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A
high-fat diet causes glucose intolerance and insulin resistance (JAMA
262(3):398-99,1989) Priorities
for an
Insulin-Dependent Diabetes
Mellitus (IDDM) 1. The patient must consume
adequate calories to maintain desirable weight. The
American Diabetes Association recommends that 12% to 20% of all calories be
protein, 20% to 30% of all calories be fat and 55% to 60% of calories be
carbohydrate. The amount of protein in the diet meets or exceeds the recommended
dietary allowance (RDA) of 0.8 g/kg of body weight. The percentage of calories
from protein may be as much as 20% in diets of 1200 calories or less and may
decrease to 12% at higher caloric levels. There is no advantage to a high
protein diet, in fact diabetics are vulnerable to renal complications. For the
person who has only a slight elevation of creatine levels, it is prudent to keep
the protein level at approximately the RDA. Reduction of fat intake is
recommended because of the high incidence of arteriosclerosis. Cholesterol
consumption should be less than 300 mg/day. • In 2004, heart disease was noted on 68% of diabetes-related death certificates among people aged 65 years or older. • In 2004, stroke was noted on 16% of diabetes-related death certificates among people aged 65 years or older. • Adults with diabetes have heart disease death rates about 2 to 4 times higher than adults without diabetes. • The risk for stroke is 2 to 4 times higher among people with diabetes. High blood pressure • In 2003–2004, 75% of adults with self-reported diabetes had blood pressure greater than or equal to 130/80 millimeters of mercury (mm Hg), or used prescription medications for hypertension. Blindness • Diabetes is the leading cause of new cases of blindness among adults aged 20–74 years. • Diabetic retinopathy causes 12,000 to 24,000 new cases of blindness each year. Kidney disease • Diabetes is the leading cause of kidney failure, accounting for 44% of new cases in 2005. • In 2005, 46,739 people with diabetes began treatment for end-stage kidney disease in the United States and Puerto Rico. • In 2005, a total of 178,689 people with end-stage kidney disease due to diabetes were living on chronic dialysis or with a kidney transplant in the United States and Puerto Rico. Nervous system disease • About 60% to 70% of people with diabetes have mild to severe forms of nervous system damage. The results of such damage include impaired sensation or pain in the feet or hands, slowed digestion of food in the stomach, carpal tunnel syndrome, erectile dysfunction, or other nerve problems. • Almost 30% of people with diabetes aged 40 years or older have impaired sensation in the feet (i.e., at least one area that lacks feeling). • Severe forms of diabetic nerve disease are a major contributing cause of lower-extremity amputations. End of statement.
Lifestyle
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