Diabetes Mellitus refers to diseases characterized by high glucose concentrations in the blood caused by malfunction in insulin secretion, insulin action, or both (Mahan and Escott-Stump, 2004, page 794). In the United States, the incidence of diabetes continues to increase. According to the Centers for Disease Control and Prevention (2008), a total of 23.6 million children and adults (or about 8% of the population) have diabetes in the year 2007. In the year 2007, the estimated cost of diabetes is $174 billion (American Diabetes Association, 2008, p. 596).
Generally, the two types of diabetes are type 1 (previously called insulin-dependent diabetes mellitus) and type 2 diabetes (previously called non-insulin-dependent diabetes mellitus). Type 1 diabetes occurs in 5-10% of all diagnosed cases of diabetes. It is primarily caused by the destruction of the pancreatic ß-cells, causing insulin deficiency which results in hyperglycemia, polyuria, polydipsia, weight loss, dehydration, electrolyte disturbance, and ketoacidosis. Meanwhile, type 2 diabetes is the more prevalent type (90-95%) that usually occurs to person older than 30 years, but it may still develop in any age. This type develops gradually, and usually goes undetected (Mahan and Escott-Stump, 2004, pp. 794-797).
In the management of type 2 diabetes, the key is in understanding the disease condition in order to address the health-related problems that come along with it. As the disease is analyzed, interventions could be applied in order to prevent further complications and to address any change or additional requirement of the body. Studying the disease condition includes tackling the organs affected, etiology/risk factors, and the pathophysiology.
In studying diabetes, it is important to understand the role of insulin in the body. Insulin is a hormone produced in the pancreas, by the specialized ß-cells (Mathur, 2008). Insulin is responsible for helping the glucose in the blood (from the digestion of food) to enter and be used by the cells of the body. If the ß-cells fail to produce insulin or if the cells of the body are unable to efficiently use insulin (insulin resistance), an abnormal increase in blood glucose (hyperglycemia) happens.
In most cases, hyperglycemia in type 2 diabetes is caused by a combination of ß-cell failure and insulin resistance. The development of this condition is often caused by the following factors as identified by Mahan and Escott-Stump (2004): genetic factors/race, pre-diabetes, history of gestational diabetes, obesity, and increased adiposity (pp. 797-798).
Researches have shown that certain race, specifically those belonging in the minority, are of high risk of developing diabetes. In addition, it is seen in populations that are products of urbanization. The possible explanation would be the related changes in diet, physical activity, and increased obesity, brought about by urbanization. Another explanation is the development of the “thrifty” gene among Native people that result in higher extraction of fat from small amounts of food, and in this time of high-fat processed food, this gene could lead to obesity and diabetes (Mahan and Escott-Stump, 2004, p. 795).
Meanwhile, pre-diabetes refers to a condition wherein the glucose level in the blood is higher than normal, but not yet high enough to be diagnosed as diabetes. This includes people who have impaired fasting glucose (IFG) and impaired glucose tolerance (IGT). This condition should be closely monitored because this could lead to type 2 diabetes, as well as heart disease and stroke (Centers for Disease Control and Prevention, 2008).
Obesity and increased adiposity are the most common risk factor of type 2 diabetes. In fact, the increase in cases of type 2 diabetes is attributed to the increase prevalence of obesity (Klein et al., 2004, p.257). According to Mahan and Escott-Stump (2004), increased fatty acid leads to decrease in insulin sensitivity at the cellular levels (page 797).
Complications of diabetes develop as a result of the abnormal blood glucose levels and the defective metabolism of carbohydrates, proteins and fats. The Center for Disease Control and Prevention (2008) identified the complications of diabetes in the U.S. as the following: heart disease and stroke; high blood pressure; blindness; kidney disease; and nervous system disease; amputations; dental disease; and complications during pregnancy.
The main objective in the management of diabetes mellitus is controlling the blood glucose levels and normalizing the metabolism of carbohydrates, proteins, and fats in order to prevent the occurrence of complications. For individuals with type 2 diabetes, nutritional management therapy (MNT) is used since they are not dependent on insulin for blood glucose control. The goal of MNT is to meet the nutritional requirements of diabetic individuals while maintaining their normal blood glucose. The key is in the proper planning of diet and proper selection of food items. A diabetic diet should be similar with a normal diet. The diet for the diabetic persons should not be restricting, instead in should be liberal, allowing an individual to eat what he wants, but in moderation. Also, it should be individualized and simplified to increase an individual’s acceptance of the diet (Kelly, 2003, p.859). However, the main difference would be the careful distribution of the carbohydrates within the day to prevent abnormal rise or decrease in the blood glucose levels (Mahan and Escott-Stump, 2004, pp. 801-803).
Another management would be lifestyle change including exercise. For obese people, proper diet and exercise is necessary for them to reach their normal nutritional status. This is important since a normal nutritional status improves glycemic control and obesity tends to lower blood glucose control (Klein et al., 2004, p.258). Exercise also helps in maintaining normal blood glucose levels, improves in insulin sensitivity, reduce cardiovascular risk factors, and control weight (Mahan and Escott-Stump, 2004, p. 807). The exercise should be based on the person’s age, interest, level of physical activity, and control of blood glucose levels. During exercise, it should be important to monitor blood glucose before, during, and after the exercise, to prevent hyperglycemia or hypoglycemia. The exercise should also be planned with appropriate diet for more controlled blood glucose levels (Mahan and Escott-Stump, 2004, p. 809).
Individuals with type 2 diabetes are not dependent to medications to control their blood glucose levels. However, oral glucose-lowering medications could be used by individuals with type 2 diabetes that have problems controlling their blood glucose levels with MNT alone. Mahan and Escott-Stump (2004) has identified four classes of oral medications (pp.809-810). First is insulin secretagoues (sulfonylureas and meglitinides) that stimulate insulin secretion from ß-cells; second is biguanides (metformin), wherein some types decrease hepatic glucose production, some increase insulin secretion, and some improve insulin sensitivity; third is thiazolidinediones (pioglitazone, rosiglitazone) that improve peripheral insulin sensitivity; fourth is alpha-glucosidase inhibitors (acarbose, miglitol) that delay carbohydrate absorption (pp.809-810). Individuals with type 2 diabetes may also require insulin use, like in cases of acute injury, infection, surgery, pregnancy, and other emergency events that require immediate normalization of blood glucose levels. Moreover, if normal levels of blood glucose cannot be maintained through MNT and oral medications, insulin could be used.
The most effective management for type 2 diabetes is the combination of proper nutrition, lifestyle improvements, and proper medical administration. Furthermore, a team of health care professionals consisting of doctors, dietitians, nurses, and other health professionals should lead in promoting healthy lifestyle to manage diabetes through nutrition education and medical awareness.
American Diabetes Association. Economic Cost of Diabetes in the U.S. in 2007.(2008). Diabetes Care, 31, 596-615. Retrieved April 29, 2009 from http://care.diabetesjournals.org/cgi/reprint/31/3/596?maxtoshow=&HITS=10&hits=10&RESULTFORMAT=&fulltext=economic+costs&searchid=1&FIRSTINDEX=0&sortspec=relevance&resourcetype=HWCIT
Centers for Disease Control and Prevention. (2008). National Diabetes Fact Sheet: general information and national estimates on diabetes in the United State, 2007. Retrieved April 29, 2009, from http://www.cdc.gov/diabetes/pubs/pdf/ndfs_2007.pdf
Kelley, D.E.(2003). Sugars and starch in the nutritional management of diabetes mellitus. The American Journal of Clinical Nutriton, 78, 858-64. Retrieved April 30, 2009, from http://www.ajcn.org/cgi/reprint/78/4/858S?maxtoshow=&HITS=10&hits=10&RESULTFORMAT=&fulltext=diabetes+complication&andorexactfulltext=and&searchid=1&FIRSTINDEX=10&sortspec=relevance&resourcetype=HWCIT
Klein, S. Sheard, N.F., Pi-Sunyer, X., Daly, A., Wylie-Rosett, J., Kulkarni K., et al. (2004). Weight management through lifestyle modification for the prevention and management of type 2 diabetes: rationale and strategies. A statement of the American Diabetes Association, the North American Association for the Study of Obesity, and the American Society for Clinical Nutrition. The American Journal of Clinical Nutriton, 80, 257-63. Retrieved April 30, 2009, from http://www.ajcn.org/cgi/reprint/80/2/257?maxtoshow=&HITS=10&hits=10&RESULTFORMAT=&fulltext=diabetes+obesity&andorexactfulltext=and&searchid=1&FIRSTINDEX=0&sortspec=relevance&resourcetype=HWCIT
Mahan, L. K., & Escott-Stump, S. (2004). Krause’s Food, Nutrition, and Diet Therapy. 11th ed. USA: W.B. Saunders Company.
Mathur, R. Diabetes Mellitus. (2008). MedicineNet.com. Retrieved April 29, 2009, from http://www.medicinenet.com/diabetes_mellitus/article.htm