1. DIETARY
MANAGEMENT OF
DIABETES MELLITUS
(DM)
Christianne Faith A. Mahinay, RND

2. DIABETES
MELLITUS

3. DEFINITION
Diabetes Mellitus is a group of
metabolic diseases characterized by
hyperglycemia resulting from defects
of in insulin secretion, insulin action,
or both.

4. CLASSIFICATION
 Type 1 DM
 Type 2 DM
 Gestational DM

5. TYPE 1 DM
• Formerly known as insulin-dependent
diabetes mellitus and juvenile onset
diabetes
• Generally occurs in young and lean
patients
• Inability of the pancreas to secrete insulin
because of autoimmune destruction of the
β-cells
• Patients are dependent on exogenous
source of insulin to their lives

6. TYPE 2 DM
• Non-insulin dependent diabetes mellitus
or adult onset diabetes
• Usually appears after the age of 40
• Risk increases with age and obesity
• Inability to make enough or properly use
insulin
• Most common form accounting for 90-
95% diabetes

7. GESTATIONAL DM
• Typically diagnosed during the 3rd
trimester and is related to the metabolic
changes during pregnancy
• Effect of insulin resistance
• GDM in pregnant women frequently
reverses immediately after delivery but
likely to develop Type 2 DM later in life

8. A. CLINICAL
1. Polyuria – frequent urination; abnormally large
volume of urine results when the kidneys have to
draw off liquid from the blood passing through it to
dissolve the excess glucose that has to be excreted.
2. Polydipsia – increased thirst, a response to the
excessive loss of water through the urine.
3. Polyphagia – increased appetite, resulting from the
failure of the cells to utilize nutrients properly.
SYMPTOMS OF DM

9. 4. Dehydration – due to excessive urinary output
which is not balanced by water intake.
5. Weight Loss – despite eating more than usual to
relieve hunger, glucose does not enter the cell due to
insulin resistance. The body uses alternative fuels
stored in muscle & fat.
6. Blurred vision – if your blood sugar is too high,
fluid may be pulled from the lenses of your eyes. This
may affect your ability to focus.
SYMPTOMS OF DM

10. 7. Slow-healing sores/frequent infections – Type 2
DM affects your ability to heal & resist infections.
8. Areas of darkened skin – some people w/ type 2
DM have patches of dark, velvety skin in the folds and
creases of their bodies – usually in the armpits and
neck. This condition, called acanthosisnigricans, may
be a sign of insulin resistance.
SYMPTOMS OF DM

11. B. BIOCHEMICAL
1. Glycosuria – presence of sugar in the urine;
occurs when renal threshold for sugar is
reached.
2. Hyperglycemia – elevated blood glucose
level due to absolute or relative lack of
insulin.
SYMPTOMS OF DM

12. 3. Ketosis or acidosis - accumulation of
ketone bodies (intermediate products of fatty
acid oxidation) due to rapid oxidation of fatty
acids when the cells cannot utilize glucose
effectively as a source of energy.
4. Ketonuria – presence of ketone bodies in
the urine
SYMPTOMS OF DM

13. Fasting
Blood Sugar
Test
Glucose
Tolerance Test
Self-Monitoring
Blood Glucose
(SMBG)
Urine
examination
Diagnostic & Monitoring Tests
Glycosylated
Hemoglobin
(HbA1C)

14. COMPLICATIONS
(short-term)

15.  Not a disease but a symptom of abnormalities in CHO
metabolism.
 Blood sugar below 70 mg/100 ml for mild symptoms &
below 50 mg for stupor.
 W/out treatment, stupor follows & with death impending
 Immediate treatment w/ CHO is essential
 If blood glucose falls below 70 mg/dL (3.9 mmol/L), 15g
CHO is given in the form of sweetened fruit juices, regular
soft drinks, sugar, candy, syrup, honey or any readily
available CHO.
HYPOGLYCEMIA/INSULIN SHOCK

16.  DKA is due to severe hyperglycemia
 If untreated, DKA can lead to coma & death
 Signs are similar with insulin shock
 acetone odor on the breath, painful rapid breathing,
drowsiness
 Symptoms of shock, unconsciousness & death
follow unless prompt measures are taken
HYPERGLYCEMIA/DIABETIC
KETOACIDOSIS (DKA)

17. SYMPTOMS OF ABNORMAL LEVELS OF BLOOD SUGAR
HYPERGLYCEMIA HYPOGLYCEMIA
• Dehydration
• Desire to drink excessive
fluids
• Dry mouth
• Fatigue
• Low blood pressure
• Low grade fever
• Polyuria
• Weight loss
• Anger
• Blurred vision
• Confusion
• Fearfulness
• Headache
• Lack of coordination
• Palpitations
• Sweating
• tremors

18.  A medical emergency & best treated in a
hospital where nursing care is available
 Intervention includes large doses of regular
insulin w/ small doses repeated as needed
every hour or so until the sugar in the urine is
reduced & blood sugar is lowered to <200
mg/dL
DIABETIC COMA

19.  Patient is given fruit juices, gruels, ginger ale,
tea & broth as soon as fluids can be taken
orally.
 2nd day: soft diet w/ 100-200g CHO
 3rd day: diet as tolerated (DAT) + particular
requirements
DIABETIC COMA

20.  Diabetic retinopathy
 Diabetic cataract
 Diabetic neuropathy
 Diabetic gastroparesis
 Diabetic nephropathy
 Cardiovascular disorders
 Periodontal disease
 Diabetic skin lesions
 Diabetic foot
LONG-TERM COMPLICATIONS

21. METHODS OF
INSULIN
THERAPY

22. INSULIN PEN

23. INSULIN INJECTION

24. INSULIN PUMP

25. AFREEZA INHALER

26. MANAGEMENT OF
DM

27. M – ONITORING
E – DUCATION
D – IET
E – XERCISE
M - EDICATION

28. MONITORING

29.  Glycemic control
 BP control
 Lipid profile
MONITORING

30. EDUCATION

31. 1. Diabetes Meal Plan
2. Food Guide Pyramid/Pinggang Pinoy
3. Food Exchange System
4. Carbohydrate Counting
EDUCATION

32. Glycemic Index
(GI)
• It is used to quantify &
compare the 2-hour
glycemic response of
individual foods.
• GI is the change in the blood
glucose after ingestion of a
particular food in
comparison w/ the change in
blood glucose after eating a
standard food.

33. Glycemic Index
(GI)
• The response is influenced
by the source & the form of
CHO & by the presence of
fiber, the length of time
required for digestion &
metabolism.

34. Glycemic Load
(GL)
• Combines the GI & the total
CHO content of an average
serving of a food.
• Defined as the weighted
mean of the dietary GI
multiplied by the percentage
of total energy from CHO.
Diets high in CHO (high GL)
w/ low glycemic index are
best for CVD risk reduction.

35. Glycemic Index of Selected Food
Items

36. DIET

37. 1. MNT is a process that includes the steps in nutrition care
process from nutrition assessment, nutrition diagnosis,
nutrition intervention and nutrition monitoring &
evaluation.
2. The term “diabetic diet” is now individualized to meet the
nutrition needs of the patient. The dietitian will need to
know the client’s diet history, food likes & dislikes, &
lifestyle at the onset. The client’s calorie needs will
depend on age, activities, lean muscle mass, size &
RRE.
3. Goals of nutrition therapy of DM:
NUTRITION THERAPY FOR DM

39. - Promote & support healthful eating patterns, in
appropriate sizes, to improve over-all health.
- Achieve & maintain reasonable weight, glycemic
control, lipid/lipoprotein profile & blood pressure
levels.
- Prevent or slow rate of development of chronic
complications.
NUTRITION THERAPY FOR DM

40. 4. Recommended dietary modifications (adopted from
American Diabetes Association, 2014)
5. Total calories should be sufficient to maintain/achieve
reasonable body weight in adults, or meet increased needs
of children, adolescents, pregnant & lactating women &
individuals recovering from catabolic illness.
NUTRITION THERAPY FOR DM

42. EXERCISE

43. A. LOW INTENSITY LEVEL
- > 150 mins/week of moderate-intensity activity or > 75
mins/week of vigorous-intensity aerobic activity, or some
combination of equivalent moderate/vigorous activity.
B. MEDIUM INTENSITY LEVEL
- > 300 mins/week of moderate-intensity activity or > 50
mins/week of vigorous-intensity aerobic activity, or some
combination of equivalent moderate/vigorous activity.
3. Exercise

44. C. HIGH INTENSITY LEVEL
- moderate or high intensity resistance exercise training
for all major muscle groups, as a separate modality from
aerobic exercise has been shown to increase muscle
mass & strength, improve glycemic control
- > 2 days/week combined with aerobic activity
3. Exercise

45. MEDICATION

46. 1. Oral Anti-Diabetes Drugs (OAD)

47. 2. Insulin

48. M – ONITORING
E – DUCATION
D – IET
E – XERCISE
M - EDICATION

49. END OF SLIDE