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Type 1 Diabetes and Appropriate Therapeutic Diet

Food and Nutrient Intake and Assessment

In type 1 diabetes therapy, nurses monitor the quantity and quality of food that patients consume in their diet. Health workers also analyze the drinks consumed and the diet in general. To record the results of the assessment, the nurses make entries in the food diary, indicating the quantity, quality, and time of meals. The patient himself can enter the necessary data after the explanations of the doctor or nurse, or ask someone from those who support him. Methods for assessing food and nutrient intake include the Food Frequency Questionnaire.

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Calorie Counting Method and Food Group Balance Interpretation

Calories are needed to maintain the energy balance of the diet, in particular the structure and function of the body, health, and well-being, including healing and physical activity. Diet and calorie intake also dictate the need for other nutrients, such as macronutrients, micronutrients, and nutritional supplements. Therefore, the nutritional balance assessment includes an assessment of the quantity and quality of food, based on a diary or 24-hour reviews. Nutritional analysis programs use this information to provide a comprehensive assessment by comparing direct and indirect calorimetry based on the patient’s age, height, weight, and activity level. Quantitative Diet Models include USDA Nutrition Scheme, USDA Vegetarian Food, USDA Mediterranean Cuisine, DASH Diet Scheme, Diabetes Exchange Meal Scheme, and others.

Evaluation and Interpretation of Foods and Beverages

Doctors and nurses evaluate data from questionnaires and diaries using software such as the Healthy Diet Index (HEI), Diet quality index (DQI), Healthy diet index (HDI), and Mediterranean diet index (MDI), evaluating and interpreting beverages such as water, caffeine, and alcohol involves examining their consumption patterns. Studying and evaluating the diet of drinks is important as they account for 75% to 85% of daily water intake, and 14% to 22% of total energy intake.

The assessment considers the risks and consequences associated with such health factors as obesity, bone health, cardiovascular disease, and kidney disease. Health professionals do not recommend the use of alcohol and carbonated drinks, as they are of low nutritional value. Moreover, such drinks are deemed dangerous, due to the adverse health effects of caffeine and alcohol, whereas inadequate drink intake increases risks of obesity and bone health.

Evaluation and Interpretation of Macronutrients

Health care providers evaluate nutritional components such as calories and macronutrients. The most common macronutrients are sugar, soluble fiber, saturated fat, and trans-fatty acids. Information about the calories contained in macronutrients and their qualities is contained in the diagrams and tables of the special software. To monitor macronutrient intakes, nurses and doctors monitor intake to be in line with generally accepted acceptable daily averages. These values are developed following the results of a variety of studies that meet the requests and needs of 97% -98% of people. Recommended Dietary Allowances (RDA) include the required recommended amount of protein and carbohydrates, which, however, is the lower limit of the recommended intake to prevent deficiency. Then, Acceptable Macronutrient Distribution Ranges (AMDRs) are research-defined ranges that minimize the risk of chronic disease by defining recommended percentages of protein, fat, and carbohydrate intake

Evaluation and Interpretation of Micronutrients

Similar to the macronutrient assessment, doctors and nurses assess the micronutrient diet of patients using the software. Various programs provide information on dietary recommendations for various vitamins and minerals found in foods. The information that gets into the charts and tables given by the programs appears as a result of the chemical analysis of products. Trace elements and biologically active components of the diet determine the nutritional value and usefulness of the diet. At the same time, biologically active components interact with components of the body’s living tissue and have many different possible effects.

Food Intake and Nutrition Knowledge

The food intake and knowledge needed can be related to the education and subsequent application of the therapeutic diet. These can be diets designed for past hospitalizations or obtained through a table review. Knowledge, beliefs, and views about nutrition can be obtained from interviews or patient surveys. Noteworthy, the information about knowledge should be identified to determine the level to which the patient the consequences and dangers of inadequate nutrition.

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The nurse or physician needs to know the patient’s beliefs as it helps to identify problems in knowledge and to explain important aspects about medicinal and nutritional substances in foods, to provide culinary advice, and to learn about the impact of cultural or religious values ​​on nutrition. Also, during the interview, the health care provider can find out if the patient has problems with emotional overeating, and if he is ready to change his diet.

Eating Behavior and Alternative Medicines

Patient eating behavior includes nutritional activities, including possible problematic practices. For example, obstacles or problems may include refusing to eat, not wanting to try new foods, cleansing the body, or overeating. Eating behavior can be controlled by self-control measures developed in conjunction with the patient. Interestingly, nutritional supplements should be evaluated in terms of their possible interactions with the food and medications the patient is taking.

Therefore, the health care provider should ask the patient about the current medications and supplements they are taking, as well as foods and drinks, since the combination of these elements can change metabolism, nutrient absorption, and gastrointestinal function. Then, the nurse or doctor also evaluates access to food, including the availability of grocery stores and access to safe foods and drinks. Moreover, the nurse should provide access to food to fix the problem of poor nutrition.

Clinical Tests

Today, healthcare providers justify the need for each test by explaining the reasons why it is needed. Typically, medical professionals order this Basic Metabolic Panel (BMP) and Comprehensive Metabolic Panel (CMP). These panels include Medicare and Medicaid Services approved test groups. When prescribing BMP and CMP, the nurse should advise the patient to fast for 10-12 hours before the test. Notably, the CMP consists of six additional tests to assess the liver and all BMP tests. These tests measure glucose, Na +, K +, Cl-, HCO3-, Phosphorous, and Triglycerides.

Chemical Tests in Urine Analysis

Chemical tests in urinalysis are done to look for possible health problems, such as kidney stones or urinary tract infections. For example, a pH of 4.6-8, acidic, is seen in patients on a high-protein diet, while taking medication, in the presence of uric acid kidney stones, calcium oxalate, and cystine. At the same time, alkaline pH <4.6 is observed in patients who eat a diet rich in vegetables and dairy products, but also with urinary tract infections, as well as with certain medications or with phosphate and carbonate kidney stones. Patients with diabetes show non-positive glucose, patients with uncontrolled type 1 diabetes show positive ketones.

Assessment of the State of Hydration

In diabetes, a nurse or doctor assesses your hydration status to determine possible electrolyte imbalances. Dysregulation of water is very dangerous, as it can include a decrease in extracellular fluid, sodium intoxication, dehydration, overhydration, and other symptoms. Dehydration can result from electrolyte loss through vomiting, diarrhea, overuse of laxatives, diuretics, or limited access to fluids. Dehydration can be accompanied by high fever, high sweating, nausea, anorexia, or depression. Symptoms of dehydration include rapid weight loss, decreased skin turgor, dry mucous membranes, weak and fast pulse, slow capillary filling, decreased body temperature (95 ° to 98 ° F), cold extremities, disorientation. Dehydration can lead to volume depletion, that is, a state of vascular instability due to blood loss, burns, vomiting, diarrhea, and gastrointestinal bleeding.

Overhydration

Overhydration or edema may occur in patients with an increase in extracellular fluid volume. Edema can be a sign of kidney failure, liver cirrhosis, chronic heart failure, sodium-containing intravenous fluids, or food. Edema leads to symptoms such as rapid weight gain, dilated neck veins, wheezing in the lungs, peripheral edema, slow peripheral venous emptying, ascites, polyuria, pleural effusion, and pulmonary edema in severe cases. Therefore, health workers measure hydration status in a laboratory way using elements such as blood urea nitrogen, serum osmolality, and urine specific gravity. It is noteworthy that the analysis and interpretation of laboratory results should be as accurate as possible since the diagnosis and subsequent treatment of patients depends on them.

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The Nutrition Care Process

The Academy of Nutrition and Dietetics has developed a standardized framework for professional nutrition care and called it the Nutrition Care Process (NCP). This structure has been adopted by nutritionists around the world, which has contributed to the improvement of the model. The NCP includes the steps for identifying, planning, and meeting nutritional needs. This model is applicable to meet the needs of groups or populations, and therefore is convenient for the implementation of various international charitable programs. The model also guides defining nutritional roles and responsibilities for Registered Dietitians-Dietitians (RDN) and Registered Dietitians and Nutritionists (NDTR) in all practice settings.

Nutrition Assessment and Reassessment

Nutritional assessment involves obtaining, validating, and interpreting data to identify health problems. These assessments create the prerequisites for making a nutritional diagnosis and are noted as symptoms or evidence in the nutritional diagnosis statement. Evaluating nutrition through a screening tool helps determine if a patient is at risk based on a summary of aspects of the patient’s life.

Assessment parameters have well-defined terms that should be used by healthcare providers in their assessment. These terms cover five areas, including nutritional history, anthropometric findings, biochemical findings, nutritional physical examination findings, and client history. Equally important, nutritional assessment is based on comparative standards, that is, criteria and norms against which nutritional assessment data are compared.

Nutrition Diagnosis and Intervention

A nutritional diagnosis is made to give a critical assessment of a specific health problem that can be solved with common sense and the right solutions. Also, this problem can be solved by intervention in the diet of a nutritionist. The diagnosis should take into account the causes of problems and provide patients with the tools to improve the situation on their own. Then, intervention should be undertaken to eliminate the signs and symptoms of the health problem.

The nutritional intervention consists of planning and execution stages and is directed at the etiology, i.e. the problem in the field of knowledge related to nutrition. Therefore, an intervention for the etiological problem of a lack of nutritional knowledge is being addressed by nutrition education. If a referral to an etiology is not possible, the nurse resolves the problem by direct intervention to change the diet.

Nutrition Intervention Terminology, Monitoring, and Evaluation

The terminology of nutritional interventions encompasses five areas, namely (1) food delivery, (2) nutrition education, (3) nutritional counseling, (4) specialist nutritional coordination, and (5) interventions on the nutrition of the population. Therefore, interventions can include education, counseling, food delivery. Monitoring and evaluating nutritional therapy implies the need to track indicators in nutrition, for example, indicators of excessive consumption of some micro- or macro-elements. In a clinical setting, interventions are monitored and evaluated to ensure that strategic treatment goals are achieved. In this process, it is very important to write down goals in measurable terms and compare the statuses of indicators and indicators.

Behavior Change and Related Factors

Nutritional behavior change is a collaborative effort between the patient and the nutritionist. Behavior modification is the change in a person’s responses to environmental cues through negative reinforcement of maladaptive behavior and positive reinforcement of adaptive behavior. Both education and counseling help patients achieve behavioral nutritional goals. Several factors influence a person’s ability to change behavior, such as the talent of a nutrition educator or the ability of a counselor. There are different levels of influence, including personal, interpersonal, institutional, social, and political, which are described in the socio-ecological model. Official US guidelines support the use of this model in patients’ diets.

Models for Behavior Change

Health professionals advise people on behavior change and educate them about nutrition using a variety of theories and models. The belief in the health model influences clients’ beliefs that they can get sick from unhealthy diets by explaining negative aspects such as the severity of the disease and positive aspects such as belief in positive effects and reducing risks. They also stimulate self-efficacy so that patients believe they can achieve what they want and give prompts for action. The trans-theoretical model introduces the person to change, and helps him take the first steps, and also ensures its action for 6 months, and offers 6 more months of support. At the same time, the stage of cessation within the framework of the model assumes that a person stops thinking about change, as he acquires a new habit.

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Lifestyle and Health Risk Factors

Life expectancy in the United States continues to rise, although growth rates are nearly 4% lower among African Americans, due in part to diseases and deaths from diabetes. Therefore, there is a need to educate the population about healthy eating and take preventive measures. Risk factors in the United States that determine morbidity and mortality are heart disease, cancer, chronic lower respiratory disease, cerebrovascular disease, accidents, Alzheimer’s disease, diabetes, and nephritis. Chronic diseases are the most costly item of expenditure, accounting for 75% of costs. Diet and lifestyle directly affect chronic diseases such as heart disease, stroke, cancer, and diabetes. The influence of social determinants and environmental factors is equally important.

Health and Nutritional Disorders

Health and nutritional disorders are especially evident in the differences in the level of health among members of different races living in the United States. A complex combination of social, environmental, and behavioral factors has contributed to the creation of racial and group inequalities in health. Health inequities are associated with differences in the burden of disease, including in terms of overall morbidity, prevalence, mortality, and survival rates.

Social determinants of health include socioeconomic factors, psychological influences, discrimination, and social support. These determinants affect the behavioral, physical, and built environment and sociocultural areas at all levels. Nutrition can be seen as a major component of health inequalities. For diseases like hypertension, type 2 diabetes, obesity, and kidney disease, nutritional care is essential. Therefore, strategies are needed to address nutritional inequalities, including dietary strategies and health literacy.

Diabetes in the US

Eating carbohydrate foods leads to high blood sugar for most people. However, with diabetes mellitus, there is a long-term increased concentration of glucose in the blood. Hyperglycemia or high glucose levels are caused by impaired insulin secretion or the action of insulin. Insulin is produced by the pancreas for the use and storage of macronutrients such as carbohydrates, fats, and proteins. Diabetes mellitus leads to an increase in mortality and morbidity, which can be reduced through prevention. Prevention will also reduce direct medical and disability costs.

Incidence and Prevalence

In the US, 9.4% of the population has diabetes, which is more than 30 million people, with 7 million undiagnosed. Diabetes diagnoses continue to rise in adults, that is, people 18 years of age and older, and the prevalence of the disease increases with age, as almost 40% of those aged 65 and older have this problem. The prevalence of type 2 diabetes has increased dramatically in younger groups, and younger ethnic minority groups.

Glucose Intolerance Categories

There are different categories of glucose intolerance, and the correct definition of the category can be crucial in the treatment of the disease. Type 1 diabetes mellitus has symptoms of excessive thirst, significant weight loss, and frequent urination. During the development of such diabetes, the beta cells of the pancreas, which produce insulin, are destroyed. This leads to the onset of the listed symptoms, as well as excessive hunger, dehydration, electrolyte disturbance, and ketoacidosis. The rate of beta-cell destruction is highest in infants and children, while it is slower in adults. Therefore, with the destruction of beta cells that begins in adulthood, adults can face a prolonged asymptomatic period of onset of the disease, which can last from several months to several years, until the beta cells are gradually destroyed.

Two Forms of Type 1 Diabetes

Remarkably, 5% of all diabetes cases are type 1 diabetes, and people with type 1 diabetes depend on insulin that is not produced by their bodies. If they don’t take exogenous insulin, they can die from ketoacidosis. Type 1 diabetes mellitus is usually diagnosed in young people and people over 65 years of age. It is noteworthy that symptoms may include weight loss or, conversely, gaining excess weight. There are two forms of type 1 diabetes mellitus – immune-mediated and idiopathic. Immune-mediated diabetes occurs as a result of the destruction of the beta cells of the pancreas, which are responsible for the production of insulin. Idiopathic diabetes mellitus is a disease of unknown etiology; only a small percentage of people fall into this category, but this disease has no known cure. Autoimmune thyroid disease is often associated with type 1 diabetes, so population screening includes a thyroid health check.

Pathophysiology

People with type 1 diabetes experience destruction of the beta cells of the pancreas. This leads to an increase in blood glucose levels, and the emergence of markers of destruction such as islet cell autoantibodies; autoantibodies to insulin; autoantibodies to glutamic acid decarboxylase, and autoantibodies to tyrosine phosphatases. These autoimmune markers are indicative of type 1 diabetes. Genetically, there is an association between TIDM and the histocompatibility locus (HLA) antigen, with links to the DQA, DQB, and DRB genes. Remarkably, adults can maintain sufficient b-cell function for a long time to prevent DKA.

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