A PROJECT PROPOSAL ON CASE STUDY AND MANAGEMENT OF A TYPE 1 DIABETES MELLITUS CLIENT. (INSULIN DEPENDANT DIABETES MELLITUS).

BY NAMAZZI WINFRED. (08/U/3900/HND/PD)

1.0 BACKGROUND. The selected condition is Insulin Dependent Diabetes Mellitus (IDDM). Diabetes mellitus is a metabolic condition or disorder that prevents the body from effectively utilising calories from carbohydrates and other sources. Clinically, its manifested by the over flow of sugar or glucose in blood instead of getting converted into glycogen. This inefficiency in the body to utilise glucose may be partial or symptomatic with diabetes mellitus. Under normal circumstances, excess calories are usually converted into glycogen which is also known as metabolic fuel which will always be available in the form of glucose. Insulin a hormone secreted by cells of the islets of langharns which are spread out in the mucosal lining of the pancreas regulates the chemical changes for the energy balance alongside the hormone glucagon secreted by the cells of the islets of langharns to sustain the conversion of the stored glycogen back to glucose for energy metabolism. Deficiency or insufficiency and failure in insulin function will result in diabetes mellitus. Diabetes mellitus is manifested in many clinical forms: juvenile diabetes/type 1 diabetes mellitus/IDDM, diabetes mellitus (2) Non Insulin Dependent Diabetes Mellitus (NIDDM), and senile diabetes. Juvenile diabetes. This type of diabetes is common to children mostly below 15years although some may carry on with the disease into adolescence and early adulthood. Its mostly a genetic condition that is inherited along filial excessive generations, however, recent studies are beginning to indicate that the disease may also be common among premature and children born to mothers who are either poorly nourished or being exposed to keratogenic factors. Diabetes mellitus (2). This type of diabetes mellitus is one of the fast growing disease conditions that is increasingly becoming a challenge to global health care systems. For a long time, it has been linked to obesity and often associated with excessive dietary intake of fats tackled by a sedentary life style. Senile diabetes. This type of diabetes occurs in elderly people is mostly due to fibrosis, tumour and waring away of the islets of langharns in the pancreas. This requires more insulin to bring the sugar

or glucose levels to normal.

Symptoms of diabetes mellitus. Signs. Excess sugar levels in urine and blood. Loss of weight. Delayed healing of wounds and are prone to injury. May develop anaeroxia. Whitening of the conjunctiva. Excessive sweating. Frequent urinations. (Polyuria). Polydipsia, (persistent sensation of thirst). Polyphagia (persistent sensation of hunger).

1.1 Effect on nutritional status or the role of nutrition in its management. In some cases, with insufficient supply of insulin or deficiency, ketosis may arise often a process of deamination and proteinuria which may lead to emusciation and loss of weight Excessive loss of minerals due to excessive sweating leading to an imbalance in some minerals in the body which may lead to conditions such as neuropathy. Diabetes also comes along with some complications and these are as follows: Diabetic retinopathy. This is the leading cause of blindness and visual disability. Diabetes mellitus is associated with damage to the small blood vessels in the retina resulting in loss of vision. Nephropathy . Diabetes mellitus is among the leading causes of renal failure but its frequency varies between populations and is also related to severity and duration of the disease. Heart disease. This accounts for approximately 50% of all deaths among people with diabetes in industrialised countries. Diabetes negates the protection from heart disease premenopausal women without diabetes experience. Diabetic neuropathy. This is probably the most common complication of diabetes. Neuropathy leads to sensory which

loss and damage to the limbs and a major cause of impotence in diabetic men. Studies suggest that up to 50% of people with diabetes are affected to some degree. Diabetic foot disease. Due to changes in blood vessels and nerves often leads to ulceration and subsequent limb amputation. Its one of the most costly complications of diabetes especially in communities with inadequate foot wear. It results from both vascular and neurological disease processes. Diabetes is the most common cause of non-traumatic amputation of the lower limb. Nutrition therefore plays a big role in the management of diabetes mellitus through dietetic counselling and nutrition education on changing of dietary life style to avoid complications which at some point may be fatal. 1.2 Prevalence of the condition. Incidence and prevalence of diabetes mellitus is on the rise from the initial of 2% of the population in the late 80s and 90s to 10% based on the latest studies of the global population. Although it was previously linked to communities of high social status especially in Europe and the Americans, its now becoming an increasingly challenging disease in many developing countries of Africa and Asia predominantly due to the global nutritional transition, a phenomenon characterised by a radical shift in the structure and complexity or composition of global diets with the increased intake of foods rich in refined sugars and carbohydrates, high saturated fats and oils, less fibre and generally low levels of fresh fruits and vegetables all of which have replaced whole some foods. More than half of all patients of NIDDM are often reported in post productive age in adults i.e. above 49years and as a result its very common that NIDDM unlike IDDM is common to adult population. Type (2) diabetes, until now has been highly prevalent in Europe and north America but uncommon in emergent countries. Recent evolution, however, indicates a sharp increase in Africa and south East Asia. Its much more common than type 1 diabetes and accounts for 30% of all diabetes causes worldwide. 1.3 Purpose of the project. The purpose of this project is to help me incorporate the different syllabus requirements into one project and give me an opportunity to widen my experience and expertise in case study and management of different conditions.

2.0 Objectives of the project. 2.1 General objective of the project. The main objective of the project is to enable me apply the knowledge from the theories and practices learnt in the different aspects of the course in the dietary management of diabetes mellitus as a selected condition for this project. 2.1.1 Specific objectives of the project. 1. To be able to describe the nutritional status of the client before and after the client. 2. To manage the diet of the client. 3. To be able to design a meal or product suitable for the nutritional management of diabetes mellitus. 4. To provide nutritional education and dietetic counselling to the client on management of his condition. 3.0 Socio-medical history of the client 3.1 Medical history of the client. The client is a female 40 years of age and with IDDM. She was found with the condition 4 years ago and currently goes for medical care at Nsambya hospital. 3.1.1 Nutritional status of the client.

100g of pumpkin. 5g of garlic. 2 carrots 10g of onions. Salt Water.

5.4 Budget for the report. Transport -25,000/= Typing and compilation of the report 15,000/= Miscellaneous 15,000/= Total 55,000/= REFERENCES. 1. Clinical nutrition, edited by, Michael, J. Gibney, Maros Elia, et al: Blackwell publishers 2005.