Introduction
Diabetes mellitus is a health complication involving an increase in the concentration in the concentration of blood sugar either due to a failure by cells to effectively respond to the production of insulin in the body, or as a result of no insulin production. Additionally, diabetes is related to irregular metabolism of food components such as carbohydrates, proteins, and fats (Wylie-Rosett 1998, p. 143). The high blood sugar levels are associated with several health complications such as polyuria, polyphagia, and polydipsia, which are recurrent. Therefore, Diabetes mellitus being a chronic disorder, there is the need to start disease management interventions to relieve the patients of unnecessary suffering (Beisswenger 2000, p. 95).
Diabetes management entails proper management of diet, physical exercising, and proper use of medications such as insulin among other counseling interventions. The process of managing diabetic patients may be hindered by other factors such as stress, co-morbidity complications and illnesses, which are unique to specific life stages. For instance, elderly individuals encounter numerous problems such as lowered appetites; poor and diminishing dentition; loss of weight; poor nutritional in-takes among other bodily disabilities, which may influence the deleterious complications of diabetes (Chau & Edelman 2001, p. 172). Beside, studies show that over 300 Million elderly persons will be diabetic by the year 2025. Most of these patients will be in the developing countries whereby they represent a 170% increase in incidence rates compared to about a 42% increment in most developed nations. In the elderly populations, diabetes affects individuals aged 45-64 years in most developing countries while in developed nations, those affected are aged 65 years and above. At this age brackets, many studies show that most individuals lead solitary lives characterized by poverty and poor nutritional care (Klein et al. 2001, p. 733; King, Aubert & Herman, 1998).
Furthermore, studies show that the first step in the management of diabetes entails controlling the blood sugar levels. Therefore, dietary intakes, which are composed of carbohydrates, proteins, and fats, form an integral part in diabetes management (Meneilly & Tessier 2001, p. 56). Assessment of the dietary content of diabetic patients is important because carbohydrates influence the levels of blood sugar and fats play a role in development of obesity and cardiovascular diseases, which are co-morbidity complications in diabetics. On the other hand, proteins are the major contributors of energy in diabetics relative to carbohydrates (Meneilly 1999, p. 239).
This essay presents an elaborate discussion on the health complications associated with uncontrolled and poor management of diabetes among older adults in addition to the potential implications of these complications on the daily activities of the patients. Additionally, most studies indicate that regulation of carbohydrate, fat, and protein diets play a significant role in diabetes management. In this essay, an extensive literature review is given relative to the efficacy of these dietary components in the management of the health complications and improvement of the quality of life among the diabetics.
Health Complications
When the blood sugar levels in the body are quite high, the ensuing condition is often referred to as hyperglycemia. This condition leads to a variety of health complications when it is prevalent in the body for a long period of time. These complications are attributed to the deleterious damages on the nerves, retina, kidney, and blood vessels. Therefore, at old age, the major health complications associated with diabetes include Diabetic retinopathy, Diabetic nephropathy, Diabetic neuropathy, Gastroparesis, Atherosclerosis, High blood pressure, Hypoglycemia, Diabetic Ketoacidosis, and Hyperosmolar hyperglycemic non-ketotic syndrome (Glasgow & Anderson, 1999, p. 2090).
The role of Diabetes and Dietary Components in the Etiology of the Health Complications
Diabetic Retinopathy (DR)
This is a health complication in which the tiny capillaries of the retina of the eye are damaged due to an increase in the concentration of blood sugar. This can lead to blindness. Besides, DR is the major cause of poor vision in the elderly persons aged 65 years and above. Over a long period of time, the high sugar levels can affect the eyes leading to swollen lenses and poor vision. In addition, diabetes enhances the development of cataracts and glaucoma, which are major risk factors that lead to blindness. Due to uncontrolled blood sugar levels in the elderly persons, severe cases of retinopathy occur in the persons aged 65 years and above (Coyne et al. 2004, p. 447).
Diabetic Neuropathy
This involves a neuropathic disorder associated with diabetes in which the micro-vascular blood vessels supplying blood to the nerves are affected. Additionally, the macro-vascular blood vessels can be affected leading to development of severe cases of the disorder. The disorder is characterized by numbness at the extremities, loss of sensation, and muscles weaknesses among other symptoms. As a result, four factors are cited in the pathogenesis of diabetic neuropathy. They include protein kinase C, micro-vascular disorder as well as the end products of advanced glycerate (Etzwiler 1997, p. 563).
However, the major pre-disposing factor in diabetic neuropathies is the micro-vascular disease. Here, some uncontrolled diabetic factors such as hyperglycemia and hyperlipidemia can change the microvasculature of blood vessels leading to vasoconstriction (‘Diabetes control and complication trial group’ 1993, p. 977). As vasoconstriction progresses, other neuronal dysfunctions and vascular disorders occur leading to thickening of the basement membranes, hypoxia, and neuronal ischemia. Finally, these pre-disposing structural and functional changes on the nerves and the blood vessels lead to the severity of diabetic neuropathy and neuronal damages.
Diabetic nephropathy
This is a diabetic complication affecting the kidneys leading to presence of proteins in urine. High and uncontrolled blood sugar levels are the major factors associated with development of diabetic nephropathy (Wylie-Rosett, 1998, p. 148). This condition occurs parallel to the prevalence of high blood pressure in a diabetic patient. As a result, the uncontrolled sugar levels cause the nephrons and the glomerulus to thicken and sometimes porous. Subsequently, other renal blood vessels are affected and severely destroyed leading to appearance of proteins in urine.
Atherosclerosis
In this disorder, the arteries are affected by the deposition of the fatty tissue on the inner walls of these blood vessels. Subsequently, the fatty matter solidifies, thickens, and finally narrows or completely blocks the blood vessels. Moreover, both the micro- and the macro-vascular blood vessels are affected by this condition (‘American Diabetes Association’ 2004, p. 15). However, if the coronary arteries are affected, the rate of blood flow to the heart is severely compromised leading to heart attacks, chest pains, high blood pressure, and stroke. The major predisposing factors in atherosclerosis include diabetes, obesity, and diets high in fats (Kahn & Porte 1997, p. 487).
The impact of the above-mentioned health complications on the daily activities of Diabetic patients
Diabetic retinopathy is a diabetic complication affecting the blood vessels of the eyes. Therefore, patients affected by this disorder have an increased probability of experiencing minor or advanced blindness. In addition, studies show that about 50-80% of diabetic patients are potentially predisposed to visual dysfunction and blindness (Madsen et al. 2002, p. 750). In a study conducted to explore the symptoms experienced by patients and the potential impact on the daily activities in patients suffering from diabetic retinopathy, it is shown that the disorder affects both the individual and social activities of the patients (Madsen et al. 2002, p. 751).
Additionally, the researchers note that the major symptoms experienced by diabetic retinopathy patients include difficulties in reading, inability to drive at night, and inability to participate in active sports and exercises. However, these symptoms vary relative to the level of severity in the patients (Campbell 1992, p. 414). Consequently, most diabetic patients at old age experience severe diabetic retinopathies, which are attributable to the heightened inabilities to carry out most diabetic management activities such as assessing nutritional information, exercising, preparing insulin injections, and the home-based glucose assessment and others (Testa & Simonson 1998, p. 1490). In addition, most patients experiencing low visual acuity are unable to accomplish various social responsibilities. Therefore, most elderly diabetic patients are social dependants and they hardly engage themselves in active physical activities such as walking around, sports and exercising.
Management of Diabetes in elderly patients
Most elderly persons are experiencing increased prevalence rates of diabetes mellitus. Besides, managing diabetes in these populations pose a variety of difficulties to physicians because most elderly diabetic patients suffer from complex health complications associated with advanced diabetic symptoms (Kahn & Porte 1997, p. 512). Additionally, elderly diabetic patients experience functional inabilities in terms of their individual and social activities. Therefore, dietary interventions and nutritional restrictions present the most appropriate intervention approaches in the management of diabetes mellitus (Musey et al. 1995, p. 483). In the elderly populations, the major dietary and lifestyle components considered in the management of diabetes include dietary fats, carbohydrates, and proteins.
The role of Dietary Carbohydrates in the Management of Diabetes
Most studies show that diabetes is a complication associated with impaired carbohydrate metabolism particularly due to its ability to alter the blood sugar levels directly. In addition, carbohydrates influence the rate of glucose absorption and clearance from the blood (DeFronzo & Ferrannini 1998, p. 683). This is called the post-prandial blood sugar response. Therefore, the source and variety of the ingested carbohydrates can affect the blood glucose concentration in many aspects. However, according to other studies, the impact of the type and origin of carbohydrates on the concentration of post-prandial blood sugar is a debatable issue (Sheard, Clark, Brand-Miller & Franz 2004, p. 2266). As a result, management of diabetes relative to the origin and variety of carbohydrates entails maintaining the concentration of blood sugar at a level comparable to the normal or near-normal concentrations.
Additionally, to categorize carbohydrate diets relative to their ability to increase or decrease the post-prandial blood sugar levels, most studies recommend that the glycemic indices and glycemic loads for different diets should be considered. The glycemic index shows the extent to which the blood sugar concentration changes after consumption of a carbohydrate meal. On the other hand, the glycemic load equals to the glycemic index of a carbohydrate meal multiplied by the total carbohydrates consumed per meal (Collier & O’Dea 2008, p. 944). Therefore, carbohydrate meals can be grouped into fast-releasing foods and slow-releasing foods. Furthermore, studies show that there is a direct correlation between increased glycemic indices and glycemic loads and the prevalence of diabetes mellitus type II. However, most other studies have failed to show this correlation.
Therefore, management of diabetes relative to the in-take of carbohydrate meals should consider the potential of the food component in terms of influencing the concentration of the post-prandial blood sugar levels. Thus, effective management of diabetes relative to carbohydrate diets does not entail restricted or decreased in-take of carbohydrates. This is because; carbohydrates are the major contributors of a huge portion of the energy required in the body. Besides, most researchers recommend that the daily carbohydrate in-take in diabetic patients should be 45-65% of the total caloric in-take to avoid a burst in the glycemic response and hyperglycemia, which is a risk factor in most metabolic and health complications associated with diabetes.
The role of proteins in the management of diabetes
To accurately determine the daily allowance for dietary proteins in the management of diabetes, most studies note that the potential benefits of proteins in the body, the role of proteins in controlling diabetes, and the diabetic health complications associated with proteins should be considered (Wylie-Rosett 1998, p. 143). Therefore, the main objective in recommending proteins for diabetes management entails determination of dietary levels of proteins that achieves the control, prevention, and delay of diabetic health complications associated with dietary components such as fats, carbohydrates, and proteins.
On the other hand, it is notable that the main function of dietary proteins in the human body is to maintain normal growth of tissues. However, proteins are also essential in regulating the blood sugar levels besides playing a major role in the development of diabetic health complications. Moreover, studies show that almost 50% of the dietary proteins are availed in blood as glucose (Wylie-Rosett 1998, p. 145). In addition, dietary proteins can influence the rate of insulin secretion and other counter-regulatory hormones such as epinephrine and glucagon.
It is also imperative to note that one-third of diabetic patients suffering from type II diabetes mellitus and an additional one-fifth of individuals suffering from type I diabetes mellitus are greatly susceptible to diabetic nephropathy within the first 15 years after their first diagnosis. However, clinical studies note that restriction of protein in-take can help to slow down the rate of progression of the kidney disorder (Wylie-Rosett 1998, p. 148). Despite of the high statistical significance in these findings, additional studies are required to determine the predisposing risk factors in diabetic nephropathy relative to protein diets. In addition, the findings fail to show how protein restriction can influence the course of the kidney disease.
However, increased protein and carbohydrate diets are implicated in the Kidney disease because their presence impairs the functions of the kidneys. Additionally, it is notable that most elderly diabetic patients suffer from severe organ dysfunctions associated with diabetes. Therefore, to effectively manage diabetes and improve the quality of life in the elderly populations, researchers note that dietary proteins should provide 12-20% of the total calories required by the body. This infers that for elderly persons, the daily recommended dietary protein allowances contain 0.8g/kg of body weight (Wylie-Rosett 1998, p. 151).
The role of dietary fats in diabetes management
The main problem associated with recommending dietary fatty acids in the management of diabetes is that the appropriate dietary fat allowances for diabetic patients cannot be extrapolated from those recommended for normal individuals. Besides, the incidence rates of diabetes are directly related to the concentration of n-6 fatty acids relative to that of the n-3 fatty acids (Berry 1997, p. 991). Therefore, the significance of fatty acids in the management of diabetes entails regulating the levels of n-3 and n-6 fatty acids in the patients’ diet. This approach is important because most studies note that n-3 fatty acids can lower the levels of triacylglycerol and high blood pressure thereby improving the health and metabolic complications associated with insulin resistance (Mollard, Gillam, Wood, Taylor & Weiler 2005, p. 499). On the other hand, n-6 fatty acids greatly affect the control of glycemic responses in some patients suffering from type II diabetes mellitus. Moreover, n-6 fatty acids can lower cholesterol levels in the body while increasing the rate of lipoprotein oxidation (Segal-Isaacson, Carello & Wylie-Rosett 2001, p. 161).
Additionally, studies show that in the presence of transition metals such as Iron and Copper, glucose generates free radicals that play a major role in the destruction of the pancreas and hinders the process of glycosylation that influences the NO-mediated relaxation of the smooth muscles (Collier & O’Dea 2008, p. 941). The effect of glucose on smooth muscles can be controlled through consuming fish oil, which contains high levels of mono-unsaturated fatty acids (MUFA). In addition, the same studies note that diets high in carbohydrates and low fats can increase the progress of hypertriglyceridemia, a condition that partially leads to atherosclerosis (Haffner 1998, p. 160). Therefore, diets rich in MUFAs can influence the level of lipids in the body and increase the antioxidant properties of most dietary components that aid in regulating lipoprotein oxidation. However, these studies fail to show the impact of high MUFA in the progress of obesity, which is a risk factor in diabetes (Madsen et al. 2002, p. 742).
Overall, to achieve effective diabetes management and improvement of the quality of life in diabetic patients relative to dietary allocations, it is advisable to individualize the dietary carbohydrate and fat allowances so that the control of glucose and fat concentrations match with other diabetes management interventions such as maintenance of appropriate lifestyles, limiting smoking, exercising, and regulating blood pressure. In addition, modification of fatty acids in the body can be encouraged through allocation of balanced diets containing different types of poly-unsaturated fatty acids (PUFA) and antioxidants among other food components.
Conclusion
The essay elaborates on the various health complications associated with diabetes and the poor control of diabetic factors in the elderly diabetic patients. From the discussions above, most diabetic patients are bound to suffer from various health complications such as diabetic neuropathies and diabetic nephropathies among other metabolic complications. In addition, these complications can have adverse effects on the daily activities of most patients. For instance, diabetic retinopathy leads to blindness, poor reading abilities, inadequate exercising, and poor nutrition.
Subsequently, the essay notes that most elderly individuals suffer from various functional disabilities that hinder effective management of diabetes such as preparation of insulin injections and assessing nutritional instructions. Therefore, nutritional interventions form an integral part in the management of diabetes in the elderly persons. This entails regulation of the carbohydrate, protein, and the fatty acid composition of the daily recommended dietary allowances for diabetic patients. This approach is imperative because the three dietary components play a major role in aggravating or controlling the health implications associated with uncontrolled diabetes.
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