DIABETES MELLITUS means (diabetes=flow through, Mel=honey) is a chronic metabolic disorder that prevents the body to utilize glucose completely or partially .It is characterized by raised glucose concentrating in the blood & alteration in CHO , Protein & fats metabolism. This can be due to failure in the formation of insulin or liberation or action since insulin is produced by the beta cell of the islet of Langerhans, any receding in the number of function cell will decrease the amounts of insulin that can be synthesized.
“Diabetes is no longer a dreaded disease ; well managed diabetes has a good life expectancy.”
CLASSIFICATION OF DIABETES MELLITUS:
- Insulin dependent diabetes mellitus (IDDM)
- Non-insulin dependent diabetes mellitus (NIDDM)
- Malnutrition related diabetes mellitus (MRD)
- Gestational diabetes mellitus
In insulin dependent diabetes mellitus also known as juvenile onset diabetes patient depend on insulin. There is usually sudden onset and occur in the younger age group and there is an inability of pancreas to produce adequate amount of insulin this may be caused by virus or due to auto immunity the child is usually underweight acidosis is fairly common.
Non-insulin dependent diabetes mellitus is non-insulin dependent form and develop slowly and is usually milder and more stable. Insulin may be produced by pancreas but action is impaired. This form occurs mainly in adult and the person is usually overweight. Acidosis is frequent in the majority of the patient improve with weight loss and are maintained on diet therapy. Women who have large baby number or family are also prone to develop this type of diabetes later in life.
Malnutrition Related Diabetes Mellitus:
Recently a third type of malnutrition related diabetes, MRDM called by WHO has been categorized as a separate entity. It occurs in some tropical country like India and age group of people between 15-30 year of age generally people with MRDM are lean and malnourished. In this type of DM the pancreas failed to produce adequate amount of insulin.
Gestational Diabetes Mellitus or Pregnancy and Diabetes:
Insulin requirement goes up to three time in pregnancy. In addition to ketoacidosis pregnant women with diabetes are more prone to pre eclampsia, toxemia, UTI, hydramnios. Uncontrolled DM during the first & third month of pregnancy increases the risk of abortion and congenital malformation in the fetus. Elevated maternal blood sugar level has a direct effect in the increased susceptibility of fetus developing diabetes later. A glucose tolerance tests value of more than 140 mg/dl after two hour with seventy five gm. of glucose is define indicator of gestational diabetes, the elevated glucose level has a cascading effect on the fetus as the mother glucose return fetus circulation.
The fetus start to secrete insulin in response to maternal glucose feed after the 11th week any abnormal amount of glucose from the mother in turn triggers the fetal pancreas to secrete more insulin to handle the glucose load.
Neonatal hypoglycemia and respiratory distress are common in newborn baby during pregnancy the diabetic should be given 30-35 kcal/kg of IBW. 1.5-2.5 kg of protein should be given.
SYMPTOMS OF DIABETES MELLITUS
- Polydipsia – increased thirst
- Polyuria – increased urination
- Polyphagia – increased hunger
- Weight loss (type1)
- Overweight (type2)
- Skin irritation
- Loss of strength
- Fluid and electrolyte imbalance
- Slow healing of wound
ETIOLOGY OF DIABETES MELLITUS
Genetic factor, infection, obesity, excess sugar intake, acute stress, HTN, sedentary lifestyle, low fiber diet.
PRINCIPLE OF DIET
Low calorie, high protein, adequate CHO, and low fat, high fiber diet is prescribed.
DIETARY MANAGEMENT OF DIABETES MELLITUS
The diet is “corner stone” in the management of diabetes mellitus.
A diabetic should be kept on a well-balanced diets providing just enough calories to maintain IBW .The latter depends on age, sex, height, and body frame. In an obese diabetic, the calories should be restricted to reduce body weight to ideal.
In a diabetic of normal weight, enough calories should be given to maintain weight. In a given to increase the weight to normal and maintain it.
The complex CHO should be suggested to the patient of diabetes because complex CHO are also content high amount of fiber which is helpful in maintaining the blood glucose level. Simple CHO are not given to the diabetic patient because it is easily digestible and gives rapidly to blood glucose level (energy) in the body.
A liberal use of CHO mainly complex form is needed for blood sugar to control . About 55-60% of total calorie is assigned to CHO.
Diabetic need not restricted the CHO intake but may have to alter the type of CHO in their diet. Most of the CHO should be in the form of polysaccharides such as bread, beans, cereals, etc. Rapidly absorbed mono & disaccharides such as sweets, chocolates, & sweetened drinks should be avoided. “Whole apple is better than apple juice because of its high fiber contents & low glycogenic index”.
Distribution of CHO:
33% of the diets served during lunch & 33 % of dinner 25 % serve during breakfast & rest 9 % during bedtime or evening.
SHORT ACTING – 2/5(BF, MM), 1/5(Lunch), 2/5 (Dinner & evening)
INTERMEDIATE – 1/7(BF), 2/7(L), 1/7(MM), 2/7(D), 1/7(Evening)
LONG ACTING – 2/5(BF), 2/5(L), 1/5(Dinner)
1/3(BF), 1/3(Lunch), 1/3(Dinner)
15-20 % of total calorie can be derived from protein the RDA of protein. Is 1 gm /kg of body wt from vegetable source are better than flesh food as they are rich in fiber & do not contribute cholesterol.
In Diabetic with associated renal problem, protein is restricted to .5gm/kg of body wt it should be of high Biological value.
Low fat diet increase binding and also reduce VLDL & LDL label and reduce the incidence of ATHEROSCLEROSIS which is more common in diabetes. Fat content in the diet should be 15-25 % of total calories and higher PUFA.
Vitamin and Mineral:
These are protective factor which are essential for the body. They are found in GLV, fresh fruit, milk and dairy product, serials, nuts, fish and eggs.
Diet containing high fiber or dietary fiber can reduce blood sugar level, serum cholesterol and relieve constipation.
High fiber food has a low glycolic index therefore diabetic should consume such food liberally. The diet high in CHO and fiber improve glucose metabolism without increasing insulin secretion dietary fiber and complex CHO benefit type 2 diabetes such diet lower the insulin requirement increase insulin sensitivity help in weight controlled, decrease serum cholesterol and triglyceride and lower B.P.
Recent studies related to FENUGREEK SEEDS have shown that it is very effective in reducing the blood glucose and cholesterol level. It contain Mucilaginous fiber and total fiber to the extent 20-50%. It also contain TRIGONELLINE a alkaloid known as to reduce blood glucose level. The quantity of fenugreek seed to be taken daily depends upon the severity of diabetes. The doses vary from 25-50 gm. To begin with 25 gm of fenugreek seed may be used in lunch and dinner. The seed can be taken as such after overnight soaking in water or in powdered form, as a drink with water or buttermilk before a meal.
The fenugreek seed powder is also incorporated in the preparation of roti, dal, and rice.
A liberal fluid intake is allowed.
FOOD TO BE INCLUDED:
- Well-cooked cereal and cereal product such as: – dosa, rice Flaxseed, poha, bread, upma, puffed rice, wheat burger.
- All pulses and legumes
- Skimmed milk and milk product
- All GLV and veg soup
- Fruit such as orange, watermelon, guava, apple, pomegranate, mausambi, pears, jamun, papaya, pineapple
FOOD TO BE AVOIDED:
- Alcoholic beverage, cold drink and smoking
- Simple sugar like jam, jelly, honey, sugar, glucose, fruit juice, sago
- Bakery product like cake, pastries, bun
- Strong tea and coffee
- Complan, horlicks, bournvita
- Fruits like mango, banana, custard apple, chiku, sweet potato.
- Oily foods with gravy
- Vegetable like arvi potato
- Fried food, fatty food, fast food, highly salty food
- Papad, pickle, sauces, chip and canned food
- Whole cream, ghee, butter, dalda
- Red meat, egg yolk, spices, chilly
- Low fat and oil should be avoided.
- Regular exercise is necessary.
- Fish-100gm, chicken-75gm, egg white-1 piece, paneer can be taken twice in a week.
- Artificial sweetener can give zero calories.
- 1 tablespoon of fenugreek seed powder can be taken with one glass of water in early morning.
- Avoid fasting.
- Have a regular walk.
- Health drink-“Resource Diabetic” or “D-Protein” and “Supplement D”.
INSULIN DEPENDENT DIABETES: (Short Term Insulin)
ONE DAY MENU PLAN
|Early morning||Tea (without sugar)||1 Cup|
|Biscuit(cream cracker)||2 piece|
|Tomato Salad||1 plate|
|Sprout (channa)||½ bowl|
|Egg white Salad||1 plate|
|Bedtime||Skimmed Milk||1 cup|