Diabetes - Diet Approach Flashcards
What are the Goals of Diet Therapy in diabetes?
¢ maintenance of a healthy body weight
¢ the best possible metabolic control
- Glycemic control: near-normal or targets
- Lipid profile: primary target LDL-C ≤2.0 mmol/L
- Blood pressure <130/80
¢ To delay or prevent complications associated with diabetes
¢ To provide specific guidelines for different stages in the lifecycle
¢ To promote self-care by providing the necessary knowledge, skills, resources and support
¢ To encourage overall health by practical instructions in optimal nutrition
What is the Nutrition Checklist provided by CDA?
- REFER for nutrition counseling by a registered dietitian
- FOLLOW Eating Well with Canada’s Food Guide
- INDIVIDUALIZE dietary advice based on
preferences and treatment goals - CHOOSE low glycemic index carbohydrate food sources
- KNOW alternative dietary patterns for type 2 diabetes
2013 - ENCOURAGE matching of insulin to carbohydrate in type 1 diabetes
- ENCOURAGE nutritionally balanced, calorie- reduced diet in overweight or obese patients
What are the recommendations for patients with BMI ≥25 kg/m2?
Nutritionally balanced, calorie-reduced diet should be followed to achieve and maintain a lower, healthier (and realistic) body weight
What are the benefits of weight loss?
Weight loss of 5-10% of initial body weight –> Improves:
- insulin sensitivity
- glycemic control
- blood pressure control,
- lipid levels
What is the order of Nutritional management of hyperglycemia in type 2 diabetes provided by CDA?
Clinical assessment
Lifestyle intervention by Registered Dietitian
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Initiate intensive lifestyle intervention or energy restriction + increased physical activity to achieve/maintain a healthy body weight
-
Provide counselling on a diet best suited to the individual based on preferences, abilities, and treatment goals using the advantages/disadvantages listed below
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If not at target
-
Continue lifestyle intervention and add pharmacotherapy
Timely adjustments to lifestyle intervention and/or pharmacotherapy should be made to attain target A1C within 2 to 3 months for lifestyle intervention alone or 3-6 months for any combination with pharmacotherapy
What is the target CHO for diabetic patients?
Carbohydrates : 45-60%
- Minimum intake of 130 g/d
- <45% may not provide enough vitamins & minerals
- Higher range should include low GI index and high fiber intake
- <10% of added sugar (sucrose)
What is glycemic index?
Scale 0-100 compared to glucose standard
- Area under the curve (AUC) in blood glucose response of a given food compared to standard (glucose or white bread) for the same content in g CHO.
Ex: 200 g cooked pasta (50 g CHO) vs. 50 g glucose or 100 g white bread (50 g CHO).
GI= AUC pasta / AUC glucose or white bread X 100= 46
What is glycemic load?
Accounts for available CHO in portion
GL= g CHO in normal serving x GI/100
GL pasta= 50 g X 46 /100 = 23
What are the ranges of glycemic index?
Low: ≤ 55
Medium: 56-69
High: ≥ 70
What are the ranges of glycemic load?
Low: ≤ 10
Medium: 11-19
High: ≥ 20
What are the dietary factors affecting the glycemic response?
¢ Dietary fibers ¢ Food form ¢ Cooking and processing ¢ Digestibility ¢ Other nutrients present (protein and fat) ¢ Interprandial differences ¢ Fast/ slow eater ¢ Glucose tolerance effect
What is the benefit of replacing high GI foods with low GI foods?
- better glycemic control
- increased HDL-C
- decreased CRP (reducing inflammation), hypoglycemia in T1DM, and medications
Recommended but teaching should be based on patient’s interest and ability.
What are the recommendations for dietary fiber intake in diabetes?
¢ Soluble fiber slows gastric emptying and glucose absorption
¢ Higher total intake recommended in DM: 25-50 g/d or 15-25 g/1000 kcal
What are the recommendations for added sucrose intake in diabetes?
<10% of total energy is acceptable
>10% increases BG and TG in some
What are the recommendations for added fructose intake in diabetes?
- in place of sucrose may help lower A1C and unlikely
harmful - > 10% increase TG in T2DM
- When excess energy: adverse metabolic profile
What are the recommendations for natural fructose intake in diabetes?
from fruits = no harm
Caution with high GI fruits: pineapple, mango, papaya, melons
What is the target fat for diabetic patients?
Fat: 20-35% of energy
Due to high risk of CVD:
- Saturated <7% of E
- Avoid trans fatty acids
- MUFAs up to 20%
- PUFAs up to 10%
What are the recommendations for Omega 3 fatty acids for diabetic people?
¢ No effect on blood glucose but decrease TG and platelet aggregation
¢ Higher intake of fish –> reduction in CVD in women with DM –> Recommendation: 2-3 servings fish/week
¢ Supplements: conflicting data –> Not recommended (except for severe hyperTG)
What is the target protein for diabetic patients?
¢ Protein: 15-20% (1.0-1.5 g/kg/day)
¢ Maintain 1.0-1.5 g/kg/d during weight-reduction
¢ Concern with chronic kidney disease (CKD)
- No more than 0.8 g/kd/d
What are the advantages and disadvantages of Hi-CHO (low-glycemic index [GI]) in diet?
Advantages:
decreased A1C, CRP, hypoglycemia
increased HDL-C
Disadvantages:
none
What are the advantages and disadvantages of Hi-CHO (high fibre) in diet?
Advantages:
decreased A1C, TC, LDL-C
Disadvantages:
decreased HDL-C
What are the advantages and disadvantages of Hi-MUFA in diet?
Advantages:
decreased A1C, TG
Disadvantages
none
What are the advantages and disadvantages of Lo-CHO diet?
Advantages:
decreased TG
Disadvantages:
decreased micronutrients
increased renal load
**no change in A1C
What are the advantages and disadvantages of Hi-protein diet?
Advantages:
decreased A1C, BP, TG
preserve lean mass
Disadvantages:
decreased micronutrients
increased renal load
