Carbobhdrates disorders second version.pptx

Carbobhdrates disorders second version.pptx

1. OVERVIEW OF CARBOHYDRATES Carbohydrates are organic compounds that consist of carbon, hydrogen, and oxygen atoms. They are classified as monossaccharides , disaccharides, and polysaccharides, based on the number of sugar units they contain. Carbohydrates are a crucial source of energy for the human body and play a vital role in various metabolic processes. They can be found in a wide range of foods, including fruits, vegetables, grains, and dairy products. Polysaccharides are made up of multiple sugar units and serve as storage forms of energy in the body. Key polysaccharides include starch, glycogen, and cellulose. Starch is found in plants and serves as a primary energy source for humans and animals. Glycogen is stored in the liver and muscles and is used as a quick energy source. Cellulose, a structural component of plant cell walls, is not digestible by humans but is essential for plant growth.

2. Monossaccharides are the simplest form of carbohydrates, consisting of a single sugar unit. Examples of monosaccharides include glucose, fructose, and galactose . They serve as the building blocks for more complex carbohydrates and are the primary source of energy for the body. Disaccharides are composed of two sugar units bonded together. Common disaccharides include sucrose (table sugar), lactose (found in milk), and maltose (formed during the breakdown of starch). Disaccharides are broken down into monossaccharides during digestion to provide energy.

3. DEFICIENCY OF CARBOHYDRATES . Definition, Is a state when the body does not receive adequate amount of carbohydrates to meet its energy needs. A deficiency in carbohydrates can lead to several health issues, as they are the primary source of energy for the body. When carbohydrate intake is insufficient, the body turns to alternative energy sources, such as fats and proteins, which can result in the production of ketone bodies. This condition, known as ketosis, can cause symptoms like nausea, fatigue, and dizziness.

4. Low carbohydrate diets can also lead to a decrease in the production of serotonin, a neurotransmitter that plays a role in mood regulation. This can result in mood swings and feelings of irritability. Moreover, carbohydrate deficiency can affect the proper functioning of the brain. The brain relies on glucose as its primary energy source, and a lack of carbohydrates can impair cognitive function, memory, and concentration. In extreme cases, a prolonged deficiency in carbohydrates can lead to a life-threatening condition called hypoglycemia, which occurs when blood sugar levels drop too low. This can cause seizures, unconsciousness, and, in severe cases, death.

5. HEALTH EFFECTS OF EXCESS CARBOHYDRATE CONSUMPTION Excessive carbohydrates Definition, It is defined as consuming disappropriate amount of carbohydrates in relation to ones energy expenditure and metabolic needs Consuming an excessive amount of carbohydrates can lead to weight gain and obesity. When the body has more carbohydrates than it needs for energy, the excess is converted into fat and stored in the body, leading to weight gain. Additionally, high carbohydrate intake, especially from refined sources like white bread and sugary foods, can contribute to an increased risk of type 2 diabetes. This is because these foods can cause rapid spikes in blood sugar levels, putting stress on the body’s insulin regulation system over time.

6. Carbohydrate disorders Carbohydrate disorders, also known as carbohydrate metabolism disorders or glycogen storage diseases, refer to a group of genetic disorders that affect the body's ability to process and use carbohydrates. Carbohydrates are a crucial source of energy for the body, and their metabolism is a complex process involving various enzymes and pathways. When there is a defect in these processes, it can lead to various health issues.

7. Carbohydrates play both a structural role in the cell as elements of nucleic acids and glycoproteins and a metabolic role as a major energy source Glucose is the primary carbohydrate energy source and when not used by the body it is stored in muscles and liver as glycogen As with other biochemical pathways, the biomarker of choice to measure for either diagnosis of disorders of carbohydrate metabolism depends on which pathway has the blockade Disorders of carbohydrate metabolism including galactosemia , Glycogen storage diseases and disorders of fructose metabolism

8. Disorders associated with deficiency intake of carbohydrates Hypoglyceamia Galactoceamia Ketosis Hurler disease Pompe disease Mucopolysaccharidosis Mucolipidosis

9. Hypoglycemia:   Hypoglycemia, also known as low blood sugar, can occur when there is a lack of carbohydrates in the diet to maintain normal blood glucose levels. Carbohydrates are the primary source of glucose, which is crucial for providing energy to the body’s cells, especially the brain. When carbohydrate intake is insufficient, blood sugar levels can drop below normal ranges, leading to symptoms such as dizziness, confusion, weakness, sweating, and in severe cases, loss of consciousness or seizures. Diabetics who take insulin or certain medications are particularly at risk of hypoglycemia if they do not balance their medication with adequate carbohydrate intake.

10. Symptoms of low blood sugar can occur suddenly. They may include: pale skin unexplained fatigue hunger shaking sweating dizziness rapid heartbeat mood changes irritability or anxiety headache difficulty sleeping skin tingling blurry vision trouble thinking clearly or concentrating loss of consciousness, seizure, or coma

11. Causes of Hypoglycemia due to Carbohydrate Deficiency: Hypoglycemia, or low blood sugar, can occur when there is a deficiency of carbohydrates in the diet. Carbohydrates are the body’s primary source of energy, and when they are lacking, blood sugar levels can drop below normal levels. Some common causes of hypoglycemia due to carbohydrate deficiency include: Inadequate Carbohydrate Intake:  Not consuming enough carbohydrates in the diet can lead to low blood sugar levels. This can happen if a person follows a very low- carb diet or skips meals regularly. Excessive Physical Activity:  Engaging in intense physical activity without adequate carbohydrate intake can deplete glycogen stores in the muscles and liver, leading to hypoglycemia. Medication:  Certain medications, such as insulin or other diabetes medications, can lower blood sugar levels. If these medications are not adjusted based on carbohydrate intake, hypoglycemia can occur. Alcohol Consumption:  Alcohol can interfere with the body’s ability to regulate blood sugar levels, especially when consumed on an empty stomach or in large amounts.

12. Management of Hypoglycemia due to Carbohydrate Deficiency: Managing hypoglycemia due to carbohydrate deficiency involves addressing the underlying cause and ensuring that blood sugar levels are brought back to normal range. Some strategies for managing this condition include: Immediate Carbohydrate Intake:  Consuming fast-acting carbohydrates such as glucose tablets, fruit juice, or regular soda can help raise blood sugar levels quickly. Regular Monitoring:  Monitoring blood sugar levels regularly can help individuals track their response to different foods and activities and make necessary adjustments to prevent hypoglycemic episodes. Balanced Diet:  Ensuring a balanced diet that includes an adequate amount of carbohydrates, proteins, and fats can help maintain stable blood sugar levels throughout the day. Medication Adjustment:  For individuals taking medications that can lower blood sugar levels, working with a healthcare provider to adjust dosages based on carbohydrate intake is essential.

13. Prevention of Hypoglycemia due to Carbohydrate Deficiency: Preventing hypoglycemia due to carbohydrate deficiency involves adopting healthy eating habits and lifestyle choices that support stable blood sugar levels. Some preventive measures include: Balanced Diet:  Eating a balanced diet that includes a variety of nutrient-dense foods, including carbohydrates from sources like whole grains, fruits, and vegetables, can help prevent fluctuations in blood sugar levels. Regular Meals:  Eating regular meals and snacks throughout the day can help maintain steady energy levels and prevent dips in blood sugar. Physical Activity:  Incorporating regular physical activity into daily routines while ensuring adequate carbohydrate intake can help improve insulin sensitivity and overall blood sugar control. Education and Support:  Seeking guidance from healthcare providers, nutritionists, or diabetes educators can provide valuable information on managing carbohydrate intake and preventing hypoglycemia.

14. Complications of Hypoglycemia Due to Carbohydrate Deficiency Hypoglycemia, which is characterized by low blood sugar levels, can occur due to various reasons, including carbohydrate deficiency in the diet. When the body does not receive an adequate amount of carbohydrates, it can lead to several complications associated with hypoglycemia. Some of the key complications of hypoglycemia due to carbohydrate deficiency include: Impaired Brain Function : Glucose is the primary source of energy for the brain. When blood sugar levels drop too low due to carbohydrate deficiency, the brain may not receive enough glucose to function optimally. This can result in symptoms such as confusion, dizziness, difficulty concentrating, and in severe cases, seizures or loss of consciousness. Hormonal Imbalance : Hypoglycemia triggers the release of hormones such as epinephrine and cortisol as part of the body’s stress response. Prolonged or recurrent episodes of hypoglycemia due to carbohydrate deficiency can disrupt the normal balance of these hormones, leading to issues like increased heart rate, sweating, anxiety, and potentially long-term hormonal imbalances. Muscle Weakness and Fatigue : Carbohydrates are essential for providing energy to muscles during physical activity. Inadequate carbohydrate intake leading to hypoglycemia can result in muscle weakness, fatigue, and reduced exercise performance. This can impact daily activities and athletic performance. Mood Changes : Low blood sugar levels can also affect mood and emotional well-being. Individuals experiencing hypoglycemia due to carbohydrate deficiency may feel irritable, anxious, or experience mood swings. These symptoms can impact relationships and overall quality of life. Risk of Severe Complications : Severe or prolonged hypoglycemia due to carbohydrate deficiency can have serious consequences if left untreated. In extreme cases, it can lead to seizures, coma, or even be life-threatening.

15. NURSING DIAGNOSIS Imbalanced nutrition: less than body requirements, related to insufficient carbohydrate intake evidenced by weight loss. Fluid volume deficit related to inadequate intake of carbohydrates evidenced a patient feeling very weight. r a to disease procesev cute pain related to p Acute pain related to disease process evidenced by a patient verbalizing pain. Acute pain related to disease process evidenced by a patient verbalizing pain

16. NURSING CONCERNS: Hypogylcaemia . Acute pain. Dehydration

17. NURSING CARE PLAN FOR HYPOGLYCEMIA AND KETOSIS assessment Nursing diagnosis Goal Implementation rationale evaluation OBJECTIVE DATA. Sweating. Body weakness. Fluid volume deficit related to inadequate intake of carbohydrates evidenced a patient feeling very weak To correct hypoglycemia within 15minutes Administer rapid-acting carbohydrates orally if the patient is conscious and able to swallow safely (e.g., fruit juice, glucose tablets). If the patient is unconscious or unable to swallow, administer intravenous dextrose solution. -measure blood glucose levels. To restore body energy. To monitor glucose levels. By the end of intervation the patient was relieved from hypoglycamia Headache Acute pain related to disease process evidenced by a patient verbalizing pain To relieve pain within 30minutes Administer analgisics such as iv paracetamol . To suppress pain receptors Pain was relieved by the end of the intervation .

18. Ketosis Ketosis is a metabolic state that occurs when the body doesn’t have enough carbohydrates to burn for energy. In response, the liver converts fat into molecules called ketones , which are then used as fuel. While ketosis is a natural process that occurs during fasting or starvation, it can also be triggered by a low-carbohydrate diet. Mild ketosis is not harmful and can lead to weight loss, but severe ketosis can cause dehydration, electrolyte imbalance, and even coma

19. Ketosis due to carbohydrate deficiency, also known as nutritional ketosis or ketotic hypoglycemia, typically occurs when the body has limited access to carbohydrates, forcing it to rely on fat metabolism for energy production. This condition can occur in various contexts, such as prolonged fasting, very low-carbohydrate diets (e.g., ketogenic diets), or conditions where carbohydrate absorption or utilization is impaired. Here's an overview of its clinical presentation, causes, diagnosis, management, complications, and prevention: Clinical Presentation: Symptoms often include fatigue, weakness, dizziness, headache, irritability, nausea, and sweating. Individuals may experience hunger, excessive thirst ( polydipsia ), and frequent urination ( polyuria ). In severe cases, symptoms may progress to confusion, seizures, or loss of consciousness.

20. Clinical Diagnosis: Clinical history: Dietary habits, recent illnesses, exercise patterns, and symptoms. Physical examination: Signs of dehydration, ketosis (e.g., fruity breath odor), and neurologic symptoms. Laboratory tests: Measurement of blood glucose, ketone bodies ( β- hydroxybutyrate , acetoacetate ), and electrolytes. Elevated ketone levels and low blood glucose are indicative of ketosis due to carbohydrate deficiency. Medical Management: Treatment aims to correct hypoglycemia and replenish glycogen stores while addressing underlying causes. Oral or intravenous glucose administration to raise blood glucose levels. If oral intake is not possible, intravenous dextrose solution may be necessary. Reevaluation of dietary habits and modification of diet to ensure adequate carbohydrate intake. Management of underlying conditions contributing to carbohydrate deficiency.

21. Complications: Severe hypoglycemia can lead to neurological complications, seizures, coma, or even death if not promptly treated. Chronic ketosis may lead to metabolic acidosis, electrolyte imbalances, and impaired organ function. Long-term complications may include nutritional deficiencies and compromised growth (especially in children). Prevention: Ensure a balanced diet with sufficient carbohydrate intake, meeting individual energy requirements. Regular monitoring of blood glucose levels, especially in individuals with diabetes or other conditions predisposing to hypoglycemia. Educate individuals on the risks of extreme dietary practices and promote balanced nutrition. Proper management of underlying medical conditions contributing to carbohydrate deficiency.

22. Excessive carbohydrate disorders Non insulin dependence Diabetes mellitus Obesity Cardiovascular diseases Digestive disorders. Dental issues Metabolic syndrome

23. Non insulin dependence Diabetes mellitus Introduction Non-insulin dependent diabetes mellitus (NIDDM), also known as type 2 diabetes, is a chronic condition characterized by high blood sugar levels due to insulin resistance or insufficient insulin production. According to the World Health Organization, type 2 diabetes affects over 422 million people worldwide and is a significant contributor to mortality and morbidity. This essay will discuss the causes, symptoms, diagnosis, and management of NIDDM.

24. Causes of NIDDM The primary cause of NIDDM is insulin resistance, a condition where the body’s cells do not respond appropriately to insulin. Insulin is a hormone produced by the pancreas that regulates blood sugar levels by allowing glucose to enter cells for energy production or storage. Over time, the pancreas produces more insulin to compensate for the decreased sensitivity of cells to insulin, leading to high insulin levels in the blood. However, this compensation mechanism eventually fails, leading to high blood sugar levels and NIDDM. Several risk factors contribute to the development of NIDDM, including obesity, physical inactivity, family history, age, and race/ethnicity. Obesity and physical inactivity are modifiable risk factors that significantly increase the risk of developing NIDDM. Genetic factors also play a role in the development of NIDDM, with certain genes associated with an increased risk of the condition.

25. Symptoms of NIDDM NIDDM often develops gradually and may not cause noticeable symptoms for several years. Common symptoms include increased thirst and urination, fatigue, blurred vision, slow healing wounds, and recurrent infections. Some people with NIDDM may also experience neuropathy or nerve damage, which can cause numbness or tingling sensations in the hands and feet. Diagnosis of NIDDM Diabetes can be diagnosed using several tests, including fasting plasma glucose (FPG), oral glucose tolerance test (OGTT), and hemoglobin A1c (HbA1c) test. The FPG test measures blood sugar levels after an overnight fast, while the OGTT measures blood sugar levels two hours after consuming a standardized glucose drink. The HbA1c test measures the average blood sugar levels over the past three months by measuring the percentage of hemoglobin glycation . A diagnosis of diabetes is made if any of these tests show a consistently elevated blood sugar level.

26. Management of NIDDM The management of NIDDM involves several strategies aimed at controlling blood sugar levels and reducing complications associated with the condition. These strategies include lifestyle modifications such as healthy eating habits, regular physical activity, weight loss, and smoking cessation. Medications such as metformin , sulfonylureas , thiazolidinediones , DPP-4 inhibitors, GLP-1 receptor agonists, SGLT2 inhibitors, and insulin may also be prescribed to help manage blood sugar levels. Regular monitoring of blood sugar levels is essential for effective management of NIDDM.

27. Planning: Goal Setting:  Collaborate with the patient to set realistic goals for blood sugar control, weight management, physical activity, and dietary changes. Education:  Provide comprehensive education on diabetes management, including medication adherence, monitoring blood glucose levels, healthy eating habits, and the importance of regular exercise. Lifestyle Modifications:  Encourage the patient to adopt a healthy lifestyle by incorporating regular physical activity and making dietary modifications. Interventions: Medication Management:  Administer oral antidiabetic medications as prescribed and monitor for any side effects or interactions. Nutritional Counseling:  Refer the patient to a dietitian for personalized meal planning to control blood sugar levels. Exercise Promotion:  Encourage regular physical activity tailored to the patient’s abilities and preferences. Monitoring and Evaluation:  Regularly assess the patient’s progress towards goals, review blood glucose monitoring records, and adjust the care plan as needed. Evaluation: Blood Glucose Control:  Evaluate the effectiveness of the care plan by monitoring HbA1c levels and assessing blood glucose variability. Patient Understanding:  Assess the patient’s knowledge and understanding of diabetes management principles.

28. Imbalanced nutrition less than body requirements related to reduction of carbohydrate metabolism due to insulin deficiency evidenced by increased urinary output Fluid volume deficit related to excessive urine output (polyuria) as evidenced by reduced skin turgor Impaired skin integrity related to decreased sensory sensation secondary to impaired circulation as evidenced by patient having an ulcer on the lower limb Activity intolerance related to weakness due to decreased energy production

29. Nursing concerns Imbalanced nutrition. Fluid volume deficit. Impaired skin intergrity . Activity intolerance.

30. NURSING CARE PLAN FOR NON INSULIN DEPENDENCE DM ASSESSMENT NURSING DX GOAL INTERVATIONS RATIONALE EVALUATION SUBJECTIVE DATA. Verbalisation of fatigue Increased urinary frequency. OBJECTIVE DATA Sudden weight loss Reduced skin turgor Fluid volume deficit related to excessive urine output (polyuria) as evidenced by reduced skin turgor By the end of 24hrs will demonstrate an improvement in fluid balance Monitor intake and output. Daily body weight measurement. To provide the estimated need for fluid replacement and renal function It helps to provide the best results on the status of hydration. By the of intervation the patient was well hydratated . SUBJECTIVE DATA Blurred vision OBJECTIVE DATA High blood glucose levels: fasting plasma glucose levels 126 mg/ dL . Increased ketones. Weight loss Imbalanced nutrition less than body requirements related to insulin deficiency evidenced by patients weight loss Restore weight gain by 3kg within 0ne week Administration of insulin or oral anti diabetic drugs Education of the patient on adequate nutritional intake and encourage on a diabetic diet Weighing of patients twice a week To low glucose level. To achieve health needs of the patient with the proper food diet . It helps to keep the patient on the program by not going out of control By the of the week the patient had gained 3kgs.

31. Impact on Blood Sugar Levels Excessive carbohydrate consumption can lead to fluctuations in blood sugar levels. When large amounts of carbohydrates are consumed, particularly those with a high glycemic index, they can cause rapid increases in blood sugar levels followed by a subsequent crash. This rollercoaster effect can lead to feelings of fatigue, irritability, and hunger shortly after eating. Influence on Heart Health High carbohydrate diets, especially those high in refined carbohydrates and added sugars, have been linked to adverse effects on heart health. Excessive consumption of these types of carbohydrates can contribute to elevated triglyceride levels and lower levels of HDL cholesterol, which are risk factors for cardiovascular disease.

32. Disorders of carbohydrate metabolism Glycogen storage diseases GSDs comprise a number of disorders that affect the metabolism of glycogen for example Pompe(Acid alpha glycosidase) Cori( affects the Glycogen debrancher enzyme) von Gierke(Glucose 6-phophotase) Mutations found in the genes encoding the enzymes that regulate the processing of glycogen lead to abnormal concentrations or structures of glucose

33. Cont…. Galactosemia This is a family of autosomal recessive disorders in which the metabolism of the sugar galactose is disrupted causing accumulation of galactose in the blood and tissues Inborn errors in Fructose metabolism Hereditary fructose intolerance (HFI)is an autosomal recessive disorder in the gene encoding the enzyme aldolase B. This gives rise to an accumulation of fructose-1-phophate that inhibits glycogenolysis and glyconeogenesis

34. Cont…. Galactosemia This is a family of autosomal recessive disorders in which the metabolism of the sugar galactose is disrupted causing accumulation of galactose in the blood and tissues Inborn errors in Fructose metabolism Hereditary fructose intolerance (HFI)is an autosomal recessive disorder in the gene encoding the enzyme aldolase B. This gives rise to an accumulation of fructose-1-phophate that inhibits glycogenolysis and glyconeogenesis

35. Fructose Intolerance: This disorder occurs when there is a deficiency in the enzyme needed to metabolize fructose, a sugar found in fruits and honey. Fructose intolerance can lead to symptoms such as abdominal pain, vomiting, and failure to thrive. Lactose Intolerance: While not a genetic disorder, lactose intolerance is worth mentioning. It occurs when the body lacks the enzyme lactase, necessary for the digestion of lactose, the sugar in milk and dairy products.

36. References Williams text book of endocrinology 12 th edition; Elsevier/Saunders Greenspan’s basic and clinical endocrinology 9 th edition. McGraw Hill medical World Health Organization (WHO) : The World Health Organization provides comprehensive information on global health issues, including statistics, research findings, and guidelines related to diabetes mellitus. Mayo Clinic : The Mayo Clinic is a renowned medical institution that provides reliable information on various health conditions, including detailed explanations of diabetes mellitus types, symptoms, treatments, and preventive strategies.

37. REFERENCES World Health Organization. ( n.d. ). Diabetes: Fact sheet. Retrieved from https://www.who.int/news-room/fact-sheets/detail/diabetes Mayo Clinic. (2021). Type 2 diabetes: Symptoms & causes. Retrieved from https://www.mayoclinic.org/diseases-conditions/type-2-diabetes/symptoms-causes/syc-20351193 American Diabetes Association. ( n.d. ). Diagnosing diabetes and learning about prediabetes : Standards of medical care in diabetes—2021. Retrieved from https://care.diabetesjournals.org/content/44/Supplement_1/S15