Diabetes Mellitus as a Serious Metabolic Disorder - Coursework Example

Diabetes Diabetes mellitus (DM) is a serious metabolic disorder, which has reached epidemic proportions in most parts of the world. At the time of writing, approximately 285 million people have type 2 diabetes and numbers are predicted to reach 438 million by 2030. Unfortunately, almost 50 percent of those with diabetes remain undiagnosed (Campbell and Rubin 23). According to the reports of the CDC in 2011, about 24 million people, i.e, almost 8% of overall population was diagnosed with diabetes in the US. It is also estimated that around 1.8 million new cases of DM are reported every year in people aged 19 years and older (Szerlong et al. 1). Though there are many factors that can contribute to the diabetes epidemic, environmental factors have significantly triggered the rapid rise in type 2 diabetes. Especially, the high prevalence of obesity in today’s modern society is directly associated with the growing rates of type 2 diabetes (Kelley 858-859). As diabetes is directly associated with carbohydrate, protein, and lipid metabolism, nutrition has always played a crucial role in the management of it. The concept of Medical Nutrition Therapy (MNT) is a dietary prescription that is widely used today to alleviate or control the symptoms of DM. The major studies have shown that effective diet management can significantly lower the symptoms of DM and prevent other associated risks with the disorder (Kelley 858-859). Main objective of nutrition management, like MNT, is to improve overall quality of life of diabetes patients by recognizing required macro- and micronutrient requirements and implementing necessary modifications in the diet (Wolever et al. 3). Based on the research of the American Dietetic Association (ADA) and the Canadian Diabetes Association (CDA), the paper discusses how effective nutrition management is used to alleviate or control the symptoms of DM. Based on the collected data and facts, the paper further provides the client health education broacher to educate the patients about proper nutritional practice for the diabetes management. Nutritional Management to Alleviate the Symptoms of Diabetes Mellitus Various studies and research of reputed nutritional associations all over the world have identified ideal percentages of protein, carbohydrate, fat, fiber, sugar, and vitamins in the diet that can effectively control the blood sugar level and consequently, the impact of diabetes on the overall quality of life. Carbohydrates The basic goal in diabetes management is to maintain normal level of blood glucose in the body. The type and quantity of carbohydrate in a food significantly influence the level of glucose in the body (Gray). The glycemic index, which is the scale of ranking carbohydrate-rich foods according to their effect on the blood glucose level, has proven to be effective in blood glucose control. According to epidemiological studies, the consumption of low GI foods (such as, pasta, barley, whole intact grains, and legumes) lowers the risk of type 2 diabetes (Kelly 860-861). Non-digestible starch, which is also another type of carbohydrate, has proven to be beneficial when included in diet of diabetes patients (Gray). According to the research of ADA, when foods with high glycemic index (white bread, white rice, potato, corn) are replaced with sucrose, it doesn’t worsen the blood glucose level. In a way, it is found that it is not necessary to eliminate simple sugars completely from the diet; instead it can be integrated in balanced diet plan (Szerlong et al. 2). The amount of CHO (carbohydrate) consumption is recommended to be in a range of 45-60% of overall daily calorie intake (Gray). National Academy of Science and ADA, emphasize on foods such as, vegetables, fruits, non-fatty dairy products, and whole grains for carbohydrate intake (Gray). Furthermore, low carbohydrate diets are found to be dangerous in diabetes management as carbohydrate is a vital source of minerals, water-soluble vitamins, fiber, and energy and central nervous system and brain require glucose for their proper functionality (Gray). Protein Protein’s role in glycemic and diabetes control is controversial. Various studies on the subject of type 2 diabetes management have found that gluconeogenis may occur from the ingested protein, but the generated amount of glucose is low and hence, glucose doesn’t present in regular blood circulation. In a way, protein is not responsible for the increase in plasma glucose concentration. Protein hasn’t found to be helpful in the hypoglycemia treatment. The research suggests that hyperglycemia can cause high protein turnover in diabetes patients. Therefore, sufficient protein intake is necessary for people with diabetes (Szerlong et al. 3). It is necessary to have minimum 0.88 g/kg/day protein consumption through vegetable protein rather than animal protein (Wolever et al. 5) In the US, 16-22% of total energy intake is contributed by protein. As most of the US adults consume 55% or more protein than required, a common diet is more than enough to avoid protein malnutrition in diabetes patients (Szerlong et al. 3) Fiber Fiber is characterized as the indigestible component of food which is obtained from plants. The studies have shown that fiber, mainly cereal fiber, controls glycemic level. As fiber rich diet is digested slowly, it lowers the appetite and promotes less calorie, fat and sugar intake, leading to reduction in obesity, cardiovascular diseases, and risk of type 2 diabetes (Gray). The fiber rich diet is linked with almost 35% reduction in the risk of type 2 diabetes development. Therefore, high fiber foods like, whole grain breads, legumes, fruits, cereals, and vegetables found beneficial for the diabetes patients (Gray). Plant sterols or phytosetrols are rich source of soluble fibers which are mainly derived from nuts, vegetable oils, beans, woods, and corn. Phytosetrols play a crucial role in lowering the cholesterol level as they prevent absorption of cholesterol from the gastrointestinal section (Gray). Therefore, daily soluble fiber consumption of 6-11 g/d from barley, oats, legumes, guar, pectin, or psyllium can lower serum cholesterol level by 6-12%. According to the CDA, diabetes patients are required to consume fiber of at least 20-40g/d from various fiber rich foods (Wolever et al. 4). Sugars Traditionally, elimination of sugar from diet was the core of majority of nutrition principles and diets for diabetes patients. However, recent research and studies in the field have shown that sugars are an admissible element of a well-balanced diet for diabetes patients, specifically sugars derived from dairy products, vegetables, and fruits. Up to 9-10% of overall calorie needs a day may include added sugars, like sugar-sweetened foods and table sugar, without affecting glycemic balance in type 1 and type 2 diabetes patients (Wolever et al. 4). Foods that consist of sugar differ in physiological effects and nutritional value. For instance, orange juice and sucrose have identical impact on blood glucose level, but possess different amounts of minerals and vitamins. As GI value of sucrose rich foods is lesser than most of refined starches, some sweetened breakfast cereals creates low insulin and plasma glucose responses than same amount of carbohydrate fraction of unsweetened cereals. In a way, complete exclusion of common sugars is not necessary (Wolever et al. 4). However, higher than 10% of total energy intake through fructose, high-fructose corn syrups, or sucrose can raise the level of LDL cholesterol and/or serum triglycerides in the body, hence it is required to avoid (Grey). In a way, added and naturally occurring sugars can be added in diet plan for diabetes patients. However, it is necessary to control the sugar intake up to 8-10% of total daily calorie requirements (Wolever et al. 4). Fat The dietary fat intake for diabetes patients is limited to 22-32% of overall daily calories from polyunsaturated or monounsaturated food sources, while saturated fat consumption is required to lower than 7-8%. Diabetes patients are required to minimize or eliminate the trans fat intake from their diet. Also, it is necessary to consume omega-3 fatty acid rich foods like, fish at least once a week in a diet (Wolever et al. 5). Monounsaturated fats are usually found in vegetable oils like, canola oil, peanut oil, and oil, while polyunsaturated fats are derived from vegetable oils like, soybean oil, safflower oil, and sunflower oil (Grey). Compare to polyunsaturated fats, monounsaturated fats lower the cholesterol level by decreasing triglyceride and LDL cholesterol without affecting HDL cholesterol. Therefore, monounsaturated fat intake is more effective than polyunsaturated fat intake in the diet (Grey). Saturated fat rich sources like, coconut oil, palm kernel, and trans fats rich foods like, deep fried foods, significantly increase the level of LDL and overall cholesterol, increasing the risk of cardiovascular diseases among diabetes patients, hence such foods are strictly required to limit in the diet (Grey). It has found that omega-3 fatty acids lower the risk of stroke and artery blockage by reducing platelet aggregation. Therefore, omega-3 fatty acids intake by adding fish in a diet is essential for diabetes patients (Wolever et al. 5). Micronutrients As diabetes is a condition of high oxidative stress, heavy doses of antioxidant vitamins has been highly advised by many doctors. However, regular supplements of antioxidant vitamins A, C and E are not recommended to diabetes patients due to lack of evidence proving its efficiency and reliability (Grey). Recently, there is growing research to identify the role of folate supplements in reducing homocysteine level in DM patients and the role of niacin in restoring beta cell mass in type 1 diabetes patients who are in the primary stage of disorder. In order to maintain the normal blood pressure and reduce the risk of hypertension, the diabetes patients are required to lower sodium intake to 2200 mg per day which can be achieved by not adding salt in meals and lowering the consumption of processed and ready-made salty food products (Grey). The research data suggests that inclusion of magnesium-rich foods like, green leafy vegetables, whole grains, and nuts can help curb the type 2 diabetes in all the genders. Also, many studies have claimed the potential role of chromium supplements in the management of body weight, insulin resistance, corticosteroid-induced diabetes, and gestational diabetes (Grey). Also, chromium is found effective in improving glycemic control among diabetes patients (Wolever et al. 6). Diabetes patients are encouraged to receive daily mineral and vitamin needs from well-balanced diet rather than supplements. Only in special needs or in case of insufficient required food intake use of mineral and vitamin supplement for certain period of time under the guidance of doctor or nutritionist is recommended to diabetes patients (Wolever et al. 6). Health Education Brochure Diabetes is a condition which largely depends on the lifestyle choices. With the help of reasonable choices and changes in the way of life this disease can be controlled or prevented. That is why, it is extremely important to identify the principles of healthy nutrition and well-balanced diet for diabetes patients. Principles of Healthy Nutrition for Diabetes Patients 1. According to the latest researches, the consumption of caffeine can reduce the risk of developing diabetes by 12 per cent. So, it is recommended to drink up to 425 mg of coffer per day. However, the patient should be aware of possible negative effects which can be caused by the consumption of more than 425 mg (Paul et al.). 2. It is advisable to consume high-fiber food and products which contain slow-release carbohydrates, since they help to control sugar concentration in blood and secretion of insulin. Fruits, vegetables, beans, least-processed grains should be included in the diabetes patients’ meals (see table 1). Table 1 Choosing Right Carbs Instead of Opt these high-fiber foods Cornflakes Bran flakes Common pasta Whole-grain pasta Corn Leafy greens or peas Sugary breakfast cereal High-fiber breakfast cereal (bran, raisin, etc.) White potatoes and related foods Sweet potatoes, winter squash, yams, cauliflower mash White rice Wild or brown rice White bread Whole-grain bread Instant oatmeal Rolled oats or steel-cut oats Source: Paul, Maya W., and Melinda Smith, “Diabetes Diet and Food Tips,” Helpguide.org, 2014, Web, table, 15 Nov. 2014. 3. A patient should avoid intake of fried, salty and oily food which is high in saturated fats and low in nutrients. It is better to eat avocado, seeds, nuts, fish, canola and olive oil, since these products contain unsaturated fats which can do no harm to patients’ health (Paul et al.). 4. Management of sugar intake is necessary, though it does not presuppose the complete elimination of sweets. A patient should just combine them with some healthy food. It is also highly required to avoid alcoholic beverages and to reduce the number of soft drinks, juice, and soda one drinks (Paul et al.). 5. The resent study shows that bitter melon should be also added to the patient’s diet, due to the fact that it lowers glucose level in blood (“Bitter Melon and Diabetes”). 6. A patient should remember that the basic principle of controlling diabetes is rational and regular nutrition. Eating a large meal can cause negative impact on the glucose level in blood. That is why, it is always recommended to have a good breakfast that will help to maintain the stable level of sugar in blood and to take small snacks up to 5 per day in regular intervals of time. Another useful advice is to keep a diet diary where a patient should put down what he or she eats and drinks. This can be an efficient method of regulating the amount of calories consumed each day and avoiding nervous and spontaneous eating (Paul et al.). Dietary Plan for Diabetes Patients The menu of diabetes patients differs greatly from that of other people. Due to this fact, they need a special dietary plan made in accordance with their individual needs and preferences. For this purpose, the American Diabetes Association in cooperation with Canadian Diabetes Association has presented a well-balanced dietary plan on numerous requests from diabetes patients (Grey). The menu shows what food they should eat on breakfast, lunch and dinner during 28 days (see fig.1). It also indicates the amount of calories a patient should get every day. For instance, it is required to consume 44-51 % of calories from carbohydrates, about 32 % fat and 19-20 % protein. Overall, the dietary plan gives 1100 or 1700 calories, providing certain guidance for adapting personal level of calories accordingly (Grey). Fig. 1. Gray, Alison, “Medical Nutritional Therapy for the Patient with Diabetes,” PBworks, 2009, Web, 15 Nov. 2014. Moreover, the recent researches show that proper vegetarian diet can be beneficial and healthy option for people who have diabetes (Wolever et al. 9). This type of diet requires consumption of proteins contained in vegetables and high-fiber gains, on the ground that they reduce the level of cholesterol in blood, as well as prevent cardiovascular diseases. Intake of such nutrients as vitamin D, iron, protein, vitamin B12 and calcium is also recommended. However, it is necessary to keep in mind, that patients should consult their doctors while planning such diet, particularly if it concerns children, expectant mothers or older people with diabetes (Wolever et al. 9). Conclusion There is no doubt diabetes is a serious health crisis in today’s world. Till present, there is no definite, total cure of the disease. In order to conquer the disease, there is a necessity of a prolonged strategy, which includes the concrete efforts for lifestyle changes at the community level to promote healthy living and an aggressive, versatile treatment approaches to minimize disability and complications in the patient. By providing various services and initiating the awareness programs about nutrition principles for diabetes management at the large levels, the governments and health organizations can restrict the further prevalence of the disease. In conclusion, implementation of effective and well-balanced nutrition management can prevent or alleviate the symptoms of diabetes. Therefore, with the guidance and support of the doctor, nutritionist, government, and with the own will power and dedication, the diabetics can get over the disease.   Works Cited “Bitter Melon and Diabetes.” Diabetes.co.uk, 2014. Web. 15 Nov. 2014. Campbell, Lesley, and Alan L. Rubin. Type 2 Diabetes for Dummies. Milton, Qld: Wiley Publishing Australia Pty Ltd., 2012. Print. Gray, Alison. “Medical Nutritional Therapy for the Patient with Diabetes.” PBworks, 2009. Web. 15 Nov. 2014. Kelley, David E. “Sugars and Starch in the Nutritional Management of Diabetes Mellitus.” The American Journal of Clinical Nutrition 78.4 (2003): 858-864. Web. 15 Nov. 2014. Paul, Maya W., and Melinda Smith. “Diabetes Diet and Food Tips.” Helpguide.org, 2014. Web. 15 Nov. 2014. Szerlong, Heidi, Lisa Daitch, and Judith Stallings. “Nutrition Therapy for New Diabetes Patients.” www.gru.edu, 6 Jun. 2011. Web. 15 Nov. 2014. Wolever, Thomas, Marie-Claire Barbeau, Stephanie Charron, Kathy Harrigan, Sharon Leung, Bev Madrick, Teresa Taillefer, and Carol Seto. “Guidelines for the Nutritional Management of Diabetes Mellitus in the New Millennium.” Canadian Journal of Diabetes Care 23.3 (2014): 1-13. Web. 15 Nov. 2014. Read More