Thursday, 19 May 2016

Level Of Success Of Dietary Intervention In The Management Of Type II Diabetes



Diabetes Mellitus is a chronic metabolic disease involving a disorder of carbohydrates metabolism and subsequent derangement of protein and fat metabolism, which occur due to inadequate production, diminished effectiveness or inadequate use of insulin a hormone secreted by the beta-cells of the Islets of Langhams in the pancreas.

Diabetes Mellitus (DM) is a heterogeneous metabolic disorder characterized by hyperglycemia and glucose intolerance, due to endogenous insulin deficiency, impaired effectiveness of insulin action or both, with DM the body cannot regulate the amount of sugar in the blood. This leads to increased glucose in the body that causes deregulation of the metabolism often accompanied with glucose urea, polydipsia, polyphagia and polyuria (ADA 2006, Mousa 2008, Redmon 2009).

In Diabetes Mellitus insulin level or poor response to insulin prevent cells from absorbing glucose. As a result glucose builds up in the blood, when glucose Laden blood glucose passes through the kidney. The kidney cannot absorb all of the excess glucose.

The excess glucose spills into the urine accompanied by water and electrolytes. This cause frequent urination to get ride of the addition water drawn into the urine, excessive thirst to trigger replacement of lost in urination. Other symptoms may include blurred vision, dramatic weight loss, irritability, weakness and fatigue, nausea and vomiting, degeneration tissues. Pains in the leg in the form of pins and needle (Redmond, 2009).
In Nigeria diabetes affect 2.8million adults between age of 20-79 years with gender distribution of 1.5million males and 1.3million females, with types II diabetes accounting for 90-95% of all diagnosed cases (W.H.O 2009).

The estimated Nigeria and global prevalence of diabetes mellitus are 1, 707,000 and 170,000,000 respectively (WHO 2000). The figure has been estimated to increases to about 438 million by the year 2025 as a result of increase population growth, increase sedentary life style and dietary habit (IDF, 2009).

Diabetes mellitus is classified, basically into the following groups.
1.     Type 1 diabetes (T1D)

2.     Type 2 diabetes (T2D)
3.     Malnutrition related diabetes mellitus (MRDM)

4.     Gestational Diabetes Mellitus (GDM)

1.  Type 1 Diabetes (T1D) commonly known as insulin dependent diabetes mellitus (IDDM), immune-medicated or juvenile-onset diabetes. This types of DM occurs as a consequence of an autoimmune-medicated, destruction of pancreatic B-cells. In this case they are attacked by the body defense system thereby leading to deficiency in insulin (IDF, 2009).

It is believed that a combination of genetic and environmental factors somehow triggers the immune system to destroy these cells. Environmental factors such as certain viruses may also contribute to the development of the disease, particularly in people who already have a genetic predisposition for the diseases, (TID) also can result from surgical removal of the pancreas.

Makers of immune destruction of the islet cell are present at the time of diagnosed in 90% of individuals and include antibodies to the islet cell to glutamic acid decarboxylase (GAD), and to insulin. Individuals with TID either produce insufficient insulin or do not make it all and therefore cannot control the blood glucose level TID or predominantly, pronounced in persons under 30years of age (Moussa 2009).

Type 1 diabetes is of the major metabolic disorders in childhood/adolescent irrespective of gender or age/ younger individual typically have a rapid rate of B-cell destruction and present with ketoacidosis, while adults of ten maintain sufficient insulin secretion to prevent ketoacidosis for many years. Ketoacidosis is the process of breakdown of stored fat for fuel as a result of inability of the body to convert glucose into energy.

The products of ketoacidosis (Ketone bodies) interferes with cellulose respiration. Affected individuals require the daily administration of insulin injection in order to maintain a normaglycemia (Zimmet, et al, 1994 CDC 2004, Wild et al 2004, Moussa 2008, IDF, 2009).

2. Type 2 Diabetes (T2D) generally known as non-insulin dependent diabetes mellitus (NIDDM), occur in individuals over 40years of age or those with a family history of diabetes. In T2D the pancreas produce insulin but the body is partially or absolutely incapable of utilizing it in absolute terms, the concentration of plasma insulin (fasting and meal stimulated) usually or increased but “relative” to the severity of insulin resistance, the plasma insulin concentration or sufficient to maintain normal glucose homeostasis (Defronzo and Ferrannimi 1991).

With time, however there is progressive beta cell failure and absolute insulin deficiency ensues. Most individual with NIDDM exhibit intra abdominal (visceral) obesity is closed related to the presence of insulin resistance (Zimmet, et al, 1994). Also hypertension, dyslipedia (high triglyceride) and low HDLG level, postprandial hyperlipedemia and elevated PA 1-1 levels often are present in these individual. This clustering of abnormalities or what is referred to as the “Insulin resistance syndrome” or the “metabolic syndrome” (Reaven, 1991).

As a result of those abnormalities these with T2D are at high risk of developing macro vascular complications such as mycadial infraction and stroke (Zimmet, et al 1994). T2D is associated with a decreased uptake of glucose into muscle and adipose tissue which leads to chronic extracellular hyperglycemic resulting in tissue damage and pathophysiological complication involving heart diseases atherosclerosis, cataract formation, retionopathy and others.

Infant complications are major causes of disability and death in patients with diabetes mellitus (Perez, Matute et al, 2009). NIDDM is treated through diet changes, exercise and a desirable glycermic control. Several possible factors leading to the development of NIIDM include obesity, diet and physical inactivity, increasing age, insulin resistance, family history of diabetes, less than optimum intrauterine environment, ethnicity (Defronzo 1997, Reaven 1988, CDF 2004, IDF 2009).

Malnutrition Related Diabetes Mellitus (MRDM),
This type of DM was first recognized by the WHO in 1985 and further subdivided into protein deficient pancreatic diabetes (PDPP) and fibrocalcalous pancreatic diabetes (FCPP). This category has been found in patients with history of childhood malnutrition, poor socio economic status, recurrent abdominal pain, pancreatic insufficiency and calculi. More also these patience are often ketosis resistance requiring excess insulin (More than 60U/Day for stabilization of hyperglycemic. It have been reported that areas with high consumption rate of cassava have the highest prevalence rate of the disease MRDM (Isah and Anaja, 1996).


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