Diabetes Mellitus is a Disease

Statistics from the United States Department of Agriculture have shown that demand for healthy, organic food has been steadily rising over the past decade. This increase in demand has led to more stores offering a wider variety of healthy food options. Although shopping for healthier food is becoming easier, deciding how healthy a particular food is can be very difficult. Most foods provide several different nutrients, so each meal must contain combinations of foods that deliver a full array of nutrients. The amount of each macronutrient in a specific food item is also important.

The Nutrition Facts panel provides valuable nutrition information such as serving sizes, nutrient quantities, and Daily Values. In addition to the serving size and the servings per container, food labels present nutrient information in both quantities and percentages of standards called the Daily Values. These values reflect dietary recommendations for nutrients. All packaged food must also contain a list of all ingredients according to the Food and Drug Administration (FDA). Consumers who understand how to read labels are best able to apply the information to achieve and maintain healthful dietary practices. Therefore, reading food labels can help consumers make healthy choices. For those who suffer from diabetes, reading food labels and understanding the values has a direct effect on the treatment of and delaying complications that arise from diabetes.

Diabetes mellitus is a disease in which the body is unable to produce insulin and/or use insulin successfully, causing elevated levels of blood glucose and irregular carbohydrate metabolism. In a healthy individual, insulin levels rise after eating to help the cells absorb glucose from food. In diabetics, the body is either unable to secrete the insulin needed for glucose absorption or cells may have become resistant to insulin. There are two main types of diabetes, type 1 and type 2. Type 1 diabetes, also known as juvenile-onset or insulin dependent diabetes, is an autoimmune destruction of the cells that produce insulin.

Type 2 diabetes occurs when the cells have developed a resistance to insulin. To offset the resistance, the pancreatic cells produce more insulin, yet the additional insulin is unable to compensate. Therefore, people with type 2 diabetes often have high levels of both insulin and blood glucose. The precise cause of both type 1 and type 2 diabetes is unknown but there are triggers for each. Type 1 develops during childhood and follows a related illness. Often, type 1 diabetics are genetically predisposed. Type 2 develops in middle aged adults and is often triggered by lifestyle choices. More than 80 percent of type 2 diabetics are obese. Prevalence increases with age and lack of physical activity. Genetic factors, such as ethnicity, also plays a role in type 2 diabetes.

Diabetes mellitus is the seventh leading cause of death in the united states today. This disease affects 29 million people with about 28 percent unaware that they have the disease. More than one-third of the U.S. population suffer from prediabetes. In 2013, every state in the U.S. had a prevalence of six percent or greater. According to the World Health Organization, the global prevalence among adults has risen from 4.7% in 1980 to 8.5% in 2014. An estimated 1.6 million deaths were caused by diabetes in 2016 and another 2.2 million deaths were due to high blood glucose in 2012.

Diabetes also leads to other serious health complications. Damaged caused by diabetes expedites the development of atherosclerosis in the heart, brain and limbs. The most common causes of death in individuals with long term diabetes are heart attack and stroke. Long-term diabetes is also associated with damages to the capillary structure and function.

The primary microvascular complications are retinopathy, damage to the capillaries of the retina, and nephropathy, damage to the capillaries of the kidneys. Nearly 2.6% of global blindness is a result of diabetes. Nearly 50 percent of diabetics will also develop neuropathy. Diabetic neuropathy involves damage to the peripheral nerves, the most common form in diabetics, or the autonomic nerves that control body organs and glands. If neuropathy occurs in the feet, the chances of developing foot ulcers, infection and eventual need for limb amputation increases.

Diabetic ketoacidosis occurs when the body has an extreme lack of insulin. Without insulin, triglycerides in adipose tissue and the protein in muscles are broken down resulting in an increased supply of fatty acids as well as amino acids. This fuels the production of ketone bodies, which are acidic, and glucose in the liver. Patients experiencing diabetic ketoacidosis suffer from severe ketosis, acidosis, hyperglycemia (extremely high blood glucose concentration) and dehydration. Ketone body accumulation is characterized by a fruity odor on a persons breath. Significant urine loss accompanies the hyperglycemia, as well as fatigue, lethargy, nausea, and vomiting. The mental state may vary from alert to comatose (diabetic coma).

For type 1 diabetics, the most common complication is hypoglycemia: low blood glucose. Inappropriate management of diabetes such as excessive dosages of insulin or antidiabetic drugs, prolonged exercise and skipped or delayed meals can lead to hypoglycemia. It is the most frequent cause of coma in insulin dependent patients and accounts for four to ten percent of deaths in type 1 diabetics. Symptoms of hypoglycemia include sweating, heart palpitations, shakiness, hunger, weakness, dizziness, and irritability. Mental confusion keeps the patient from recognizing the symptoms and taking action.

Severe hypoglycemia or a delay in treatment can cause irreversible brain damage.
There is no cure for diabetes, but with careful self-management and control, diabetics can live long and healthy lives. Managing blood glucose levels requires a delicate balancing of food, exercise and medication. Treatment involves maintaining blood glucose levels within a desirable range to prevent or reduce the risk of complications. Frequent adjustments are necessary to maintain good glycemic control. Other treatment goals include maintaining healthy blood lipid concentrations, controlling blood pressure, and managing weight, all of which helps decrease the risk of developing diabetic complications.

Treatment among the two types of diabetes slightly differs. Treatment for type 1 diabetics requires insulin therapy. The forms of insulin differ by their onset of action, timing of peak activity, and duration of effects. They are classified by rapid acting, short acting, intermediate acting, or long acting. These classifications allow flexibility of day to day dietary needs. Type 2 diabetes can be initially treated with nutrition therapy and exercise, but most patients who cannot maintain glycemic control will need antidiabetic medications or insulin eventually. A health care team comprised of a diabetic specialist and a Certified Diabetes Educator, whom is often a nurse or dietitian, provides an individual with the knowledge and skills necessary to implement treatment.

Patients must learn about appropriate meal planning, how to monitor blood glucose levels, correct medication administration, weight management, physical activity, and prevention and treatment of diabetic complications. Treatment largely involves monitoring glycemic status by using a glucose meter, a device used for self-testing of glucose concentrations. The meter reads a drop of blood from a finger prick that is applied to a chemically treated paper strip. This testing provides feedback when the patient adjusts food intake, medications, and physical activity and is helpful for preventing hypoglycemia.

Patients with type 1 diabetes should measure blood glucose levels more frequently to prevent complications. Some patients achieve better glycemic control by also using a continuous glucose monitoring system. This device is placed under the skin and monitors blood glucose levels every few minutes. The frequency of self-monitoring varies according to the specific needs of individual patients.

Diet and exercise plays a huge role in improving glycemic control and preventing acute and chronic complications. The nutrition care plan has to factor in personal preferences and lifestyle habits. In addition, dietary intakes must be modified occasionally to accommodate growth, lifestyle changes, aging, and complications that may develop. A registered dietitian designs and implements the nutrition therapy for diabetic patients.

This dietary care plan focuses on specific macronutrients and how much a patient should intake. The percent of calories from carbohydrate, fat, and proteins depends on food preferences and metabolic factors. Consistency in carbohydrate intake is important for glycemic control, unless the patient is undergoing intensive insulin therapy that matches insulin doses to carbohydrate intakes at each meal. The more grams of carbohydrate ingested, the greater the glycemic response.

Therefore, carbohydrate recommendation must be based in part on the persons metabolic needs, types of insulin or other medications used to manage the diabetes, as well as individual preferences. Sources for carbohydrates should be vegetables, fruits, whole grains, nuts, and milk products. Different carbohydrate-containing foods have different effects on blood glucose levels as well as each portion size. A foods glycemic effect is influenced by a number of factors including the type of carbohydrate in a food, the fiber content, the preparation method, and other foods included in a meal. Diabetic patients must consume foods that are high in fiber and minimally processed.

A diabetic can manage food intake in two main ways: by carbohydrate counting or by meal planning. Carbohydrate-counting is simpler and more flexible than other menu-planning approaches and are widely used for diabetics. The dietitian must first learn about the patients usual food intake and calculates nutrient and energy needs and give the patient a daily carbohydrate allowance. That allowance is then divided into a number of meals and snacks according to individual preferences.

The carbohydrate allowance can be expressed in grams or as the number of carbohydrate portions allowed per meal. The patient should only be concerned about meeting carbohydrate goals and may choose any of the carbohydrate-containing food groups when planning meals. This allows the individual to have the freedom to choose the foods desired without risking loss of glycemic control. This basic carbohydrate-counting method is helpful, but requires a consistent carbohydrate intake to match the medication regimen.

Meal planning allows individuals to create an eating plan by choosing foods with specified portions from a variety of food lists. The lists group foods according to their proportions of carbohydrate, fat, and protein so that all items on a particular list have similar macronutrient and energy contents. Each food on a food list can be substituted for any other food on the same list without affecting the macronutrient balance in a meal. The food list is helpful for patients wanting to maintain a diet with specific macronutrient percentages, but it is less flexible than carbohydrate counting and has no advantages for maintaining glycemic control. The food lists may be helpful for patients using carbohydrate-counting methods because the portions are similar to the portions used in carbohydrate counting.

Because diabetes is also referred to as the sugar disease many people believe the misconception that diabetics need to avoid sugar and sugar-containing foods. Consumption of sugar does not adversely affect glycemic control. Therefore, sugar recommendations for diabetics are often similar to those for the general population: minimize foods and beverages that contain added sugars. Realistically, sugars and sugary foods must be included in the daily carbohydrate allowance. Fructose is not advised because excessive dietary fructose may adversely affect blood lipids unless it is naturally occurring, such as in fruits. Sugar alcohols and artificial sweeteners are great sugar substitutes because they contain no digestible carbohydrate.

Nutrition bars are a nutritional supplement that comes in a variety of brands and flavors. The demand for convenience foods has aided the growth of the protein bar market, which was valued at 837 million United States Dollars in 2016. They appeal to those looking for a quick meal replacement without sacrificing their health. These bars claim to promote weight management, improved muscle mass, and increasing energy. They can be found almost anywhere, in grocery and convenient stores as well as many fitness gyms and nutritional supplement based companies. Since protein bars are associated with good health, they can be ideal consumers with specific dietary needs. Choose Your Foods: Food Lists for Weight Management even list a snack bar as a recommended for diabetics.

According to Protectivity insurance company, there are more than 50 different bars on the market. Each brand has its own health claim. Some brands, like the Lara Bar, pride themselves on having very few ingredients. Others promote themselves as protein bars or as meal replacements. With so many options, it can be hard choosing which bar to consume. But are all nutritional bars as healthy as they claim to be? Some bars may not be a good choice, especially for those, like diabetics, with specific dietary needs.
To decide if nutrition bars should be recommended for diabetics, I compared the nutritional values of four different brands of bars: Zone Perfect in chocolate peanut butter, Lara Bar in peanut butter cookie, RX Bar in peanut butter chocolate and Clif bar in chocolate chip peanut crunch. The table below shows nutritional facts for each bar.

The daily recommended macronutrient value depends on food preferences and metabolic factors such as lipid levels. Suggested values for the general population are often used as a guideline though they differ for each individual. For example, studies suggest that women should intake 2,000 calories per day to maintain and men should intake around 2,500 calories. These values will differ based on age, weight height, levels of activity and metabolic factors. In general, the United States Department of Agriculture suggest that 45-65% of total kilocalories should be from carbohydrates, 20-35% from fat, and 10-35% from protein.

These values are used as a guideline for diabetic individuals as well, with an emphasis on carbohydrate intake because of the direct correlation between carbohydrates and blood sugar concentrations.
All the percent daily values are within the recommended guidelines, but few of the values are vague. At a glance, the amount of sugar in each nutrition bar seems acceptable. The American Heart Association suggest that individuals should limit their daily intake of added sugars to six teaspoons (25 grams) per day for women and nine teaspoons (37.5 grams) per day for men.

There is no true guideline for the amount of natural sugars we should consume each day, but the World Health Organization recommends having two to three servings of fruit per day. For those with diabetics, it is encouraged to minimize added sugars even further. Although each bar lists their sugar percentages, only two of the four list if these sugars are from added sugars. The Lara Bar and the RX Bar both have zero added sugars. This means that all sugars in each are from naturally occurring sugars in fruit. Neither the Zone Perfect bar nor the Clif Bar list if these sugars are added, but the list of ingredients certainly identifies them. Both bars contain multiple variations of syrup, meaning they both have added sugars.

Both bars also do not list any fruits or dried fruits as an ingredient, so it is safe to assume that all the sugar in both bars are from added sugars. Though the Zone Perfect and Clif bar are still within the recommended range for added sugars, they both have more than half of the total recommended daily amount. If a normal individual were to eat a Clif bar, they would only have five grams of allowed added sugar left to consume that day (17.5 grams if male). Because diabetics are urged to limit their added sugar intake further, consuming a Clif bar could leave no room for any other added sugars in other meals or snacks.

It would be fairly easy for any diabetic to exceed their added sugar allowance.
Along with the high sugar content, the Zone Perfect bar also has a high saturated fat percentage. A healthy individual should intake no more than 10% of their daily calories in saturated fat. The Zone bar contains one-fifth of the daily recommended value of a person consuming around 2,000 calories per day. But what if the person is diabetic? Since diabetes is closely related to cardiovascular disease, the amount of saturated fat should be kept at less than 7%. The Zone bar is still within range, but it does not leave much room for other meals or snacks. A diabetic would have to keep a very close eye on their saturated fat content of each meal.

By comparing these four nutrition bars, we can see that these bars are vastly different from each other. Because diabetics should watch their added sugar intake, they should stay away from bars like Zone Perfect and Clif. Though the Lara Bar and the RX Bar have better ingredients and percent daily values than the other two bars, fruits and vegetables are the overall better option for any individual, especially diabetics. Since treatment for diabetics vary from person to person, nutrition bars should be generally avoided, as should most prepackaged foods. Reading through each food label of different nutritional bars can be tricky.

Not all brands are honest, some may not specify if they have added sugars. Instead, they hide the sugars within the list ingredients that can be confusing. Choosing an option like fruit can be the easier option. There is no ingredient list to examine with fruit, no daily values that have to be monitored. Fruits are a very good source of natural sugar and are full of natural fibers and nutrients that are needed and are more cost efficient than nutritional bars.  

Cite this page