Diabetes and Nutrition

Diabetes mellitus is a continual disorder of carbohydrate and lipid metabolism in which blood levels of glucose and lipids are elevated. This abnormal metabolism results from a relative lack of insulin, either too little insulin is secreted or the insulin that is secreted is not effective. In addition, diabetes is associated with chronic systemic complications, which, over time, can affect the retina, kidneys, nerves, and cardiovascular system. The most common classifications of diabetes mellitus include type I, or insulin-dependent, diabetes mellitus (IDDM); type II, non-insulin-dependent diabetes mellitus (NIDDM); and gestational diabetes (GD).How it is DevelopedThe problems of diabetes originate in an organ located behind the stomach about the length of a human hand called the pancreas. The pancreas is necessary for both digesting food and regulating energy. It is the regulation of energy for the body that is important in the development of diabetes. The pancreas produces hormones that metabolize food. These hormones regulate the use of glucose, a simple sugar, which is used for most of the activities in our bodies. The pancreas regulates energy in a variety of behaviors in which humans engage such as exercise and movement, responding to trauma and stress, and infections.The pancreas emits three different types of hormones. Insulin is the first hormone that is produced when glucose rises in the blood. Insulin usually rises after eating a meal, and excess glucose that is not used is stimulated by insulin to be stored in muscles and fat cells so that energy can be used later. The liver also stores excess glucose in the form of a carbohydrate called glycogen. The second type of pancreatic hormone is glucagon. Glucagon breaks down glycogen stored in the liver so that it can be used as energy when blood glucose supplies are down. The third type of pancreatic hormone is called somatostatin, thought to be important in regulating both insulin and glucagon.When diabe tes develops, this balanced control system does not operate properly. The glucose in the bloodstream increases, and the cells are not able to utilize it. The individual develops hyperglycemia (excess glucose in the blood). This can be detected by measuring the glucose in the blood from a blood sample, or if the glucose is elevated enough, it can be detected in the urine as spillover. This sort of situation occurs when there is not enough insulin to permit the cells to utilize the glucose, or there is resistance most likely at the cellular level to the presence of insulin. Both cases produce diabetes.Symptoms of DiabetesSome of the symptoms of Diabetes Mellitus are increased thirst, increased urination, weight loss even though the individual is eating more, fatigue, nausea, and vomiting, skin infections, vaginitis, blurred vision, bladder infections, and impotence in men and cessation of menses in women.One severe symptom of diabetes is diabetic ketoacidosis. This symptom sometimes p roduces slightly sweet-smelling breath that is caused by acetone, a metabolic byproduct, when the body is forced to burn fatty acids rather than glucose. This process becomes more and more toxic to the body as it continues; the individual may develop diabetic coma and die. Ketoacidosis occurs when individuals are either not getting enough insulin or the insulin is not adequate to allow cells of the body to utilize the glucose.Effects of DiabetesDiabetes has two types of long-term effects. One type is associated with blood vessel involvement. Damage to the large vessels puts the diabetic at greater risk of stroke, heart attack, and gangrene of the feet. When small blood vessels are damaged, eyes, kidneys, and nerves become damaged. The other long-term effect is nerve damage usually in the feet, but also occasionally in the hands. This nerve damage is called diabetic neuropathy. This damage may cause a painful burning sensation with loss of sensation over time, making the body part mo re subject to injury and infection. Foot ulcers and gangrene can develop, with further damage in the extremities. In men, diabetic neuropathy may cause erectile impotence.Nutrition for DiabetesConsultation with a dietitian familiar with children and with type 2 diabetes is important for all patients. The dietitian should assess the nutritional status and practices of the patient and then counsel them to provide a meal plan which, at least initially, does not deviate in a major way from their usual eating practices. Changes made gradually, through subsequent appointments and interviews, frequently achieve compliance more successfully than does radical and rapid change.Individuals providing counseling must be clear about the differences in the management of patients with type 1 and type 2 diabetes. Because obesity is a typical finding in type 2 diabetes and caloric restriction results in improved glycemic control and insulin sensitivity, modest caloric restriction and weight loss or m aintenance are important goals: so is correction of the dyslipidemia, which frequently accompanies the metabolic syndrome or IRS.In general, calories from dietary fat should not exceed 30% of energy intake, and calories from saturated fat should not exceed 10%. An effort is also made to limit cholesterol in the diet to