Psychological And Cognitive Function

Any level of psychological or cognitive deficit may lead to a poor or erratic diet affecting both nutritional state and glycaemic control. Memory lapses can result in missed meals and medication or an inadvertent repeated dose of some medications leading to, amongst other things, hypoglycaemia. Cognitive function is also impaired in people with diabetes due to increased incidence of cerebrovascular disease and depression (57,58). Psychological problems are both a predictor of mortality and of...

Endocrine Disturbances

Chronic alcoholism can also affect gonadal function and lead to testicular atrophy, gynaecomastia (enlargement of male breasts) and sterility. It is not known what the exact mechanism for these changes is, but it is thought to be a result of reduced liver function. This reduced liver function decreases the rate of metabolism of female sex hormones, thereby leading to an increased level of circulating oestrogens. A second mechanism is thought to be that alcohol reduces synthesis of testosterone...

References

Brydon P, Smith T, Proffitt M, Gee H, Holder R, Dunne F. Pregnancy outcome in women with Type 2 diabetes mellitus needs to be addressed. Int J Clin Prac 2000 54 418-419. 2. Casson IF, Clarke CA, Howard CV et al. Outcomes of pregnancy in insulin dependent diabetic women results of a five year population cohort study. Br Med J 1997 315 275-278. 3. Hawthorne G, Robson S, Ryall E, Sen D, Roberts SH, Ward Platt MP. Prospective population based survey of outcome of pregnancy in diabetic women results...

Consequences Of A Diabetic Pregnancy

Maternal hyperglycaemia results in an excess maternal-foetal transfer of glucose. The placental glucose transporter protein, GLUT1, is increased in diabetic pregnancies, and maternal hyperglycaemia quickly results in foetal hyperglycaemia and foetal hyperinsulinaemia (4). Maternal hyperglycaemia is not only a critical factor in glucose-mediated congenital malformations, but also in many aspects of foetal development, neonatal well-being and future health, see Table 7.1. An accelerated foetal...

Fatty Liver Hepatitis And Cirrhosis

Chronic alcohol consumption can cause the deposition of excess triglycerol in the liver leading to a condition known as 'fatty liver'. This damage can lead to hepatitis and, if severe enough, to cirrhosis. The damage is thought to be due to the high concentrations of ethanal within the cell and if severe enough will result in cell death. Cell damage and death trigger an inflammatory response, i.e. infiltration of lymphocytes and activation of an immune response. If this is not treated it will...

Realistic Diet Prescriptions

Weight loss and weight control are arguably the most challenging aspects of managing diabetes, yet are likely to offer the most immediate and obvious benefit. People with diabetes find it more difficult to lose weight and maintain the loss compared with those without the disease. Fortunately, it is now clear that they do not need to reach their ideal body weight in order to improve their metabolic status as little as a 5-10 reduction in body weight is sufficient to result in clinically relevant...

Dialysis

While survival on dialysis continues to improve, diabetic patients still do less well than non-diabetic patients (6). Results from the Italian Cooperative Peritoneal Study Group Registry show the 10-year patient survival for the 301 diabetic patients to be less than half that of the 1689 non-diabetic subjects (20.6 vs 55.6 ) (7). Higher mortality rates among diabetic patients receiving HD also occur (8), but with good glycaemic control these rates can be improved (9). Peritoneal dialysis is the...

The Optimal Mix Of Dietary Carbohydrate And Fat For

The diet for the diabetic mother needs to limit excess maternal-foetal transfer of glucose. As post-prandial hyperglycaemia is the time of maximal maternal-foetal glucose transfer, treatment interventions need to target this period (6). Controversy exists on how best to achieve this. Some authorities recommend limiting carbohydrate at the expense of increasing dietary fat, while others favour high-carbohydrate diets with a low glycaemic response. It is the authors' belief that promoting diets...

The Satiety Value Of Highcarbohydrate Diets

The satiating capacity of high-carbohydrate diets may be the major explanation for weight control benefits. The energy density of foods strongly influences the amount of food people consume and consequently influences body weight (61). High-fat foods are energy dense, very palatable and less satiating, a combination which makes them easy to 'passively overconsume' (62). On the other hand, less refined, 'natural' high-carbohydrate foods (legumes, wholegrains, fruits and starchy vegetables) are...

Energy Gains and Losses from Glucose Fluxes During Dialysis

Energy requirements for CAPD patients are partially met from absorbed dialysate glucose. Requirements from dietary intake are therefore lower at 30 kcal kg body weight (25 kcal kg if obese) and 25-30 kcal kg body weight if older than 65 years (21). Patients absorb approximately 70 of dialysate glucose, amounting to 300600 kcal or 2.5-17 g of glucose per hour during dwell times (22) (See table 15.4). Bag volumes range from 1 to 3 litres, with higher dextrose concentrations and larger volumes...

Morbidity And Mortality

Transplantation provides the best renal replacement option for diabetic patients with ESRF, improving the quality of life (3,4), and resulting in less neuropathy and anorexia. Unfortunately, renal transplantation does not improve pre-existing metabolic conditions such as dyslipidaemia or bone disease. These continue to progress and contribute to the long-term morbidity and mortality. The medications used to prevent graft rejection also contribute to metabolic risk factors, including weight gain...

List of Contributors

Nutrition and Dietetic Department, Charing Cross Hospital, Fulham Palace Road, London W6 8RF, UK Human Nutrition Unit, Department of Biochemistry, University of Sydney, NSW 2006, Australia Research Dietitian, Hammersmith Hospital, Du Cane Road, London W12 0HS, UK Nutrition and Dietetic Department, Charing Cross Hospital, Fulham Palace Road, London W6 8RF, UK CLEATOR, JACQUELINE Diabetes and Endocrinology Clinical Research Group, Clinical Sciences Centre, University Hospital Aintree, Longmoor...