Transcript Remember when…

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Carbs Are the Key:
Current Nutrition
for Diabetes
Contributed by Karen Auwaerter, RD
Review Date 4/10
D-0556
Remember when…
• No sugar or sugary foods
• More complex carbohydrates, because they
are digested more slowly and will not
increase blood sugar as rapidly
Remember when…
(cont’d)
• American Diabetes Association (ADA):
Nutrition Recommendations and Principles for
People With Diabetes Mellitus, 1986:
 People with diabetes can safely
incorporate 1 teaspoon of sugar into a
meal, as long as blood sugar is under
good control
Remember when…
(cont’d)
• Patients followed rigid meal plans and could
not request any foods high in concentrated
carbohydrates
• Calories were calculated to within
100 calories of the diet prescription
(ie, 1800 ADA)
• Patients were told: “I am sorry, but that is
not on your diet.”
Remember when…
(cont’d)
• HS snack was automatic
• Snacks included protein, because it helped
“regulate” blood sugar
• Patients typically were on NPH insulin or
sulfonylureas (Diabinese®, Glucotrol®,
Micronase®)
Newer research…
• Abraira C, Derler J. Large variations of sucrose in
constant carbohydrate diets in type II diabetes. Am
J Med. 1988;84:193-200.
• Bantle JP, Swanson JE, Thomas W, Laine DC.
Metabolic effects of dietary sucrose in type II
diabetic subjects. Diabetes Care. 1993;16:13011305.
• Malerbi DA, Paiva ES, Duarte AL, Wajchenberg BL.
Metabolic effects of dietary sucrose and fructose in
type II diabetic subjects. Diabetes Care. 1996;19:
1249-1256.
The research says…
• Postprandial glucose levels and insulin
responses to a variety of starches and
sucrose are similar if the amount of
carbohydrate is constant
• Day-to-day variations in energy and protein
or fat intake are not significantly related to
HbA1c
ADA Guidelines change to
reflect new science
• “Sugars” and concentrated sweets are
allowed as part of a healthy eating pattern
for all persons with diabetes
• Sweets can replace other forms of
carbohydrates in a meal pattern
• Most carbohydrates should come from
nutritious sources, such as fruits and
vegetables, grains, and low-fat or fat-free
dairy foods
ADA=American Diabetes Association
The evidence says…
• Foods containing carbohydrates (CHO) from
whole grains, fruits, vegetables, and low-fat
milk are important components—include
them in a healthy diet
• The total amount of CHO in meals or snacks
is more important than the source or type
The evidence says…
(cont’d)
• Because sucrose does not increase glycemia
to a greater extent than isocaloric amounts of
starch, it is not necessary to restrict sucrose
and sucrose-containing foods
• However, you must substitute sucrose and
sucrose-containing foods for other CHO
sources or cover them with insulin or other
glucose-lowering medication
Position Statement, ADA,
2009
• Implementation of a “consistent
carbohydrate” diabetes meal plan at health
care facilities
• Elimination of the name ADA Diet and No
Concentrated Sweets (NCS) Diet
• CHO content comparable from day to day at
each breakfast, lunch, and dinner
• Diet approximately 50% CHO, 20% protein,
30% fat
ADA=American Diabetes Association
Position Statement, ADA,
2008
• Patients requiring clear or full liquids should
receive approximately 200 grams (g) CHO
daily
• Sugar-free liquids are not appropriate
• After surgery, initiate food intake as quickly
as possible
Source: American Diabetes Association, Bantle JP, Wylie-Rosett J, et al. Nutrition
recommendations and interventions for diabetes: a position statement of the American
Diabetes Association. Diabetes Care [serial online]. 2008;31(suppl 1):S61-S78. Available
at: http://care.diabetesjournals.org/content/31/Supplement_1/S61.full.pdf. Accessed
March 30, 2010.
ADA=American Diabetes Association
Consistent CHO diet
• Typically 60 g CHO at each meal
• Occasional sweets counted into the total CHO
(coffee cake, Fig Newtons®)
• Increased amount of fresh vegetables, fresh
fruit, and whole grains
• 60 g CHO in all liquid diets
Patient and staff
education is key
• The “old” ADA Diet no longer exists
• Artificial sweeteners are allowed to help
reduce total carbohydrate intake of a meal
• Foods with “added sugars” are acceptable, as
long as they do not affect the overall
carbohydrate balance of a meal
References
American Diabetes Association, Bantle JP, Wylie-Rosett J, et al. Nutrition
recommendations and interventions for diabetes: a position statement of the
American Diabetes Association. Diabetes Care [serial online]. 2008;31
(suppl 1):S61-S78. Available at:
http://care.diabetesjournals.org/content/31/Supplement_1/S61.full.pdf.
Accessed March 30, 2010.
American Dietetic Association. Nutrition Care Manual®. Available at:
http://www.nutritioncaremanual.org/auth.cfm?p=%2Findex.cfm%3F.
Accessed March 30, 2010.
Executive summary: standards of medical care in diabetes—2010. Diabetes
Care [serial online]. 2010;33:S4-S10. Available at:
http://care.diabetesjournals.org/content/33/Supplement_1/S4.full.pdf+html.
Accessed March 30, 2010.
References (cont’d)
Franz MJ, Bantle JP, Beebe CA, et al. Evidence-based nutrition principles
and recommendations for the treatment and prevention of diabetes and
related complications. Diabetes Care. 2002;25:148-198.