Type 1 diabetes mellitus is an autoimmune disorder caused by the destruction of the beta cells of the pancreas
Type 1 diabetes mellitus is an autoimmune disorder caused by the destruction of the beta cells of the pancreas
Post 1
Discuss the pathophysiology of type 1 and type 2 diabetes.
Type 1 diabetes mellitus is an autoimmune disorder caused by the destruction of the beta cells of the pancreas. There are also immune cells and antibodies in the blood, which can be triggered by certain viral infections or genetic types (Holman et al., 2019).
Type 2 diabetes mellitus is a chronic condition due to the cells’ inability to respond to insulin, causing insulin resistance and decreased insulin production by the beta cells. This type is linked to sedentary lifestyles, obesity, and genetics (Holman et al., 2019).
Develop a nutritional education plan for a person with type 1 diabetes and a person with type 2 diabetes.
According to Gray & Threlkeld (2019), one of the goals of the American Diabetes Association 2019 is to promote healthy eating patterns by recommending a variety of nutrient-dense foods in portion sizes appropriate for people with diabetes to help improve their overall health. A way to achieve this goal is to control insulin levels in people with diabetes by eating three meals a day at regular intervals and having a diabetic diet consisting of nutritious foods such as healthy carbohydrates, fiber-dense foods, seafood, and healthy fats (Mayo Clinic, 2021). Healthy carbohydrates and fiber-dense foods include fruit, vegetables, whole grains, and legumes. Examples of seafood include salmon and tuna, which are rich in omega-3 fatty acids and healthy fats like avocados and peanut oils (Mayo Clinic, 2021).
In your educational plan, include the nutritional considerations and medication interactions for at least one oral medication and one type of insulin.
Metformin belongs to the therapeutic class of antidiabetics. The mechanisms of action of metformin are to reduce glucose production in the liver, increase the sensitivity of insulin receptors, and increase glucose transport across the membrane. Important teaching while taking metformin is to caution patients to avoid alcohol since it can increase the risk of hypoglycemia and lactic acidosis (Vallerand & Sanoski, 2021).
Insulin glargine is a parenteral preparation antidiabetic medication that is a long-acting type working over 24 hrs. The mechanism of action of insulin is that it helps move glucose from the blood and into other tissues in the body for energy use, and it helps inhibit the liver from producing more glucose (Vallerand & Sanoski, 2021). Insulin glargine can cause low levels of potassium in the blood. Therefore, it is advised not to use other medications, salt substitutes containing potassium, or supplements unless the primary provider is aware (Mayo Clinic, 2023).
References:
Gray, A., & Threlkeld, R. J. (2019, October 13). Nutritional recommendations for individuals with diabetes – NCBI bookshelf. Retrieved February 28, 2023, from https://www.ncbi.nlm.nih.gov/books/NBK279012/
Holman, H. C., Williams, D., Johnson, J., Sommer, S., Ball, B. S., Morris, C., Leehy, P., Hertel, R., & Assessment Technologies Institute (Contributors). (2019). RN adult medical surgical nursing (11th ed.). Assessment Technologies Institute.
Mayo Foundation for Medical Education and Research. (2021, March 25). Diabetes diet: Create your healthy-eating plan. Mayo Clinic. Retrieved February 28, 2023, from https://www.mayoclinic.org/diseases conditions/diabetes/in-depth/diabetes-diet/art-20044295.
Mayo Foundation for Medical Education and Research. (2023, February 1). Insulin glargine, recombinant (subcutaneous route) precautions. Mayo Clinic. Retrieved February 28, 2023, from https://www.mayoclinic.org/drugs-supplements/insulin-glargine-recombinant-subcutaneous-route/precautions/drg-20067770
Vallerand, A. H., & Sanoski, C. A. (2021). Davis’s Drug Guide for Nurses (17th ed.). F.A. Davis Company.
Post 2
In both type 1 and 2 diabetes the patient’ body is not properly using glucose due to an abnormal amount of insulin in the body due to a dysregulation of its production by the pancreas. In type 1 diabetes, the islet autoantibodies indiscriminately attack the cells in the islet of Langerhans. As such the clinical presentations of Type1 diabetes do not show until enough pancreatic beta cells are destroyed that insulin needs can not be met (Lewis et al., 2019). Patients with Type 1 diabetes tend to come to the E.R. and are diagnosed because they developed diabetic ketoacidosis and are experiencing polyuria, polydipsia, and polyphagia. The destruction of pancreatic beta cells can also occur as a casualty to the immune system’s response to a viral infection. In Type 2 diabetes, the cells of the body does not absorb an appropriate amount of glucose from the blood due to insulin resistance, low insulin production, or excess glucose is produced by the liver (Lewis et al., 2019). A common scenario for the development of type 2 diabetes starts with a patient who consistently consumes an unhealthy and high calorie diet that requires an increased production of insulin by the pancreas. Overtime, the pancreas may hit its maximum in producing insulin or get fatigued and thus stop producing the amount of insulin needed to maintain normal blood glucose levels. The reason is unknown but another reason for abnormal blood glucose is that the liver releases glucose haphazardly instead of as needed to maintain homeostasis.
Nutritional goal for a patient with type 1 diabetes is to know the amount of carbohydrates consumed in a day as well as the glycemic index of the carbohydrates consumed so that the patient can adjust either the meals, for those with fixed insulin, or amount of insulin they inject so that blood glucose levels are regulated. A type 1 diabetic patient should consume 6 or more servings of fiber rich grains, dark green or yellow vegetables, and beans with a focus on eating whole grain foods and low fat breads (University of Florida Diabetes Institute, 2023). The patient should consume 2 to 3 servings of meat or fish and try to mostly eat lean cuts of meat and prepare the meat in any other way then frying. The patient should try to consume 2 to 4 servings of whole fruits and try to limit their consumption of fruit juices with added sweeteners and fruit juices in general. The patient can have 2 to 3 serving of nonfat milk or plain low-fat dairy products. The patient should generally limit consumption of fatty foods, especially those rich in saturated and trans fats, and have smaller portions of sweets (University of Florida Diabetes Institute, 2023). The main nutritional goal for a type 2 diabetic patient is to lower cholesterol and lipid levels while encouraging mild weight loss via lowering carbohydrate consumption to hopefully reverse the diabetes and prevent associated diseases from further progressing. Thus, the nutritional recommendations are similar for a type 2 diabetic patient as a type 1 diabetic patient but the type 2 diabetic patient’s carbohydrates and fat serving are a bit smaller.
A commonly prescribed long-acting insulin to keep blood glucose at baseline throughout the day even when the patient is not eating is called glargine, or Lantus. A patient on glargine should make sure not to skip meals and meet the caloric requirement the Lantus was adjusted to control. A patient on glargine should monitor their blood glucose more regularly if they are also on aspirin as the medications together can increase patient’s chance of developing hypoglycemia. A patient on glargine should monitor their blood glucose more regularly if they are also on Lasix as the medications together can limit the effectiveness of glargine and increase the patient’s chance of having elevated blood glucose. A commonly prescribed oral antidiabetic medication is Metformin. Similar to glargine, a patient on metformin should have regular meals to avoid a hypoglycemic episode. A patient on metformin should monitor their blood glucose more regularly if they are also on glargine as the medications together put the patient at significant risk for developing hypoglycemia. A patient on metformin should monitor their blood glucose more regularly if they are also on glargine as the medications together can limit the effectiveness of both.
References
Lewis, S. L., Dirksen, S. R., Heitkemper, M. M., & Bucher, L., & Camera, I. M. (2019). Medical-surgical nursing: Assessment and management of clinical problems. (11th ed.). Mosby Elsevier
University of Florida Diabetes Institute. (2023). Type 1 diabetes nutrition. https://diabetes.ufl.edu/outreach/resources/nutrition/type-1-diabetes/Links to an external site.
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