Page 511 - Nutrition Essentials for Nursing Practice

C H A P T E R 1 9 Nutrition for Patients with Diabetes Mellitus 499

(Anderson, Riley, and Everette, 2012). The statistics are staggering (Centers for Disease
Control and Prevention [CDC], 2011).

■ In 2010, an estimated 25.8 million Americans, or 8.3% of the population, had diabetes.
Of those cases, 7 million were undiagnosed.

■ More than 35% of American adults have prediabetes based on fasting glucose or hemo-
globin A1c levels.

■ In 2010, an estimated 1.9 million Americans aged 20 years or older were newly diag-
nosed with diabetes.

■ Diabetes is the seventh leading cause of death in the United States.
■ The estimated direct and indirect cost associated with diabetes in 2010 was $174 billion.

This estimate does not include the economic cost of undiagnosed diabetes or the im-
measurable costs of pain and suffering related to diabetes (Fowler, 2010).

Type 1 Diabetes: Type 1 Diabetes
diabetes characterized
by the absence of Type 1 diabetes, formerly known as insulin-dependent diabetes mellitus or juvenile dia-
insulin secretion. betes, is characterized by the absence of insulin. It occurs from an autoimmune response
that damages or destroys pancreatic beta cells, leaving them unable to produce insulin.
Polyuria: excessive Interaction between genetic susceptibility and environmental factors, such as viral infec-
urine excretion. tion, is thought to be responsible for type 1 diabetes (Fowler, 2010). There is no known
way to prevent type 1 diabetes. All people with type 1 diabetes require exogenous insulin
Polydipsia: excessive for survival.
thirst.
Although it can occur at any age, type 1 diabetes is most often detected in children
Polyphagia: excessive and adolescents. The classic symptoms of polyuria, polydipsia, and polyphagia appear
appetite. abruptly. Sometimes, the first sign of the disease is ketoacidosis. Type 1 diabetes accounts
for 5% to 10% of all diagnosed diabetes cases.
Ketoacidosis: the
accumulation of ketone Type 2 Diabetes
bodies leading to
acidosis related to Type 2 diabetes, previously referred to as non–insulin-dependent diabetes or adult-onset
incomplete breakdown diabetes, can occur at any age and accounts for 90% to 95% of diagnosed cases of diabetes.
of fatty acids from Unlike type 1 diabetes, in which there is a relatively abrupt and absolute end to insulin
carbohydrate deficiency production, type 2 diabetes is a slowly progressive disease characterized by a combination
or inadequate carbohy- of insulin resistance and relative insulin deficiency (Fowler, 2010). When cells do not re-
drate utilization. spond to insulin as they should, the pancreas compensates by secreting higher than normal
levels of insulin. This period of impaired glucose tolerance/impaired fasting glucose
Insulin Resistance: is known as prediabetes: glucose levels are normal or slightly elevated to levels below the
decreased cellular criteria for diabetes and insulin levels are increased. Over time, chronic hyperinsulinemia
response to insulin. leads to a decrease in the number of insulin receptors on the cells and a further reduction
in tissue sensitivity to insulin. Insulin production progressively falls to a deficient level,
Impaired Glucose and frank type 2 diabetes develops. Because hyperglycemia develops gradually in type 2
Tolerance: 2-hour diabetes and is often not severe enough for patients to recognize any of the classic diabetes
values in the oral symptoms, type 2 diabetes may go undiagnosed for years. Many patients will have already
glucose tolerance test developed complications by the time of diagnosis (Ahmad and Crandall, 2010).
of 140 to 199 mg/dL.
Risk factors for type 2 diabetes appear is Box 19.1. Overweight and obesity are strongly
Impaired Fasting correlated with the development of type 2 diabetes and may be responsible for the growing
Glucose: fasting epidemic (Fowler, 2010). Other risks are increasing age, lack of physical activity, and race/
plasma glucose levels ethnicity. Abdominal obesity, abnormal serum lipid levels (low high-density lipoprotein
of 100 to 125 mg/dL. cholesterol and/or high triglycerides), and hypertension are additional risks that are shared

Prediabetes: fasting
plasma glucose of 100
to 126 mg/dL or an oral
glucose tolerance test
of 140 to 199 mg/dL.

Hyperinsulinemia:
elevated blood levels
of insulin.