I’m working on a nutrition question and need guidance to help me study.

please reply to both posts using apa format and scholar source thank you

post 1

It is important to note that type 1 versus type 2 diabetes differ in pathophysiology as it affects how the patient’s treatment plan goes. Having experienced seeing patients who are diabetic in hospitals during clinicals, it is definitely a common diagnosis seen across the board. Type 1 diabetes is usually diagnosed in children and adults. It develops when the body’s own immune system destroys the pancreatic beta cells. These pancreatic cells are the only cells in the body that produce the hormone insulin which regulates our blood glucose. Type 2 is the most common form of diabetes and is seen usually with adults, however, there have been increasing cases of children who get diagnosed with type 2 diabetes. Type 2 diabetes have etiology that include both genetic and environmental factors that affect beta-cell function and tissue insulin sensitivity. With the pathophysiology of type 2 diabetes, either the body doesn’t produce enough insulin, or the cells ignore the insulin secretions. It usually begins as insulin resistance and the cells don’t end up properly using the insulin and with the need for insulin rising, the pancreas gradually loses its ability to produce it. Glucose then builds up in the wrong area, and goes in the blood instead of the cells and it can cause other health implications such as kidney damage or heart disease, which is what I’ve commonly noticed over the span of the weeks I’ve spent at clinicals. Every morning, these patients get their blood glucose levels checked and this gives the nurses an idea of where their blood glucose levels are at and if they need insulin and if they need modifications to their diet, which they usually do and try to limit the sugar intake from their meals. This leads me to discuss the educational nutrition plan for patients with type 1 and type 2 diabetes. For type 1 diabetes, most individuals use long acting insulin which will continue to lower blood sugar over 24 hrs due to the fact that their immune system have destroyed the pancreatic beta cells. This means that it will lower blood sugar even if there is no glucose from dietary carbs to act upon. Therefore, skipping meals or eating late puts people at risk for hypoglycemia. For type 1 diabetic patient, their meal timing will be essential to include their nutrition plan for this reason. Foods to include in their nutrition plan includes complex carbohydrates such as whole wheat, oatmeal, fruits and vegetables. For type 2 diabetes, foods included should be rationed out to have balanced fats, proteins, and complex carbohydrates, basically the main macronutrients and avoid the simple carbohydrates. One type of PO med for type 2 diabetes is called Glucotrol, or glipizide. This PO med can cause upsetting of the GI, so as a nurse, you would want to administer with food and monitor for any signs of nausea or vomiting. For insulin that is long acting like discussed earlier, it will be important to make sure the patient does not become hypoglycemic and make sure they are eating their meals on time.

Pathophysiology of Diabetes Mellitus. Kindred. (n.d.). https://www.kindredhealthcare.com/resources/blog-kindred-continuum/2013/11/07/pathophysiology-of-diabetes-mellitus.

POST 2

Discuss the pathophysiology of type 1 and type 2 diabetes.

Diabetes triggers chronically increased blood sugar levels (hyperglycemia) due to either insufficient insulin production by the pancreas or insulin resistance of the cells in the body (LevelUpRN, 2020). In type 1 diabetes, an autoimmune dysfunction kills beta cells in the pancreas, leading to a lack of insulin secretion. Patients with type 1 diabetes are insulin-dependent and will require insulin for the rest of their lives for the glucose to get from their bloodstream into the cells. Type 1 diabetes is identified as juvenile diabetes because it is most often detected in children, can also strike adults (LevelUpRN, 2020). In type 2 diabetes is a result of progressive insulin resistance and diminished insulin production from the pancreas. Progressive insulin resistance indicates that insulin’s effectiveness at transporting glucose decreases over time insulin becomes less effective, usually occurring in adults, but there have been increasing cases of children with type 2 diabetes.

Develop a nutritional education plan for a person with type 1 diabetes and a person with type 2 diabetes.

The diets for both type 1 and type 2 are similar, with the significant differentiation being the absence of insulin and insulin resistance. Both require healthy eating habits, with type 2 focusing on weight loss or maintenance. If you have type 1 diabetes, most likely, you will work with your doctor to identify how much insulin is needed to inject after eating meals. For instance, carbohydrates can cause blood sugar levels to increase quickly. You will need to counteract this by taking insulin, but you will need to know how much insulin to take.

Individuals with type 2 diabetes need to focus on healthy eating. Weight loss is often a part of type 2 diabetes treatment plans, so your doctor may recommend a low-calorie meal plan by reducing animal fats and junk food consumption. Consistently eating at the same time every day is essential for some people, especially those who take long-acting insulin. If the person skips or delays a meal, they are at risk for developing low blood glucose. Carbohydrates are the primary energy resource in the diet and include starches, vegetables, fruits, dairy products, and sugars (Evert et al., 2019). Eating a consistent quantity of carbohydrates at each meal can help control blood sugar levels, especially if you take long-acting insulin (Evert et al., 2019).

A diet that includes carbohydrates from fruits, vegetables, whole grains, legumes, and low-fat milk is encouraged. People with diabetes should avoid sugar-sweetened beverages. An assortment of eating patterns such as low fat, low carbohydrate, Mediterranean, and vegetarian are acceptable (Evert et al., 2019). Fat quality is more critical than fat quantity (ADA, 2021). Saturated and trans fat contribute to coronary heart disease, while monounsaturated and polyunsaturated fats are comparatively protective. People with diabetes are at enhanced risk for heart disease and stroke. Following a diet plan low in saturated fat, trans fats, and cholesterol can reduce cholesterol levels and decrease these risks (ADA, 2021). A high fiber diet (25 to 30 grams per day) may help control blood sugar levels and glycated hemoglobin. Also, a diet that is low in sodium (less than 2300 mg per day) and high in fruits, low-fat dairy products, and vegetables can help manage blood pressure (ADA, 2021). For individuals with diabetes and heart failure, a low sodium diet may reduce symptoms. Saturated fats, found in meats, cheese, ice cream, can be replaced with monounsaturated and polyunsaturated fatty acids found in fish, olive oil, nuts. Trans fatty acid intake should be kept as low as possible. Although minimal amounts of trans fats are naturally present in meats, poultry, and dairy products, the quantity is too small for concern (ADA, 2021). Eating a consistent amount of food every day and taking medications as directed can significantly improve blood sugar control and decrease the risk of diabetes-related complications. Also, a dietitian can help to create a food plan tailored to a patient’s medical needs, lifestyle, and personal preferences.

Your educational plan includes the nutritional considerations and medication interactions for at least one oral medication and one type of insulin.

Taking certain medications while taking metformin can increase the risk of developing lactic acidosis. You should inform your provider if you are taking diuretics (acetazolamide), corticosteroid (prednisone), blood pressure medication (amlodipine), anticonvulsants (topiramate and zonisamide), oral contraceptives, and antipsychotic drugs, such as chlorpromazine (Seladi-Schulman, 2020). Avoid drinking large quantities of alcohol while on metformin. Drinking alcohol while taking metformin raises your risk of developing low blood sugar or even lactic acidosis (Seladi-Schulman, 2020). According to the University of Michigan, one should avoid eating high-fiber foods after taking metformin, as fiber can bind to drugs and reduce their concentration (Seladi-Schulman, 2020). Metformin levels decrease when taken with large amounts of fiber (> 30 grams per day). You do not have to eat particular foods when you have diabetes. Carbohydrates raise blood sugar higher and quicker than any other nutrient. The more carbs you eat at one meal, the higher your blood sugar will rise (ADA, 2021).

Insulin regular (human) injectable solution can interact with many other medications, and different interactions can cause different effects. For instance, several can interfere with how well a drug works, while others can cause increased side effects. Taking thiazolidinediones with regular insulin (human) may cause fluid retention and heart failure. Examples of these drugs include pioglitazone or rosiglitazone. Taking pramlintide in addition to insulin regular (human) may cause very low blood sugar. Taking certain antibiotic drugs may cause high or low blood sugar levels. An example of this would be sulfonamide and pentamidine. Foods recommended when taking insulin regular (human) should include foods that help stabilize insulin and blood sugar. These include non-starchy vegetables, whole grains, healthy fats, fish, and cacao (ADA, 2021). Foods to avoid or consume in limited amounts include sugary drinks, juices, and sports drinks, processed foods and baked goods, white rice, bread, and pasta, breakfast cereals with added sugar, yogurts with added sugar, honey and maple syrup, flavored, sugary coffee drinks, and dried fruit (ADA, 2021).

References

American Diabetes Association (2021). Facilitating behavior change and well-being to improve health outcomes: standards of medical care in diabetes-2021. Diabetes care, 44(Suppl 1), S53–S72. https://doi.org/10.2337/dc21-S005

Evert, A. B., Dennison, M., Gardner, C. D., Garvey, W. T., Lau, K., MacLeod, J., Mitri, J., Pereira, R. F., Rawlings, K., Robinson, S., Saslow, L., Uelmen, S., Urbanski, P. B., & Yancy, W. S., Jr (2019). Nutrition therapy for adults with diabetes or prediabetes: a consensus report. Diabetes care, 42(5), 731–754. https://doi.org/10.2337/dci19-0014

LevelUpRN. (2020). Med-Surg endocrine system Part 18: Diabetes mellitus. https://www.leveluprn.com/blogs/medical-surgical-n…

Seladi-Schulman, J. (2020). Grapefruit and metformin: Is it safe? Healthline. https://www.healthline.com/health/grapefruit-and-m…