Hey, welcome to the Medical Advice Channel blog, today I have created a very in-depth article on the nutritional management of diabetes mellitus. This article is not only for those managing Diabetes Mellitus patients but also for patients suffering from Diabetes, not forgetting those who have friends or family members with Diabetes. If you have never heard of Diabetes, don’t worry, this article is also for you. Feel free to try the short quiz at the end to see how much you have understood.
For today’s discussion, we will look at the following topics:
- Introduction to diabetes
- Types of diabetes
- Risk factors of diabetes
- Signs and symptoms of diabetes
- Nutrition therapy of a diabetic patient
- Nutrition management of diabetes mellitus
- Exercise and physical activity
- Complications of diabetes
- Diagnosis of diabetes
Introduction to diabetes Mellitus
Diabetes mellitus is one of the commonly known metabolic disorders. It is a chronic metabolic disorder that occurs when the pancreas does not produce any insulin or produce less insulin. It also occurs when the body cannot effectively utilize the insulin it produces.
Diabetes mellitus is characterized by decreased ability or complete inability of the tissue to utilize carbohydrates accompanied by a change in the metabolism of fats, protein, water, and electrolytes.
Diabetes results in elevated blood sugar which over time leads to multiple organ damage. We can associate with acute complications. These complications include ketoacidosis and hypoglycemia as well as long-term complications affecting the eyes, kidneys, feet, nerves other organs.
This is the reason why you need to know and understand the nutritional management of diabetes mellitus.
Types of Diabetes Mellitus
We can classify diabetes mellitus into three types, they include;
Type 1 Diabetes Mellitus
Type 1 Diabetes Mellitus can also be called Insulin Dependent Diabetes. is a type of diabetes mellitus that results from the body’s failure to produce insulin. In this case, the body may produce very little or no insulin.
As we know, insulin is a very important hormone, it helps the body cells absorb glucose, which can later be used in the production of energy.
The reason for a person developing Diabetes Mellitus type one is not really known. The known fact is that in diabetes mellitus, the body’s soldiers, also known as antibodies, attack the insulin-producing cell and destroy them. These cells are located in the Pancrease and are known as Islets of Langerhans. This leads to the production of very little, or no insulin.
To read more on Type 1 diabetes mellitus, read the below article;
:::::::::::>>> Type 1 Diabetes Mellitus <<< ::::::::::::::
Type 2 Diabetes Mellitus
Glucose is very important In the body. The body cells use Glucose in metabolism to produce ATP energy. In Diabetes Mellitus type 2, the is interference in the way glucose is metabolized by the body.
This results in insulin resistance, a condition in which cells fail to use insulin properly, sometimes it is combined with other relative insulin deficiency.
Long ago, it was also known as adult-onset diabetes. Things have changed these days, in that it is becoming more in children also. I think this is because many children are developing obesity, which by the way, is a risk factor for diabetes.
Some of the common signs and symptoms of Type 2 diabetes include;
- Sores that take long to heal.
- Poor or blurred vision.
- An increase in the frequency of infections.
- Increased frequency in urination.
- Increased feeling of thirst.
To read more on Diabetes Mellitus type 2, read the article below;
:::::::::::::: >>> Type 2 Diabetes Mellitus <<< :::::::::::::
is a type of diabetes mellitus that usually occurs in pregnant women. An expectant woman is said to have gestational diabetes if they never had diabetes mellitus before and yet have high levels of blood sugar. It affects about 4% of all pregnant women worldwide and it may precede the development of type 2 diabetes mellitus.
Unlike other types of Diabetes, Gestational Diabetes doesn’t cause signs and symptoms that easily noticeable, but the increased frequency in urination or, an increase in the feeling of thirst may be possible signs.
The best news is that gestation diabetes can easily be managed by exercising and eating right. As always, see your doctor for a check-up, or if there are any concerns.
To learn more about Gestational Diabetes, read the article below;
:::::::::: >>> Gestational Diabetes <<< ::::::::::
Risk factors of diabetes mellitus
Risk factors for diabetes mellitus include;
- Hereditary factors
- Dietary factors
- Sex (Gender)
- Physical inactivity
Having a parent with type 2 diabetes most likely increases diabetes risk. This is due to the fact that diabetes is often related to lifestyle choices e.g. Unhealthy eating, parents may pass on poor health habits to their children in addition to genetic predisposition. This increases their children’s risk of getting type 2 diabetes mellitus.
- Dietary factors
Drinking more sugar-sweetened beverages or eating fewer fruits and vegetables both are associated with an increased risk of type 2 diabetes, whereas eating a low-fat diet does not appear in any change of diabetes risk. Therefore complex carbohydrates are recommended when dealing with a diabetic patient.
older adults are at risk for the development of type 2 diabetes due to the combined effects of increasing insulin resistance and impaired pancreas islet function with aging. Age is therefore an important factor when we look at risk factors of diabetes.
Diabetes is more common in males rather than females. Never the less, fewer females have more serious complications and a greater risk of death. Diabetic neuropathy a type of nerve damage associated with diabetes can cause sexual issues, numbness, pain, or lack of feeling can also occur in the genitals.
- Physical inactivity
The excessive free fatty acid released by adipose tissue leads to a decrease in insulin sensitivity of muscle, fat, and liver, which is followed by raised glucose levels, insulin resistance, and type 2 diabetes mellitus. It is therefore recommended that a diabetic patient spare at least 30 minutes daily for exercise and physical activity.
- Common infections
High blood sugar from diabetes can affect the body’s immune system by impairing the ability of Leukocytes to come and fight at the site of an infection. Diabetic patients should stay away from micro-organisms and always keep safe and stay in a healthy environment always to avoid common infections.
Signs and symptoms
- polydipsia (Increased thirst)
- polyuria (Increased urination)
- Increased hunger (polyphagia)
- Weight loss in type 1 diabetes mellitus
- Overweight in type 2 diabetes mellitus
- Sugar in urine (glycosuria)
- Elevated blood sugar
- Skin irritation or infection
- General loss of strength
- Body weakness
When managing diabetes mellitus, nutrition is a very important aspect. Dietary modification is therefore important to meet the needs of the patient. An increase in physical levels is also important for a diabetic patient. The objectives of nutrition therapy include;
- To attain and maintain blood glucose levels as close to normal as possible.
- Try and prevent hypoglycemia and hyperglycemia.
- Attain optimum blood lipids and blood pressure control and reduce the risks of macrovascular disease.
- To assess energy intake to achieve optimum body weight.
- Promote physical, social, and psychological well-being.
- Prevent, delay, or minimize the onset of chronic degenerative complications.
- Achieve and maintain optimal metabolic and physiologic outcomes.
- Provide relief from symptoms.
- To individualize the meal plan according to a person’s lifestyle and based on usual dietary intake.
Planning a Diabetic Diet
In planning a diabetic diet, the following principles should be considered;
- Trying to balance energy intake to energy expenditure.
- Provide adequate quality and quantity of macro and micronutrients.
- Intergrade a healthy meal plan according to socio-economic status.
- To make starchy foods the basis of all meals.
- Limit the intake of fatty foods and simple sugars.
- Include 2 to 4 fresh foods which is the basis of a meal.
- Limit intake of fatty foods and simple sugars.
- Include 2 to 4 fresh fruits for the day.
Nutritional Management of Diabetes Mellitus.
When it comes to diabetes mellitus, high carbohydrate foods have the greatest effect on blood glucose levels because, after digestion, they are mostly converted to glucose, which is absorbed from the intestines straight into the bloodstream.
Proteins and fats do not affect blood glucose levels.
Important food groups for a Diabetic patient
The following are the most important food groups that are included in a diabetic diet;
- Starchy foods
- Dietary fats and oils.
Now let us look at these food groups in more detail.
- Starchy foods
They provide energy and are required by the body for daily functioning. They are key components of a healthy diet and should be included in the meal plan. It is recommended that 55-60% of energy should come from carbohydrates.
The most common sources of carbohydrates are cereals, grains, e.g maize, rice, arrow roots, sweet potatoes, iris potatoes wheat and wheat products, and cassava. The number of carbohydrates a person eats can make big difference in their blood glucose levels.
When a diabetic patient eats more carbohydrates than usual at a meal, their blood glucose level is likely to be higher than usual several hours afterward.
Whole-grain carbohydrates are recommended because they are digested at a slower rate than simple sugars, in turn, either reduce the demand on beta cells in the pancreas to produce insulin or reduce the need to inject large amounts of insulin.
Complex carbohydrates also have more vitamins, minerals, and fiber. Examples of complex carbohydrates include brown bread, cereals, rice, sweet potatoes, cassava, arrow roots, spaghetti, and corn.
Proteins are bodybuilding foods and are for the maintenance & repair of the body tissues. The protein in the diet can help to stabilize blood sugar level as it does not break down as quickly to glucose like carbohydrates and it, therefore, decreases the demand for insulin on your pancreas.
Never the less, it is important not to consume excess protein when excess because it can be converted to glucose by the liver. There are presently two Sources of protein; animal & plant sources. Nutritionists recommend that 12-15% calories should come from proteins.
Animal Protein sources include;
- Meat and meat products.
- Milk and milk products.
Plant sources include;
- dry legumes e.g beans, peas, soybeans, tofu, lentils, and nuts. Plant-based protein sources provide high-quality protein.
Most of the fat in these products is unsaturated and their foods contain fiber so they are good for your heart as well, especially if you substitute them for other meats or poultry in your diet.
Foods in this group include;
- Dried beans such as black
- Pinto, and bean products,
- Lentils such and dried peas.
- Soy-based products, soy nuts, nuts.
- Spreads such as almond butter, cashew butter, peanut butter, and soy nut butter.
Nutritionists do not advise a Diet high in protein and low in carbohydrates for a diabetic person because it is generally high in saturated fats.
Fruits are important because they provide carbohydrates, vitamins, minerals, and fiber. We recommend that one uses fruits in season. Fruits should be basic in a diabetic diet and you should be eating them adequately for a better outcome.
I recommend 5 servings of fruits daily because fruits contain soluble fibers that help to reduce the absorption of glucose in the intestines. Examples of fruits include; apples, strawberries, peach, mango, banana, watermelon, orange, grape, lemon, guava, pawpaw, tangerine, passion fruits, and canned fruits.
Vegetables provide vitamins, minerals, and fiber. I would recommend that a diabetic patient eats at least 5 servings of vegetables in a day because they help in the absorption of glucose in the intestines. They are low in carbohydrates and they include both green leafy and yellow or orange vegetables in your diet.
Examples of vegetables
- spinach and Kales
- green beans.
- Dietary fat and oils
These are high energy giving foods. Doctors recommend that fat intake should not be more than 30% of your total calorie intake per day. Total fats depend on many factors. The unsaturated fats are the best for diabetic patients. The type of fat an individual eats is more important than total fats.
All fats provide more energy per gram than other macronutrients, fats provide 9kcals per gram but only differ in their action on cholesterol metabolism. Some of the sources of fats include; bacon, butter, salad dressing oil, mayonnaise, margarine, avocado and, olives,
Exercise and physical activity
Exercise and physical activity is an important component of diabetes management. Doctors recommend that every patient, not only patients but also you, should have at least 20 to 30 minutes of exercise every day. Everyone should individualized exercise and physical activity plan. This helps patients to;
- Improve insulin resistance and lipid profile.
- Lower blood pressure.
- Reduce mortality in type 1 diabetes.
- Protect against the development of type 2 diabetes.
- Maintain appropriate body weight.
Also read this article;
:::::::: >>> How to Live a Healthy Lifestyle Easily <<< :::::::::
Complications in Diabetes mellitus
Complications of diabetes include;
- Metabolic acidosis
Lets me define the above terms and, give you a brief explanation;
We can also call it Low Blood Sugar. Hypoglycemia occurs when there is a decreased level of blood sugar in the body, beyond normal levels.
Please note that the blood sugar we are talking about in this case is glucose. The normal blood glucose levels in a normal human being are as follows;
Normal : < 7.8 mmol/L or 140mg/dL
In Diabetes : > 200mg/dL
In Prediabetics : value between 140 – 199mg/dL or 7.8 – 11 mmol/L
Diagnosis of Diabetes mellitus.
Tests that can be used to diagnose diabetes include;
- Fasting plasma glucose test
- The A1C test
- Random glucose test
- Glucose challenge test
- Oral glucose tolerance test.
Let us take a closer look.
Fasting plasma glucose test.
It the most preferred diagnostic method for screening for diabetes mellitus. measures blood glucose level at a single point in time, for the most reliable results, it is best to have this test in the morning, after you fast for at least 8 hours.
A fasting plasma glucose level >126 mg/dl (7.0 mmol/l) or casual plasma glucose > 200mg/dl (11.1 mmol) meets the threshold for the diagnosis of diabetes. In the absence of unequivocal hyperglycemia, you must confirm the diagnosis on a subsequent day.
::::::::: >>> Fasting Plasma Glucose test <<< :::::::::
The A1C test.
is a blood test that provides an average level of blood glucose over the past 3 months. Unlike in the Fasting Plasma Glucose test, You can eat and drink before the test. You can also call this test a glycohemoglobin test.
When you do this test, you will expect the results to be in percentage form. The normal value for a healthy person is <5.7%. It can be used to diagnose type 2 diabetes.
Normal < 5.7%
Diabetes between 5.7% – 6.4%
Prediabetes 6.5% or more.
Random plasma glucose test.
Doctors do this test when diabetes symptoms are already present, and they do not want to wait until you have fasted. You do not need to fast overnight for the random plasma glucose test, you may have this blood test at any time.
Glucose challenge test.
This test helps health professionals know the amount of glucose that is in circulation in the patient’s blood. in this test, a health care professional will draw your blood 1 hour after you drink a sweet liquid containing glucose. You do not need to fast for this test, there, if you had eaten earlier or not eaten since yesterday, will not affect your results.
Prediabetes between 100 – 125mg/dL
Diabetes 126mg/dL or greater
Oral glucose tolerance test.
This test is used to measure the tolerance or response of your body to glucose. measures blood glucose after you fast for at least 8 hours. First, a health care provider will draw your blood then you will drink the liquid containing glucose. Doctors highly recommend it for pregnant women to see if they have developed gestational diabetes.
Treatment of Diabetes Mellitus
Treatment of Type 1 diabetes
The most common treatment for type 1 diabetes involves the use of Insulin injections. These injections are given on the fat layer under the skin. This layer is commonly known as the subcutaneous layer.
The common places for insulin injections include;
- The arm
- On the abdomen
- The thigh
The abdomen area is the most preferred location. Those who have type 1 will have to use insulin for their entire life. This is because, if you can remember, their body is not able to produce insulin on their own.
Medications may also be prescribed. Some medications may stimulate the pancreas to produce insulin, while others may inhibit the amount of glucose production by the liver, subsequently lowering the amount of insulin needed. Other medications may limit the amount of glucose reabsorbed by your liver.
They are also required to do frequent blood sugar checks and carbohydrate counting.
In some type 1 diabetes patients, pancreas transplant surgery may be recommended. These surgeries are not always successful and therefore risky.
Treatment of Type 2 Diabetes
For type 2 Diabetes mellitus, patients are required to have a lifestyle change, monitor their blood sugar levels, and additionally, take medications prescribed by their health providers, with may or may not include insulin.
Although we do not consider this as a treatment option, gastric bypass surgery may be done in obese patients with a Body Mass Index of 35 and above. This procedure usually has long-term complications, therefore consult your doctor to advise you accordingly. The other name for this procedure is Bariatric surgery.
The doctor may also prescribe Medications such as Fortamet to increase tissues and cell’s sensitivity to insulin.
Treatment for Gestational Diabetes
Blood sugar checkup is very vital in the treatment of gestational diabetes. Expectant mothers should also ensure they eat healthily and do regular exercises. Insulin and other medications may, or may not be recommended.
I really hope this article was helpful, if so, leave a comment down in the comments section. If you feel there is something I can add to the article, also leave a comment and I will back to you.
Test your understanding of the topic.
If you think that you have understood today’s topic on Nutritional management of diabetes mellitus, test yourself out by trying the quiz bellow. Let me know in the comment section what your score is.
[HDquiz quiz = “31”]