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Type 2 Diabetes References Pathophysiology Type 2 Diabetes is an issue of insulin resistance or decreased sensitivity to insulin in metabolic tissues of organs such as the liver, skeletal muscle, and adipose tissue, which leads to insufficient insulin usage. Obesity plays a role in insulin resistance because due to the released fatty acids and cytokines from the fat cells. Fatty acids and cytokines interfere with insulin signals, interfere with insulin receptors, and inhibit the entrance of insulin into the liver, muscle, and adipose tissue. There is also decreased insulin secretion from beta cells in response to glucose exposure. The levels of insulin in diabetes type 2 leads to an inadequate response of beta cells to the circulating glucose. Excessive circulating glucose results from the release of glycogen from the liver together with the suppression by glucagon. Since the receptors of liver, skeletal muscle and adipose tissue do not respond to the signals of insulin, that makes the tissues resistant to insulin. Some of the main manifestations of diabetes type 2 are caused by long term complications that may occur with diabetes, such as visual changes, issues in kidney function, coronary artery disease, and neuropathy (Braun, 2017).

Braun, C. A., & Anderson, C. M. (2017). Pathophysiology: A clinical approach (3rd ed.). Wolters Kluwer. Lewis, S. L., Shannon Ruff Dirksen, R., Heitkemper, M. M., Bucher, L., Harding, M. M., Kwong, J., & Roberts, D. (2020). Medicalsurgical nursing: Assessment and management of clinical problems, single volume (11th ed.). Mosby. Migala, J. (2021, January 11). Is the Mediterranean diet best for diabetes? EverydayHealth.com.

Name: Nutrition in Health and Disease Professor West Coast University-Ontario

The Mediterranean Diet

Oral Antidiabetics Biguanides: Metformin works by Reduces the production of glucose within the liver through suppression of gluconeogenesis. Increases glucose uptake and use in fat and skeletal muscles. Decreases glucose absorption in the gastrointestinal tract. First choice medication for most clients who have type 2 diabetes. Alcohol can increase the risk of lactic acidosis with concurrent use. Concurrent use of iodine-containing contrast media can result in acute kidney failure. Avoid having high fiber foods because it lowers the concentration of metformin. Sulfonylureas: Glipizide works by releasing insulin from the pancreas; can increase tissue sensitivity to insulin over time. Use of alcohol can result in nausea, vomiting, and palpitations. Limit grapefruit juice to 1 quart per day. Chewing tobacco increases blood sugar.

The Mediterranean diet is considered one of the healthiest diets; it has been studied for its heart health benefits. However, researchers suggest that this diet is also beneficial for people with type 2 diabetes because it has demonstrated to improve blood sugar, weight loss, besides containing flavorful ingredients. Mediterranean diet helps those with type 2 diabetes because it includes beneficial food choices such as vegetables, whole grains, healthy fats found in nuts and olive oils. Vegetables are a good source of dietary fiber. Whole grains have nutrients such as protein, vitamin B, fiber, antioxidants, and minerals (iron, zinc, copper, and magnesium). Healthy fats support cell growth, protect organs, and are necessary for the absorption of vitamin A, D, E, and K. Foods that should be avoided or limited include foods high in sodium like canned foods, sausages to prevent water retention or hypertension. Pastries cookies, and cakes are not a good option because they contain added sugar with empty calories that increase blood glucose. Also, avoid fried foods because they contain LDL that can cause atherosclerosis.

Websites for More Information There are available resources for information related to standards of care for people with diabetes. The ADA (American Diabetes Association) provides the most updated evidence-based recommendations for the diagnosis and treatment of children and adults with type 1 and type 2 diabetes. https://www.diabetes.org/ There are also blogs that have resources for information about diabetes. The blog, “Diabetes Selfmanagement,” has patient education information about blood sugar charts to learn to read the glucose ranges, diabetes friendly recipes, and life-style tips. https://www.diabetesselfmanagement. com/ There is a website available for a 7day meal plan for a diabetes friendly Mediterranean diet. It lists the foods that should be eaten during the different times of the whole day and whole week. It also explains why the Mediterranean diet is a friendly diet for people with diabetes. https://www.everydayhealth.com/type2-diabetes/diet/is-mediterranean-diet-

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