Diabetes #5

Question 1

what is especailly important for those taking insulin

Answer 1

, the importance of consistency in carbohydrate content from day to day (and meal/snack to meal/snack) relates to the specific insulin regimen, and particularly whether the client takes multiple insulin injections (intensive versus conventional insulin regimens).

Question 2

for type 2 on insulin what else should we keep in mind

Answer 2

not only is carbohydrate important in type 2, but, given the high rate of obesity and the beneficial effects to Type 2 diabetes of reversing this, it is very important to remember total kilocalories and fat content

Question 3

What affect nutritional counselling and approach in treating diabetes.

Answer 3

• Motivation, ability of clients to understand and participate in dietary modifications and insulin regimens (and to make insulin adjustments independently), and desire for flexibility for diet and lifestyle all affect nutritional counselling and approach in treating diabetes. e.g. Perhaps Beyond the Basics is too complex for your client, so you use a simplified approach (a simpler exchange system).

Question 4

what is important to remeber in children

Answer 4

• Remember the importance of providing adequate energy (and all nutrients) for growing children that have Type 1 (or Type 2) diabetes.

Question 5

why is it used:
A. Getting Started version of Beyond the Basics (Poster)
-e.g. A client with Type 2 diabetes who is not on insulin

Answer 5

• Uses:
  1) For newly diagnosed clients in order to start to become familiar with what carbohydrate is, understand portion sizes for protein, and how to minimize fat intake.
  2) Also, commonly used for other Type 2 clients (not just those newly diagnosed, either because of:
  a) the low cost of the poster or
  b) the client finds Beyond the Basics too complicated.

Question 6

why is . Beyond the Basics used

who should use it

Answer 6

The “complete” exchange system.

• Used to design a mealplan and help the client make “choices” within food groups.
  e. g. client with Type 2 diabetes who is not on insulin
• Note: The “choices” from those groups that contain CHO have average CHO values of 15g. This strategy is not particularly accurate in providing for consistency in carbohydrate, but is often sufficient for this type of client.
• Thus, this approach would not be a good choice for someone with Type 1 diabetes or someone with Type 2 diabetes on insulin. These clients would do CHO counting instead.

Question 7

what are the principles of beyond the basics

Answer 7

1. The Goal: To allow the patient to maintain a consistent dietary pattern from day to day but at the same time, provide maximum variety in food choices.
2. Foods are interchangable within a group (not between food groups).
   - The word “choice” is used to refer to a measured amount of food within a group. One choice is based upon a measured portion that provides approximately15 g carbohydrate (not precise).
   - Vegetables are considered non-carbohydrate-containing to be used liberally in Type 2 to provide satiety (with some exceptions that we will discuss).
   - Protein and fat choices are based upon portions that provide similar kilocalories to each other. i.e. What influence do fat and protein have on blood [glucose]?
   - One food choice replaces another within a food group.
3. Most foods are eaten in measured amounts.

Question 8

what are the steps in developing a meal plan using beyond the basic

Answer 8

Step 1
a) Diet history: enter the food into the mealplan table

Step 2
-Develop a “mealplan” with the individual patient, based on your diet history of their usual eating pattern and discussions/negotiations about suggested modifications. Will you suggest changes? What is your client’s opinion?
Be sure to consult the attached guidelines for wise use

Step 3

• Total up the # of choices in each group.
• Using Beyond the Basics, convert this to grams of pro, cho, fat contributed from each food group.
• Then add up the pro, fat, cho.
• Add up kcals.
• Then evaluate how pro/cho/fat ratio looks on a percent energy basis compared to the recommendations. Again, will you suggest changes? What is your client’s opinion?

Question 9

CARBOHYDRATE COUNTING
– Examples of Different Approaches:

Approach #1

Answer 9

Approach #1
CHO content is counted (tallied) but held consistent for a given meal from day to day (e.g. 75 g at lunch on each day of the week). The starting point for the amount of CHO is based on diet history. Who would use this system? How precise should the CHO counting be?

– For a client with Type 2 diabetes who has 1 or 2 insulin injections per day, the cho counting might be based on the less precise system of taking the average value of 15 g per choice from the Grains & Starches, Fruits, Milk & Alternatives, or Other Choices groups from Beyond the Basics.

• For a client with Type 1 diabetes who will be on multiple (intensive) insulin injections per day or a pump, the CHO counting should be based on the more precise method of the actual available cho content of individual foods (more precise).

Question 10

Approach #2 for carb counting

who would use this system

Answer 10

The carbohydrate content can vary from day to day within meals and snacks. e.g. Mon lunch CHO total might differ from Tues lunch CHO tally. This is compensated for by changing rapid-acting insulin injections by using an insulin:carbohydrate ratio.

• This client is on multiple insulin injections per day or a pump to allow for the flexibility needed in changing insulin dosages.
• This system allows for the maximum flexibility in diet and lifestyle and is common for individuals on intensive insulin regimens.
• To be precise, the available carbohydrate content of individual foods is used

The typical client has Type 1 diabetes, but some clients with Type 2 diabetes may do this also if they fit the more intensive insulin regimen criteria.