Type 2 Diabetes Mellitus (T2DM)

Important note: All information given are just guidelines and prevention options may vary to treatment options. You must consult a medical practitioner before altering, adding to or influencing current treatment or individual practices in any way shape or form.

  • Typically the onset of this disease has been after age 40 however there has been a considerable decline in that age in the past decade due to the increase in sedentary lifestyles and obesity levels among children.
  • 90% of all Diabetes cases are of Type 2 in relation.
  • Inactivity and obesity are the main causes.
  • T2DM arises from insulin receptors on cell surfaces of certain body tissue, especially muscle tissue. Blood glucose is not readily transferred into these cells – patient develops hyperglycaemia as a result (high glucose levels in the bloodstream). The pancreas attempts to increase insulin output to compensate-however eventually limits its ability to do this. Over time this continual pressure on the pancrease to overproduce insulin leads to pancreatic functioning failure, leading to a reduced overall insulin output – mimicking symptoms and treatments of Type 1 Diabetes Mellitus.
  • Key Point: Avoid – obesity, diet rich in animal and other solid fats, high Glycemic Index (GI) foods and inactivity/sedentary behaviours.
  • If associated with obesity T2DM often disappears as weight is lost!
  • Medication that decreases glucose production by liver – metformin.
  • Medication that increases the ability of the pancrease to release insulin – glipizide
  • Medication that increases the body’s response to its own insulin – rosiglitazone.
  • Eventually it may be necessary to inject insulin in T2DM, as nothing else may be able to control blood glucose.
  • Key Point: Regular physical activity helps the muscles take up more glucose.
  • Key Point: Regular meal patterns, emphasis on control of energy, low GI foods consumption and ample fiber intake are necessary in the prevention, maintenance and/or treatment of T2DM.
    Note: Most nuts fulfil the last 2 goals of low GI foods and ample fiber content.
  • Distributing Carbohydrates (CHO) throughout the day is important – helps minimising high and low swings in blood glucose levels.
  • Moderate alcohol consumption is fine.
  • Diagnosing T2DM – Plasma Glucose Concentrations (PGC).
    Diabetic – Fasting >7.0 PGC 2 Hour Post Glucose Load – >11.1 PGC <7.0 Fasting and <7.8 2 Hour Post Glucose Load PGC is considered normal.
  • Hypertension is common as well as high VLDL (very low density lipoproteins) and low HDL (high density lipoproteins) cholesterol levels.
  • Role of Insulin – Stimulates glucose uptake and metabolism by muscles and adipose cells. Also inhibits glucose output by the liver and stimulates amino acid uptake and protein synthesis.
  • Insulin resistance places a greater demand on the pancreatic capacity to produce insulin, which declines with age, leading to the development of diabetes.
  • As the percentage of central abdominal fat increases, insulin sensitivity decreases which means the ability of insulin to lower circulating glucose concentrations is more difficult resulting in greater glucose concentrations in
    the blood.
  • HaemoglobinA1C (HbA1C) – changes are steady over time and do not change during day-to-day functioning. Is the key marker to Glycemic control. Reflects mean glucose over the past 2-3 months.

Recommendations

  • Total energy – Reduce to cause energy deficit (Approx. 500 kilocalories per day = 0.5 to 1 kg loss per week). Important to note it is not the reduction in energy that is important but the deficit when comparing energy expenditure and intake!
  • Fats – Saturated, Polyunsaturated and Monounsaturated intake should be <30% total daily intake.
  • CHO – should account for 55-60% of total dietary intake.
  • Physical Activity: Skeletal muscles are the biggest net user of glucose (energy) – major site of circulating glucose. Muscle contractions elicit insulin like effects on glucose uptake.
  • Recommended guidelines to undertake in 30 min/day of moderate intensity physical activity on most if not all days of the week. Can be cumulative – i.e. Three 10 minute bouts of exercise throughout the day. Individuals should also enjoy some vigorous exercise whenever possible on most if not all days of the week.
    *Simple things like taking stairs instead of elevators really do help!
  • Key Message: Decrease total fat intake, increase overall fiber intake and increase exercise levels!
  • Increase consumption of foods rich in soluble fiber.
    – 2 pieces of fruit at least per day – with the skin on preferably.
    – 5 vegetables serves per day (1 serve = half a cup).
    – Eat lentils and legumes as regular foods.
  • Average dietary intake from most Australians is approximately 23 grams of fibre per day. Recommended daily intake is 30-35grams per day.
  • High CHO and fiber diets equal improved glycemic control and decreased insulin output, however this is often difficult to achieve and/or maintain.

Filed under: Useful Informations

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