Diet And Diabetes Mellitus PDF

Diet and Diabetes Mellitus Objectives May lead to diabetic coma, which ​ Describe diabetes mellitus and can result in death if the client is identify the types. not treated quickly with fluids and...

Diet and Diabetes Mellitus Objectives May lead to diabetic coma, which ​ Describe diabetes mellitus and can result in death if the client is identify the types. not treated quickly with fluids and ​ Describe the symptoms of diabetes insulin. mellitus. ​ Explain the relationship of insulin Complications to diabetes mellitus. ​ Atherosclerosis is a major cause of ​ Discuss appropriate nutritional death in individuals with diabetes. management of diabetes mellitus. ​ Retinopathy is the leading cause of blindness Diabetes Mellitus ​ Kidney disease resulting in dialysis ​ A group of serious and chronic ​ Nerve damage (neuropathy) is not disorders affecting the metabolism uncommon. of carbohydrates. ​ Infections, especially of the urinary ​ Glucose is the primary source of tract are frequent problems. energy for the body. ​ Glucose is transported by the Etiology blood, and its entry into the cells is ​ The cause of diabetes is unclear, controlled by insulin. but it is believed to be hereditary. ​ Environmental factors may also Insulin play a role in the development of ​ Secreted by the beta cells of the diabetes. islets of Langerhans in the ​ Viruses or obesity may precipitate pancreas gland the disease. ​ When there is inadequate production of insulin, or the body is Classification unable to use the insulin it ​ Prediabetes: precursor to type 2 produces, glucose cannot enter the ​ Type 1: insulin-dependent diabetes cells and it accumulates in the mellitus blood, creating hyperglycemia. ​ Type 2: non-insulin-dependent diabetes mellitus Symptoms ​ Gestational diabetes: diabetes in ​ Glycosuria: glucose in the urine pregnancy ​ Polyuria: excessive urination ​ Polydipsia: excessive thirst Prediabetes ​ Polyphagia: excessive appetite ​ Improper use of insulin by the cells ​ Loss of weight, weakness, and of the body fatigue ​ Fasting blood glucose > 110 mg/dL but < 126 mg/dL Complications ​ May advance to type 2 diabetes ​ Ketones: substances into which fatty acids are broken down in the Type 1 Diabetes liver ​ Formerly juvenile-onset diabetes ​ Ketoacidosis: condition in which mellitus acids from ketones accumulate. ​ 5%-10% of all new diabetes cases  ​ Little, if any, insulin is secreted. Treatment Regimes Clients become insulin dependent, ​ Diet alone requiring both insulin injections and ​ Diet combined with a carefully controlled diet. glucose-lowering medication ​ Risk factors: genetics, autoimmune ​ Diet combined with insulin status, and environment ​ Exercise combined with any of the above Type 2 Diabetes ​ Regularly monitor blood glucose ​ Previously called adult-onset levels in addition to any of the diabetes above. ​ Used to occur after age 40, but now found in teens and young Nutritional Management adults because of obesity > Client's calorie needs will depend on ​ Risk factors: family history, older age, activities, lean muscle mass, size age, history of gestational and resting energy expenditure (REE). diabetes, physical inactivity, and > Recommended race or ethnicity ​ 50% to 60% of the calories from ​ Treatment: diet, exercise, oral carbohydrates diabetes medication (may or may ​ 40% to 50% from complex not need insulin) carbohydrates ​ Goals of medical nutrition therapy ​ 10% to 20% from simple sugars include maintaining healthy glucose, blood pressure, and lipid Carbohydrate Counting levels, as well as weight reduction ​ Newest method for teaching a diabetic client how to control blood Gestational Diabetes sugar with food ​ Occurs between 16th and 28th ​ The starches and breads, milk, and week of pregnancy fruits have all been put under the ​ Insulin required if not responsive to heading of carbohydrates. diet and exercise. ​ Exchange lists are used in ​ Usually disappears after the infant carbohydrate counting as well as in is born. traditional meal planning. ​ Diabetes can develop 5 to 10 years after the pregnancy. Diets Based on Exchange Lists ​ Foods within each list contain Treatment approximately equal amounts of > Goals calories, carbohydrates, protein, ​ Control blood glucose levels and fats. ​ Provide optimal nourishment for ​ One food on a particular list can be the client substituted for any other food on ​ Prevent symptoms and thus delay that particular list and still provides complications the client with the prescribed types > Normal blood glucose levels are 70 to and amounts of nutrients and 110 mg/dL calories. ​ The amounts of nutrients and calories on one list are not the same as those on any other list.  ​ The diet is given in terms of Exercise exchanges rather than as ​ Type 1: exercise can complicate particular foods. glucose control. If done, should be on a regular basis, and considered Fiber carefully as meals are planned to ​ High-fiber intake appears to reduce avoid hypoglycemia. the amount of insulin needed ​ Type 2: exercise helps improve because it lowers blood glucose. weight control, glucose levels, and ​ It also appears to lower blood the cardiovascular system cholesterol and triglyceride levels. ​ High fiber may mean 25-35 g of Insulin Therapy dietary fiber a day. ​ Clients with type 1 diabetes must ​ Increase water when increasing have injections of insulin every day fiber. to control blood glucose levels. ​ Insulin must be injected because it Alternative Sweeteners is a protein and would be digested ​ Saccharin has been shown to if swallowed produce bladder cancer in rats ​ Human insulin is the most common when used in large quantities. and the preferred insulin; it is made ​ Approved by the FDA synthetically. ​ Aspartame: made from amino ​ Classified by action: very rapid-, acids; does not require insulin for rapid-, intermediate-, and metabolism long-acting ​ Sucralose: sweetener made from ​ Intermediate types work within 2 to sugar molecules 8 hours and are effective 24 to 28 hours. Dietetic Foods ​ Shorter- and longer-acting insulin ​ Use of dietetic foods is may be given together and more unnecessary and often misleading than one injection a day may be to the client. required. ​ Dietetic foods often contain the ​ Insulin pumps are now available same ingredients as foods and can deliver short-acting prepared for the general public, but continuous dose and premeal at a higher cost. boluses. ​ Consumers need to read the food labels. Insulin Reactions ​ An insulin reaction, or Alcohol hypoglycemic episode, can result ​ Not recommended for diabetic from too much insulin. clients ​ Symptoms include headache, ​ Limited use sometimes allowed if blurred vision, tremors, confusion, approved by a physician poor coordination, and eventually ​ Some diabetic clients who use unconsciousness. hypoglycemic agents cannot ​ Brain damage, coma, or death can tolerate alcohol. result. ​ Include in diet plan if used Treatment for Insulin Reactions  ​ Conscious clients may be treated by giving them a glucose tablet, a sugar cube, or a beverage containing sugar followed by a complex carbohydrate. ​ Unconscious clients require intravenous treatment with dextrose and water. ​ Diabetic clients should carry identification. Considerations for the Health Care Professional ​ If diet is followed, medication is taken, and time is allowed for sufficient exercise and rest, one can live a near-normal life. ​ Emphasize the importance of eating all of the prescribed food. ​ Meals should be eaten at regular times, and clients should read labels. Summary ​ The diabetic diet is used in treating diabetes mellitus, a metabolic disease caused by the improper functioning of the pancreas. ​ Serious complications, including death, can occur if the condition is left untreated. ​ Treatment includes diet, medication, and exercise. Diet and Cardiovascular Disease  ​ Arteriosclerosis: arteries harden, Objectives making the passage of blood ​ Identify factors that contribute to difficult and sometimes impossible heart disease. ​ Atherosclerosis: thickening and ​ Explain why cholesterol and weakening of artery walls by saturated fats are limited in some cholesterol and fatty deposits cardiovascular conditions. called plaque ​ Identify foods to avoid or limit cholesterol-controlled diet. Atherosclerosis ​ Explain why sodium is limited in ​ Plaque may cause a reduced some cardiovascular conditions. blood flow beyond the obstruction ​ Identify foods that are limited or and ischemia. prohibited in sodium-controlled ​ Ischemia may cause pain. diets. ​ Angina pectoris: chest pain; may radiate down left arm Cardiovascular Disease ​ If the lumen narrows completely in ​ Affects heart and blood vessels a coronary artery, a heart attack ​ Leading cause of death and occurs. permanent disability ​ Coronary artery bypass graft ​ Cardiovascular disease can be (CABG): procedure to bypass acute (sudden) or chronic. circulation around a clogged artery ​ Metabolic syndrome puts one at ​ Cerebrovascular accident (CVA): risk for coronary heart disease, blood flow to the brain is blocked stroke, peripheral vascular or a blood vessel bursts (stroke) disease, and type 2 diabetes. ​ Peripheral vascular disease: vessels in the extremities are Metabolic Syndrome affected. ​ Risk factors in adults and children ​ Abdominal obesity Risk Factors ​ Hyperlipidemia ​ Major ​ High blood pressure ​ Hyperlipidemia (elevated total ​ Insulin resistance cholesterol; high LDL, low HDL) ​ Elevated highly sensitive ​ Hypertension » C-reactive protein (CRP) in blood ​ Smoking Cardiovascular Disease Contributory factors ​ Acute: myocardial infarction (MI); ​ Obesity also known as heart attack ​ Diabetes mellitus ​ Chronic: develops over time; loss ​ Male sex of heart function ​ Heredity ​ Heart may beat faster and enlarge ​ Personality type to maintain circulation in ​ Age compensated heart disease ​ Sedentary lifestyle ​ Inability to compensate leads to congested heart failure (CHF) Arteriosclerosis and Atherosclerosis Hyperlipidemia: Medical Nutrition Therapy ​ Caused by blockage of a coronary ​ Involves reducing the quantity and artery supplying blood to the heart types of fats, and often calories, in ​ Heart tissue beyond the blockage the diet dies. ​ American Heart Association ​ Causes: atherosclerosis, guidelines hypertension, abnormal blood ​ Blood cholesterol of 200 mg/dL or clotting, infection such as that less is desirable. caused by rheumatic fever ​ 200 to 239 mg/dL is borderline (damages heart valves) high. ​ 240 mg/dL and greater is high. Continued ​ After the heart attack, the client is American Heart Association in shock. recommendations for prevention: ​ Fluid shift occurs, and client may ​ Adult diets less than 200 mg of be thirsty. cholesterol per day ​ Client should be NPO (nothing by ​ No more than 30% of calories from mouth). fat; maximum of 7% from saturated ​ IV fluids may be given. fats and trans fats, 8% from ​ After several hours, client may polyunsaturated fats, 15%-20% begin to eat. from monounsaturated fats ​ Liquid diet usually recommended ​ Proteins 12%-20% of calories, and for the first 24 hours. carbohydrates 50%-55% of ​ Then, a low-cholesterol, calories low-sodium diet Activity Congestive Heart Failure Your client has been given a very low fat ​ From decompensation or severe diet to follow. The client expresses to you injury to the heart muscle that it is almost impossible to follow this ​ Decreased circulation causes diet. decreased oxygenation of the 1. What recommendations would you body. suggest? ​ Shortness of breath, chest pain on exertion, and edema are common. Cholesterol-Lowering Agents ​ The heart beats faster and ​ If blood lipid levels are not enlarges. corrected after 3-6 months of a ​ Death can occur in severe cases. fat-restricted diet alone, a ​ Decreased nutrients to body cholesterol-lowering drug may be tissues prescribed. ​ Edema may mask the problems of ​ Food and/or drug interactions are malnutrition and underweight. common with cholesterol-lowering ​ Fluid restriction may be ordered. agents. ​ Diuretics and a sodium-restricted diet are typically prescribed. Myocardial Infarction Hypertension  ​ Chronically high blood pressure ​ Essential, or primary hypertension: Sodium-Restricted Diets 90% of cases; cause is unknown ​ Regular diet with limited sodium ​ Secondary hypertension: 10% of ​ Food and Nutrition Board cases; caused by another recommends daily intake of no condition more than 2,300 mg. ​ Causes of secondary hypertension ​ Board sets a safe minimum at 500 include kidney disease, problems mg/day for adults. of the adrenal glands, and the use ​ African Americans and people with of oral contraceptives hypertension should limit sodium intake to 1,500 mg/day. Continued ​ 必 ​ Sphygmomanometer is used to ​ Sodium-free diet is impossible. measure hypertension. ​ Most foods naturally contain ​ Systolic pressure: top number sodium. taken as the heart contracts ​ Water contains varying amounts of ​ Diastolic pressure: taken when the sodium. heart is resting ​ Processed foods often contain high ​ Continued amounts of sodium. ​ Measured in millimeters of mercury ​ Some over-the-counter medicines (mmHg) contain sodium. ​ Normal: < 120/80 ​ Prehypertension: 120-139/80-88 Adjustment to Sodium Restriction ​ Stage 1: 140-159/90-99 ​ Transition to sodium-restricted diet ​ Stage 2: 160/100 may be difficult. ​ Gradual reduction in sodium is Continued easier. ​ Contributes to heart attack, stroke, ​ Remind the client of the numerous heart failure, and kidney failure herbs, spices, and flavorings ​ "Silent disease" because sufferers allowed. can be asymptomatic ​ Heredity, age, obesity and Considerations for the Health Care African-American race are Professional predisposing factors. ​ Most cardiac clients will be told to ​ Smoking and stress also contribute reduce fat, sodium, and to hypertension. sometimes, the amount of calories in their diets. Dietary Treatment ​ Help the cardiac client want to ​ Weight loss usually lowers blood learn how to help himself or herself pressure and, consequently, clients via nutrition. are often placed on weight-reduction diets. Conclusion ​ Sodium-restricted diet and/or ​ Cardiovascular disease is the diuretics can be prescribed to leading cause of death in the alleviate edema. United States. ​ Increasing fruits and vegetables to ​ May be acute, as in myocardial 6-10 servings per day helps to infarction, or chronic, as in lower blood pressure. hypertension and atherosclerosis. ​ Hypertension may be a symptom of another disease. Diet and Clients with Special Needs Objectives  ​ Describe the body's reactions to weakness, cramps, vomiting, and stress and relate them to nutrition. diarrhea shortly after eating ​ Explain the special dietary needs ​ Caused by food moving too quickly of surgical clients and clients with from the stomach into the small burns. intestine ​ Discuss enteral and parenteral ​ To prevent, eat a diet high in nutrition. protein and fat, and restricted in ​ Explain the special dietary needs carbohydrates. of clients with fever and infection. ​ Complex carbohydrates ​ Explain the special dietary needs reintroduced gradually. of clients with AIDS. ​ Fluids should be limited to 4 ounces at meals. Homeostasis ​ Total daily food should be served ​ Homeostasis is a state of physical as several small meals to avoid balance; a stable condition. overloading the stomach. ​ When the body experiences the ​ Nasogastric tube (NG) inserted trauma of surgery, severe burns, or through the nose and into the infections, this balance is upset. stomach or small intestine. ​ Gastrostomy (opening into the Nutritionat Care of Surgery Clients stomach) or jejunostomy (opening ​ If the surgery is elective, nutritional into the jejunum) may be done status should be evaluated before surgically if feeding is needed for surgery. longer than 6 weeks. ​ Extra protein, carbohydrates, ​ Modular formulas (3.8-4.0 vitamins, and minerals may be calorie/mL) can be used as needed. supplements or for developing ​ For overweight clients, improved customized formulas for certain nutritional status may include clients. weight reduction before surgery whenever possible. Possible Complications with Enteral ​ Clients will usually be NPO Nutrition (nothing by mouth) after midnight ​ The osmolality of a liquid the night before surgery to prevent substance means the number of regurgitation and aspiration of particles per kg of solution. stomach content during surgery. ​ When a formula with high osmolality reaches the intestine, Nutritional Care After Surgery the body may draw fluid from the ​ When peristalsis returns, ice chips blood to dilute the formula. may be given followed by a clear ​ Weakness and diarrhea can occur. liquid diet. ​ Aspiration in the lungs can occur, ​ Progress to a regular diet depends causing pneumonia. on the type of surgery. ​ Tube may become clogged, or ​ Some clients may need parenteral client may pull the tube out. or enteral feedings. ​ Placement of tube should be checked initially with an X-ray, then Dumping Syndrome with gastric pH before each use. ​ May occur following gastric surgery ​ Keep head of bed elevated. Characterized by dizziness, Parenteral Nutrition ​ Extra liquid is needed to replace ​ The provision of nutrients losses. intravenously ​ Used if the gastrointestinal tract is The Client with AIDS not functional or if normal feeding ​ Human immunodeficiency virus is not adequate for the client's (HIV) invades the T cells, which needs. are white blood cells that protect ​ Total parenteral nutrition (TPN) or the body from infections. hyperalimentation is when ​ When the T cells cannot function parenteral nutrition is used to normally, the body has no provide total nutrition. resistance to opportunistic infections. Complications of Parenteral Nutrition ​ Opportunistic infections are caused ​ Infection at site of catheter can by other microorganisms that are cause infection of blood called present but do not affect people sepsis. with healthy immune systems. ​ Bacterial or fungal infections can ​ HIV infection ultimately leads to develop in the solution. acquired immunodeficiency ​ Abnormal electrolyte levels, syndrome (AIDS), which is phlebitis, or blood clots can occur. incurable and fatal. ​ Persons diagnosed as being HIV Nutrition Therapy for Clients with positive should have a baseline Burns nutrition and diet assessment. ​ Increased need for vitamin C and ​ A healthful diet may delay the zinc for healing onset of AIDS. ​ Vitamin B is needed for the ​ Unhealthful eating habits can be metabolism of the extra nutrients. corrected at an early stage of the ​ Sufficient fluids are needed to disease, and future nutritional maintain kidney function. needs explained. ​ Clients with AIDS experience The Client with Infections serious protein-energy malnutrition ​ Fever is a hypermetabolic state in (PEM) and thus, body wasting which each degree of fever on the known as "wasting syndrome." Fahrenheit scale raises the basal ​ This results in hypoalbuminemia metabolic rate (BMR) 7%. and weight loss. ​ If extra calories are not provided, ​ When possible, medications the body uses its sources of stored should be given after meals to energy. reduce the chance of nausea. ​ Protein intake should be increased. ​ Sores in the mouth or esophagus ​ Minerals are needed to help build can make eating painful, and soft and repair body tissue and to foods may be better tolerated. maintain acid base, electrolyte, ​ Taste can be affected. Avoid spicy, and fluid balance. highly acidic, and extremely hot or ​ Extra vitamins are also necessary cold foods. for the increased metabolic rate ​ Additional sugar and flavoring and to help fight the infection may increase the acceptability of causing the fever. liquid supplements.  ​ Because of the nausea and diarrhea, sufficient fluids are essential. ​ Tube feeding may be necessary if client has difficulty swallowing or simply cannot eat. Summary ​ Surgery, burns, fevers, and infections are traumas that cause the body to respond ina hypermetabolic manner. ​ This response creates the need for additional nutrients at the same time that the injury causes a loss of nutrients. Nutritional Care of Clients Nutritional Care ​ Fever, nausea, fear, depression, chemotherapy, and radiation can destroy one's appetite.  ​ Vomiting, diarrhea, chemotherapy, radiation, and some medications ​ Offer bedpan and hygiene care can reduce or prevent absorption before and after the meal. of nutrients. ​ Any unpleasant sights should be removed. Protein Energy Malnutrition ​ Open containers and try to ​ When food intake does not meet anticipate the client's needs. body needs, the body uses its own ​ Give sufficient time to eat and stores of energy. reheat food as needed. ​ When glycogen and fat stores are ​ Document intake per facility policy. exhausted, the body must break down its own tissues to provide Feeding the Client who Requires protein for energy. Assistance ​ Protein-energy malnutrition (PEM) ​ Sit near the side of the bed. can be a problem among ​ Small amounts of food should be hospitalized clients. placed toward the back of the mouth with a slight pressure on the tongue with the spoon or fork. ​ Do not feed a client with a syringe. Improving the Client's Nutrition ​ Formal nutritional assessments ​ If paralyzed, food and straw should should be made on a regular basis. be placed on non paralyzed side of ​ All members of the health care the mouth. team should be alert to signs of ​ If client begins to choke, help her malnutrition every day. or him sit up straight. ​ Listen to client's concerns and ​ A client diagnosed with dysphagia watch the reaction to food served. will require a specialized diet. ​ Include the dietitian in the plan of ​ A client with dysphagia should not care. use a straw. Feeding the Client Feeding the Blind Client ​ In the home, the family menu ​ Arrange the food as if the plate should serve as the basis for the were the face of a clock. client's meal whenever possible. ​ Use a consistent pattern for ​ Omit or add certain foods as preparing the meal, so the client necessary. knows where each item will be ​ Vary the method of preparation if each time. needed. ​ People who are blind usually feel better when they can help Serving the Meal themselves. ​ Make tray and food arrangement as attractive as possible. Physical Problems of the ​ Serve water, as well as another Institutionalized Elderly beverage. ​ Majority of people 85 and over ​ Serve food at proper temperature. have at least one chronic disease ​ Client should be in a comfortable such as arthritis, osteoporosis, position with tray and utensils diabetes mellitus, cardiovascular placed conveniently. disease, or a mental disorder.  ​ These conditions affect their ​ Bed-bound clients should be attitudes, physical activities, offered the bedpan and assistance appetites and, thus, nutritional with hygiene care before meals. status. ​ PEM is a major problem for this population. ​ Anemia can develop and contribute to fatigue, confusion, and depression. ​ Sufficient animal protein and vitamin C should be provided in the diet. ​ Pressure ulcers (bedsores) can develop in bedridden clients and must be prevented. ​ Healing of pressure ulcers requires treatment of the ulcer, relief of the pressure, a high-calorie diet with sufficient protein, vitamin C, and zinc supplements. ​ Constipation can be caused by inadequate fiber, fluid, or exercise. ​ Other causes include medication, reduced peristalsis, or former abuse of laxatives. ​ Treatment includes increasing fluid, fiber, and exercise. ​ The sense of smell declines with age and the appetite diminishes. ​ Xerostomia (dry mouth) can be caused by disease or medications. ​ Drinking water, eating frequent, small meals, and chewing sugar-free gums or candies may be helpful. Summary ​ Illness and surgery can have devastating effects on a client's nutritional status. ​ PEM can be a significant problem in hospitals.