Diabetes- a condition wherein the body is not able to use sugar as it should because the pancreas does not

produce enough insulin, or the available insulin is not effective. Diabetes mellitus has been recognized as a disease for centuries. Diabetes derives from a Greek word meaning to siphon, referring to the increase output of urine. Mellitus derives from a Latin word meaning sweet. The two words together identify the disease as an outpouring of sweet urine. When diabetes is not treated, blood sugar level rises, a condition called Hyperglycemia, as more sugar overflows into the urine (Glycosuria), other symptoms include extreme thirst and hunger, weight loss, blurred vision and general weakness. Insulin- one of the hormones produced by the pancreas. It helps keep your blood sugar at the right level. Too much production of insulin causes Hypoglycemia or low blood sugar level, while too little insulin brings out Hyperglycemia or high blood sugar level.
Classification and Characteristics of Types of Diabetes and Related Carbohydrate Intolerance Disorders
Diabetes Mellitus (DM) Classification Type I: Insulin-dependent diabetes mellitus (IDDM) Characteristics Onset: any age, but usually before age 30. Rapid onset of symptoms. Client is usually thin to normal weight. Client depends on insulin to sustain life. Frequent complications. Constitutes 10% to 20% of all diabetes cases. Onset: any age, but usually after age 35. Slow onset of symptoms. Client often is obese, but weight may be normal. Oral antidiabetic drugs are effective; 20% to 30% of clients may require insulin. Frequent complications. Constitutes 80% to 90% of all diabetic cases. Occur secondary to other conditions or pharmacologic treatment. Pancreatic causes: pancreatitis, pancreatectomy, cystic fibrosis. Hormonal causes: acromegaly, Cushings syndrome, pheochromocytoma. Drug-induced causes: phenytoin (Dilantin), steroids, estrogen (e.g. oral contraceptives), beta- adrenergic blockers, monoamine oxidase (MAO) inhibitors. Onset: during pregnancy. Increases risk of complications. Treated with diet and insulin as needed to maintain normal blood glucose levels. Increases clients risk of developing diabetes later in life. Glucose tolerance test results are abnormal, but fasting blood glucose is normal or only slightly elevated. Client rarely has symptoms. Client may revert to normal. Although now normal, client has had elevated blood glucose levels or an abnormal glucose tolerance test. Client is normal at time of glucose testing; has risk factors for DM, such as family history of DM, identical twin with DM, obesity, high-risk ethnic background.

Type II: Non-insulin-dependent diabetes mellitus (NIDDM) Nonobese NIDDM Obese NIDDM

Other types of DM

Gestatational Diabetes Mellitus (GDM)

Impaired Glucose Tolerance

Impaired glucose tolerance (IGT) (may be nonobese, obese, or associated with other conditions)

Potential abnormality of glucose tolerance (Pot AbGT)

Chronic Complications of Diabetes: Retinopathy- damage of the retina Angiopathy- damage of the blood vessels Neuropathy- damage of the nervous system Nephropathy- damage of the kidney Diabetic Diet (Calculated Diet)- basically it is a balanced diet measured to provide the number of exchanges or servings based on the individuals caloric requirement. Serving sizes are dictated by the Food Exchange List.
Table 1-2: Nutrient Recommendations for Adults with Diabetes
Nutrient Calories (kcal) Carbohydrates Protein Saturated fat and cholesterol Fiber Sodium Vitamins and minerals Alcohol Recommended Daily Intake Amount needed to attain and maintain reasonable weight (defined as the weight an individual and health care provider acknowledge as short-term and long-term achievable and maintainable). Individualized, based on clients individual eating habits, and glucose and lipid goals. Approximately 10% to 20% of the daily caloric intake; should be from both animal and vegetable sources. Less than 10% of the daily calories should be from saturated fats, with dietary cholesterol limited to 300 mg or less per day. 20 to 30 g of dietary fiber each day from a wide variety of food sources. The same as for the general population; no more than 2,400 mg to 3,000 mg per day. Sufficient to meet daily requirements. For people using insulin, up to 2 alcoholic beverages can be ingested with and in addition to the usual meal plan (1 alcoholic beverage equals 12 ounces of beer, 5 ounces of wine, or 1 ounces of distilled spirits). Special considerations are important for people with a history of alcohol abuse, those who are pregnant, and those with other medical problems. The alcohol should only be ingested with a meal to decrease the risk of hypoglycemia.

Distribution of Kilocalories. To maintain or attain reasonable weight, the client must control kcal intake. The daily kcal allowance for the person with diabetes is usually calculated on the basis of his or her desirable weight (that is, weight at age 25, provided that the person was healthy and not overweight). This number of kcal is then divided among carbohydrates, proteins, and fats. The following guidelines or used to determine kcal needs for adults with diabetes: 1. Calculate basal calories: desired body weight (lb) x 10. 2. Add activity calories: a. Sedentary: desirable body weight (lb) x 3. b. Moderate: desirable body weight (lb) x 5. c. Strenuous: desirable body weight (lb) x 10. 3. Add calories for indicated weight gain, growth in pregnant women, or lactation: a. Pregnancy: Add 300 kcal per day to gain 23 lbs in 9 months. b. Lactation: Add 500 kcal per day. c. To gain 1 lb per week, add 500 kcal per day. 4. Subtract calories for indicated weight loss: to lose 1 lb per week, subtract 500 kcal per day. Calculating the Diabetic Diet Plan. The diabetic diet is based on the persons ideal (or reasonable) weight, activity level, age and occupation. These factors determine the total kcal that the person may consume each day. After the calories have been determined, the proportions of carbohydrates, proteins, and fats are calculated using Table 1-2.

The distribution of foods throughout the day is based on exchange lists, as shown in Table 1-3. There are 6 categories of food: milk, vegetables, fruits, breads, meats, and fats. The name and quality of food that make up one exchange (or serving) are listed; standard household measurements are used. One food portion on the list can be substituted (exchanged) for another with very little difference in calories or amount if carbohydrates, proteins, and fats. The meal plan prescribes how many exchanges are allowed for each food group per meal and snacks. A sample meal plan is given in Table 1-4.
Table 1-3: Exchange List Examples
Exchange Food Quantity in One Excha nge 1 cup cup 1 cup 1 cup 1 cup cup cup cup cup cup cup cup 1 small 1/3 cup 2 medium small 12 1 small 2 medium 1 slice 1 slice 1 cup cup cup cup cup 3 cups 2T 3 2 6 cup cup

Milk

One exchange equals 12 g carbohydrate, 8 g protein, trace of fat, and 80 kcal.

Vegetable

One exchange equals 5 g carbohydrate, 2 g protein, and 25 kcal. Raw vegetables from this exchange that may be used as desired include cucumbers, Chinese cabbage, lettuce, dill, pickles, and radishes. One exchange equals 10 g carbohydrate and 40 kcal.

Fruits

Breads

One exchange equals 15 g carbohydrate, 2 g protein, and 70 kcal.

Whole milk (delete 2 fat exchanges) Canned evaporated whole milk 2% fat fortified milk (delete 1 fat exchange) Skim or nonfat milk Yogurt made from skim milk (plain, unflavored) Asparagus Beets Broccoli Greens Summer squash Tomatoes Tomato juice Apple Apple juice Apricots, fresh Banana Grapes Orange Prunes Bread White Whole wheat Small bagel Hamburger bun Tortilla Cereal Unsweetened ready-to-eat Cooked Grits, cooked Rice or barley, cooked Pasta, cooked (spaghetti, noodles, macaroni) Popcorn, popped, no added fat Flour Crackers Graham, 2.5 inches square Matzoh, 4 inches x 6 inches Saltines Dried beans, peas, & lentils Dried & cooked Baked beans, no pork, canned

Starchy vegetables Corn Corn on the cob Lima beans Peas Potato, mashed Sweet potato Meats, Cheeses & Eggs One exchange of lean meat equals 7 g protein, 3 g fat, and 55 kcal. One exchange of medium-fat meat equals 7 g protein, 5 g fat, and 75 kcal. One exchange of high-fat meat equals 7 g protein, 8 g fat, and 100 kcal. All visible fat should be trimmed off and meat measured after cooking. Lean meats Beef: chunk, flank, round, rump Pork: whole, center shank Fish (fresh or frozen) Medium-fat meats Ground beef Dried beans & peas (delete 1 bread exchange) Creamed cottage cheese Parmesan cheese Egg High-fat meats Commercial hamburger, rib roast Pork, ribs Cheddar cheese Frankfurter Margarine (soft, tub, stick) Avocado (4 inches in diameter) Peanut oil Olives (small) Spanish peanuts Bacon, crisp French dressing

1/3 cup 1 small cup cup cup cup 1 oz 1 oz cup 1 oz cup cup 3T 1 1 oz 1oz 1 oz 1 small 1 tsp 1/8 1 tsp 5 20 1 strip 1T

Fats

One exchange equals 5 g fat and 45 kcal.

Table 1-4: Meal Plan Examples: 1800 kcal

Breakfast Exchange Allowances Milk Vegetable Fruit Bread Meat Fat 1 1 2 2 2 1 cup skim milk 2 slices toast cup strawberries 2 slices bacon 2 tsp margarine Lunch 1 1 1 2 2 2 1 cup yogurt 1 cup cooked pasta cup zucchini cup mozzarella cheese 2 T Italian dressing Dinner 1 1 1 2 2 1 1 cup skim milk 1 cup mashed potatoes Lettuce salad cup cauliflower cup applesauce 2 oz baked turkey 1 tsp margarine I T French dressing Bedtime

Food Choices from the Exchange List

1 1 1 small English muffin cup cottage cheese 1 tsp margarine