All you need to know about type 2 diabetes. early well management of type 2 diabetes can help you to be recovered from this diseases, did you know?

 

1. what is type 2 diabetes 

Type 2 Diabetes also known as non-insulin dependent diabetes, it represents 90 to 95% of diagnosed cases of diabetes. The cause of diabetes is not confirmed so far. Although it appears that may be genetic, environmental factors also may contribute to its occurrence. For example, being obesity and physical inactive may affect people to acquire diabetes. The World Health Organization(WHO) indicated that the prevalence of diabetes increasing worldwide, especially in areas showing improvement in living standards and in urban area rather than in rural area.

After reading this paper you will be able to understand the following four main things about type 2 diabetes;

• Risk factors of type 2 diabetes
• Signs and symptoms of type 2 diabetes
• Complications of type 2 diabetes 
• Management of type 2 diabetes

 

2.      RISK FACTORS OF TYPE 2 DIABETES

There is no cause of type 2 diabetes but they are some different risk factors that can contribute its occurrences. Those risk factors are included; Genetic, Environmental factors, Old age, Obesity, Physical inactivity, and etc.

  

3.      SIGNS AND SYMPTOMS OF TYPE 2 DIABETES

• Thirsty
• Hunger
• Fatigue
• Weighty loss
• Headache

4.      COMPLICATIONS OF TYPE 2 DIABETES

When hyperglycemia exceed to renal threshold, some of these complications provided below should start to affect the body of type 2 diabetic patient. 

1. Glycosuria: this is the presence of sugar especially glucose in the urine

2. Polyuria: it’s the production of the abnormally large amount urine as result of diabetes.

3. Polydipsia: it’s abnormal excessive thirst this because of the high amount of glucose in the blood kidney try produce more urine to remove extra glucose in the blood. Meanwhile, body lose alt of fluid and then brain tells your body to drink more to replenish those fluid lost.

4. Polyphagia: due to lack of glucose in the body cells as result of insulin resistance or absence of insulin that will allow glucose from blood to enter into the cells. The body will be unable to convert food you eat into energy. This lack of energy will increase hunger.

5. Ketonemia, Ketonuria, and ketone acidosis: without enough insulin, body cells are not receiving glucose to be converted into energy. so that, the body will use fats as fuel. This process causes the buildup of acids in the bloodstream called ketones that lead to diabetic ketoacidosis, ketones are acids that lower blood pH, causing acidosis. Acidosis can lead to diabetic coma, which can result in death if the client is not treated quickly with fluids and insulin.

6. Diabetic coma: high concentration of glucose in the blood turns your blood thick and syrupy. The excessive sugar passes from your blood into urine which triggers a filtering process and lead to draw tremendous amounts of fluid from your body. This cause life threatening dehydration and a diabetic coma.

7. Vascular system lead to atherosclerosis: In addition to the symptoms previously mentioned, diabetic clients suffer from diseases of the vascular system. Atherosclerosis (this occurs when there is a heavy buildup of fatty substances inside artery walls, reducing blood flow) this can cause of the death among diabetic clients.

8. Retinopathy: This is caused by high concentration of sugar in the blood. Overtime and prolonged high concentration of glucose in the blood lead to damage of your retina. So that, it will unable to send the signals to the brain through a nerve in the back of your eye (optic nerve).

9. Nephropathy: prolongation and uncontrolled hyperglycemia damage nerves and interferes in their ability to send signals, this cause the diabetic neuropathy. In addition, high concentration of sugar in the blood destroys the wall of capillaries that supply oxygen and nutrients to the neurons.

10. Hearing impairment: as we have seen, the overtime and prolonged high blood glucose level in the blood affecting the supply of blood, oxygen and nutrient to tiny nerves. This causes the damage of the nerves and blood vessels and affecting the person’s ability to hear.

11. Amputation: if a wound is not felt right way, it can’t be checked. Poor blood circulation can make it difficult to heal this wound and led to infection and other serious complication. Thus, amputation becomes necessary.  

5. MANAGEMENTS OF TYPE 2 DIABETES

The management of type 2 diabetes is intended to Control blood glucose level, Provide optimal nourishment for the client and prevent symptoms and thus delay the complications of the disease.

Treatment is typically beginning when blood tests indicate hyperglycemia or when other previously discussed symptoms and complication occur. By WHO, normal blood glucose levels are from about 80 to 126 mg/dl during fasting state and less than or equal to (≤ 200mg/dl) post 2hours of feeding.

Treatment can be by diet alone or by a diet combined with insulin or an oral glucose-lowering medication plus regulated exercise and the regular monitoring of the client’s blood glucose levels.

      A. NUTRITIONAL MANAGEMENT OF TYPE TWO DIABETES

The dietitian(nutritionist) needs to know; client’s diet history, food likes and dislike, lifestyle at the onset, client’s family history, other related diseases and financial capacity as well.

The client’s calorie needs will depend on age, activities, lean muscle mass, size, and recommended energy expenditure(REE). It is recommended that carbohydrates provide 50% to 60% of the calories.

Approximately 40% to 50% should be from complex carbohydrates (starches). The remaining 10% to 20% of carbohydrates could be from simple sugar. Research provides no evidence that carbohydrates from simple sugars are digested and absorbed more rapidly than are complex carbohydrates, and they do not appear to affect blood sugar control.

It is the total amount of carbohydrates eaten that affects blood sugar levels rather than the type. Fats should be limited to 30% of total calories, and proteins should provide from 15% to 20% of total calories. Lean proteins are advisable because they contain limited amounts of fats.

The client with type 2 diabetes may be overweight. The nutritional goal for this client is not only to keep blood glucose levels in the normal range but to lose weight as well. Exercise can help attain both goals.

Remarks: The total energy requirements for adult diabetic clients who are not overweight will be the same as for nondiabetic individuals. When clients are overweight, a reduction in calories will be built into the diet plans, typically allowing for a weight loss of 1 pound a week.

A diabetes meal plan can follow a number of different patterns and have a variable ratio of fats, proteins, and carbohydrates.

• Carbs consumed should be low glycemic index, and come from mainly in vegetables and fruits.
• Proteins should be mainly from the plant sources
•  Fats also should be based on plant sources
• Water and moderate physical exercises should be recommended.

         1. CARBOHYDRATES

Food with low glycemic index raise blood sugar slowly, and thus it is better choice for people with diabetes.  Main foods with low glycemic index are those complex carbohydrates.

Example of foods with low glycemic index are:

• Brown rice
• Whole wheat
• Vegetables
•  Fruits
• Potatoes
• Squash
• Corn
• Other root vegetables
• Etc.

The above starchy vegetables are the best eaten in smaller portions (1 cup) as part of a combination meal that includes protein and plant based fat.

Non-starchy vegetables such as green vegetables should be eaten in abundance, this because they have limited impact on blood sugar and also have many nutritional benefits like source of vitamins and minerals. We need at least 5 servings per day.

Simple carbs (high glycemic index) should be limited/avoided in diet plan of diabetic patients because they raise blood sugar level directly after consumed and also they don’t contain other nutrient to slow dawn the absorption of this sugar.

Some Examples of food with high glycemic are:

• Sugar
• White pasta
• White bread
• White potatoes
• Breakfast cereals
• Soda and other soft drinks 
• Fruits juice
• Pineapples
• Watermelon, and etc. 

           2. PROTEINS

Proteins provide slow steady energy with relatively little effect on blood sugar. Proteins especially plant-based should be the part of meal or snacks for diabetic patients. Proteins not only keeps blood sugar stable but also helps with sugar cravings and feeling full after eating(satiety), proteins may be both animals and plant sources but, animal sources may also be the sources of unhealthy saturated fat.

Good source of proteins is including;

• Beans
• Legumes
• Eggs
• Fish and seafood
• Organic dairy product
• Peas
• Tofu and soya foods
• Lean meat and etc.

                 

                   3. FATS

Fats have little direct effect on blood sugar; but, as part of meal, they are useful in slowing absorption of carbohydrates. Fats also have effects on health that are not related to blood sugar such as cardiovascular diseases.

Plant based fats such as olive oil, nuts, seeds and avocado oil are associated with lower cardiovascular diseases. Fats also contributes of feeling of satiety and can play a role in managing overeating and carbohydrates craving. 

     B. DRUGS USED IN TREATMENT OF TYPE 2 DIABETES

Types of drug	Mechanism	Risks and constraint
Metformin	To enhance the action of insulin
Sulphonylureas	To stimulate increased insulin secretion from the pancreas.	•      Potential risk of provoking hypoglycemia. •      Their use requires guidance on regular timing of meals and snacks.
Glycosidase inhibitors (acarbose)	To delay carbohydrate absorption from the gut

 

                          SUMMARY

Type 2 diabetes can be managed by diets alone or diets combined with oral medications. before preparing meal plan of diabetic patient, dietitian/nutritionist should know and take patient’s blood glucose, dietary history, ages, sex, family history, food like and dislikes, food available and affordable to him/her, other health problems, and etc.

Meal plan should provide essential nutrients body needs such energy giving food, body building foods and body protecting foods, water should be considered and moderate physical exercises as well. As we have seen diabetic patient needs to eat plant based food rather than animal’s food sources. Either fats or proteins are most important when are from plant sources.

 

References

Murdock, D. H. (2002) ‘Encyclopedia of Foods. A Guide to Healthy Nutrition’, Academic Press, p. 529. doi: 10.1146/annurev.nu.25.062205.100003.

States, U. (2012) Nutritive Value of Foods.

www.healthline.com>nutrition