes mellitus (type 2 DM).
Other types include gestational diabetes mellitus (GDM), impaired glucose tolerance (IGT), and other forms of diabetes. The majority (more than 90%) of persons with diabetes have type 2 DM, whereas 5% to 10% have type 1 DM.
What is diabetes?
Diabetes Mellitus is a metabolic disorder characterized by High Blood Sugar or what we called Hyperglycemia. There are other signs as distinct from a single disease or condition. There are three main form of diabetes, World Health Organization (WHO) said.
These are type 1, type 2, and Gestational Diabetes (diabetes that affects pregnant women who have never had diabetes before). All these form have similar signs and symptoms but have different causes.
Type 1 is formerly known as “childhood,” “juvenile,” or “insulin-dependent” diabetes. It is an autoimmune disorder in which the body’s own immune system attacks the beta cells in the Islets of Langerhans of the Pancreas and destroying them to reduce and eliminate Insulin (hormone secreted by the B cells of the islets of Langerhans) production. The autoimmune attack may be triggered by reaction to an infection. Example of this is German measles or Rubella.
Type 2 is characterized by tissue-wide insulin resistance and varies widely; it sometimes progresses to loss of beta cell function. Gestational Diabetes is no known specific causes but the hormones of the victim produced during pregnancy reduce a woman’s receptivity to insulin resulting in high blood sugar. This is also similar to Type 2 diabetes. In point of fact, there are two types of Gestational Diabetes. Type A1, diet modification is sufficient to control glucose level. Type A2, Insulin or other medications are required.
Endocrine glands release hormones (chemical messengers) into the bloodstream to be transported to various organs and tissues throughout the body. For instance, the pancreas secretes insulin, which allows the body to regulate levels of sugar in the blood.
The thyroid gets instructions from the pituitary to secrete hormones which determine the pace of chemical activity in the body (the more hormone in the bloodstream, the faster the chemical activity; the less hormone, the slower the activity).
Causes
Diabetes can be caused by too little insulin (a hormone produced by the pancreas to control blood sugar), resistance to insulin, or both.
Diabetes causes an excessive amount of glucose to remain in the blood stream which may cause damage to the blood vessels. Within the eye the damaged vessels may leak blood and fluid into the surrounding tissues and cause vision problems.
To understand diabetes, it is important to first understand the normal process of food metabolism. Several things happen when food is digested:
· A sugar called glucose enters the bloodstream. Glucose is a source of fuel for the body.
· An organ called the pancreas makes insulin. The role of insulin is to move glucose from the bloodstream into muscle, fat, and liver cells, where it can be used as fuel.
People with diabetes have high blood sugar. This is because their pancreas does not make enough insulin or their muscle, fat, and liver cells do not respond to insuliormally, or both.
Islets of Langerhans contain beta cells and are located within the pancreas. Beta cells produce insulin which is needed to metabolize glucose within the body.
There are three major types of diabetes:
· Type 1 diabetes is usually diagnosed in childhood. The body makes little or no insulin, and daily injections of insulin are needed to sustain life.
In response to high levels of glucose in the blood, the insulin-producing cells in the pancreas secrete the hormone insulin. Type I diabetes occurs when these cells are destroyed by the body own immune system.
· Type 2 diabetes is far more common than type 1 and makes up most of all cases of diabetes. It usually occurs in adulthood. The pancreas does not make enough insulin to keep blood glucose levels normal, often because the body does not respond well to the insulin. Many people with type 2 diabetes do not know they have it, although it is a serious condition. Type 2 diabetes is becoming more common due to the growing number of older Americans, increasing obesity, and failure to exercise.
· Gestational diabetes is high blood glucose that develops at any time during pregnancy in a woman who does not have diabetes.
Diabetes affects more than 20 million Americans. About 54 million Americans have prediabetes.
There are many risk factors for diabetes, including:
· A parent, brother, or sister with diabetes
· Obesity
· Age greater than 45 years
· Some ethnic groups (particularly African Americans, Native Americans, Asians, Pacific Islanders, and Hispanic Americans)
· Gestational diabetes or delivering a baby weighing more than
· High blood pressure
· High blood levels of triglycerides (a type of fat molecule)
· High blood cholesterol level
· Not getting enough exercise
The American Diabetes Association recommends that all adults over age 45 be screened for diabetes at least every 3 years. A person at high risk should be screened more often.
Symptoms
High blood levels of glucose can cause several problems, including frequent urination, excessive thirst, hunger, fatigue, weight loss, and blurry vision. However, because type 2 diabetes develops slowly, some people with high blood sugar experience no symptoms at all.
Symptoms of type 1 diabetes:
· Increased thirst
· Increased urination
· Weight loss in spite of increased appetite
· Fatigue
· Nausea
· Vomiting
Patients with type 1 diabetes usually develop symptoms over a short period of time, and the condition is often diagnosed in an emergency setting.
Symptoms of type 2 diabetes:
· Increased thirst
· Increased urination
· Increased appetite
· Fatigue
· Blurred vision
· Slow-healing infections
· Impotence in men
Signs and Tests
A urine analysis may be used to look for glucose and ketones from the breakdown of fat. However, a urine test alone does not diagnose diabetes. The following blood glucose tests are used to diagnose diabetes:
· Fasting blood glucose level — diabetes is diagnosed if higher than 126 mg/dL on two occasions. Levels between 100 and 126 mg/dl are referred to as impaired fasting glucose or pre-diabetes. These levels are considered to be risk factors for type 2 diabetes and its complications.
To monitor the amount of glucose within the blood a person with diabetes should test their blood regularly. The procedure is quite simple and can often be done at home
· Random (non-fasting) blood glucose level — diabetes is suspected if higher than 200 mg/dL and accompanied by the classic symptoms of increased thirst, urination, and fatigue. (This test must be confirmed with a fasting blood glucose test.)
· Oral glucose tolerance test — diabetes is diagnosed if glucose level is higher than 200 mg/dL after 2 hours (This test is used more for type 2 diabetes.)
You should also ask your doctor how often to you need your hemoglobin A1c (HbA1c) level checked. The HbA1c is a measure of average blood glucose during the previous 2 to 3 months. It is a very helpful way to determine how well treatment is working.
Ketone testing is another test that is used in type 1 diabetes. Ketones are produced by the breakdown of fat and muscle, and they are harmful at high levels. The ketone test is done using a urine sample. High levels of blood ketones may result in a serious condition called ketoacidosis. Ketone testing is usually done at the following times:
· When the blood sugar is higher than 240 mg/dL
· During acute illness (for example, pneumonia, heart attack, or stroke)
· Wheausea or vomiting occur
· During pregnancy
Treatment
There is no cure for diabetes. Treatment involves medicines, diet, and exercise to control blood sugar and prevent symptoms and complications.
LEARN THESE SKILLS
Basic diabetes management skills will help prevent the need for emergency care. These skills include:
· How to recognize and treat low blood sugar (hypoglycemia) and high blood sugar (hyperglycemia)
· What to eat and when
· How to take insulin or oral medication
· How to test and record blood glucose
· How to test urine for ketones (type 1 diabetes only)
· How to adjust insulin or food intake when changing exercise and eating habits
· How to handle sick days
· Where to buy diabetes supplies and how to store them
After you learn the basics of diabetes care, learn how the disease can cause long-term health problems and the best ways to prevent these problems. People with diabetes need to review and update their knowledge, because new research and improved ways to treat diabetes are constantly being developed.
SELF-TESTING
If you have diabetes, your doctor may tell you to regularly check your blood sugar levels at home. There are a number of devices available, and they use only a drop of blood. Self-monitoring tells you how well diet, medication, and exercise are working together to control your diabetes and can help your doctor prevent complications.
The American Diabetes Association recommends that premeal blood sugar levels fall in the range of 80 to 120 mg/dL and bedtime blood levels fall in the range of 100 to 140 mg/dL. Your doctor may adjust this depending on your circumstances.
WHAT TO EAT
You should work closely with your health care provider to learn how much fat, protein, and carbohydrates you need in your diet. A registered dietician can be very helpful in planning dietary needs.
Never Again “This Lifetime”.
· No Fruit, (exception) half pink grapefruit Daily, eaten over time.
· No Dairy (except Full Cream Full Fat Yogurt. and Butter, preferably grass raised.
· No Grains, of any kind.
· No Processed Food, (Anything with a label is “processed”.)
· No refined foods,
· No Sugars, No Artificial Sweetners, (Stevia, Okay).
· No Man Made Fats Or Oils. (no vegetable oils)
· No Chemical Enhancers (MSG example) No Flavors Or Colors.
· No Drinking Food. (exception Green Tea and Cocoa)
· No Underground Vegetables Cooked, (example potatoes) Carrots,Onions, Garlic Okay Raw
· No Alcohol
People with type 1 diabetes should eat at about the same times each day and try to be consistent with the types of food they choose. This helps to prevent blood sugars from becoming extremely high or low.
Persons with type 2 diabetes should follow a well-balanced and low-fat diet.
Insulin
All persons with type 1 DM require exogenous insulin to maintaiormal blood glucose levels. Some individuals with type 2 DM may require insulin to optimize blood glucose control. Regardless of the type of diabetes, the goal of insulin therapy is to mimic physiologic insulin delivery. This is usually accomplished by a variety of methods: split-dose regimen, multidose therapy, or insulin pumps.
The following factors are usually considered by the physician when deciding when to begin insulin therapy:
• Severity of the diabetes (e.g., degree of hyperglycemia) and presence or absence of clinical symptoms
• Presence or absence of concurrent diseases and conditions
• Preferences of the patient after being informed about use, expected therapeutic effects, and possible side effects of oral glucose-lowering medications or insulin
• Motivation of the patient
Oral Glucose-Lowering Medications
Oral glucose-lowering medications are used to treat type 2 DM when diet and physical activity cannot control hyperglycemia. Effectiveness of medications varies with each individual and is closely associated to residual beta cell function.’ The variety of new drugs for treatment of diabetes has greatly expanded during the past several years. To complement insulin and sulfonylurea drugs, several other classes of medications have become available: thiazolidinediones, alpha-glucosidase inhibitors, biguanides, and meglintinides.
Exercise
The Relationship Between Exercise and Diabetes
One of the best ways to reduce obesity is through exercise, and a correlation between exercise and diabetes incidence is indeed found in the Gallup-Healthways data. In a review of January through September 2009 results, a sharply higher incidence of reported diabetes is found among those who did not exercise at least 30 minutes on any day in the previous week.
The positive relationship between exercise and reduced diabetes rates prevails even after controlling for weight class, as both obese and non-obese adults who did not exercise in the last week are more likely to say they have been diagnosed with diabetes than are their intra-weight-class counterparts who exercised. Even among obese adults, therefore, the likelihood of having been diagnosed with diabetes is lower among those who report engaging in at least some exercise each week, consisting minimally of one to three 30-minute workouts.
General long-term trends in exercise are also consistent with the relationships noted above. While exercise is seasonal and is expected to climb in the warmer months, year-over-year comparisons reveal a 2009 decline of 2.7 points in the percentage of American adults (nationally, about 6 million fewer people) who say they are exercising at least 30 minutes three or more times per week, compared with 2008.
The importance of sport and health can be described as follows:
– Exercise to burn calories will help you lose weight or maintain weight in the ideal proportions.
– Regular exercise can help your body respond to insulin and is known to be effective in managing blood glucose. Exercise can lower blood glucose and possibly reduce the amount of medication you need to treat diabetes, or even eliminate the need for medication.
– Exercise can help reduce cholesterol and high blood pressure. High cholesterol and high blood pressure can cause heart attacks or strokes.
– Exercise can help reduce stress. This is good, because stress can increase blood sugar levels.
– Exercise can also reduce the risk of heart disease, lower cholesterol and blood pressure.
– For some cases, exercise combined with a planned meal can control type 2 diabetes without medication.
Along with medical nutrition therapy and insulin, exercise is the third component used to treat diabetes. Exercise, like insulin, lowers blood glucose levels, assists in maintaining normal lipid levels, and increases circulation. For most individuals, consistent and individualized exercise helps reduce the therapeutic dose of insulin. Patients should be instructed not to perform exercise at the time insulin is at its peak. Ideally, they should exercise when blood glucose levels are between 100 and 200 mg/dl or about 30 to 60 minutes after meals. They should avoid exercising when blood glucose is above 250 mg/dl20 and ketones are present in the urine.
In the case of type 1 DM, glucose control can be compromised if proper adjustments are not made in food intake or insulin administration.
Patients with type 2 DM who take oral hypoglycemic agents may be at risk of postexercise hypoglycemia.
General guidelines that may assist in regulating the glycemic response to exercise in persons with type 1 DM are summarized as follows:
• Metabolic control before exercise: Avoid exercise if fasting glucose levels are greater than 250 mg/dl and ketosis is present or if glucose levels are greater than 300 mg/dl, regardless of whether ketosis is present. Ingest added carbohydrate if glucose levels are less than 100 mg/dl.
• Blood glucose monitoring before and after exercise: Identify when changes in insulin or food intake are necessary. Learn the blood glucose response to different exercise conditions.
• Food intake: Consume added carbohydrate as needed to avoid hypoglycemia.
Carbohydrate-based foods should be readily available during and after exercise
People with type 1 DM who do not have complications and are in good blood glucose control can perform all levels of exercise, including leisure activities, recreational sports, and competitive sports.20 To do this safely, the patient must possess the ability to collect self-monitored blood glucose data (during exercise) and then use these data to adjust the therapeutic regimen (insulin and medical nutrition therapy).
Exercise can increase the risk for hypoglycemia in persons with type 1 DM. Hypoglycemia during exercise of 40 minutes or less is rare. Onset is more likely to occur after exercise, often between 4 and 10 hours afterward.10 Blood glucose levels should be monitored at 1- or 2-hour intervals after exercise to assess response to the exercise and allow for adjustments in insulin and food intake.
HOW TO TAKE MEDICATION
Medications to treat diabetes include insulin and glucose-lowering pills called oral hypoglycemic drugs.
Persons with type 1 diabetes cannot make their own insulin, so daily insulin injections are needed. Insulin does not come in pill form. Injections that are generally needed one to four times per day. Some people use an insulin pump, which is worn at all times and delivers a steady flow of insulin throughout the day. Other people may use a new type of inhaled insulin.
Insulin preparations differ in how quickly they start to work and how long they remain active. Sometimes different types of insulin are mixed together in a single injection. The types of insulin to use, the doses needed, and the number of daily injections are chosen by a health care professional trained to provide diabetes care.
People who need insulin are taught to give themselves injections by their health care providers or diabetes educators.
Unlike type 1 diabetes, type 2 diabetes may respond to treatment with exercise, diet, and medicines taken by mouth. There are several types of medicines used to lower blood glucose in type 2 diabetes. They fall into one of three groups:
· Medications called oral sulfonylureas that increase insulin production by the pancreas.
· Medications called thiazolidinediones that help increase the cell’s sensitivity (responsiveness) to insulin.
· Medications that delay absorption of glucose from the gut. These include acarbose and miglitol.
There are some injectable medicines used to lower blood sugar. They include exenatide and pramlintide.
Most persons with type 2 diabetes will need more than one medication for good blood sugar control within 3 years of starting their first medication. Different groups of medications may be combined or used with insulin.
Some people with type 2 diabetes find they no longer need medication if they lose weight and increase activity, because when their ideal weight is reached, their own insulin and a careful diet can control their blood glucose levels.
It is unknown if hypoglycemic medicines taken by mouth are safe for use in pregnancy. Women who have type 2 diabetes and take these medications may be switched to insulin during pregnancy and while breastfeeding.
Gestational diabetes is treated with insulin and changes in diet.
EXERCISE
Regular exercise is especially important for people with diabetes. It helps with blood sugar control, weight loss, and high blood pressure. People with diabetes who exercise are less likely to experience a heart attack or stroke than diabetics who do not exercise regularly. You should be evaluated by your physician before starting an exercise program.
Here are some exercise considerations:
· Choose an enjoyable physical activity that is appropriate for your current fitness level.
· Exercise every day, and at the same time of day, if possible.
· Monitor blood glucose levels before and after exercise.
· Carry food that contains a fast-acting carbohydrate in case you become hypoglycemic during or after exercise.
· Carry a diabetes identification card and a mobile phone or change for a payphone in case of emergency.
· Drink extra fluids that do not contain sugar before, during, and after exercise.
Changes in exercise intensity or duration may need changes in diet or medication dose to keep blood sugar levels from going too high or low.
FOOT CARE
People with diabetes are prone to foot problems because of the likelihood of damage to blood vessels and nerves and a decreased ability to fight infection. Problems with blood flow and damage to nerves may cause an injury to the foot to go unnoticed until infection develops. Death of skin and other tissue can occur.
If left untreated, the affected foot may need to be amputated. Diabetes is the most common condition leading to amputations.
To prevent injury to the feet, people with diabetes should adopt a daily routine of checking and caring for the feet as follows:
· Check your feet every day, and report sores or changes and signs of infection.
· Wash your feet every day with lukewarm water and mild soap, and dry them thoroughly.
· Soften dry skin with lotion or petroleum jelly.
· Protect feet with comfortable, well-fitting shoes.
· Exercise daily to promote good circulation.
· See a podiatrist for foot problems or to have corns or calluses removed.
· Remove shoes and socks during a visit to your health care provider and remind him or her to examine your feet.
· Stop smoking, which hinders blood flow to the feet.
Blood Glucose Monitoring
Blood glucose levels are the cornerstone of diabetes management.
Blood glucose levels can be monitored several ways:
(1) fasting blood glucose,
(2) glycosylated hemoglobin, and
(3) self-monitoring.
Fasting blood glucose, also called fasting blood sugar, is the level of glucose in the blood after an 8-hour fast. Normal values range from 70 to 110 mg/dl depending on the standards set by individual laboratories. Fasting levels of blood glucose are elevated in uncontrolled diabetes.
Glycosylated hemoglobin (HgbAlc) is formed through an irreversible process. As red blood cells (RBCs) circulate in the bloodstream, hemoglobin combines with glucose, forming glycohemoglobin. The amount of glycohemoglobin formed depends on the amount of glucose in the bloodstream circulation over the RBCs’ 120-day life span. Therefore the amount of HgbAlc is a reflection of average blood glucose level for the 100- to 120-day period before the test; the more glucose the RBC was exposed to, the greater the value. This value is not affected by short-term factors such as food intake, exercise, or stress, therefore the blood sample can be drawn at any time; this is an easier sample to obtain than the fasting blood glucose test.
Self-monitoring can be performed in the patient’s home with blood glucose meters (sometimes called glucometers), which can be purchased at pharmacies.
A droplet of blood is obtained through a finger prick on a regular basis to monitor glucose levels before and after meals and at bedtime. Self-monitoring and charting is particularly useful in evaluating glycemic control, physical activity, and effectiveness of the meal plan in meeting the goals of medical nutrition therapy.
Records should be kept of self-monitored blood glucose levels for review by the healthcare team to determine food, insulin, and exercise needs. This allows for individualized treatment, especially with meal plans, and makes indiscriminate, general dietary advice or tear-off diet sheets unjustified. The frequency of monitoring depends on the type of diabetes and therapy prescribed. For some, monitoring up to seven times a day may be appropriate: before and after (1 to 2 hours after) breakfast, lunch, and dinner and at bedtime.
Expectations (prognosis)
With good blood glucose and blood pressure control, many of the complications of diabetes can be prevented.
Studies have shown that strict control of blood sugar and blood pressure levels in persons with diabetes helps reduce the risk of kidney disease, eye disease, nervous system disease, heart attack, and stroke.
Complications
Emergency complications include diabetic hyperglycemic hyperosmolar coma.
Long-term complications include:
· Hyperlipidemia, hypertension, atherosclerosis, and coronary artery disease
Calling Your Health Care Provider
Go to the emergency room or call the local emergency number (such as 911) if symptoms of ketoacidosis occur:
· Increased thirst and urination
· Nausea
· Deep and rapid breathing
· Abdominal pain
· Sweet-smelling breath
· Loss of consciousness
Go to the emergency room or call the local emergency number if symptoms of extremely low blood sugar (hypoglycemic coma or severe insulin reaction) occur:
· Weakness
· Headache
· Convulsions or unconsciousness
Prevention
Maintaining an ideal body weight and an active lifestyle may prevent the onset of type 2 diabetes. Currently there is no way to prevent type 1 diabetes.
Simply put, diabetes mellitus is a serious disease that impairs the body’s ability to use food properly as a source of essential nutrition and energy.
Normally, glucose, a form of sugar produced when starches and sugars are digested, is burned as fuel to supply the body with energy. This process – turning food into energy – is called metabolism.
But in order to metabolize glucose properly, the body requires another substance: insulin.
Insulin is a hormone produced by beta cells which are part of the islets in the pancreas, a gland located just beneath the stomach.
The role of insulin is to regulate the body’s use of glucose. Insulin is essential to the metabolic process.
Trying to burn glucose without insulin is like trying to cook food without heat. It can’t be done.
And that’s the problem for people who have diabetes: they either don’t produce enough insulin to properly metabolize glucose, or the insulin they have works inefficiently.
Without insulin to turn glucose into energy the glucose piles up in the bloodstream and spills into the urine. Excessively high levels of sugar in the blood and the urine are the hallmarks of untreated diabetes.
The main goal of diabetes treatment is to control blood sugar levels and keep them in the normal range to avoid the complications such as heart and kidney disease, stroke, blindness, and limb amputation. The specific kind of treatment used to control blood sugars depends on the type of diabetes a person has.
The signs and symptoms of diabetes include the following:
· Unusual thirst
· Frequent urination
· Weight change (gain or loss)
· Extreme fatigue or lack of energy
· Blurred vision
· Frequent or recurring infections
· Cuts and bruises that are slow to heal
· Tingling or numbness in the hands or feet
· Trouble getting or maintaining an erection
Once you are over the age of forty, your risk of diabetes increases and you should consider being tested every three years. If any of the following risk factors apply, you should be tested earlier and more often:
Being:
· A member of a high risk group (Aboriginal, Hispanic, Asian, South Asian, or African descent)
· Overweight (especially if you carry most of your weight around your middle)
Having:
· A parent, brother or sister with diabetes
· Health complications associated with diabetes
· Given birth to a baby that weighed more than
· Had gestational diabetes (diabetes during pregnancy)
· Impaired glucose tolerance or impaired fasting glucose
· High blood pressure
· High cholesterol or other fats in the blood
Being diagnosed with any of the following conditions:
· Polysystic ovary syndrome
· Acanthosis nigricans (dark patches of skin)
· Schizophrenia
Type 1 diabetes (insulin-dependent or juvenile diabetes)
Type 1 diabetes (insulin dependent or juvenile diabetes) can occur at any age, but is most commonly diagnosed from infancy to the late 30s. In this type of diabetes, a person’s pancreas produces little or no insulin. Approximately 10 percent of diabetics have type 1 diabetes.
Although the causes are not entirely known, scientists believe the body’s own defense system, the immune system, attacks and destroys the insulin-producing beta cells in the pancreas. People with type 1 diabetes must inject insulin several times every day in order to control their blood sugar levels.
Type 2 diabetes (non-insulin-dependent or adult-onset diabetes)
Type 2 diabetes (non-insulin dependent or adult onset diabetes) typically develops after age 40, but can appear earlier, and has more recently begun to appear with more frequency in children. Approximately 90 percent of diabetics have type 2 diabetes.
In this form of diabetes the pancreas still produces insulin, but the body does not produce enough insulin or is not able to use it effectively. Treatment includes diet control, exercise, self-monitoring of blood glucose and, in some cases, oral drugs or injected insulin.
About 2 to 5 percent of pregnant women develop high blood sugar levels during pregnancy. This form of the disease is called gestational diabetes and prompt diagnosis is important because children born to mothers with gestational diabetes may be “macrosomic,” a medical term meaning severely obese.
Macrosomic babies have a higher risk of hypoglycemia after birth-a dangerously low blood glucose level-as well as severe breathing problems. They are also at higher risk for potential long-term obesity and glucose intolerance. Although this type of diabetes usually disappears after the birth of the baby, women who have had gestational diabetes are at high risk of developing type 2 diabetes later in life.
Effectively managing your diabetes will often involve a number of the following commitments:
· Stop smoking
· Check blood glucose levels and keep them in your target range
· Keep your cholesterol and other blood fats in your target range
· Maintain a health weight
· Maintain your blood pressure close to target level
· Take your medication as prescribed
· Manage your stress effectively
· Follow a balanced meal plan
· Be physically active
· Take care of your feet
· Regularly visit your dentist, eye care specialist, and doctor
People with diabetes can live active, independent and vital lives if they make a lifelong commitment to careful diabetes management, which includes the following:
Education
Diabetes education is an important first step. All people with diabetes need to be informed about their condition.
Physical activity
Regular physical activity helps your body lower blood glucose levels, promotes weight loss, reduces stress and enhances fitness.
Nutrition
What, when and how much you eat all play an important role in regulating blood glucose levels.
Weight management
Maintaining a healthy weight is especially important in the management of type 2 diabetes.
Medication
Type 1 diabetes is always treated with insulin. Type 2 diabetes is managed through physical activity and meal planning and may require medications and/or insulin to assist your body in making or using insulin more effectively.
Lifestyle management
Learning to reduce stress levels in day-to-day life can help people with diabetes better manage their disease.
Blood pressure
High blood pressure can lead to eye disease, heart disease, stroke and kidney disease. People with diabetes should try to maintain a blood pressure level at or below 130/80.
Herbal Remedies for Diabetes Mellitus
I have scoured the ancient Ayurveda and folk writing of
Three very effective measures against Diabetes Mellitus are:
Light Daily Exercise: A brisk walk twice a day for a couple of Kilometers each time is very useful in control of blood sugar levels. This is a must for all patients of Diabetes.
Reduce Obesity: If you are overweight for your height and age, you need to reduce your weight. However for patients of diabetes, it is important to reduce the body weight slowly under doctor supervision. The benefits are immense.
Diet Control : Stop over eating and follow a doctors recommended diet strictly.
Some Herbs are found to be effective against Diabetes.
One well known and ancient remedy is Bitter Gourd
This vegetable is an effective cure against diabetes and has been used for time immemorial against this problem. However it may not be effective in all cases but is worth a try. Squeeze and crush the vegetable in a juicer or by hand to collect one ounce (approximately 6 – 7 tea spoons) in a glass. The juice will be very bitter. Drink this juice on empty stomach in the morning and also once in the evening. Try this therapy for at least 30 days to find improvement in blood sugar levels. This therapy is practiced in many households for effective control of diabetes and has been found to be curative also in some cases. So try it.
Fenugreek is also an effective curative herb for this problem. A tablespoonful of fenugreek leaf juice taken early in the morning for about three months has been found to cure early stages of Diabetes Mellitus. The powder of Fenugreek seeds is also effective in this condition. Crush the seeds in a blender and take
One teaspoon of cinnamon powder taken twice a day , morning and evening with water has also been found to be effective against Diabetes. This is an easy remedy so all patients of this problem , must try it for two to three weeks to find, if it is effective for them or not.
Some other common herbs found useful in treating Diabetes Mellitus are Jamun and its seeds, Gulair (Ficus Glomerata), Coriander seeds, Lettuce, Red rose flower & Fennel seeds. a mixture of the powders from these herbs taken twice a day , is also found to be effective for this problem.
There are a few herbal powders available in the market, which use a combination of two or more of the above herbs. They may be also tried for treatment of this disease. At times for some body types, they can be very effective.
In conclusion, diabetes patient needs to exercise regularly, cut down on white sugar, reduce weight if obese and try some natural herbs. A combination of the above treatment and lifestyle change can work wonders. Take your pick and experiment to find the best solution to your problem.
What is diabetic nephropathy?
Diabetic nephropathy is the kidney disease that occurs as a result of diabetes. This is more likely to occur if the blood sugar is poorly controlled.
Do all diabetics develop nephropathy? The overall risk of developing diabetic nephropathy varies between about 10% of type II diabetics to about 30% of type I diabetics and some are:
· Blood sugar control is poor
· High blood pressure
· Smoking
· Relatives have had kidney disease or high blood pressure
Treatment?
· No proteinuria
1. Aim under 130/80mmHg (120/70mmHg in type I diabetes).
2. Aim HbA1c under 7%
3. Dietary advice for sugar and fat
4. STOP SMOKING
· Microalbuminuria & Proteinuria
1. Aim BP <125/75mmHg
2. Add further blood pressure lowering drugs if needed. Add ACEi/ARBif possible.
3. Aim total cholesterol under 3.5mmol/l
4. Add ACE inhibitor if possible
· Declining kidney function
1. Prepare for dialysis and/or transplantation
Diabetic nephropathy (nephropatia diabetica), also known as Kimmelstiel-Wilson syndrome and intercapillary glomerulonephritis, is a progressive kidney disease caused by angiopathy of capillaries in the kidney glomeruli. It is characterized by nephrotic syndrome and nodular glomerulosclerosis. It is due to longstanding diabetes mellitus, and is a prime cause for dialysis in many Western countries.
Key points:
Inspect your feet daily and clean
Control your blood sugar, blood pressure and cholesterol levels.
Type 2 Diabetes Diet Plan by American Diabetes Association
Type 2 diabetes diet:
With more than 14.6 million Americans suffering from diabetes, it has become a major health concern in the
Diabetes diet plan:
A diabetes diet plan should be followed only after consulting an expert physician. Your doctor will also take into account any other health problems, if any, before prescribing you a diabetes diet plan.
Diet recommended by American Diabetes Association:
The diet recommended by American Diabetes Association is all about making healthy food choices. The diet lays more emphasis on fruits, non – starchy vegetables (carrots, spinach, green beans, broccoli), dried beans, and lentils. You may choose to eat whole grain foods instead of processed grain products and also include brown rice in your diet. The diet recommended by American Diabetes Association can help you manage your diabetes effectively provided that you watch the portion sizes while eating. Even healthy foods, if eaten in large quantities, can increase your weight making diabetes management more difficult.
Role of the Nurse
The role of the nurse in caring for the nutritional needs of patients with diabetes varies depending on setting and age of the client. However, the general approach is to become aware of and help assess the patient’s knowledge and understanding and adherence with the prescribed diet. When possible, observing meals and food choices as well as monitoring glucose levels can give important clues to the level of compliance. When compliance is faulty, the nurse needs to determine whether knowledge or motivation is the problem. Knowledge deficits can be remedied in appropriate areas by the nurse or dietitian; lack of motivation may be harder to handle.
For example, (1) adolescents with diabetes may not believe long-term complications are related to diet and may be more motivated by the need to eat like their peers, or (2) older adults with diabetes may be set in long-time food intake patterns and may not want to change them as long as they take medication for hyperglycemia.
When a trusting relationship exists between the nurse and patient, discussions about motivations and concerns can take place. The nurse may then influence the patient to be more concerned about his or her long-term welfare. A care plan that meets the patient’s social, psychologic, and physical needs can be developed as a result of collaboration among the nurse, physician or primary healthcare provider, dietitian, and patient.
Additional forms of support may be provided by community agencies and associations. As mentioned previously, nutrition and diet are considered by both patients and health professionals to be the most difficult problems in the management of diabetes.
Every day we are faced with changes in our environments that require some adaptation to the situation. We’re late for work, so maybe we skip breakfast or grab something quick along the way. The kids have ball practice tonight, so dinner becomes sandwiches and fruit instead of a full-course meal. Most of us make the required changes in stride, not thinking too much about it. Why should we think life for persons with diabetes is any different? Historically, those with diabetes have been taught consistency in everything they do: eat at the same time every day, eat the same number of kcalories every day, take the same amount of insulin every day, and on and on. The new recommendations for medical nutritional therapy consider these perpetual lifestyle changes.
Wouldn’t it also be practical when encouraging dietary adherence with a person who has diabetes to discuss situations that cause the individual problems in maintaining control over his or her eating?
Comprehensive education for persons with diabetes should include assessment of these obstacles and situational problem solving.
Natural Diabetes Treatment with Vitamins, Herbs & Supplements
Supplement Summary – Custom formulated “just for you”
“Diabetes is a quite common and well-known condition. Are you experiencing any of the following: fatigue, thirst, weight loss, blurred vision or frequent urination? These are some symptoms of Diabetes, though some sufferers of this disease show no symptoms.
Diabetes can be diagnosed by a blood test. This natural treatment formula includes ingredients that can optimize blood sugar control and may improve the overall health condition. Essential natural ingredients are included in tthis natural treatment of diabetes; for example, chromium which helps to regulate blood sugar level and indirectly affects level of fats in the blood, and taurine may improve insulin sensitivity and decrease cholesterol level.”
Main Functions:
Diabetes is a disorder characterized by abnormally high blood glucose levels. People with diabetes cannot properly process glucose, a sugar the body uses for energy. As a result, glucose tends to move inefficiently from the bloodstream to the tissues of the body where it is needed. Therefore, at the same time that blood glucose levels are elevated, the rest of the body can be starved for glucose. Chromium helps to regulate blood sugar level and indirectly affects level of fats in the blood. Alpha-Lipoic Acid may relieve symptoms of nerve damage in people with diabetes and may improve the glucose-lowering action of insulin.
Diabetes can lead to poor wound healing, higher risk of infections, and damage to the eyes, kidneys, nerves, and heart. Zinc is an essential mineral that is a component of enzymes needed to repair wounds, maintain fertility in adults, help cells reproduce, preserve vision, boost immunity, and protect against free radicals, among other functions. Antioxidants, including Vitamin C, Vitamin E and phytonutrients in Bilberry, prevent damage to the nerves, eyes, and heart.
Ingredients Description:
Chromium helps to regulate blood sugar levels and indirectly affects the level of fats in the blood. Alpha-Lipoic Acid may relieve symptoms of nerve damage in people with diabetes and may improve the glucose-lowering action of insulin. Vitamin B Complex helps produce enzymes that convert glucose to energy and may also aid in preventing diabetic nerve damage. Flaxseed contains essential fatty acids that protect against nerve damage and keep the blood supply of the arteries consistent. Flaxseed also works to lower cholesterol, thereby protecting against heart disease. Antioxidants, including Vitamin C, Vitamin E and phytonutrients in Bilberry, prevent damage to the nerves, eyes, and heart. Gymnema may increase insulin production or increase insulin release. Taurine may improve insulin sensitivity and decrease cholesterol level. Zinc is an essential mineral that is a component of enzymes needed to repair wounds, maintain fertility in adults, help cells reproduce, preserve vision, boost immunity, and protect against free radicals, among other functions. Copper is needed with long-term use of zinc, because zinc inhibits copper absorption.
Diabetes Management through the Life Span
The role of medical nutrition therapy is crucial for optimal blood glucose control.
In various life stages, pregnancy outcome, and growth and development of children can be influenced by nutritional intake.
Pregnancy
Women with preexisting diabetes who become pregnant are vulnerable to fetal complications, and maternal health can be compromised when complications of diabetes occur. Occasionally, the stress of pregnancy may induce gestational diabetes mellitus (GDM), which is a form of glucose intolerance that has its onset during pregnancy and is resolved on parturition. Whether the mother has preexisting diabetes or GDM, risk of fetal abnormalities and mortality are increased in the presence of hyperglycemia, so every effort should be made to control blood glucose levels. All women with GDM should receive nutrition counseling by a registered dietitian when possible.
Changes that take place during pregnancy greatly affect diabetes control and insulin use. Some hormones and enzymes produced by the placenta are antagonistic to insulin, thus reducing its effectiveness. Maternal insulin does not cross the placenta, but glucose does. This will cause the fetus’s pancreas to increase insulin production if blood glucose levels get too high.
The increased production of insulin causes the most typical characteristic of infants born to women with diabetes— macrosomia.
Newborns may also have other problems such as respiratory difficulties, hypocalcemia, hypoglycemia, hypokalemia, or jaundice.
Larger body size Individualization of medical nutrition therapy contingent on maternal weight and height is recommended.” Medical nutrition therapy should include provision of adequate kcalories and nutrients to meet the needs of the pregnancy and should be consistent with established maternal blood glucose goals.” Self-monitoring of blood glucose (SMBG) presents important information about the impact of food on blood glucose levels. At the start, minimal daily SMBG should be planned four times a day (fasting and 1 or 2 hours after each meal).34 Blood glucose goals during pregnancy are the following:
• Fasting: less than 95 mg/dl
• 1 hour postprandial: 140 mg/dl
• 2 hours postprandial: less than 120 mg/dl
Frequency of SMBG may be decreased once blood glucose control is established.
However, some monitoring should continue throughout pregnancy Desired weight gains and nutrient requirements are the same as for established pregnancy guidelines:
During the second and third trimesters, an increased energy intake of approximately 100 to 300 kcal/day is recommended.22’23 High-quality protein should be increased by 10 g/day and can be met easily with one or two extra glasses of low-fat or skim milk or 1 to
Kcalorie restriction must be viewed with caution. A minimum of 1700 to 1800 kcal/day of carefully selected foods has been shown to prevent ketosis. Intakes below this level are not advised.34 Weight gain goals are based on prepregnancy BMI. Weight gain should still occur even if patients have gained considerable weight before onset of GDM.34 Each patient with GDM should be evaluated individually by a registered dietitian, have her care plans adjusted, and be provided patient education as needed to achieve weight goals.
Pregnancy in Overt Diabetes.
A successful pregnancy for a woman who has diabetes requires planning and commitment. Because most fetal malformations occur during the first trimester of pregnancy, achieving and maintaining excellent glycemic control before conception and during early pregnancy is a must. The optimal period of care for a woman with diabetes is before conception.
Ideally, preconception counseling should begin during puberty and continue through the childbearing years.
Insulin requirements increase during the second and third trimesters because of increased blood glucose levels caused by increased production of pregnancy-associated hormones that are insulin antagonists.
Successful preconception care programs have used the following pre- and postprandial goals:’
• Before meals: capillary whole-blood glucose 70 to 100 mg/dl or capillary plasma glucose 80 to 110 mg/dl
• 2 hours postprandial: capillary whole-blood glucose less than 140 mg/dl or capillary plasma glucose less than 155 gm/dl
Glycated hemoglobin levels should be normal or close to normal as possible before conception is attempted.
Pregnancy will require greater attention to medical nutrition therapy on a day-today basis. Guidance during early pregnancy should include special consideration for food cravings and nausea. The meal plan should be individualized and should evolve throughout the pregnancy to meet changing nutritional needs and insulin requirements.
Three meals and three snacks are usually recommended. The use of frequent home blood glucose monitoring can help the patient maintaiormal fasting and postprandial glucose levels and avoid frequent or severe hypoglycemic reactions.
Gestational Diabetes.
Gestational diabetes mellitus (GDM) will develop in about 2% to 5% of all pregnancies. Women who develop GDM are often obese, but weight reduction should not be attempted at this time. Although the specific components of an ideal diet for GDM have not been determined, good glucose control must be maintained and is usually accomplished by individualization of intake and graphing of weight gain. Often, insulin may be prescribed in addition to medical nutrition therapy to reduce the risks of fetal macrosomia, neonatal hyperglycemia, and perinatal mortality.
Oral hypoglycemic agents are teratogenic to the fetus and therefore not recommended. Glucose levels usually revert to normal following delivery, but there is an increased risk for later development of type 1 or type 2 DM. Nearly 30% to 40% of women with GDM eventually develop type 2 DM.
Maturity Onset Diabetes of the Young (MODY)
Incidence and prevalence of type 2 DM in children have increased 30-fold over the past 20 years, causing the term epidemic to be used to describe the phenomenon.
This means the burden of diabetes and accompanying complications will affect many more individuals, thus causing an enormous drain on resources.
More Americans will be taking potent medications, which have side effects, for most of their lives.'” What has accompanied this epidemic of type 2 DM in children across the United States? The answer apparently lies within another epidemic—that of childhood obesity.
Obesity is the most prominent clinical risk factor for type 2 DM in children and adolescents. About one third of children with type 2 DM have a BMI greater than 40, indicating morbid obesity, and 17% have BMIs greater than 45 (normal BMI range for the pediatric population is 35 to 39). Besides morbid obesity, other clinical signs that may indicate risk for type 2 DM include the following'”:
• Acanthosis nigricans (hyperpigmentation and thickening of the skin into velvety irregular folds in the neck and flexural areas), which reflects chronic hyperinsulinemia
• Polycystic ovarian syndrome (PCOS), which is associated with insulin resistance and obesity
• Hypertension, which may occur in 20% to 30% of patients with type 2 DM
• Presence of acanthosis nigricans and hypertension, which suggests hyperinsulinemia Girls appear to be more susceptible than boys to type 2 DM, with an overall female-to-male ratio of 1.7:1 regardless of race.
In addition, adolescents with type 2 DM generally have obese parents who themselves tend to have insulin resistance or overt type 2 DM. Reported cases of type 2 DM showed diagnosis to occur during the usual pubertal age period (ages 12-16 years).’
As with type 2 DM in adults, the ideal treatment goal is normalization of blood glucose values and HgbAlc. Successful control of associated comorbidities, such as hypertension and hyperlipidemia, is also important. The ultimate goal is to decrease risk of acute and chronic complications associated with diabetes.’
Initial treatment will vary depending on clinical symptoms. The range of disease at diagnosis varies from asymptomatic hyperglycemia to DKA and hyperglycemic hyperosmolar nonketotic (HHNK) syndrome. Both DKA and HHNK are associated with high morbidity and mortality in children.’9 Medical nutrition therapy and exercise are obvious first-line treatments, but most children diagnosed with type 2 DM will require drug therapy. Although insulin is the only FDA-approved drug for treatment of diabetes in children, oral agents are most often used for children with type 2 DM.
All children with type 2 DM should receive comprehensive self-management education including SMBG, referral to a registered dietitian with knowledge and experience iutritional management of children with diabetes, behavior modification strategies for lifestyle changes, increased daily physical activity, and decreased sedentary activity (e.g., TV viewing and computer use).
Perhaps the relevance of this epidemic is best summed up by Levetan:
“Less than one century ago, there were no airplanes, no cars, and no fast-food restaurants.
Not surprisingly, this phenomenal technologic growth has come at a price—an expanded girth that has extended not only to adults, but also to children. This has resulted in a 70% rise in diabetes among 30- to 40-year olds and a doubling in the number of children with type 2 diabetes in less than a decade.”
