Page 513 - Nutrition Essentials for Nursing Practice

C H A P T E R 1 9 Nutrition for Patients with Diabetes Mellitus 501

Sorbitol: the alcohol ■ Not a member of en ethnic/racial group with a high prevalence of diabetes, such as Native
counterpart of glucose. Americans, Hispanic Americans, Mexican Americans, African Americans, Asian Americans,
High glucose levels can and Pacific Islanders
lead to an accumulation
of sorbitol in cells, Women at average risk of GDM should be tested at 24 to 28 weeks of gestation; those at
which exerts osmotic high risk should be tested as soon as feasible and retested at 24 to 28 weeks if not diagnosed
pressure. at screening. For more on GDM, see Chapter 11.

Glycoproteins: Long-Term Complications
compounds containing
glucose or glucose Sustained hyperglycemia alters glucose metabolism in virtually every tissue. Damage to
fragments and proteins; small vessels (microvascular) can lead to retinopathy, nephropathy, and neuropathy. Large
high glucose levels can blood vessel (macrovascular) damage increases the risk of cardiovascular disease and stroke.
promote their formation. Other complications include impaired wound healing, gangrene, periodontal disease, and
increased susceptibility to other illnesses. Although the precise mechanisms by which dia-
Oxidative Stress: betes causes long-term complications are not completely understood, damage is likely to
the state in which the arise from several different mechanisms, such as an accumulation of sorbitol, injury from
production of oxidants glycoproteins, and oxidative stress (Fowler, 2011).
(e.g., oxygen and other
substances that oxidize Studies show that improved glycemic control can reduce the risk of complications in
other compounds) and both type 1 and type 2 diabetes. According to the CDC (2011),
free radicals exceeds
the body’s ability ■ Every percentage point drop in hemoglobin A1c can reduce the risk of microvascular
to neutralize their complications (retinopathy, nephropathy, neuropathy) by 40%. Actual percentage im-
damaging effects. provement varies among subgroups.

■ Controlling blood pressure lowers the risk of cardiovascular disease in people with diabe-
tes by 33% to 50% and the risk of microvascular complications by approximately 33%.

■ Lowering low-density lipoprotein (LDL) cholesterol can reduce cardiovascular complica-
tions by 20% to 50%.

DIABETES MANAGEMENT

For both type 1 and type 2 diabetes, nutrition therapy, physical activity, and blood glu-
cose monitoring are integral components of management. Additionally, type 1 diabetes is
treated with insulin. If lifestyle interventions fail to achieve glycemic control in people with
type 2 diabetes, oral medications and often insulin are added to the regimen. Regardless of
the type of diabetes, nutrient recommendations are the same; only issues of body weight
and meal timing may differ between the two types of diabetes.

The ADA’s position statement on nutrition recommendations and interventions for dia-
betes are highlighted in the following sections. Goals and interventions are specified for three
levels of prevention: the primary prevention of diabetes among people with prediabetes or at
high-risk of diabetes; the secondary prevention of managing existing diabetes; and the tertiary
prevention of preventing or slowing the rate of diabetes complications (Bantle et al., 2008).

Preventing Diabetes

Because of the strong link between excess weight and insulin resistance/type 2 diabetes,
weight loss, through a combination of healthy eating and exercise, is the primary focus
of diabetes prevention (Box 19.2). A major, multicenter clinical trial called the Diabetes
Prevention Program (DPP) found that in a diverse group of overweight people with im-
paired glucose tolerance, diet, exercise, and behavior modification decreased the incidence