SPECIAL CONSIDERATIONS FOR THE DIABETIC CLIENT
The therapeutic value of fiber in the diabetic diet has become increas-ingly evident. High-fiber intake appears to reduce the amount of insulin needed because it lowers blood glucose. It also appears to lower the blood cholesterol and triglyceride levels. High-fiber may mean 25 to 35 grams of dietary fiber a day. Such high amounts can be difficult to include. High-fiber foods should be increased very gradually, as an abrupt increase can create intestinal gas and discomfort. When increasing fiber in the diet one must also increase intake of water. An increased fiber intake can affect mineral absorption.
Sucralose is the newest sweetener to gain approval by the FDA. Sucraloseis made from a sugar molecule that has been altered in such a way that the body will not absorb it. Aspartame is the generic name for a sweetener composed of two amino acids: phenylalanine and aspartic acid. The FDA removed the sweetener saccharine from its list of products that could cause cancer. Research indicates that all these sweeteners are safe. All have been approved by the FDA, and their use has been endorsed by the American Diabetes Association.
The use of diabetic or dietetic foods is generally a waste of money and can be misleading to the client. Often the containers of foods will contain the same ingredients as containers of foods prepared for the general public, but the cost is typically higher for the dietetic foods. There is potential danger for diabetic clients who use these foods if they do not read the labels on the food containers and assume that because they are labeled “dietetic,” they can be used with abandon. In reality, their use should be in specified amounts only, as these foods will contain carbohydrates, fats, and proteins that must be calculated in the total day’s diet.
It is advisable for the diabetic client to use foods prepared for the general public but to avoid those packed in syrup or oil. The important thing is for the diabetic client to read the label on all food containers purchased.
Although alcohol is not recommended for diabetic clients, its limited use is sometimes allowed if approved by the physician. However, some diabetic clients who use hypoglycemic agents cannot tolerate alcohol. When used, alcohol must be included in the diet plan.
Exercise helps the body use glucose by increasing insulin receptor sites and stimulating the creation of glucagon. It lowers cholesterol and blood pressure and reduces stress and body fat as it tones the muscles. For clients with type 2 diabetes, exercise helps improve weight control, glucose levels, and the cardio-vascular system.
However, for clients with type 1 diabetes, exercise can complicate glucose control. As it lowers glucose levels, hypoglycemia can develop. Exercise must be carefully discussed with the client’s physician. If done, it should be on a regular basis, and it must be considered carefully as the meal plans are devel-oped so that sufficient calories and insulin are prescribed.
Clients with type 1 diabetes must have injections of insulin every day to control their blood glucose levels (Figure 17-2). This insulin is called exogenousinsulin because it is produced outside the body. Endogenous insulin isproduced by the body.
Exogenous insulin is a protein. It must be injected because, if swallowed, it would be digested and would not reach the bloodstream as the complete hormone. After insulin treatment is begun, it is usually necessary for the client to continue it throughout life.
Human insulin is the most common insulin given to clients. This insulin does not come from humans but is made synthetically by a chemical process in a laboratory. Human insulin is preferred because it is very similar to insulin made by the pancreas. Animal insulin comes from cows or pigs and is called beef or pork insulin. These insulins are rarely used because they contain anti-bodies that make them less pure than human insulin.
Various types of insulin are available. They differ in the length of time required before they are effective and in the length of time they continue to act.
This latter category is called insulin action. Consequently, they are classified as very rapid-, rapid-, intermediate-, and long-acting. Those most commonly used are intermediate-acting types that work within 2 to 8 hours and are effective for 24 to 28 hours. For type 1 diabetes, insulin is often given in two or more injections daily and may contain more than one type of insulin. Injec-tions are given at prescribed times.
More insulin-dependent diabetic clients are using insulin-pump therapy for better blood glucose control. Pumps deliver insulin two ways: the basal rate and a premeal bolus. The basal rate is a small amount of short-acting insulin deliv-ered continuously throughout the day. This insulin keeps blood glucose in check between meals and during the night. Premeal boluses of short-acting insulin are designed to cover the food eaten during a meal. This allows more flexibility as to when meals are eaten. Insulin pumps are not for everyone. An endocrinologist and diabetes educator can determine the best candidates for pump therapy.
When clients do not eat the prescribed diet but continue to take the prescribed insulin, hypoglycemia can result. This is called an insulin reaction, or hypo-glycemic episode, and may lead tocomaand death. Symptoms includeheadache, blurred vision, tremors, confusion, poor coordination, and even-tual unconsciousness. Insulin reaction is dangerous because if frequent or prolonged, brain damage can occur. (The brain must have sufficient amounts of glucose in order to function.) The physician should be consulted if an insulin reaction occurs or seems imminent.
Conscious clients may be treated by giving them a glucose tablet, a sugar cube, or a beverage containing sugar followed by a complex carbohydrate. If the client is unconscious, intravenous treatment of dextrose and water is given. It is advisable for the diabetic client to carry identification explaining the condi-tion so that people do not think he or she is drunk when, in reality, the person is experiencing an insulin reaction.