Discuss the pathophysiology of type one and type two diabetes. Develop a nutritional education plan for either a type one or type two diabetic. Include in your plan the nutritional considerations for one oral medication and one type of insulin used in the treatment of the disorder. Cite your sources.

 

Diabetes mellitus refers to a group of metabolic syndrome characterized by elevated blood glucose levels. It is a chronic disease if left untreated results in serious damage to the vital organs heart, kidneys, retina and the nervous system.

Diabetes commonly results from disruption in uptake of glucose into the cells and tissues. Glucose is the common source of energy. Insulin a hormone secreted from pancreatic cells that helps in uptake of glucose into the cells and tissues.

Diabetes is classified into Type 1 diabetes, Type 2 diabetes, Gestational diabetes.

TYPE 1 Diabetes:

- Etiology is unknown. It is also termed as Insulin dependent diabetes/ Juvenile diabetes . Research studies found the self-destruction of pancreas results in type 1 diabetes. The risk factors includes people of young age, family history of diabetes.

Pathophysiology: Type 1 Diabetes :

Etiological factors ( Family history of diabetes, Environmental influences)

  Recognizing pancreatic cells as foreign bodies by the immune system

  Formation of autoantigens on the beta cells of pancreas

   Circulation of the autoantigens in the blood and lymphatic system

   Results in activation of T lymphocytes

  Inflammatory reactions activated by the release of macrophages, and cytotoxic cells, B lymphocytes

  Destruction of beta cells of the pancreatic Langerhans

   Results in deficiency in insulin production

   Type 1 diabetes.

Type 2 Diabetes :

- It often refers to non insulin dependent diabetes, its a genetic disorder caused by defect in DNA. Obesity, liver disorders are the common causes contributing to Type 2 diabetes. The risk factors includes age group above 40 years, family history of diabetes, heart diseases, poor dietary control, intake of excess of carbohydrates and triglycerides.

Pathophysiology: Type 2 Diabetes

Etiology factors ( obesity, poor life style, genetic predisposition, alcohol consumption, excess consumption of carbohydrates and triglycerides)

 Inflammation of beta cells of pancreas

 Dysfunction of beta cells of pancreas

 Lack of insulin production results in excess circulation of glucose in the blood.

 Hyperglycemia

 Once left untreated results in microvascular complications(Retinopathy, Neuropathy, Nephropathy) and macrovascular complications ( Coronary artery disease, stroke and Peripheral arterial disease )

ORAL HYPOGLYCEMIC AGENTS:

- Drugs that used to reduce blood glucose levels.

- Biguanides a common class of drugs used for majority of patients. It acts on liver and reduces the hepatic glucose production, and also increases the insulin cell sensitivity. Examples : Metformin. Metformin acts by improving the insulin sensitivity and thereby decreases the higher blood glucose levels.

Step-by-step explanation

DIABETES MELLITUS

It is a diseases condition in which there is an increase amount of glucose leveling the body.

INSULIN

Insulin is a hormones produced in the Beta cells of islets of langerhans in pancreas which maintains the glucose level by converting the glucose into glycogen and stored in the liver.

It is divided into 3 types

1. TYPE 1 Diabetes Mellitus (Insulin Dependent Diabetes)
2. TYPE 2 Diabetes Mellitus(Noninsulin - Dependent Diabetes Mellitus)
3. Gestational Diabetes Mellitus

TYPE 1 Diabetes Mellitus(Insulin Dependent Diabetes)

It is a type of Diabetes Mellitus in which due to any diseases the the Beta Cells of the pancreas will not be able to produce the Insulin which will lead to Type 1 Diabetes Mellitus.

TYPE 2 Diabetes Mellitus(Noninsulin - Dependent Diabetes Mellitus)

The Type 2 Diabetes Mellitus will occur when the cells of the body is not responding properly to the insulin produced.

Gestational Diabetes Mellitus

It is an another type of Diabetes Mellitus which occurs during the pregnancy stage.(The word Gestation is related to pregnancy)

PATHOPHYSIOLOGY OF TYPE 1 DIABETES MELLITUS

• Due to any etiological factors such as pancreatic cancer which will lead to the Lymphatic infiltration or Destruction of Beta Cells of the islets of langerhans in the pancreas where the insulin is produced.
• When the Beta ells destructed, the production of insulin also will reduce.
• When there is a reduce production f insulin will lead to increased glucose level of the body.
• It will lead to Type 1Diabetes Mellitus.

PATHOPHYSIOLOGY OF TYPE 2 DIBETES MELLITUS

• The amount of insulin available is insufficient and the cells are poorly responds to the effect of insulin
• The glucose will not be absorbed properly by the body cells
• It will lead to increase glucose level in the blood.

NUTRITIOANL EDUCATIONAL PLAN FOR TYPE 1 DIABETES MELLITUS

CARBOHYDRATES

• Advice the patient to take carbohydrate foods but alter the type of carbohydrate type.
• Eg: Cereals and pulses
• 55-60 % of total oral intake of calories

PROTEINS

• Advice the person to have protein rich food which will reduce the blood glucose and lipids.
• Eg: meat, pulses, milk etc.
• 10-15% of total daily intake of calories

FAT

• Educate the person that fats are the concentrated form of energy
• There are 3 types of fat saturated, non saturated and poly-saturated
• Saturated Eg: ghee, butter and coconut oil taken in small quantity.
• 20-25% of total daily intake of calories.

DIETARY FIBER

• Explain the patient that the intake of dietary food will reduce the glucose and serum cholesterol level.
• Eg: Whole grains, ragi and green leafy vegetables
• Intake of 25gm dietary fiber per 1000 cal.

Medical management

Insulin Therapy

Eg: Admelog ( insulin lispro injection ) 100units/ml

Nutritional considerations includes advice the patient to try to maintain normal blood glucose level as possible by eating the above given foods because once if the insulin injection is started it is very difficult to come back to the normal cycle of reduction of glucose level.

Drug Therapy

Eg: Imiglimin 1000-1500mg//kg/ twice a day

Nutritional considerations includes advising the patient tp take adequate calories and also eat permissible food before taking this medicine.