Diabetes Dietary Effect Flashcards
Why applying Diet Therapy (3)
1. encourage the attainment or maintenance of a healthy body weight
2. achieve the best possible metabolic control (w/o seriously compromising quality of life (glycemic control, lipid profile, BP))
3*.to delay or prevent complication
Goals of Diet therapy (3)
- provide specific guidelines for a different stage in the life cycle (as DM is a long term disease)
2*. to promote self-care ( by providing the necessary knowledge, skills, resources and support) - to encourage overall health (by practical instructions in optimal nutrition)
On the nutrition Checklist: refer? follow? individualize? choose? know? encourage (2)?
refer to RD for NUTR counselling; follow CFG; individualise the dietary advice by preference and Tx goals; choose low GI food; know the alternative dietary patterns for DM2; Encourage matching insulin to CHO in DM1; encourage the balanced calorie-reduced diet in pt with O/W and obesity
the procedure of nutritional management of hyperglycemia in DM2
- clinical assessment by RD (+ healthy behaviour intervention)
- to achieve/ maintain a healthy body weight by initiating an intensive healthy behaviour interventions or energy restriction + PA
- provide counselling in a diet tailored to individuals
- if not at target, continue healthy behaviour interventions and add pharmaco-therapy
- timely adjustment to interventions:
Healthy behaviour inter. : 2 to 3 months to attain A1C; if combining with Pharmaco-therapy: 3 to 6 months
Diabetes Canada: Macro-nutrient component in a diet
CHO :45-60%
Protein: 15-20%
Fat:20-35%
Diabetes Canada:
why should more than 45%
the limitations (3)
- to prevent high intake of Sat fat to incr. risk of CVD
1. minimum intake: 130g/d
2. <10% added sugar (sucrose)
3. at high range ~ 60%: should inclue low GI food and high fibre intake
def. Glycemic Index (GI)
- area under the curve, AUC, in blood glucose response of a given food, compared to standard for the same content in g of CHO
- with the scale 0-100
what’s glucose standard?
- CHO or white bread
def. glycemic load
the accounts for available CHO in portion
How to calculate glucose load?
glucose load=#g CHO content in the given food * GI/100
How to calculate GI?
AUC given food/AUC glucose(the same content CHO) *100
standard range GI:
low
Medium
high
L: no more than 55
M: 56-69
H: no less than 70
no unit
standard range GL:
low
Medium
high
L: no more than 10
M: 11-19
H: no less than 20
no unit
T/F High GI must be with a high GL
F
T/F high GL must cause a high GI
F
T/F a high GL food may be high GI
T
T/F a high GI food may be with low GL
T
Give 5 dietary factors affecting glycemic response and give one example for each
- Dietary fibre: oats
- cooking method: the harder texture of pasta
- other nutrient presence: yogurt
- low eater
- digestibility
why DM pts should intake more dietary fibres, especially soluble fibre?
it will be the bulky agent in the gut to slow down the gastric emptying and glucose absorption
what’s the guideline of fibre: (2)
- total 30-50g/d
1/3 from viscous soluble fibre - food: pulses, whole grains, F/V
Sugar: the guideline and why
<10%, if beyond, it incre. Blood Glucose and TG
why sugar is substituted by fructose
frudctose does not affect the blood glucose after eating, so can help lower A1C level
what is the concern to fructose (3)
- HFCS: high-fructose corn syrup is no different from sugar
- > 10%, it still affects TG in DM2 although it lowers the A1C level
- fructose from F/V is no harm, but the high GI fruits should be concern (pineapple, mango, papaya)
- sugar-sweetened beverage
How is low-carb diet in terms of effect on DM pts ?
- in the short term, there is some improvement in weight loss but not consistent after 12 months
- an improvement of A1C if pts are adherent, but the adherence is modest overall (limited studies in CM1)
What is low-Carb diet?
CHO of 4% to 45% of total energy
ketogenic diet: carb below 25%
What is low-Carb diet?
CHO of 4% to 45% of total energy
ketogenic diet: varb below 25%
Is it harmful in terms of low-carb diet? (3)
it is not harmful overall, but we should consider the specific conditions.
- for DM pts, it is easier to trigger ketoacidosis to the one following insulin treatment
- it also affect the medication with Na-Glucose transport?
- blunt response to glucagon injection under a severe hypoglycemic condition (the stimulus cannot induce glycogen, as there is no storage to release.)
what to consider in terms of fat?
the main risk factor of CVD
How to resolve the concern of fat?
- avoid trans fatty acids
- limit sat fat less than 9% of NRG
- replace sat fat from meat to other sources of PUFAs, MUFAs OR LOW-GI Carbs
How about intaking omega-3 supplements?
NOT rec.
- no benefits on CVD or mortality
- may decr. TG level and platelet aggregation
How about fish?
High intake of fish can reduce the risk of CVD, kidney disease in DM2, and less albuminemia in DM1.
2-3 servings /week
why highly recommend Mediterranean diet to DM pts?
- reduce A1C
- reduce CVD risk
- no disadvantage
the same as DASH and Portfoil
But M diet also can reduce the risk of retinopathy
what is the disadvantage and concern of vegetarian diet?
- Low B12 absorption
- need adjust medication in order to improve glycemia and lipids
Five types of diet
Mediterranean, Portfolio, Vegetarian, DASH(HTN + 1 RCT), Nordic (MetS)
How do you suggest the pt who is a moderate EtOH
- limit 2 drinks/d for F, or no more than 3 drinks/d for M.
- no big effect on BG if having with meals
- actually it helps to inverse A1C status and lower risk of CHD (coronary heart disease) in DM2
How do you remind a pt who often drink EtOH
- it may mask symptoms of hypoglycemia and increase ketones
How do you remind a pt who is going intermittent fasting?
- the same benefits as continous NRG restriction
- but should careful monitoring of medication on fasting days
How do you remind a pt who is following Ramadan?
- close self-monitor
- prevent the risk of hypoglycemia in insulin treatment
- discourage who had hx of severe hypoglycemia
How do you remind a pt who hv followed insulin Tx when drinking EtOH?
- remind: there is a delayed hypoglycemia after drinking with meals
4 special concerns with insulin Tx
- regularity of meal spacing and CHO content may help glycemic control
- if the pt tends to consume diets low in fibre, high in fat and protein, it shows requiring more insulin (less insulin, spontaneously low CHO consumption)
- snacking: helps to avoid hypoglycemia and balance potential Wt gain
- Bed-time protein snack: prevent nocturnal hypoglycemia
what are the 5 stage-targeted strategies for DM2?
- pre-diabetes
- early type 2 diabetes
- Not on insulin
- on basal insulin only
- on basal-bolus insulin
what is the most significant difference among the 5 stage-targeted strategies for DM2(3+1)?
pre-DM: induce low GI CHO + reduce refined CHO
DM w/o insulin: CHO distribution, low GI + high fibre
W/ insulin Tx: CHO consistancy, low Gi+high fibre
* in basal-bolus therapy: CHO distribution initially then learn CHO counting
How to self-care glycemic level during illness?
- no less than 4 days of SMBG
b/c it is hard to follow the diet and undesired syndrome or coma may occur if due to dehydration or infection - keep hydrate: 250ml - 370ml/hr
- F/V: drink semi-liquid containing CHO ( in case of vomiting lol)
- consulting MD if cannot tolerate if BS > 20 mM,…. DM symptoms, liquid intolerance
