- Through the digestion of carbohydrates
- Through the breakdown of glycogen. This storage polysacharride is made from excess glucose in a process called glycogenesis. Glycogen is particularly plentiful in the liver and muscle cells. When necessary, glycogen can be broken down quickly to release glucose in the process of glycogenolysis
- Conversion of a non-carbohydrate compounds following deamination, this conversion process is called gluconeogenesis
How the treatment for diabetes was discovered (3.0)
In early science, the way scientists studied an organs function in the body was to remove the organ and observe any effects of this loss. They would then inject a ground up extract of the gland, if symptoms were cured. The organ was then identified as an endocrine gland. By the beginning of the 20th century, this technique had clarified the role of numerous organs. Researchers had the idea that the pancreas was an endocrine gland, they encountered obstacles when trying to use this method to show that the pancreas produced the hormone responsible for controlling glucose metabolism.
After researchers removed the pancreas of a dog it presented signs of diabetes but when they injected the dog with the extract of ground up pancreas it did not irradiate any of the symptoms presented. A Canadian doctor hypothesised that digestive enzymes produced by the pancreas could be responsible for destroying any other active substances that were being made there. The Canadian doctors along with his assistant preformed experiments on the dogs, the animals were split into two groups A and B. The pancreatic ducts of group A dogs were tied so the dogs were unable to produce pancreatic juice. Over several weeks the cells of the acini degenerated leaving the islets of langerhans still functioning. Group A dogs did not become diabetic. The group B dogs had their pancreases removed and all became diabetic. The researchers then produced a pancreatic extract from the group A dogs and injected it into the group B dogs. The results were astounding, the researchers found an immediate reduction in blood sugar. The researchers proceeded with their research and began injecting humans with the same extract as the group B dogs. This proved disappointing as the humans became feverish. The help of biochemist James Collip was enlisted, he went on to produce a purer extract which could be used on humans.
Estimated diagnosed diabetes by Type and country for the UK (4.0)
The number of people with diabetes in the UK has jumped to 1.8m. According to Diabetes UK this is an increase of 400,000 in just eight years, and represents 3% of the total population. The charity predicts numbers will continue to rise as the population ages and becomes more overweight. Around £10m a day - 5% of the NHS budget - is currently spent on treating diabetes and its effects. That is predicted to rise to 10% by 2011. Of the 1.8m, almost 250,000 people have Type 1 diabetes and just over 1.5 million have Type 2 diabetes. It is estimated that there are up to a million people who have Type 2 diabetes but are yet be diagnosed.
Case Study One Before Diagnoses
Symptoms Suffered Previous to Diagnosis (5.1)
Paul Darling is a 26 year old male, he was not diagnosed with diabetes until he was 24 years old, he went to the doctors suffering from fatigue, weight loss, blurred vision and a frequent need to urinate along with an increase in thirst, these symptoms had been prevalent for seven months until seeing his General Practitioner. Paul had put these symptoms down to being in his 3rd year of university and feeling stressed. In the last couple of months before being diagnosed Paul had lost 11 pounds despite maintaining a healthy appetite.
Past Medical History (5.2)
Paul say’s before being diagnosed with diabetes he had no previous illness or hospitalization. He was not taking any medication and didn’t have any known allergies.
Family History (5.3)
Both Paul’s paternal grandparents suffered with diabetes, there is no known history of heart disease, obesity or hypertension in the family.
Social History (5.4)
Paul professes to drinking alcohol on the weekends but does not exceed his weekly recommendation of units. He does not smoke cigarettes and he drinks several cups of coffee daily. He did not follow a specific diet and reports on occasions his diet can be erratic by skipping breakfast, eating later in the evening and snacking at odd times during the course of the day. Paul exercises on a regular basis.
Vital Statistics (5.5)
Height: 178cm
Current Weight: 116 pounds
Usual Weight: 176 pounds
Heart Rate: 80 beats per minute
Blood Pressure: 102/70
Prior to Diagnosis Paul’s Usual Food Diary- 24 hour period (6.0)
Snack (7am ) Coffee with whole milk, 2 sugars
Breakfast (10am) Orange juice, bagel, cream cheese
Lunch (1:30pm) Beef bolognaise, cheese, 4 slices of white bread, mayonnaise, crisps and coca cola
Snack (5pm) Yoghurt
Dinner (8pm) Pizza, coca cola
Evening Snack (11pm) Jam Doughnut, ice- cream, whole milk
Nutritional Information (6.1)
From my calculations of looking at similar foods, I estimate the following:
Total Calories: 3239 calories per day
Protein: 13% of total calories
Fat: 38% of total calories
Carbohydrate: 49% of total calories
Fibre: 11% in diet
Diagnosis (6.2)
After Paul’s test results and based on his history, he was diagnosed with type 1 diabetes mellitus (insulin dependent diabetes mellitus) and he was referred to a diabetes clinic.
Medical explanation for Paul’s symptoms of fatigue, increased thirst, excess need to urinate and weight loss despite a good appetite (6.3)
Insulin deficiency reduces the uptake and utilization of glucose by the insulin sensitive tissues predominantly in the liver and skeletal muscles. As a result the conversion of glucose to glycogen in the liver is greatly diminished, the formation of glucose from sources such as amino acids is increased. These effects contribute to an acumination of glucose in the blood. When the blood sugar level exceeds the kidneys ability to reabsorb glucose from its ultrafiltrate it results in excessive loss of free water, glycosuria, and the elimination excessive glucose in the urine. Increased thirst and increased frequency and volume of urination is frequently associated with hyperglycemia. With the absence of insulin lipolysis is increased, as fatty acids are released from the adipose tissue they provide an alternative energy source to glucose, but when excessive amounts of these fatty acids are released, the liver produces ketone bodies. As the body has a limited capacity to metabolize ketone bodies as an energy source, excess ketone bodies accumulate in the blood and are excreated in the urine. The production of increased amounts ketosis can cause metabolic acidos. Although serum glucose levels are elevated, insulin must be present for the cellular uptake of glucose to occur. In insulin dependent diabetes the cells are in a starved state that causes an increase in appetite. As serum glucose levels and ketone bodies rise, the renal threshold is overwhelmed and the glucose and ketones are lost in the urine. Thus individuals with recent onset diabetes experience rapid weight loss.
Nutritional Analysis of Paul’s Diet Prior to Diagnosis (7.0)
Nutritional analysis is an essential role in the management of both type 1 and type 2 diabetes. Recommendations for a revised meal plan must be individualized to meet his needs and be flexible enough in order for Paul to continue with his current lifestyle, with minimal disruption. In order to meet the needs of Paul’s nutritional requirements I will need to bare in mind his social, economical situation, current lifestyle, ethnic or religious considerations, daily schedule, meal frequency, meals and snacks eaten away from the home and his physical activity level.
Calculating Paul’s Daily Calorie and Nutritional Requirements and Recommending Dietary Alterations (7.1)
I am going to calculate Paul’s daily calorie intake requirements using his height, weight and level of activity. From my calculations Paul should be consuming approximately 2740 calories per day. The current recommendation for an adult with diabetes from the Diabetes UK charity is their diet should be composed of 55 to 60 percent carbohydrate, 12 to 20 percent protein, 20 to 35 percent fibre and 25 to 30 percent fat. Looking at Paul’s previous daily diet, his diet was not optimal as his calorie and fat intake exceed the recommended daily allowance. Despite Paul consuming a more than adequate calorie intake, he was still loosing weight as he is unable to utilize the nutrients. Previously sufferers of diabetes were encouraged to limit carbohydrate in order to reach optimal glucose control, but this made the diet exceed the recommended fat intake. As diabetes increases the risk of coronary heart disease, it best to follow a low fat diet and increase the consumption of complex carbohydrates and foods high in fibre such as whole cereals, bran, grains and vegetables. Paul has a large intake of simple carbohydrates, these need to be reduced as simple carbohydrates can cause fluctuations in blood sugar levels. Fat should be limited to 30 percent of consumed calories, saturated and polyunsaturated fat should total 10 percent of the daily intake, whereas 15 per cent can be obtained from monosaturates.
Should Paul be Encouraged to Exercise? (8.0)
Exercise is an effective management tool for people with diabetes as it improves insulin sensitivity and lipoprotein profiles helping to maintain a desirable body weight and lower blood pressure. This can all assist in preventing further complications associated with diabetes. Paul embarking on an exercise program would need food and or insulin adjustments, based on monitoring of blood glucose levels and prior evaluation on he’s previous experiences. Paul would need to discuss with an expert practitioner how to avoid the risks of immediate and delayed hypoglycaemia and increased hyperglycaemia and ketosis.
Should Paul Continue to Drink Alcohol? (8.1)
Paul can continue to drink alcohol being cautious regarding alcohol usage. However for people with type 1 diabetes, moderation is essential. Paul should limit his alcohol consumption as it increases the risk of hypoglycaemia. An alcohol metabolism impairs neogenesis and inhibits the release of glucose from glycogen in the liver. Paul is currently taking evening NPH insulin, when he drinks excessively at night, quite often in the morning he experiences very low blood sugars in the middle of the night or early in the morning. To avoid this drop in low blood sugars Paul should eat whilst drinking an alcohol and avoid high sugar drinks and mixes.
Sample Revised Meal Plan For Paul (8.2)
Breakfast (7-7:30am) Bagel, Margarine, orange, Coffee
Lunch (12-12:30pm) Chicken sandwich on brown bread, light mayonnaise, low fat yoghurt, baked crisps and diet cola
Dinner (5-6:00pm) Tomato pasta with salad, banana and diet cola
Evening Snack (9-10pm) Low fat milk, tuna salad, brown bread
Nutritional Information
From my calculations of looking at similar foods I estimate the following:
Total calories: 2795 calories per day
Protein: 20% of total calories
Fat: 28% of total calories
Carbohydrates: 52% of total calories
Case Study Two after Diagnosis (9.0)
Jeremy Perkins is a 47 year old male who has had non-insulin dependent diabetes, he has been diagnosed for 6 years. He has recently been feeling unwell, he suspects his blood sugar levels are elevated, he has been urinating more frequently and feeling fatigued. He does not take any medication and does not test his blood sugar at home.
Past Medical History (9.1)
Jeremy has not had any previous hospitalisations or other illnesses.
Family History (9.2)
Jeremy’s family have a history of diabetes, his grandmother developed non-insulin dependent diabetes at 59 years old. There is no family history of hypertension, heart disease or obesity.
Social History (9.3)
Jeremy is a solicitor, is single and lives alone, he currently does not follow a specific diet. He drinks on average 2 beers a night when he comes home from work and he has never smoked. Jeremy does not take part in any regular exercise and does not take any vitamins or herbal supplements, he has no known allergies or intolerances.
Vital Statistics (9.4)
Height: 175cm
Weight: 98kg
Resting heart rate: 72 BPM
Blood pressure: 120/80
Jeremy’s Food Diary- 24 hour period (9.5)
Breakfast Raisin bran cereal with a chopped banana in whole milk and a glass of orange juice
Lunch 2 slices of corned beef, edam cheese, granary bread, coleslaw, French dressing, crisps and cranberry juice
Dinner Chinese fried rice, fried chicken, prawns and cashews, 2 beers and orange juice
Nutritional Information (9.6)
From my calculations of looking at similar foods, I estimate the following:
Total Calories: 3411 calories per day
Protein: 14% of total calories
Fat: 40% of total calories
Carbohydrate: 46% of total calories
Fibre: 11% in diet
Jeremy’s Ideal Body Weight (10.0)
From my calculations Jeremy is 34 percent over his ideal body weight, according to these results Jeremy is mildly obese. This is not unusual for a person with non-insulin-dependant diabetes, over 80 percent of people with type 1 diabetes are over their ideal body weight. Studies by the diabetes organisation charity suggest that even a loss of ten pounds can help to improve blood sugar levels. A reasonable weight goal for Jeremy is 175 pounds.
Revised Calorie Intake (10.1)
For Jeremy to loose weight he will need to reduce he’s daily calorie intake. In order to loose one pound per week Jeremy will need to reduce his calorie intake to 2911 calories per day and once his ideal body weight has been reached to maintain his weight he would need to follow a diet of 2100 calories per day bearing in mind his sedentary lifestyle. Jeremy’s glycemic control will improve with weight loss.
Nutritional Guidelines for Jeremy (10.2)
Jeremy’s fat intake should account for less than 30 percent of his total intake of calories and less than 10 percent of intake should come from saturated fat. As weight loss is a priority for Jeremy reducing his fat intake will help to reduce calories as fat is the most calorie dense nutrient.
Carbohydrate intake can account for 55 to 60 percent of the total calories consumed but this amount does vary according to the individuals eating habits, glucose and lipid level goals, previously starchy carbohydrates were advised but new scientific evidence has shown that sucrose containing foods as part of the total carbohydrate content are more stabilising for blood glucose levels.
Protein intake should account for 12 to 20 percent of the total calorie intake. High protein foods are usually high in fat, so Jeremy needs to select leaner red meats, fish, chicken and turkey.
Although some forms of fibre may delay the absorption of glucose from the small intestine, fibres overall effect on improving glycemic control is probably insignificant. Fibre intake for a person suffering from diabetes is the same as the general population. 20 to 35 grams of fibre per day is optimum from a variety of sources.
Ordinarily a vitamin supplement for people suffering from diabetes is not necessary if they are consuming a nutritionally balanced diet. However as Jeremy is planning on reducing his daily calorie intake to meet his desired weight goal, a multivitamin could be beneficial to him.
Analysis of Jeremy’s Current Diet (11.0)
People with Diabetes are at a greater risk of cardiovascular disease and in order to avoid this risk it is advised that they follow a low fat diet. At present Jeremy’s diet is providing him with 3411 calories per day, which is far higher than the 2100 calories he requires for weight maintenance. His total fat intake is also 40 per cent, again higher than the 30 percent of total calories. Jeremy’s high intake of fried foods, crisps, whole milk and large quantities of meat all contribute to his high fat and calorie intake. If Jeremy reduces his consumption of these foods, substituting them for foods lower in fat will reduce his fat and calorie intake, improve his blood sugar levels, and he most likely would lose weight.
Food Alternatives to Reduce Calorie and Fat intake (11.1)
Additional Lifestyle Changes (11.2)
An increase in physical activity could assist Jeremy in loosing weight and controlling his blood sugars. Exercise increases the number and binding capacity of the insulin receptors, lowers blood glucose levels in non insulin dependent diabetics, it also reduces insulin requirements in sufferers who use insulin to control hyperglycaemia and improves lipid levels, thereby reducing the risk of coronary heart disease that diabetic sufferers have an increased risk of. In an addition to this Jeremy could self monitor his blood glucose levels which would further educate him in managing his diabetes more effectively.
Conclusion (12.0)
Since Paul’s diagnoses of insulin dependent diabetes he has had a qualified dietician compose a revised meal plan for him, since implementing his revised diet the symptoms of fatigue, weight loss, blurred vision, a frequent need to urinate along with an increase in thirst have reduced dramatically. From this I conclude that Paul’s dietary changes have been a key factor in managing his diabetes along with he’s regular insulin injections. Jeremy’s high in fat and calorific diet was the most probable cause of him becoming diabetic as you are 80% more likely to get non-insulin dependent diabetes if you are overweight.
As I am not a qualified practitioner it would be unsafe for me to implement changes on Jeremy’s diet. So I am unable to prove or disprove my hypothesis that diabetes related health complaints i.e. excess thirst and urinating would be reduced if they were to make nutritional alterations to their current diet. However it is well documented that glucose levels can be controlled to an optimal level if the correct diet is implemented, with this I am able to conclude that if Jeremy reduced his fat and calorie intake he would lose weight, he would feel well, he’s blood sugar levels would stabilise, he’s excess need to urinate would decrease and he would have far more energy if Jeremy continues with his current lifestyle he as at an increased risk of cardiovascular disease.
Index
- Introduction and Hypothesis
- What is diabetes?
- Symptoms and type of diabetes
- How the treatment for diabetes was discovered
- Estimated diagnosed diabetes by type and country for the UK
- Case study one before diagnosis
5.1- Symptoms suffered previous to diagnosis
5.2- Past medical history
5.3- Family history
5.4- Social history
5.5- Vital statistics
6.0- Prior to diagnosis Paul’s usual food diary- 24 hour period
6.1- Nutritional information
6.2- Diagnoses
6.3- Medical explanation for Paul’s symptoms of fatigue, increased thirst, excess need to urinate and weight loss despite a good appetite
7.0- Nutritional analysis of Paul’s diet prior to diagnosis
7.1- Calculating Paul’s daily calorie and nutritional requirements and recommending dietary alterations
8.0- Should Paul be encouraged to exercise?
8.1- Should Paul continue to drink alcohol?
8.2- Sample revised meal plan for Paul
9.0- Case study two after diagnosis
9.1- Past medical history
9.2- Family history
9.3- Social history
9.4- Vital statistics
9.5- Jeremy’s food diary- 24 hour period
9.6- Nutritional information
10.0- Jeremy’s ideal body weight
10.1- Revised calorie intake
10.2- Nutritional guidelines for Jeremy
11.0- Analysis of Jeremy’s current diet
11.1- Food alterations to reduce calorie and fat intake
11.2- Additional lifestyle changes
12.0- Conclusion
13.0- Index
References
- British Diabetic Association Sub-Committee (1992) dietary recommendations for people with diabetes
- Nutrition in primary care- a handbook for health professionals, by Briony Thomas (1996)
- Providing diabetes care in general practice- a practical guide for the primary care team by M, Mackinnon (1993)
- Sugars and blood glucose control by J, Brand-Miller and T.M.S, Wolever (1995)
- Collins biology
- Alcohol and diabetes- Diabetes spectrum by M.J, Franze (1993)
- Prescription for exercise by E.S, Horton (1994)
- Stop Diabetes by Gretchen Becker (2003)
- Diabetes A to Z- what you need to know by American Diabetes Association (2000)
- Diabetes by Professor Peter Sonksen, Charles Fox and Sue Judd (2003)
- Beating Diabetes by David M. Nathan, M.D. and Linda M. Dehlanty, M.S., RD
