Medical Nutrition Therapy For Diabetes Mellitus PDF

14/11/2024...

14/11/2024 FR MEDICAL NUTRITION THERAPY FOR DIABETES MELLITUS The number of people with diabetes rose from 108 million in 1980 to 422 million in 2014. Diabetes is a major cause of blindness, kidney failure, heart attacks, stroke and lower limb amputation. Between 2000 and 2019, there was a 3% increase in diabetes mortality rates by age. In 2019, diabetes and kidney disease due to diabetes caused an estimated 2 million deaths. UNIVERSITY OF SANTO TOMAS Key Facts WHO April 2023 DEPARTMENT OF NUTRITION AND DIETETICS FR FR HORMONES INVOLVED IN METABOLISM Review: CHO Metabolism ▪ 80mg/dl after an overnight fast INSULIN: 51 amino acid polypeptide ▪ 120 mg/dL after meal STIMULATED: elevated serum glucose load, arginine, lysine, leucine, alanine, gastrin, CCK, secretin POST PRANDIAL POST ABSORPTIVE insulin= fuel storage (muscle insulin= decrease and adipose) peripheral glucose uptake INHIBITED: somatostatin, phenytoin, Ca ch blockers, hypokalemia proteolysis and lipolysis glucagon levels ⮚Binds to specific receptors on the target cell surface where it facilitates glucose transport into cells ⮚Suppress endogenous glucose productions, stimulates glycogen synthesis glycogen in liver and muscle hepatic glycogenolysis , gluconeogenesis ⮚Stimulates secretion of lipoprotein lipase= lipogenesis ⮚Stimulates amino acid uptake and CHON synthesis Modern Nutrition in Health and Disease 9th edition (January 1999): by Maurice E. Shils, James A. Olson, Moshe Shike, A. Catherine Ross By Lippincott, Williams & Wilkins Modern Nutrition in Health and Disease 9th edition (January 1999): by Maurice E. Shils, James A. Olson, Moshe Shike, A. UNIVERSITY OF SANTO TOMAS UNIVERSITY OF SANTO TOMAS Catherine Ross By Lippincott, Williams & Wilkins DEPARTMENT OF NUTRITION AND DIETETICS DEPARTMENT OF NUTRITION AND DIETETICS 1  14/11/2024 FR HORMONES INVOLVED IN METABOLISM FR HORMONES INVOLVED IN METABOLISM CATECHOLAMINES: epinephrine and norepinephrine GLUCAGON: α cell of the pancreas Stimulated by stress or fever STIMULATED: low serum glucose level, arginine, stress, ACTION: inc. glucose levels (glycogenolysis, gluconeogenesis: acetylcholine, vagal nerve stimulation target organ: muscle) ▪ Increase glycogenolysis, gluconeogenesis, ketogenesis CORTISOL: relative insulin resistance ▪ Decrease fatty acid synthesis ACTION: increase proteolysis, potentiate glucagon action Modern Nutrition in Health and Disease 9th edition (January 1999): by Maurice E. Shils, James A. Olson, Moshe Shike, A. Modern Nutrition in Health and Disease 9th edition (January 1999): by Maurice E. Shils, James A. Olson, Moshe Shike, A. Catherine Ross By Lippincott, Williams & Wilkins Catherine Ross By Lippincott, Williams & Wilkins UNIVERSITY OF SANTO TOMAS UNIVERSITY OF SANTO TOMAS DEPARTMENT OF NUTRITION AND DIETETICS DEPARTMENT OF NUTRITION AND DIETETICS DIABETES MELLITUS FR FR Metabolic disorder DIABETES MELLITUS TYPE I: IDDM TYPE II: NIDDM STRESS INDUCED- inc. in stress hormones ▪ Onset: Acute-symptomatic ▪ Onset: Slow; often asymptomatic SECONDARY FORMS- pancreatic disease, gestational, hormonal ▪ damaged pancreas ▪ insulin resistance ▪ Ketosis is rare (except during stress) ▪ Tendency towards ketosis (DKA) ▪ Hyperglycemia due to inc. hepatic ▪ Hyperglycemia, polyuria, polydipsia, overproduction of glucose (HHS) significant weight loss ▪ OHA/ODA ▪ Requires daily insulin injections ▪ Symptoms are less marked than type → late ▪ Cause: unknown, autoimmune diagnosis ▪ Cause: excess weight, low PA, Family Hx Modern Nutrition in Health and Disease 9th edition (January 1999): by Maurice E. Shils, James A. Olson, Moshe Shike, A. Catherine Ross By Lippincott, Williams & Wilkins Philippine Practice Guidelines for the Management of Diabetes June, 2020 https://www.who.int/news-room/fact-sheets/detail/diabetes UNIVERSITY OF SANTO TOMAS UNIVERSITY OF SANTO TOMAS Modern Nutrition in Health and Disease 9th edition (January 1999): by Maurice E. Shils, James A. Olson, Moshe Shike, A. DEPARTMENT OF NUTRITION AND DIETETICS DEPARTMENT OF NUTRITION AND DIETETICS Catherine Ross By Lippincott, Williams & Wilkins 2  14/11/2024 Risk factors for Type 2 Diabetes FR FR Diagnostic Criteria For Diabetes ▪ Age > 40 years ▪ First-degree relative with diabetes 1. A1C ≥6.5%. OR ▪ History of impaired glucose tolerance, impaired fasting glucose 2. FPG ≥126 mg/dl (7.0 mmol/l) * ▪ Vascular disease OR ▪ History of gestational diabetes 3. 2-h plasma glucose ≥200 mg/dl (11.1 mmol/l) during an OGTT* ▪ Hypertension OR ▪ Dyslipidemia 4. In a patient with classic symptoms of hyperglycemia or ▪ Abdominal obesity hyperglycemic crisis, a random plasma glucose ≥200 mg/dl (11.1 mmol/l). ▪ Overweight or Obese, high WC and W:H *In the absence of unequivocal hyperglycemia, criteria 1–3 should be confirmed by repeat testing. ▪ Polycystic ovary disease From: American Diabetes Association Philippine Practice Guidelines for the Management of Diabetes Philippine Practice Guidelines for the Management of Diabetes UNIVERSITY OF SANTO TOMAS UNIVERSITY OF SANTO TOMAS DEPARTMENT OF NUTRITION AND DIETETICS DEPARTMENT OF NUTRITION AND DIETETICS FR FR MACROVASCULAR- disorders that affect large blood vessels, including CVD and arteries of the limbs COMPLICATIONS - structural changes in major blood vessels, including thickening of the arterial wall, calcification and endothelial damage. OF DM: ▪ Atherosclerosis ▪ CHD ▪ HTN ▪ Claudication: pain while walking due to inadequate supply of blood to muscles Contribute to foot ulcers (poor blood circulation that results to poor wound healing and nerve damage dampens pain) Lead to gangrene (tissue death) Modern Nutrition in Health and Disease 9th edition (January 1999): by Maurice E. Shils, James A. Olson, Moshe Shike, A. Catherine Ross By Lippincott, Williams & Wilkins UNIVERSITY OF SANTO TOMAS UNIVERSITY OF SANTO TOMAS DEPARTMENT OF NUTRITION AND DIETETICS DEPARTMENT OF NUTRITION AND DIETETICS 3  14/11/2024 MICROVASCULAR- disorders that affect small FR Drugs for Diabetes in the Philippines FR blood vessels. SULFONYLUREAS (SU) drugs that stimulate the beta cell to increase insulin RETINOPATHY- damage to small blood vessels Visual impairments and blindness BIGUANIDES (METFORMIN) NEPHROPATHY- damage to small blood vessels of the kidney increase uptake/entry of the glucose in the muscle Renal failure decrease the gluconeogenesis in the liver drugs that prevent the breakdown of fat NEUROPATHY- damage to nerves ▪ pain or burning numbness and tingling in the hands and feet or loss of sensation THIAZOLIDINEDIONES (TZD) ▪ Pain or cramping at night increase uptake/entry of the glucose in the muscle ▪ Contributes to foot ulcers decrease the gluconeogenesis in the liver ▪ Gastroparesis (delayed stomach emptying) drugs that prevent the breakdown of fat UNIVERSITY OF SANTO TOMAS Modern Nutrition in Health and Disease 9th edition (January 1999): by Maurice E. Shils, James A. Olson, Moshe Shike, A. UNIVERSITY OF SANTO TOMAS DEPARTMENT OF NUTRITION AND DIETETICS Catherine Ross By Lippincott, Williams & Wilkins DEPARTMENT OF NUTRITION AND DIETETICS FR FR Drugs for Diabetes in the Philippines When do we use insulin? 1. Symptomatic Severe Hyperglycemia ALPHA GLUCOSIDASE INHIBITORS (AGI) 2. Contraindications or Allergy to OAD drugs that delay the absorption of dietary glucose 3. PTB, Liver and Kidney Disease 4. Seriously Ill Patients ( ICU ) INCRETINS (GLP-1 AGONISTS/ DPP-4 INHIBITORS) 5. Major Surgery drugs that stimulate the alpha cell to decrease glucagon 6. Pregnancy decrease the gluconeogenesis in the liver 7. By Choice INSULIN UNIVERSITY OF SANTO TOMAS UNIVERSITY OF SANTO TOMAS DEPARTMENT OF NUTRITION AND DIETETICS DEPARTMENT OF NUTRITION AND DIETETICS 4  14/11/2024 FR FR Nutrition Rapid acting Short acting Intermediate acting Therapy Long acting UNIVERSITY OF SANTO TOMAS UNIVERSITY OF SANTO TOMAS DEPARTMENT OF NUTRITION AND DIETETICS DEPARTMENT OF NUTRITION AND DIETETICS FR FR Assessment: Assessment: ▪ Food and Nutrition Intake: ▪ Biochemical - Glucose, Lipid profile, kidney function - calories, CPF, SFA, cholesterol, sugar, fiber, supplements, eating pattern ▪ Food and Nutrition Knowledge/Skill ▪ Nutrition Focused Physical Findings - symptoms, BP, gangrene, Acanthosis nigricans - management, sources of CHO, SFA, fats, acceptance, behavior (for change), ▪ Anthropometric: ▪ Others: Client history, Social history - BMI, WC, W:H, weight change, body composition - socio demographic profile, past medical hx, family hx, socioeconomic factors (financial, meal prep capacity) UNIVERSITY OF SANTO TOMAS UNIVERSITY OF SANTO TOMAS DEPARTMENT OF NUTRITION AND DIETETICS DEPARTMENT OF NUTRITION AND DIETETICS 5  14/11/2024 FR FR TREATMENT Diabetic diet is an Individualized Diet Goals: ✔Attain and maintain optimal metabolic outcomes ✔Prevent and treat complications ✔Enhance health ✔Address individual nutritional needs UNIVERSITY OF SANTO TOMAS DEPARTMENT OF NUTRITION AND DIETETICS FR SPECIFIC NUTRITION RECOMMENDATIONS FR NUTRITION MGT. CARBOHYDRATES Complex CHO ESTIMATING REQUIREMENTS: 45-65% TER and not