[Expert Solution]: CHAPTER 9 LEARNING OBJECTIVES • Identify the…

CHAPTER 9 LEARNING OBJECTIVES • Identify the magnitude and etiology of the diabetes epidemic today. • Describe the pathophysiology of the different types of diabetes. • Assess nutrition status and formulate a nutrition care plan for people with type 1 diabetes. • Describe three methods of meal planning for people with diabetes. • Identify nutrition interventions for nephropathy, neuropathy, and cardiovascular disease. • Specify the classes of diabetes medications and their mechanism of action. • State the benefits of exercise and the exercise recommendations for people with diabetes. • Determine best enteral and parenteral feeding practices for blood glucose control. Diabetes is a disease that effects 30.3 million people in the United States. In the book, it says that by 2050, it is estimated that 1 in 3 people will be diagnosed with diabetes (Kane, Prelack, 2019). Type 1 Diabetes is an autoimmune disease in which the body does not produce insulin. Typically, people with Type 1 DM are diagnosed in childhood. Type 2 Diabetes typically occurs in adulthood because of lifestyle choices. These people develop insulin resistance due to the amount of sugar they take in. Gestational Diabetes can develop in women that are pregnant. Sometimes it is because of genetics, whereas other times, the body cannot respond to how the mother is eating (Kane, Prelack, 2019). The pathophysiology of Type 1 Diabetes is a destruction of beta cells in the pancreas. Beta cells are important to produce insulin, so destruction of them can be detrimental to the control of blood glucose levels. The book discusses that those diagnosed at a young age have had rapid deconstruction of beta cells, whereas those who are diagnosed later in life have a slow destruction. Type 2 Diabetes is not like Type 1; in that it is not autoimmune. It typically results from lifestyle factors. Type 2 results from insulin resistance, which is “triggered by insulin receptor defects in target cells” (Kane, Prelack, 2019). As insulin resistance becomes more taxing on the body, Type 2 Diabetes may occur. The beta cells are then unable to produce the insulin the body needs due to the high glucose levels in the blood stream at all times. Gestational Diabetes is characterized as “glucose intolerance during pregnancy” (Kane, Prelack, 2019). With weight increase during pregnancy, women can develop insulin resistance. This is due to the need of insulin secretion (Kane, Prelack, 2019). In the nutrition assessment, I would get anthropometric data of the patient, such as height, weight, BMI, IBW, and waist circumference. I would then get labs (biochemical data) to look at blood glucose levels, A1c, lipid profile, and protein labs. Clinical data would be taken such as medical history, comorbidities, and interpretation of labs. Dietary data, like a 24-hour recall or food diary, would be taken to see what the patient is eating and in what quantities. The food diary may be more accurate when getting a food log because they do not need to take from their memory and forget some of the food they ate (Kane, Prelack, 2019). For the nutrition care plan, I would make a nutrition diagnosis. For example, it could be “Inadequate carbohydrate intake related to Type 1 diabetes as evidenced by a high A1c and high blood glucose levels.” For the intervention, I would recommend the basic carbohydrate counting method. This is the easiest way for the patient to control the amount of carbohydrates they are eating. We would set an amount of carbohydrate choices they could have in a day and discuss ways to incorporate them in meals and snacks. I would then have them come back in a month to evaluate their progress and take labs again. We would then tailor their plan to how they are doing at that time (Kane, Prelack, 2019). The three methods of meal planning for people with diabetes are the plate method, exchange method, and the basic carbohydrate counting method (Kane, Prelack, 2019). The plate method is a visual for those with diabetes. There is a plate with dividers marked on it. This helps the patient fill their plate with the right amounts of each type of food. Non-starchy vegetables take up half the plate, while protein and starchy foods take up the other two fourths of the plate. The American Diabetes Association also adds a glass of milk and a piece of fruit to the outside of the plate (Kane, Prelack, 2019). The exchange method is just that: exchanging foods for one another. Patients get a number of servings per food group they can eat in a day and there is an extensive list of foods that fit in each category and serving. This is helpful in giving the patient autonomy in what foods they are using to fuel their bodies while still following a plan (Kane, Prelack, 2019). The basic carb counting method makes it easier for a diabetic patient to know how many carbs they are eating with basic numbers. In this method, each carbohydrate choice is 15 grams. For each meal, there is a cer