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

Most Common

• Diabetes• Overweight/Obesity• Hypertension• High Cholesterol• Renal Disease• HIV/AIDS• Pregnancy• Emotional eating

Least Common• Underweight• Gastrointestinal issues• Celiac disease• Food allergies• Eating disorders• Sports nutrition• Vegetarianism • Bariatric surgery

MNT Goals for Diabetes

1. Achieve and maintain:• 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– 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: 10-35% of total calories

• Total fat: 20-35% of total calories

% CHO, PRO, FAT

CHO

PROTEIN

FAT

Nutrition Counseling

• 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

• www.diabetes.org• www.dlife.com• www.diabeticlivingonline.com• www.calorieking.com• www.sparkpeople.com

www.friedmandiabetesinstitute.comRefer 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.