Diabetes Cure Help

Base your diet recommendations on treatment goals designed specifically for your patient . Consider the various roles of proteins, carbohydrates, fats, sweeteners, fiber, sodium, and alcohol in your patient’s diet.

Cultural and Ethnic Considerations

Each patient’s cultural and ethnic background strongly influences her food customs, eating rituals, food preparation, and body image. Religion also can affect dietary habits. For example, Hindus are vegetarians, and Orthodox Jews follow kosher dietary laws.

Family traditions may dictate mealtime habits and foods to be eaten or avoided. A patient’s finances, social status, and geographic region affect the type and availability of foods she eats, as well. The health care team performs a thorough nutritional assessment of cultural and ethnic practices and incorporates them into a personalized nutritional plan.

Food Labels

The Food and Drug Administration’s requirements for food labels have made a big difference to patients with diabetes as they shop for food. The information on labels is useful not only for assessing individual products but also for comparing ingredients of similar products and of different brands of the same product.

Show your patient several labels of healthful and less healthful foods. Point out that many imported foods lack nutritional information.

Ingredients on food labels are listed in descending order by weight. Determining total sugar content may take some analysis, however, because different forms can be listed separately. Give your patient a list of sugar’s many names, including sorghum, sucrose, lactose, and maple syrup. Explain that foods labeled dietetic aren’t necessarily sugar-free and that natural doesn’t mean sugar-free. Cane sugar, for example, is natural. Dietetic foods are usually more expensive, and they’re unnecessary for patients who make an effort to choose foods intelligently.

Food labels also list the number of calories, total fat content, and amount of saturated fat per serving. The difference between total fat and saturated fat is the portion that consists of polyunsaturated or monounsaturated fats. The polyunsaturated and monounsaturated fat content should be greater than the saturated fat content. Also listed are levels of cholesterol, sodium, total carbohydrate, fiber, sugar, and protein.

A food label promising no cholesterol can be misleading. Vegetable oils containing no cholesterol, for example, may be high in saturated fats. Also, teach your patient to scrutinize labels claiming that a food is a certain percentage fat free. A product that is 75% fat free contains 25% fat by weight-and even more than 25% of the total calories may come from fat. The total calories from fat, listed next to the total calories on the label, will give your patient a clearer picture of fat content. Teach her to carefully read labels boasting fewer calories, light, or lite.

Besides ingredients, food labels now list details of nutritional content. This information makes it easier for your patient to choose foods in accordance with her treatment goals.

The information on the food label is based on the serving size, which appears at the top of the food label. Make sure your patient understands that the nutritional content of the entire package isn’t being described unless the label states that the container has only one serving. The percent of daily value listed on the label is based on a 2,000-calorie diet; teach patients with a different calorie plan to take this into consideration.

Carbohydrates supply the body’s primary source of energy. The brain and red blood cells use only glucose, the building block of carbohydrates. The American Diabetes Association recommends determining your patient’s protein requirements, using the recommended dietary allowance of 0.8 g/kg of body weight for adults, before determining the desired amount of carbohydrates and fat. Also, use your patient’s treatment goals, habits, and blood glucose and lipid goals as guides.When your patient chooses which carbohydrates to consume, instruct her to focus on the glycemic value of a carbohydrate rather than on the type of carbohydrate, such as simple or complex. The glycemic index, created in 1981, provides average glycemic values of certain foods. It can help you predict the rise in blood glucose after your patient has eaten certain carbohydrates. Foods that raise blood glucose levels quickly have a high glycemic value. These include white bread, some cereals, glucose, and root vegetables, such as carrots and potatoes. Foods with a low glycemic value include nuts, legumes, dairy products, fructose, and raw fruits.

Advise your patient to use the index as a guide and to monitor her blood glucose levels after she eats certain foods. Make it clear, however, that the glycemic value of a food is not equivalent to its nutritional value. Although sucrose has a lower glycemic value than a potato, for example, it provides far less nutritional value. And inform your patient that the glycemic value of a food can rise or fall depending on many factors, including the ripeness of the food, the preparation of the food, and the other foods eaten at the same meal.

If your patient is using regular insulin, she can count grams of carbohydrates to help her make food choices. Instruct her to count the total number of grams of carbohydrate in a meal she’s planning to eat. She should then compare that number to the amount of carbohydrate recommended for that particular meal in her meal plan. If she’s consuming more than is recommended, she can increase her regular insulin dose by 1 unit for every additional 10 grams of carbohydrate. If she’s consuming fewer carbohydrates than is recommended, she can decrease her insulin by 1 unit for every 10 grams less.

Instruct your patient to count grams of carbohydrates by consulting food labels, exchange lists, and carbohydrate-counting books. Counting grams of carbohydrate allows for more accurate insulin dosing and more flexible meal scheduling. It also reduces the number of hypoglycemic and hyperglycemic episodes.

When caring for a patient after a kidney and pancreas transplant, repeatedly assess the function of both organs. Assess your patient for hypovolemia and dehydration, which may damage the kidney tubules and increase the risk of thrombosis of the pancreatic vessels. Monitor the patient’s intake and out­put, vital signs, skin turgor, blood urea nitrogen (BUN) level, creatinine level, and hematocrit. Elevated BUN and creatinine levels may indicate kidney dysfunction and rejection. A steadily declining hematocrit may reflect bleeding.

For the first 24 hours after surgery, adjust I.V. fluids every hour in response to your patient’s urine and nasogastric (NG) output. If she has an indwelling urinary catheter, you can monitor urine output accurately. The catheter also decompresses the bladder, allowing the suture line within to heal. After the NG tube and urinary catheter are removed, continue to monitor your patient’s intake and output.

Monitor blood glucose levels every 30 minutes to 1 hour for the first 24 hours after surgery and administer insulin or fluids containing dextrose as necessary. A patient may require insulin for 1 to 2 days after surgery because the function of the transplanted pancreas may be delayed. She may also require insulin if she’s receiving steroid therapy.

Review your patient’s daily laboratory test results, including electrolytes, complete blood count, hemoglobin level, and serum and urine amylase measurements. Collect urine specimens for cumulative amylase determinations taken at 12-hour or 24-hour intervals. Assess insulin, glucagon, and human C peptide levels three or four times per week. Pancreas scans and ultrasound examinations may be performed on the first day after surgery, then once a week until discharge. Ultrasounds examine the function of the new organs and enable the physician to determine the size of the graft and the patency of the veins.

Check your diabetes patient’s abdominal dressing and incision for blood and urinary drainage and for signs of infection. To decrease postoperative complications, have your patient sit on the side of her bed within 24 hours of surgery. She can begin sitting in a chair and taking short walks the day after surgery. Encourage her to cough, breathe deeply, and change positions frequently.

Acarbose, an Intestinal Alpha-Glucosidase Inhibitor, decreases postprandial hyperglycemia by inhibiting the digestion and absorption of carbohydrates. It achieves this by inhibiting the enzymes responsible for the digestion of starches and other carbohydrates in the brush border of the small intestine.The peak action of acarbose occurs within 1 hour of ingestion. The drug is metabolized by intestinal bacteria and digestive enzymes. Because the half-life for acarbose is only about 2 hours, the drug should be taken three times a day.

A physician will begin acarbose therapy at 25 mg three times a day. She will adjust dosages every 4 to 8 weeks based on 1-hour postprandial blood glucose levels and on tolerance until an effective dose is achieved. The maximum recommended dosage is 50 mg three times a day for patients who weigh 60 kg or less. For those who weigh more than 60 kg, the maximum dosage is 100 mg three times a day.

Indications and Contraindications

Acarbose is used with stable Type 2 patients as an adjunct to diet and exercise to reduce blood glucose levels. This drug benefits patients who can’t achieve near-normal blood glucose levels with sulfonylureas or metformin.

Because acarbose increases gas formation in the intestine, it’s contraindicated for anyone with inflammatory bowel disease, ulcerations of the colon, or intestinal obstruction. The drug is also contraindicated for patients with chronic intestinal diseases that alter digestion or absorption. Acarbose is contraindicated during pregnancy or breast-feeding. Patients with kidney dysfunction, DKA, or a hypersensitivity to the drug also shouldn’t take it.

Adverse Effects and Interactions

The most common reactions to acarbose are GI signs and symptoms. Patients may complain of abdominal pain, diarrhea, and flatulence caused by undigested carbohydrates in the intestines. These signs and symptoms tend to subside with time. At doses of 100 mg, acarbose may cause an asymptomatic, reversible increase in serum transaminase levels, especially in women.

The action of acarbose decreases with the concurrent use of charcoal, an intestinal adsorbent, and digestive enzyme preparations that contain carbohydrate-splitting enzymes, such as amylase and pancreatin. Hyperglycemia may result if a patient takes acarbose with thiazide and other diuretic drugs, beta-blockers, corticosteroids, phenothiazines, thyroid preparations, estrogens, oral contraceptives, phenytoin, nicotinic acid, sympathomimetics, calcium channel blockers, or isoniazid. Acarbose can be taken with a sulfonylurea or insulin, but these combinations may cause hypoglycemia. However, acarbose can help to prevent weight gain associated with sulfonylurea therapy.

Advise your patients to take acarbose with meals. Because the goal is to prevent the absorption of intestinal glucose, they should take the drug along with the first bite of food. No food interactions occur.