Types of diabetes

1. ZERA INTERNATIONAL COLLEGE OF
HEALTH SCIENCES
DEPARTMENT OF CLINICAL MEDICINE
MEDICAL BIOCHEMISTRY & MEDICAL NUTRITION (MBC 120)
LECTURE 15
UNIT 4: NUTRITION IN CLINICAL CARE
- DIABETES MELLITUS
Mrs Natasha N Ng’andwe
BSc, BMS

2. INTRODUCTION
• Impaired insulin secretion or cells that are normally responsive to insulin
may become resistant to its effects or both.
• Pregnancy can also lead to abnormal glucose tolerance and the
condition known as gestational diabetes which often resolves after
pregnancy.
• This is a risky factor for type 2 diabetes
• Diabetes can also be caused by a medical condition that damage the
pancreas or interfere with insulin function.
• This leads to reduced utilization of glucose in muscle and adipose cells
and unrestrained gluconeogenesis (break down of fats and proteins) in

3. INTRODUCTION
• The result is hyperglycemia, a marked elevation in blood glucose levels
that can ultimately cause damage to the blood vessels, nerves and
tissues.
• Since insulin promotes the synthesis of triglycerides and protein in body
cells, a defect in insulin metabolism leads to the degradation of these
nutrients, an increase in fatty acid and triglyceride levels in the blood,
and muscle wasting.

4. SYMPTOMS
• Usually related to the degree of hyperglycemia present.
• Plasma glucose concentration > 200mg/dL is above renal threshhold.
• Presence of glucose in the urine draws additional water from the blood,
increasing the amount of urine produced.
Symptoms include;
 Frequent urination (Polyuria)
 Dehydration and increased thirst (Polydipsia)
 In some cases loss of weight and increased appetite (polyphagia)
 Blurred vision, due to exposure of eye tissues to hyperosmolar fluids.

5. SYMPTOMS
• Increased infections (weakened immune function)
• In some cases constant fatigue is the only symptom and may be related
to the altered energy metabolism, dehydration, or other effects of the
disease

6. TYPE 1DIABETES (ABSOLUTE INSULIN
DEFICIENCY)
• Accounts for about 5 to 10% of diabetes cases
• Affected persons are usually lean
• Have abrupt onset of symptoms before the age of 30 years (can also occur at any age)
• Dependent on exogenous insulin to prevent ketoacidosis and death.
Causes
 Idiopathic (no known etiology)
 Autoimmunity – destruction of beta cells of the pancreas (by viral infections, toxic
chemicals etc)
 Genetic susceptibility

7. TYPE 2 DIABETES MELLITUS
• Accounts for 90 to 95% of cases
• Affected persons are older than 30 years at diagnosis, although it is now
occurring frequently in young adults and children
• Individuals are not dependent on exogenous insulin for survival, they may
require it for adequate glycemic control.
• Often asymptomatic
• Primarily due to insulin resistance, a reduced sensitivity to insulin in muscle,
adipose, and liver cells.
• To compensate, the pancreas secretes larger amounts of insulin, and plasma
insulin concentrations can rise to abnormally high levels (hyperinsulinemia)

8. TYPE 2 DIABETES MELLITUS
• Overtime, the pancreas becomes less able to compensate for the cells’
reduced sensitivity to insulin, and hyperglycemia worsens.
• The high demand for insulin can eventually exhaust the beta cells of the
pancreas and lead to impaired insulin secretion and reduced plasma
insulin concentrations
• Type 2 diabetes is therefore associated with both insulin resistance and
relative insulin deficiency (the amount of insulin is insufficient to
compensate for its diminished effect in the cells).

9. CAUSES OF TYPE 2 DIABETES
• Actual cause is unknown
• But risk is substantially increased by obesity, aging, and physical
inactivity.
• An estimated 80 to 90% of individuals with type 2 are obese, and obesity
itself can directly cause some degree of insulin resistance
• Prevalence of type 2 increases with age >22% in persons >60years of
age
• However many cases remain un diagnosed.

10. TYPE 2 DIABETES IN CHILDREN AND
ADOLESCENTS
• Children and adolescents who are overweight or have a family history of
diabetes also are at increased risk.
• Ketoacidosis can result in macro vascular diseases such as; Coronary
artery disease, Peripheral vascular disease and cerebrovascular disease.
And also microvascular disease such as; Retinopathy, Nephropathy and
Neuropathy.

11. PREVENTION OF TYPE 2 DIABETES
 Weight management: A sustained weight loss of 5 to 10% of body
weight is recommended for overweight and obese individuals.
 Health eating behaviors should be encouraged to prevent additional
weight gain.
 Active lifestyle: At least 30 minutes of moderate physical activity, such
as brisk walking, is recommended daily.
 Dietary modifications: An increased intake of whole grains and dietary
fiber has been associated with a reduced risk of type 2 diabetes.
 Individuals who are overweight or obese should decrease their intake
of dietary fat to avoid consuming excessive energy.

12. MANAGEMENT OF DIABETES MELLITUS
 Monitoring blood glucose levels to determine adjustments in food
and medication, exercise, medication

13. GLYCEMIC INDEX
• Glycemic index is the relative ability of a carbohydrate to raise the level
of blood glucose.
• A carbohydrate high in glycemic index elevates blood glucose faster and
to a high level than one with low glycemic index.

14. GLYCEMIC INDEX OF COMMONLY EATEN
FOOD.
Food Glycemic Index
All bran cereal 51
Cornflakes 83
Oats 48
Chocolate 49
Doughnut 76
Pizza, cheese 60
Popcorn 55
Potato chips 56
Shortbread cookies 64
Jam 51
Pan cakes 77
Crackers (wheat) 67
Millet 71

15. GLYCEMIC INDEX OF COMMONLY EATEN
FOOD.
Food Glycemic Index
Corn meal 68
Honey 62
Table sugar 64
Macaroni 46
Fresh boiled carrots 49
Fresh sweet corn, boiled 56
Fresh peas boiled 48
Potato soup 38
Yam 54
Chocolate milk 35
Custard 43
Ice cream 60
Skim milk 32

16. GLYCEMIC INDEX OF COMMONLY EATEN
FOOD.
Food Glycemic Index
Soy milk 31
Whole milk 30
Plain Yoghurt 14
Fruit Yoghurt 36
Beans boiled 30
Kidney 29
Lentils 30
Lima beans 32
Soy,boiled 16
Hamburger bun 61
Oat and raising 54
Pizza, cheese 60
Apple juice 40

17. GLYCEMIC INDEX OF COMMONLY EATEN
FOOD.
Food Glycemic Index
Colas 65
Grape fruit juice 48
Orange juice 46
Pineapple juice 46