Transcript Medical Nutrition Therapy for Diabetes

Medical Nutrition Therapy
for Diabetes
Does a perfect eating plan exist?
Jennifer Regester, RD, CDN, CDE
Nutrition Assessment
• Type of diabetes, any
complications
• Blood sugar control
• Past medical history
• Anthropometrics- height,
weight, BMI, body
composition
• Biochemical- labs
• Medications, including
supplements
• Dietary 24 hour recall
(meals, snacks, and
beverages)
• Favorite foods
• Food allergies
• Eating patterns and
habits
• Physical activity
• Readiness to change
• Attitude
Nutrition Assessment
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Most Common
Diabetes
Overweight/Obesity
Hypertension
High Cholesterol
Renal Disease
HIV/AIDS
Pregnancy
Emotional eating
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Least Common
Underweight
Gastrointestinal issues
Celiac disease
Food allergies
Eating disorders
Sports nutrition
Vegetarianism
Bariatric surgery
MNT Goals for Diabetes
1. Achieve and maintain:
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Blood glucose levels in the normal range
Lipid profile that reduces risk for
cardiovascular disease
Blood pressure levels in the normal range
2. To prevent (or slow) the rate of
development of chronic complications by
modifying nutrient intake and lifestyle
MNT Goals for Diabetes
3. To address individual nutrition needs,
taking into consideration personal and
cultural preferences and willingness to
change
4. To maintain the pleasure of eating by only
limiting food choices when indicated by
scientific evidence
MNT Recommendations
• Monitor carbohydrate intake for glycemic
control
• Include a variety of carbohydrates from
fruit, vegetables, whole grains, legumes,
and fat-free/low-fat dairy products
• The use the glycemic index may provide a
modest benefit
• Avoid excess energy intake
Special Considerations
Overweight/Obese
Type 1 Diabetes
Type 2 Diabetes
Gestational Diabetes
Special Considerations
• Weight loss
– Weight loss has been shown to improve insulin
resistance
– Encourage dietary changes, increased physical
activity, and behavior modification
– Weight loss medications may be considered and can
help with an additional 5-10% weight loss with
lifestyle modifications
– Bariatric surgery
Special Considerations
• Type 1 Diabetes
– Insulin therapy may be integrated into an individual’s
dietary and physical activity pattern
– Adjust rapid-acting insulin doses based on
carbohydrate content in meals and snacks
– When on fixed daily insulin doses keep carbohydrate
content consistent with respect to time and amount
– Adjust insulin for planned exercise. For unplanned
exercise, extra carbohydrate may be needed
Special Considerations
• Type 2 Diabetes
– Encourage lifestyle modifications to improve
glycemia, dyslipidemia, and blood pressure
– Reduce caloric intake, saturated and trans fats,
cholesterol, and sodium
– Increase fiber, nutrient-rich foods
– Increase energy expenditure
Special Considerations
• Pregnancy
– Adequate caloric intake and nutrients needed to
provide appropriate weight gain for mother and fetus
– Focus on food choices for a healthy and steady
weight gain, glycemic control, and absence of
ketones
– Aim to develop healthy habits and lifestyle
modifications (diet and exercise) for after delivery
Meal Planning Strategies
• Timing of meals
• Healthy choices and
balanced meals
• Variety including
nutrient-rich foods
and high-fiber foods
• Moderation using
portion control
• Limit refined sugars
• Carbohydrate
counting
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Prescribed meal plan
Exchange system
Carbohydrate servings
Label reading
Glycemic index
Insulin to carbohydrate
ratio + correction
factor (if applicable)
Breakdown of Macronutrients
• Total carbohydrate:
45-65% of total
calories
• Total Protein: 1035% of total
calories
• Total fat: 20-35% of
total calories
% CHO, PRO, FAT
CHO
PROTEIN
FAT
Nutrition Counseling
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Patient’s lifestyle
Work schedule
Family life
Support system
Education level
Knowledge about
diabetes and nutrition
• Record keeping
abilities
• Attitude
• Ability to adapt to
change
• Reaction to advice
• Goal setting
“So what do I eat?”
How to be a “Nutritionist” when
you do not have an RD
Doctor’s Advice
• “Nutrition is an important part of taking care of
your diabetes”
• Avoid telling patients to diet and lose weight
without resources
• Do not recommend fad diets, try to encourage
healthy lifestyle changes instead
• Be specific- “try to be active at least 30 minutes
most days of the week”
• Keep it positive
Basic Nutrition Advice
• Timing of meals and snacks (no more than
4 hours without eating)
• Get a variety of healthy, high-fiber foods
• Limiting refined carbs and added sugars
• Watch portion sizes and read labels
• Keep a food journal
• Learn to make lifestyle changes and not
diet for a short period of time
How to Read a Nutrition Label
http://www.dtc.ucsf.edu/images/charts/nutrition_facts1.gif
MyPyramid
http://www.mypyramid.gov
Portion Control
http://www.ncescatalog.com
Portion Control
http://www.snacksense.com/files/u1/portions_v4.jpg
The Plate Method
http://www.tops.org/images/plate.gif
Follow-up Resources
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www.diabetes.org
www.dlife.com
www.diabeticlivingonline.com
www.calorieking.com
www.sparkpeople.com
www.friedmandiabetesinstitute.com
Refer patients to RDs
Does a perfect eating plan exist?
References
1.
Franz, Marion J., MS, RD, LD, CDE. “Medical Nutrition Therapy for Diabetes
Mellitus and Hypoglycemia of Nondiabetic Origin”. Krause’s Food, Nutrition, and
Diet Therapy. Saunders: Philadelphia. 2004: p. 792-837.
2.
“Nutrition Recommendations and Interventions for Diabetes”. American Diabetes
Association. Diabetes Care. 2008;31(suppl 21):S61-S78.
3.
Carey, Rita E., Ms, RD, CDE. “Wanted: The Best Diabetes Diet for Optimal
Outcomes”. Today’s Dietitian. 2009;11(No. 8): p. 24-30.
4.
Escott-Stump, Sylvia. “Type 1 Diabetes Mellitus”. Nutrition Diagnosis-Related
Care. Philadelphia: Lippincott Williams & Wilkins, 2002. p. 379-385.
5.
Escott-Stump, Sylvia. “Type 2 Diabetes Mellitus”. Nutrition Diagnosis-Related
Care. Philadelphia: Lippincott Williams & Wilkins, 2002. p. 388-393.
6.
Escott-Stump, Sylvia. “Gestational Diabetes”. Nutrition Diagnosis-Related Care.
Philadelphia: Lippincott Williams & Wilkins, 2002. p. 394-396.