Healthcare Assignment: Diabetes Type 2 & Low Carbohydrate Diet Efficacy

Question

Task:
Healthcare Assignment Task: You are a nutritionist working in the field of endocrine-related metabolic diseases, and have been asked to provide a brief review on healthcare assignment (1250 words maximum) on the efficacy of very low carbohydrate diets for the management of people who suffer from type 2 diabetes. The review is intended for a monthly journal publication aimed at a non-specific health professional readership. In particular, you have been asked to focus on some key points in your review:

1. Discuss key impairments that are characteristic in the altered glucose metabolism of people with type 2 diabetes.
2. As a result of these impairments, describe the expected differences in post-prandial metabolism of a given load of digestible carbohydrates in people with type 2 diabetes compared with healthy, non-diabetic individuals.
3. Discuss how a very low carbohydrate diet might alter glucose-related metabolic pathways in the body compared with a diet much higher in carbohydrate content. In your answer you should describe endocrine effects, glycaemia effects, and alterations in pathways of energy metabolism.
4. Briefly critique the evidence available that has investigated the efficacy of very low carbohydrate diets in improving glucose control in people with type 2 diabetes.
5. Briefly summarize your key findings. Based on your metabolic knowledge about type 2 diabetes, effects of very low carbohydrate diets, and the strength of the current evidence available, provide some recommendations and/or perspectives in relation to use of very low carbohydrate for the management of type 2 diabetes.

Answer

A1. Type 2 diabetes is a chronic disease and it is the most common type of diabetes. It has been seen in this healthcare assignment that the common symptom of the disease is higher level of blood sugar. Considering this factor, it has been seen that the insulin is the metabolic regulator in the body as this can effectively help in the metabolism of glucose in the body by controlling the cell membrane permeability and glucose absorption. However, in type 2 diabetes, the beta cell undergoes dysfunction and cannot produce enough insulin to maintain the glucose metabolism in the body^[1]. Moreover, the insulin resistance in the skeletal muscle cells and liver is also visible which leads to the issue of non absorption of glucose in the cells mentioned above and builds up a higher amount of glucose in the blood. Hence, the primary symptom of type 2 diabetes that is hyperglycaemia occurs. This disease develops with time that is people from the age of 40 and above is mostly vulnerable and if the person is obese or overweight the he or she will be more vulnerable to the disease. Hence, the dysfunction of beta cell, insulin resistance of the skeletal muscle and liver cells, hyperglycaemia and also lack of energy as lack of glucose absorbance and energy formation is also visible among the patients of type 2 diabetes. The earlier mentioned are the primary symptoms or issues of type 2 diabetes^[2]. Moreover, it is one of the most common chronic diseases among older people.

A2. In type 2 diabetes patients the factors of the metabolism are impaired due to the inability to absorb glucose or carbohydrate by the cell as the insulin levels are low and also the insulin resistance by the cell membranes. Hence, the aspects of the post prandial metabolism will also be impacted among the type 2 diabetes patients in a negative manner as the absorption of the glucose will not occur in the cells and thus, the energy production from the same will not happen as well. Hence, the hyperglycaemia will develop and ketone bodies will increase in the body. These factors will lead to development of saturated fat or low density lipids that will be absorbed in the organs and lead to overweight or obesity along with coronary issues^[3]. On the other hand, the hyperglycaemia will lead to the development of multiple organ failure issues. Thus, in case of post prandial metabolism a person with type diabetes cannot metabolise the meal and absorb optimal nutrient due to the glucose resistance of the cells and this will lead to different fat metabolism and absorption related issues. Moreover, the aspects of the development of ketone body and reactive oxygen species in a higher manner will lead to the issues of blood toxicity in the body which develops multiple organ failure issues a well. Whereas, a healthy person without the type 2 diabetes can effectively absorb the glucose in the cells and thus, the post prandial metabolism is normal for the person depending on the calorie intake and physical activities of the person^[4].

A3. Dietary carbohydrate reduction can be effective in case of the type 2 diabetes patients. It has been seen that the type 2 diabetes patients suffer from the primary issue of insulin inactivity and non absorption of glucose in the skeletal muscle cells and also in liver and lead to the development of hyperglycaemia. Hence, the reduction in the carbohydrate or glucose intake will be effective in this case as the glucose intake lowering can reduce the blood glucose level without the issue of non absorption and metabolism^[5]. On the other hand, plasma saturated fatty acids are being controlled by the carbohydrate in the body that is increasing glucose level lead to the ketosis and development of saturated fat in the body. This factor leads to overweight and obesity as well. On the other hand, the development of higher amount of cholesterol can also lead to the development of cardiovascular issues. Moreover, the lower glucose intake can also lead to high density lipid formation which is good for the physiological factor. Thus, the lower carbohydrate intake can reduce the hyperglycaemia issue as well as the lipid metabolism related dysfunction as well. Moreover, the risk of obesity or cardiovascular disease can also be reduced without any kind of weight loss trainings through this diet. The low carbohydrate diet is also referred as the keto diet and it has been seen to be effective for both type 1and type diabetes patients. However, in case of type 2 diabetes, it is more effective as it reduces the risks of the pharmacological interventions and side effects as well. On the other hand, the type 1 patients needs lower amount of insulin supplements as well^[6].

Keto diet is effective in the process of the ketone body reduction in the body hence; the factor of the impact of the low carbohydrate diet can reduce the ketone body which can affect the body in various ways. The reactive oxygen species are increased due to the ketone bodies and impair the metabolic functionality. Thus, the fat absorption and fat metabolism in the body cannot be done properly. Considering all these factors, it should be stated that the low carbohydrate diet or the keto diet can lead to the development of better situation for the reactive oxygen species reduction^[7], better fat absorption and metabolism and also balance the glucose level in the body. Thus, the energy balance and the metabolism can be maintained effectively. The carbohydrate can be replaced with the proteins in the diet which can improve the muscle strength and energy in a better manner. Moreover, the protein based diet can improve the structural and functional factors of the body in a better manner rather than the higher carbohydrate diet^[8]. Considering all these factors, the implementation of the keto diet or the low carbohydrate diet would be more effective for the type 2 diabetes patients.

In type 2 diabetes the patients should focus on the weight loss exercises mostly as most of the evidences highlighted that the impact of the weight loss is very much effective in obesity or overweight reduction and subsequently the energy imbalance in the body as well. Hence, the factor of the low carbohydrate diet can also replace the weight loss training as well as the low carbohydrate intake can reduce the risk of higher blood glucose level, impaired lever function, reactive oxygen species and ketone body related issues along with the saturated fat development issues in the body^[2]. Thus, the muscle functionality and structure can be maintained and also the energy balance can be maintained as well. Based on the recent evidences the impact of the low carbohydrate diet is very much effective for the body to maintain the functional effectiveness in a proper way. Moreover, replacing the carbohydrate of the diet with protein can also be effective for the optimal energy development and functionality maintenance of the muscles without lacking the energy development issues due to non absorption of carbohydrate in the skeletal muscle cell among the type 2 diabetes patients. Considering all these factors, it should be stated that the keto diet or the low carbohydrate diet along with protein based diet would be very much effective for the type 2 diabetes patients^[5]. Moreover, the lower glucose intake can also lead to high density lipid formation which is good for the physiological factor. Thus, the fat metabolism can also be maintained properly and the risk of obesity and also overweight issues can also be reduced as well.

References
1. Medlineplus.gov. Type 2 diabetes: MedlinePlus Medical Encyclopedia [Internet]. Medlineplus.gov. 2021 [cited 23 May 2021]. Available from: https://medlineplus.gov/ency/article/000313.htm

2. Cleveland Clinic. Diabetes: Types, Risk Factors, Symptoms, Tests, Treatments & Prevention [Internet]. Cleveland Clinic. 2021 [cited 23 May 2021]. Available from: https://my.clevelandclinic.org/health/diseases/7104-diabetes-mellitus-an-overview

3. Søndergaard E, Johansen RF, Jensen MD, Nielsen S. Postprandial VLDL-TG metabolism in type 2 diabetes. Metabolism. 2017 Oct 1;75:25-35.

4. Grace MS, Dempsey PC, Sethi P, Mundra PA, Mellett NA, Weir JM, Owen N, Dunstan DW, Meikle PJ, Kingwell BA. Breaking up prolonged sitting alters the postprandial plasma lipidomic profile of adults with type 2 diabetes. The Journal of Clinical Endocrinology & Metabolism. 2017 Jun 1;102(6):1991-9.

5. Feinman RD, Pogozelski WK, Astrup A, Bernstein RK, Fine EJ, Westman EC, Accurso A, Frassetto L, Gower BA, McFarlane SI, Nielsen JV. Dietary carbohydrate restriction as the first approach in diabetes management: critical review and evidence base. Nutrition. 2015 Jan 1;31(1):1-3.

6. Chadt A, Al-Hasani H. Glucose transporters in adipose tissue, liver, and skeletal muscle in metabolic health and disease. Healthcare assignment PflügersArchiv-European Journal of Physiology. 2020 Jun 26:1-26.

7. Daryabor G, Atashzar MR, Kabelitz D, Meri S, Kalantar K. The effects of type 2 diabetes mellitus on organ metabolism and the immune system. Frontiers in immunology. 2020;11.

8. DeFronzo RA, Tripathy D. Skeletal muscle insulin resistance is the primary defect in type 2 diabetes. Diabetes care. 2009 Nov 1;32(suppl 2):S157-63.