NUTRITIONAL CARE IN DM

Medical Nutrition Therapy

• MNT is integral to total diabetes care &
management
• Requires a coordinated team effort
• MNT requires an individual approach &
effective nutrition self-management education
 Goals of MNT for DM
Goals of MNT that apply to all
persons with diabetes
1. Attain & maintain optimal metabolic outcomes
including :
- blood glucose levels in the normal range or as close
to normal as is safely possible to prevent or reduce
risk or complications of diabetes
- A lipid & lipoprotein profile that reduces risk for
CV disease
- Blood pressure levels that reduce the risk for
vascular disease
2. Prevent & treat the chronic complications :
Modify nutrient intake as appropriate for the
prevention and treatment of obesity, CV
disease, hypertension & nephropathy
3. Improve health through healthy food choices
& physical activity
4. Address individual nutritional needs, taking
into consideration personal & cultural
preferences & lifestyle while respecting the
individual’s needs & willingness to change
 Goals of nutrition therapy that apply
to specific situations

1. For youth with type 1 DM, provide adequate energy

to ensure normal growth and development;
integrate insulin regimen into usual eating &
exercise habits
2. For youth with type 2 DM, facilitate changes in
eating and exercise habits that reduce insulin
resistance and improve metabolic status
3. For pregnant & lactating women, provide adequate
energy and nutrients needed for successful
outcomes
4. For older adults, provide for the nutritional needs of
an aging individual
5. For individuals treated with insulin or insulin
secretagogues, provide information on prevention and
treatment of hypoglycemia and exercise-related blood
glucose problems and how to manage acute illness
6. For individuals at risk for DM, decreased risk by
increasing physical activity and promoting food
choices that facilitate moderate weight loss or at
least prevent weight gain
 Prioritizing nutrition therapy for
type 2 DM
• To adopt lifestyle strategies that improve the
associated metabolic abnormalities of
glycemia, dyslipidemia & hypertension
• Lifestyle strategies independent of weight loss
that can improve glycemia include reducing
energy intake, monitoring CH servings, limiting
consumption of saturated fats and increasing
physical activity
 carbohydrate
• Total amount of
carbohydrate is more
important than the
source (starch or sugar)
• The 1st priority for food
and meal planning is the
total amount of =
carbohydrate
 Carbohydrate and Diabetes

• Include foods containing carbohydrate from

whole grains, fruits, vegetables and low-fat
milk
 Carbohydrates
Simple
Complex

Fiber
• Severe restriction of dietary carb is not
indicated
• Within the total caloric recommendation →
carb should be 45 – 60% of total energy intake
 Carbohydrate and Diabetes

• Consistency in carbohydrate intake is

important from day to day
– For people taking a fixed dose of insulin
• Insulin should be adjusted based on amount
of carbohydrate at meals
– For people on varying doses at meal
times
 Carbohydrate and Diabetes
• Several things affect how much blood
glucose increases after eating :
– amount of carbohydrate
– type of sugar or starch
– cooking and food processing
– food form
– other foods in the meal that slow digestion
 Carbohydrate and Diabetes
• Limited amounts of sugar or foods
containing sugar can be used without
affecting blood glucose
– when substituted for other carbohydrates at
the meal
• Large amounts of sugar-containing foods
are not recommended
 Protein and Diabetes

• The recommendation in the absence of

renal insufficiency is (0.8g/kg BW/day) →
10 – 20% of total energy intake
• Intakes >20% → higher incidence of
albuminuria
• Protein intake should be reduced
in the setting of renal insufficiency
 Dietary Fat and Diabetes

• Primary goal - Lower LDL cholesterol by:

– Eating less saturated fat and
cholesterol
– Eating less trans fats
 Dietary Fat and Diabetes
• Choose monounsaturated fat in place of
saturated:
– olive oil, canola oil, peanut oil,
olives, avocados, nuts
 Dietary Fat and Diabetes
• Recommendation : 20-35% total calorie
• Eat less total fat
• Low-fat diets can help:
– with weight loss
– improve cholesterol and other fats
 Weight Loss and Diabetes
A small amount of weight loss can:
• improve insulin resistance
• lower blood glucose
• improve blood cholesterol
• reduce blood pressure
 Weight Loss and Diabetes

Successful weight loss usually requires:

• a structured weight loss program
• education
• reduced fat and calories
• regular physical activity
• frequent follow-up
 Vitamins and Minerals and
Diabetes
• Vitamins and minerals supplementation is of
dubious benefit except in cases of documented
deficiency
• High doses of vitamin and mineral supplements
can be toxic
• Intake of vitamin & minerals should be
encourage through natural food sources, most
notably vegetables & fruits
Regular meals based on
carbohydrate

14
 Dietary Guidelines
• Eat a diet low in saturated and total fat.
• Eat a diet moderate in sodium and sugar.
• Eat 5 or more fruits and vegetables a day.
• Choose a diet rich in whole grains.
 Dietary Guidelines
• Eat at the same time everyday , at least
within 1 hour of regular time.
• Eat about the same amount of
carbohydrate with each meal.
 Dietary recommendation
Carbohydrate 45-60% total energy
Dietary fiber 14g/1000 kal
Total fat 20-35% total energy
saturated < 10%total energy
PUFA (esp. n3) 7-10% total energy
MUFA 15-20% total energy
trans fat as low as possible
Cholesterol <300 mg/day
Protein 10-20% total energy
Energy maintain BMI < 25kg/m2
 Essential self-management
nutrition education skill
• Sources of carb, protein & fat
• Understanding nutrition labels
• Modification of fat intake
• Use of blood glucose monitoring data for
problem solving related to food choices and
physical activity option
• Grocery shopping guidelines
• Guidelines for eating out : restaurant, etc
 Essential self-management nutrition
education skill
• Snack choices
• Use of sugar-containing foods and nonnutritive
sweeteners
• Behavior modification techniques
• Vitamin, mineral and botanical supplements