The Role of Nutrition in the Prevention of Diabetes Mellitus

Diabetes Mellitus is a condition that emerges due to the lack of insulin production or the failure of the body to use insulin. The incidence of the condition has been increasing steadily over the years due to factors such as low mortality, increased obesity incidences, and extended life expectancy. About 400 million people across the world suffer from the condition with expectations of people suffering from the condition to reach nearly 600 million by 2030 (Zaccardi, Webb, Yates & Davies, 2016). Nearly 30 million Americans have diabetes in which type 1 diabetes accounts for about 8 percent of all diabetes cases (CDC, 2019). The condition is in two forms, type 1 diabetes that relies on insulin and type 2 diabetes that does not depend on insulin. Type 1 diabetes is also called juvenile-onset diabetes as it affects children mostly. Type 2 diabetes is the dominant condition that affects adults mostly. Type 1 diabetes is an autoimmune condition that is influenced by genes in which the immune system harms its Langerhans beta cells inside the pancreatic islet due to exposure to toxic materials or pathogenic infections. The pancreatic islet produces insulin. The damage results in less or lack of insulin production. Nearly 10 percent of patients suffering from type 1 diabetes suffer from the idiopathic condition without identified causes (Zaccardi et al., 2016). Type 2 diabetes emerges either due to inadequate insulin production or the incapability of the body to use the produced insulin. Risk factors for type 2 diabetes include genes, adults over 45 years old, hypertension, history of gestational diabetes, overweight, hypercholesterolemia, inactive lifestyle, abdominal obesity, and poor diet. People suffering from type 2 diabetes experience insulin resistance leading to a modified response to glucose that causes hyperglycemia. 

The current paper investigates diabetes mellitus by examining its etiology, progression, alteration in health, treatment, the role of nutrition in its prevention, recommended diet, required nursing assessment and intervention concerning nutrition, components of client education, and strategies to encourage patients to adhere to the recommended diet. 

Etiology 

The autoimmune destruction of pancreatic beta cells causes type 1 diabetes. Environmental factors trigger this process in genetically vulnerable people. Type 1 diabetes symptoms emerge after nearly 75 percent of the beta cells have been damaged since this causes the body to become incapable of maintaining normal serum glucose levels. Environmental factors here may include enteroviruses, cytotoxins, early life dietary issues such as lack of vitamin D or being exposed to dairy milk, and chemicals (Bonora & Defronzo, 2018). Enteroviruses are strongly associated with type 1 diabetes than other factors. Genetics also contribute to the development of type 1 diabetes in which genes such as HLA-DP, HLA-DQ, and HLA-DR that encode the major histocompatibility complex (MHC) genes are involved. These genes influence protein-coding to make them appear to be foreign to the immune system, which triggers autoimmune reactions that destroy pancreatic beta cells (Bonora & Defronzo, 2018). The influence of genetics is, nevertheless, inconclusive and needs further research. 

The etiology of type 2 diabetes involves insulin resistance and the gradual reduction in insulin secretion through the pancreatic beta cells (Bonora & Defronzo, 2018). The main cause of type 2 diabetes include genes and demographic or lifestyle factors. While specific genes increase the risk of developing type 2 diabetes, the illness emerges only after the genes interact with specific lifestyle factors (Bonora & Defronzo, 2018). The involved lifestyle factors include obesity, excess adipose tissue, sedentary lifestyle, age, and the existence of metabolic syndrome. 

Progression 

For type 1 diabetes, T cells, specifically the CD4+ and CD8+ destroy the insulin-producing pancreatic beta cells. The destruction causes insufficient insulin secretion, which leads to metabolic derangements. The destruction also leads to abnormal pancreatic alpha cell functioning leading to excessive glucagon production. High glucagon levels worsen the metabolic problems caused by inadequate insulin (Baynest, 2015). Insufficient insulin causes uninhibited lipolysis and high free fatty acid levels in blood plasma that inhibits the metabolism of glucose in peripheral tissues like the skeletal muscle. The result of this is impaired glucose use while the insufficient insulin reduces the expression of several genes required for a normal reaction to insulin such as glucokinase in the liver. 

Protein, lipid, and glucose metabolism mechanisms break down in type 2 diabetes, which leads impaired insulin production due to dysfunctional pancreatic beta cells and impaired insulin activity due to insulin resistance (Bonora & Defronzo, 2018). In insulin resistance, the many beta-cells are transformed to gain the ability to increase the supply of insulin and compensate for the abnormal insulin demand. In turn, this increases the concentration of insulin in the blood even though insulin resistance leads to inadequate insulin concentration to ensure normal glucose homeostasis. Glucose tolerance then emerges due to hyperinsulinemia and insulin resistance (Baynest, 2015). Insulin resistance leads to impaired insulin-mediated uptake of glucose in the periphery, impaired triglyceride uptake through fat, and incomplete hepatic glucose output suppression. Islet cells overcome insulin resistance by increasing the level of the produced insulin. For type 2 diabetes patients or those with impaired fasting glucose, endogenous production of glucose occurs at a faster rate. The increased rate occurs during hyperinsulinemia, which leads to hyperglycemia in the initial and intermediate stages of type 2 diabetes. 

The Alteration in Health (Disease) 

The main alteration in diabetes includes impaired protein, lipid, and glucose metabolism due to hyperglycemia. Other alterations occur in the cardiovascular system, the autonomic nervous system, and the peripheral system. Diabetes leads to long-term alterations such as retinopathy that can lead to vision loss, nephropathy that can cause renal failure, autonomic neuropathy that leads to cardiovascular, genitourinary, and gastrointestinal symptoms, and sexual dysfunction (Zaccardi et al., 2016). Diabetes can also cause cerebrovascular, peripheral arterial, and atherosclerotic cardiovascular illnesses. 

Symptoms 

The main symptoms of diabetes include polyuria, glycosuria, polydipsia, and polyphagia (Bonora & Defronzo, 2018). Polyuria involves increased production of urine due to high levels of blood glucose. Glycosuria refers to the presence of sugar in the urine due to excessive levels of blood glucose. Polydipsia refers to increase thirst due to dehydration caused by frequent urination. Polyphagia refers to increased hunger due to lack of glucose in the cells. The outcome of these symptoms leads to ketoacidosis in which the body breaks down fats and proteins to produce energy due to the lack of glucose that is used for metabolism. Weight loss also emerges due to protein and fat metabolism, mainly for type 1 diabetes. The absence of glucose uptake leads to lethargy as muscles lack energy. Visual disturbances also emerge such as blurred vision due to retina and lens damage. 

Diagnosis 

Four tests can be used in diabetes diagnosis. The A1C test computes the glucose concentration in the hemoglobin. A high A1C than 5.7 percent means a high average blood sugar concentration for the previous two to three months (Bonora & Defronzo, 2018). A1C from 5.7 to 6.4 shows prediabetes while A1C higher than 6.4 suggests type 2 diabetes. Fasting plasma glucose (FPG) test is another diagnostic tool that is performed following overnight fasting to measure the blood glucose. Normal FPG test outcomes are below 100 mg per dL. Diabetes diagnosis considers the existence of blood glucose levels equal to or more than 126 mg per ml following an overnight fast or the existence of blood glucose levels more than 200 mg per 100 ml in general. Random plasma glucose (RPG) test computes blood glucose level at a specific time. The RPG test result of more than 200 mg per dL shows diabetes. The Oral glucose tolerance test (OGTT) also measure blood glucose levels at intervals, prediabetes occurs if blood glucose ranges from 140 to 199 mg per dL (Bonora & Defronzo, 2018). Blood glucose level above 200 mg per dL demonstrates type 2 diabetes. 

Treatment 

For diabetes mellitus, treatment aims at decreasing the concentration of blood glucose to normal levels. Besides diet and physical activity, other treatment strategies entail insulin therapy and medications for controlling blood glucose levels (Bonora & Defronzo, 2018). For type 1 diabetes, insulin therapy is required. The therapy involves regular insulin injections based on patient requirements. The therapy may involve short-acting insulin injection that acts just like the normal body insulin upon injection or long-acting insulin that acts after about 24 hours upon injection. There is also rapid-acting insulin that acts within minutes after being inhaled. The level of insulin should be maintained at low levels to mimic the normal insulin secretion pattern. Insulin therapy also depends on dietary intake based on the physical activity level. For instance, more food and less insulin injection may be required if the physical activity intensity and frequency are high. 

Some drugs can be used to manage the levels of blood glucose for type 2 diabetes. These oral medications such as hypoglycemic drugs like sulfonylureas stimulate insulin secretion from the pancreas to decrease the levels of blood glucose. Antihyperglycemic drugs such as metformin focus on reducing glucose production and increasing insulin action on adipose tissues and muscles. Thiazolidinediones drugs are used to decrease insulin resistance of adipose and muscle cells and increase glucose transport into muscle and adipose tissues. 

The Role of Nutrition in the Prevention of Diabetes Mellitus 

Diabetes mellitus is a metabolic and endocrine disease that is linked directly to protein, lipid, and carbohydrate metabolism. Consequently, nutrition is key to the prevention or management of the disorder. It is possible to halt the development of the disease by implementing primary prevention strategies using. These strategies focus on reducing the risk of the disease by encouraging healthy nutritional choices combined with physical activity. 

Recommended Diet 

The recommended diet for the prevention of diabetes includes structured approaches that encourage moderate weight loss involving 7 percent of body weight, regular physical exercise spanning 150 minutes every week, and nutritional intake with a focus on decreased calorie and dietary fat intake (Bagchi & Sreejayan, 2012; Bonora & Defronzo, 2018). People are also encouraged to achieve the recommended dietary fiber involving 14g fiber per 1,000kcal and whole-grain diets. 

Nursing Assessment and Nursing Interventions Concerning Nutrition 

For patients with diabetes, management of the condition is vital. For patients with type 1 diabetes, it is important to integrate insulin therapy into the patient’s physical activity and dietary pattern. Patients using insulin pumps or rapid-acting insulin through injection must alter their meal insulin doses by considering the amount of calorie in the meals. Patients using fixed regular insulin doses must ensure the consistency of calorie intake regularly to ensure it remains constant concerning the amount and time. Patients can adjust insulin doses for arranged exercise and consider taking additional carbohydrate for unplanned exercise (Bagchi & Sreejayan, 2012). For type 2 diabetes, patients must consider reducing energy, trans and saturated fatty acids, sodium, and cholesterol intakes and exercise more to enhance blood pressure, dyslipidemia, and glycemia (Bonora & Defronzo, 2018). Nurses can use glucose monitoring to evaluate whether food and meal alterations are adequate to achieve blood glucose objectives or whether drugs are needed in addition to dietary interventions. 

The areas of nursing assessment relevant to diabetes include the history of the patient to examine how the patient is handling self-management and self-care of their condition, whether additional assistance is needed, whether they have developed any complications, and how they are coping with and adhering to dietary recommendations. The patient’s existing physical activity level can also be assessed to evaluate if improvements can be implemented or if patients can be enrolled in new exercise programs. 

Outline of Client Education Components 

It is also important to train patients regarding how to manage their condition through diet. The components of client education include teaching on: 

How to alter health habits by considering supportive diet choices and exercising while quitting smoking; 

How to check blood sugar and track their condition using a blood glucose monitor; 

How to self-administer insulin shots; 

How to cope with insulin reaction; 

How to identify high and low blood glucose symptoms and the steps to take if they happen; and 

How to examine feet for wounds that may necessitate medical attention. 

Strategies Ensure Adherence to the Recommended Diet. 

Different approaches can be used to help diabetic patients adhere to the recommended diet. Patients can be encouraged to join a diabetes support group that involve people facing the same issues. This helps a patient to comply with the recommendations because others in the group are also complying. People in the group can help the patient to stay on track if they face obstacles. Helping a patient get a mentor is also vital particularly during tough times. A mentor helps the patient to be more confident in adhering to dietary recommendations to improve their health. 

Conclusion 

Studies demonstrate the increasing incidence of diabetes cases, particularly type 2 diabetes, across the world. Diabetes is a serious illness that develops gradually without a known cure. People can implement dietary and life changes, nevertheless, to reduce the risk of developing the disease. Patients suffering from the condition can also adhere to the recommended nutrition and physical activity levels while monitoring their blood glucose levels and taking the required medications to manage their condition. It is, however, challenging to prevent or cure type 1 diabetes effectively. Management is therefore vital in slowing the severity and progression of the disease complications. It is possible to prevent type 2 diabetes through nutrition and lifestyle changes. 

References 

Bagchi, D., & Sreejayan, N. (2012).  Nutritional and therapeutic interventions for diabetes and metabolic syndrome . Elsevier Academic Press. 

Baynest, H. W. (2015). Classification, Pathophysiology, Diagnosis and Management of Diabetes Mellitus.  Journal of Diabetes & Metabolism ,  06 (05). https://doi.org/10.4172/2155- 6156.1000541 

Bonora, E., & Defronzo, R. A. (2018).  Diabetes Epidemiology, Genetics, Pathogenesis, Diagnosis, Prevention, and Treatment . Cham Springer International Publishing. 

CDC. (2019).  National Diabetes Statistics Report . CDC. https://www.cdc.gov/diabetes/data/statistics/statistics-report.html 

Zaccardi, F., Webb, D. R., Yates, T., & Davies, M. J. (2016). Pathophysiology of type 1 and type 2 diabetes mellitus: a 90-year perspective.  Postgraduate Medical Journal ,  92 (1084), 63– 69. https://doi.org/10.1136/postgradmedj-2015-133281