Week_06_Diet_Therapy_Diabetic_Cardiac_Pts_S3_2023_2024.pdf

BSN 111 Applied Nutrition for Nurses Diet Therapy for Diabetic Patients 2023 / 2024 Semester 3 – Week 6 By: Firas Qatouni, RN., M.Ed., 6/23/2024 1...

BSN 111 Applied Nutrition for Nurses Diet Therapy for Diabetic Patients 2023 / 2024 Semester 3 – Week 6 By: Firas Qatouni, RN., M.Ed., 6/23/2024 1  What is Diabetes Mellitus? Is a chronic disease involving abnormal carbohydrates, fat, and protein metabolism characterized by hyperglycemia. It is not one disease, but several different diseases with varying etiologies resulting from glucose intolerance or high blood glucose (hyperglycemia). Diabetes mellitus usually occurs as a result of decreased or absent insulin production from the beta cells of the pancreas. The diagnosis of DM is made If the fasting blood glucose is greater than or equal to 126 mg/dl 3  Prediabetes Lifestyle management for prediabetes: Weight loss of 5% to 10% of body weight. Moderate physical activity. Diet rich in fruits, vegetables and whole grains with low fat dairy and minimal alcohol intake. 4  Type 1 Diabetes Symptoms of Type 1 Diabetes Polydipsia Polyuria Polyphagia Extreme (increased ( loss of (increased weight loss thirst) water) hunger) 5  Type 1 Diabetes Management of Type 1 Diabetes Medical Nutrition Therapy (MNT) Physical Activity Insulins A consistent carbohydrate diet with insulin correction for hyperglycemia before each meal is recommended for those with type 1 diabetes 6  Type 2 Diabetes Most common in over weight people over the age of 40 years. Consequences of type 2: 1. Neuropathy 2. Blindness or visual impairment 3. Coronary artery disease 4. Renal disease 5. Stroke 7  Type 2 Diabetes Symptoms of Type 2 Diabetes Visual Tingling, Recurrent Fatigue Dry skin blurriness numbness infections 8  Type 2 Diabetes Management of Type 2 Diabetes 1. During early stages can be managed effectively with nutrition and physical activity. 2. In a progressive disease , oral medications are added to the treatment plan 3. Later, insulin can be added if oral medications are ineffective. 9  For Review and Self Reading Gestational Diabetes Gestational diabetes refers to diabetes diagnosed during pregnancy. Pregnant women must keep normal blood glucose (euglycemia). High risk women should have glucose testing as soon as the pregnancy diagnosed. Low risk women ( less than 25 years) should have glucose testing at 24 weeks of gestation. 10  Medical Nutrition Therapy for Diabetes 1. Carbohydrates intake recommendations 2. Fat intake recommendations 3. Protein intake recommendations 4. Vitamin supplementations 5. Alcohol intake 11  Nutrients Intake Recommendations 1. Carbohydrates Carbohydrates intake compromise 60% to 70% of the total calories The minimum consumption of 130 gm/day A variety of carbohydrates sources from fruits, vegetables, whole grains. Individuals with type 2 DM must consume whole grain foods cause they improve insulin sensitivity. Calculate the carbohydrates intake. If hypoglycemia occurs, 15 to 20 gm of carbohydrates should be consumed. Check blood glucose level should be rechecked after 15 min. 12  Nutrients Intake Recommendations Glycemic index and Glycemic load are methods used to quantify the body response to specific foods. It measures how quickly and how much a food item Glycemic index: raises blood sugar levels after consumption. Carbohydrates are rated according to how rapidly the food is digested and metabolized to produce blood glucose during the 2 hours after consumption when compared to an equal amount of carbohydrates from a slice of white bread or 50 gm of glucose. Foods high in glycemic index as potato Foods low in glycemic index as brown rice, fiber rich foods 13  Nutrients Intake Recommendations estimates the impact of carbohydrate consumption on blood Glycemic load: sugar levels Represents both the quantity and quality of CHOs and is calculated as the product of the glycemic index of a specific food and the amount of CHOs eaten, rather than the set 50 gm CHO portion used in glycemic index calculations. 14  Nutrients Intake Recommendations 2. Fat Intake Recommendations A primary goal for individuals with diabetes is to limit intake of saturated fat and trans fats to decrease the risk of cardiovascular diseases. Cholesterol intake should be less than 200 to 300 mg daily. Saturated fats limited to not more than 7% to 10% of the total energy intake. 17  Nutrients Intake Recommendations 3. Protein Intake Recommendations During prolonged hyperglycemia, protein catabolism can contribute to a need for increased protein intake, but consumption of more than 20% of total energy intake is not recommended because the risk of kidney damage. 18  Nutrients Intake Recommendations 4. Vitamin Supplementations Routine vitamin supplementation is not recommended for persons with diabetes unless there is insufficiency 5. Alcohol Intake Alcohol consumption leads to hypoglycemic effect due to inhibition of gluconeogenesis. 19  Weight Management Weight loss of 5% to 10% to decrease the risk of type 2 diabetes. Also, weight reduction is recommended for individual with diabetes to decrease blood pressure, blood glucose, lipid levels, and sleep apnea risk. The use of bariatric surgery to treat those with type 2 DM showed significant improved health outcome and diminished disease associated risks. 20  Complications of DM 1. Hypertension 2. Cardiovascular 3. Diabetic nephropathy 4. Is the leading cause for kidney failure 5. Diabetic neuropathies 6. Nerve dysfunction due to hyperglycemia 21  BSN 111 Applied Nutrition for Nurses Diet Therapy for Cardiac Patients 2023 / 2024 Semester 3 – Week 6 By: Firas Qatouni, RN., M.Ed., 6/23/2024 22  Dietary Factors that Influence Blood Cholesterol 1. Dietary fat. 2. Nutritional factors 3. Medical nutrition for hypercholesterolemia 26  1. Dietary Fat Saturated Fats Increased Total LDL/Cholesterol Animal fat Increase Risk of Heart Disease Butter Lard Processed foods Polyunsaturated Fats Fish Vegetables oils Improve Cholesterol Profile Decrease Risk Heart Disease 27  1. Dietary Fat Trans Fats Increased Total LDL/Cholesterol Processed foods Increase Risk of Heart Disease Monounsaturated Fats Olive oil Nuts Avocado Improve Cholesterol Profile Decrease Risk Heart Disease 28  Heart Healthy Diet High in Antioxidants Dietary fiber Micronutrients Moderate in Healthy unsaturated fats Low in Saturated fat Trans Fat Added sugar Salt (sodium) 29  2. Other Nutritional Factors a. Plant sterols/stanols: Are chemically resemble cholesterol Plant sterol fortified foods have been shown to lower blood cholesterol by up to 10% by reducing cholesterol absorption. 30  Other Nutritional Factors (plant sterols) Sources : Obtained from fruits and vegetables and are not made by human. A serve of these products contain 0.8-1g plant sterols/serve. Need to consume 2 gm/day of plant sterols to lower cholesterol levels. 31  Other Nutritional Factors b. Soluble fibers: Reduces LDL cholesterol Food sources as: Oats , barely, legumes, flaxseed and fruits (apples, citrus fruits) Soy consumption in large amounts is not effective at reducing LDL. c. High protein diets: These type of diet is under debate in its relationship with CVD 32  3. Medical Nutrition Therapy Therapeutic Life Change (TLC): Refers to maintaining the dietary intervention be incorporated into both primary and secondary prevention of CVD. The focus is to : 1. Reduce daily intake of SFAs and cholesterol to less than 7% of total calories and less than 200 mg respectively. 2. Adding 2 gm of plant stanols/sterols per day. 33  Medical Nutrition Therapy Therapeutic Life Change (TLC): The focus is to : 3. Decrease LDL by consuming 5 to 10 gm of soluble fibers per day. 4. Decrease trans fatty acid consumption to less than 1% 5. Foods high in saturated and trans fats should be replaced with foods high in PUSF & MUSF. 34  Nutrition and Reducing Risk of CVD 1. Polyunsaturated Omega 3 Omega 3- Marine Omega 3- Plant Based Foods (ALA) 2. Alcohol and CVD 3. Dietary supplementation 35  Nutrition and Reducing Risk of CVD 1. Polyunsaturated Omega 3 Omega 3- Marine Heart Foundation recommends 2 serves of oily fish/week e.g. Salmon, tuna, sardines, mackarel. Alternatively, can use fish oil capsules or liquid to meet omega 3 recommendations. 36  Nutrition and Reducing Risk of CVD 1. Polyunsaturated Omega 3 Omega 3- Plant Based Foods Alpha-Linolenic Acid (ALA) Aim for 1g ALA / day. Found in nuts, seeds, oils, spreads (soybeans/canola). 37  Nutrition and Reducing Risk of CVD 2. Alcohol and CVD Intake of three or more drinks per day is associated with high blood triglyceride levels, cardiomyopathy, hypertension and stroke. 38  Nutrition and Reducing Risk of CVD 3. Dietary Supplements Little researches support the relationship between consumption of dietary supplements and prevention of CVD. 39  Hypertension Defined as systolic blood pressure (SBP) more than 140 mm Hg or diastolic blood pressure (DBP) more than 90 mm Hg. Lifestyle factors contributing to hypertension : 1. Obesity 2. Lack of physical activity 3. Alcohol abuse 4. Smoking 40  Dietary Approaches to Stop Hypertension (DASH) Fruits (5 servings / day) Vegetables (3 servings / day) Low fatty dairy products (2 servings / day) Following DASH for 8 weeks significantly lowered SBP by 5.5 mm Hg and DBP by 3 mm Hg. Studies reported a decrease in risk of CHD, stroke and overall mortality in those with hypertension who follow the DASH diet. 43  Medical Nutrition for Hypertension Weight management. Regular physical activity at least 30 minutes per day. Decrease alcohol consumption. Diet should be rich in fruits, vegetables and low-fat dairy products. Reducing sodium to levels less than 2300 mg /day (less than 1tsp salt ) significantly reduce blood pressure. 44