Management of Diabetes - Case Study Example

Nutritional Management in Treating Type 2 Diabetes Mellitus Nutritional Management in Treating Type 2 Diabetes MellitusDiabetes mellitus (DM) is a disorder of glucose metabolism, which develops because of defects in insulin function. Persons suffering from such a disorder show elevated blood glucose levels. The disease is often characterised by episodic ketoacidosis. Patients display varied symptoms including polyuria, glycosuria, lipemia, thirst and hunger. Nonketotic hyperosmolar coma and fatal ketoacidosis may result if the disease is left untreated. Complications that relate to chronic kidney and cardiovascular disease link to diabetes mellitus. There are two main types of diabetes mellitus. Type 1 DM where the pancreas fails to produce sufficient amounts of insulin. In Type 2 DM, the body cells insulin response is defective. Type 2 DM is often referred to as non-insulin-dependent diabetes mellitus (NIDDM) since it may be treated without insulin injections. Management of diabetes involves physical exercise, pharmacotherapy and nutrition therapy. Diabetes management aims to control metabolism of the patient. Nutrition therapy refers to the modification of nutrient intake as a form of disease treatment. Nutrition therapy is individualised as no one eating pattern fits all patients (He et al., 2010). Nutrition therapy aims to promote healthful eating to attain individualised glycaemic, blood pressure and lipid goals, as well as attaining a desired body weight, which helps prevent complications of diabetes. The risk of microvascular complications is reduced by managing glycated haemoglobin (HbA1c) levels. This alongside management of blood pressure and lipid profiles also reduce the risk of cardiovascular disease (Jenkins et al., 2011). The prime focus of glycaemic management in medical nutrition therapy is carbohydrate intake control. Carbohydrate intake directly affects postprandial blood glucose levels and hence insulin effect. Nutrition therapy also focuses on energy balance and hence weight control. Effective management of type 2 diabetes requires pharmacotherapy, nutrition therapy and physical activity. Energy balance is an essential aspect of nutrition therapy for patients with Type 2 diabetes. Individuals suffering from Type 2 diabetes are often overweight and obese. Weight loss is recommended to manage the disease. It has been associated with improved glycaemia, blood pressure and desired lipid profiles (Estruch et al., 2013). Nutrition therapy promotes weight loss by decreasing energy intake by the patient while maintaining healful eating patterns. Reduction of adiposity results in improvement in insulin resistance. Several studies show improvement in HbA1c with weight loss. The increase in high-density lipoprotein (HDL), cholesterol decrease in triglyceride and drop in blood pressure. Hence, reduction of the risk of cardiovascular disease upon weight loss is evidenced by various studies. Studies show that weight loss is highly effective in the management of Type 2 diabetes in the early stages of the disease process (Jenkins et al., 2012). There is, however, no unified recommended optimal macronutrient intake for weight loss. Similarly, in the general management of the disease, there is no optimal mix of macronutrient recommended. It is, therefore, necessary to develop an individualised nutrition plan for all type 2 diabetes patients (Gannon et al., 2001). Nutrition assessment offers the basis for the nutrition therapy intervention. Macronutrient distribution should be based on the metabolic status of the patient such as lipid profile, their metabolic goals and the patient eating pattern, as well as food preferences. Studies have not shown an ideal or optimal amount of carbohydrate intake for the management of type 2 diabetes. It is therefore recommended that the carbohydrate intake levels should be individualised based on the patients metabolic status. Several studies, however, evidence that lower levels of carbohydrate intake diets have improved markers of insulin sensitivity and glycaemic control (Brehm et al., 2009). Low levels of carbohydrate intake have also been associated with improved triglyceride, VLDL triglyceride, VLDL cholesterol, total cholesterol and HDL cholesterol levels. However, other studies show no significant difference in glycaemic markers and lipid and lipoprotein with lower levels of carbohydrate intake (American Diabetes Association et al., 2008). Though studies show no conclusive results in the effect of different levels of carbohydrate intake, monitoring intake of carbohydrate is still a key strategy in achieving and maintaining glycaemic control (West et al., 2007). The quantity and type of carbohydrate influence postprandial blood glucose levels. Carbohydrate intake, therefore, influences glycaemic response and should be considered in nutrition therapy to manage type 2 diabetes. Vegetables, fruits, legumes and cereals are recommended sources of carbohydrates as opposed to sources containing added fats, sodium and sugar. Glycaemic load and glycaemic index are used to assess the quality of carbohydrates. The glycaemic index measures the effect of the carbohydrates on blood glucose. It measures the increase in blood glucose levels postprandial. Some foods cause a drastic rise in blood glucose levels while others cause a slower rise (Iqbal et al., 2010). Glycaemic load, unlike glycaemic index, takes into account the amount of carbohydrate in food. It is recommended for type 2 diabetes patients diets in nutrition therapy that food with low glycaemic load is substituted with those with higher glycaemic load. Some studies show that low glycaemic index diets resulted in decreased HbA1c levels, as well as lower cholesterol (Esposito et al., 2009). Fibre is recommended for patient with type 2 diabetes. It has been associated with lower mortality rates in diabetes patients (Gidding et al., 2009). Studies show that fibre lowers pre-prandial glucose and HbA1c levels. It has been shown to reduce the glycaemic index of food. By lowering the glycaemic index, fibre slows the rate at which glucose is released into the blood stream and hence attenuates insulin response. Various studies show that fibre has beneficial effects on serum cholesterol and blood pressure. It is, therefore, associated with reduced risk of cardiovascular disease. Whole grains have also been associated with reduced systemic inflammation and reduced cardiovascular deaths (Dyson et al., 2007). Fibre and whole-grain intake are recommended as part of the nutrition therapy to manage type 2 diabetes and complications associated with the disease. Resistant starch has been associated with control of glycaemic response, prevention of hypoglycaemia and reduced cases of hyperglycaemia (Gannon et al., 2003). Legumes and plants with high amylose content and starch granules are recommended for patients to help in the management of the disease. Fructans such as inulin have been evidenced to have lowering effect on glucose levels. Sucrose substitution for starch is also another key factor in type 2 diabetes nutrition therapy. This should, however, be done with caution so as not to increase the overall caloric intake of the patient (Howard et al., 2004).This is because foods high in sucrose content tend to be high in calories. Sucrose is found in sugar cane and sugar beets, and it is a disaccharide of the monosaccharides fructose and glucose. Fructose has been shown to be better in glycaemic control when compared to other carbohydrates. Studies show that fructose does not affect blood glucose levels and hence insulin levels. It has been allied with lower levels of glycated blood protein. Free fructose from sources such as fruits are recommended for type 2 diabetes patients. However, fructose in the disaccharide sucrose and high-fructose syrup found as sweeteners in various beverages should always be avoided to lessen the risk of cardiovascular disease and weight gain. Diabetes patients are advised to substitute caloric sweeteners for non-nutritive and hypocaloric sweeteners (Khoo et al., 2011). These sweeteners reduce the general caloric intake of the patient. Non-nutritive sweeteners have been associated with better glycaemic control since they do not produce any glycaemic effect. They have also been associated with reduced risk of cardiovascular disease and weight loss. Studies have associated high protein intake with reduced levels of HbA1c. This is however not conclusive. It has also been shown that higher protein diet result in improvement of total cholesterol, serum triglycerides and LDL cholesterol. Studies are inconclusive on the optimum protein intake for patients with type 2 diabetes for the purpose of glycaemic control (Bonsu et al., 2011). Reducing the associated risk of cardiovascular disease, nutrition therapy in the matter of protein intake should, therefore, be individualised. Protein intake has also been connected with the increased insulin response and minimal effects on blood glucose levels (Burger et al., 2012). Hypoglycaemia treatment with carbohydrate sources high in protein is therefore not recommended. Optimal fat intake levels for type 2 diabetes patients is not conclusively defined. Therefore, dietary patterns for the patients should be individualised. However, low intake of fat and high intake of carbohydrate has been associated with higher risk of coronary heart disease. Trans fatty acids have been associated with many health complications. The type of fatty acid consumed should, therefore, be of more importance than the amount of fat in food when constructing the patient’s diet plan. Monounsaturated fatty acids have been shown to have improved effects on cardiovascular disease, as well as improved glycaemic control. They have also been associated with improved lipid profiles (Ekinci et al., 2011). Omega-6 polyunsaturated fatty acids are also recommended for type 2 diabetes management. Nutrition therapy should substitute omega-6 polyunsaturated fatty acids and monounsaturated fatty acids for saturated and Trans fatty acids. Omega-3 fatty acids have been connected to decreased triglyceride levels. However, they do not show improvement effect on glycaemic control. Diets with omega-3 fatty acids are recommended for diabetic patients for the purpose of prevention of heart disease, effects on lipoprotein and associated improved insulin sensitivity. With cholesterol, trans fatty acids and saturated fatty acids, type 2 diabetic patients are advised to follow recommendations for the general population (Ekinci et al., 2011). Patients are advised to replace foods high in saturated fatty acids such as butter and bacon with foods high in monounsaturated fatty acids and polyunsaturated fatty acids such as vegetable oils and avocados. The intention of this is to cut the risk of cardiovascular disease. Studies show that plant sterols and stanols inhibit the intestinal absorption of dietary and biliary cholesterol (Jenkins et al., 2011).They are therefore recommended for patients with type 2 diabetes to reduce the total cholesterol and LDL cholesterol levels. Phytosterols and phytosterols have been shown to have cardioprotective effect by a number of studies. Diabetes is often associated with micronutrient deficiencies. However, studies show no evidence for the need of supplementation of vitamins and minerals in patients for the management of the diseases (Gannon et al., 2003). Some studies show that antioxidant supplementation such as with vitamin E and carotene may be harmful. This supplementation also has no benefit in glycaemic control or management of complications associated with type 2 diabetes. Other supplementations with various micro nutrients such as magnesium and vitamin D also show no effect on glycaemic control. This is also the case with chromium, cinnamon and other herbs. For patients, micronutrient intake should, therefore, meet the recommended daily allowance and supplementation should be advised only in the case of deficiency. Several studies illustrate that moderate alcohol consumption has beneficial effects on glycaemic control, cardiovascular risk and mortality decline in patients with type 2 diabetes (Ekinci et al., 2011). However, excessive consumption of alcohol has been shown to contribute to hyperglycaemia. Some studies, however, show that alcohol consumption may lead to increased risk of delayed hypoglycaemia. Therefore, alcohol consumption recommendations should be individualised with all patients suffering from type 2 diabetes. Sodium. Low sodium intake in type 2 diabetes patients has been associated with reduced blood pressure(Jenkins et al., 2012). Low sodium intake has therefore been associated with reduced risk of cardiovascular disease. However, some studies have associated mortality with the lowest sodium intakes. Sodium intake should, therefore, be individualised taking into consideration factors such as availability and palatability. Nutrition therapy has been shown to be highly effective in the management of type two diabetes mellitus and the problems associated with the disease. Since there is no universal eating pattern that fits all type 2 diabetes patients, it is necessary for health officials to develop individualised diet plans for each patient (Burger et al., 2012). The diet plan should take into consideration factors such as the patient’s metabolic status, metabolic, weight goals and preferences to maximise the effectiveness of the therapy. Counselling and patient education should also be included as a key part of the therapy to maximise its effectiveness. Type 2 diabetes mellitus is a manageable disorder. It is the responsibility of health officials and the patients to reduce the mortality rate of the disease. The general population should also be educated to alter a modern unhealthy lifestyle that lead to the development of the type 2 diabetes mellitus. Bibliography American Diabetes Association, Bantle, J.P., Wylie-Rosett, J., Albright, A.L., Apovian, C.M., Clark, N.G., Franz, M.J., Hoogwerf, B.J., Lichtenstein, A.H., Mayer-Davis, E., Mooradian, A.D., Wheeler, M.L., 2008, ‘Nutrition recommendations and interventions for diabetes: a position statement of the American Diabetes Association’, Diabetes Care 31 Suppl 1, S61–78. doi:10.2337/dc08-S061 Bonsu, N.K.A., Johnson, C.S., McLeod, K.M., 2011, ‘Can dietary fructans lower serum glucose? J. 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