Diabetes Nutrition Therapy Flashcards
(69 cards)
1
Q
Discuss the nutrition therapy from the 1920’s until today
A
- 1920s: Carb restriction (max 100 g/day), fasting
- Mid 20th century: Isocaloric diet w/ moderate fat consumption
- Now: Encourage MUFA & CHO (60-70% of E) and INDIVIDUALIZE the diet
2
Q
What is a key concept with diabetic nutrition therapy?
A
It is a “common sense” diet, however it must be individualized to the patient
3
Q
% CHO? kcal/day?
A
- 45-60%
- 225-300
4
Q
% Pro? kcal/day?
A
15-20%
-75-100
5
Q
% Fat? kcal/day?
A
-20-35%
-44-78
<9% SFA
6
Q
Protein recommendation?
A
1-1.5 g/kg/day
7
Q
What is a key CHO recommendation?
A
We must teach how to count net carbs
8
Q
Net carbs?
A
Total carbohydrate - (fibres + sugar alcohols)
9
Q
What are key concepts to address w/ label reading?
A
- Serving size
- Calories
- Fat
- Sodium
- Net carbs
- *NOT just CHOS**
10
Q
How can we chose healthy carbohydrates?
A
- Increase fibre
- increase pulses
- Increase whole grains
- Increase fruit and veg
11
Q
Fibre recommendation?
A
- Increase to 30-50 g/day
- 1/3 of fibre (10-20g) should be from viscous soluble fibre
12
Q
Low GI CHO?
A
- Pumpernickel
- Oat Bran
- Pasta/noodles
- Sweet potato
13
Q
Medium GI CHO?
A
- Rye
- Oatmeal
- Brown/basmati rice
- White potato
14
Q
High GI CHO?
A
- White bread
- Corn-flakes
- Short-grain rice
- French fries
15
Q
What are 3 healthy dietary patterns that may be recommended for diabetes?
A
- Mediterranean
- Vegetarian
- DASH
16
Q
Overarching diet recommendation for those with a BMI >/= 25?
A
Nutritionally balanced, caloric-reduced diet should be followed to achieve and maintain a lower, healthier body weight
17
Q
What is the significance of a 5-10% weight loss of initial body weight?
A
Improved insulin sensitivity, glycemic control, blood pressure control, lipid levels
18
Q
First three steps in the nutritional management of hyperglycemia in type II diabetes?
A
1) Clinical assessment
2) Intensive healthy behaviour interventions or energy restriction/increased PA to achieve/maintain HBW
3) Provide counselling on a diet best suited to ind. needs
19
Q
What happens if HBW target is not met after initial assessment by dietitian?
A
- Continue healthy interventions and add pharmacotherapy
- Adjustments should be made with healthy behaviours and/or meds to attain A1C within 2-3 months, or 3-6 months for any combination with meds
20
Q
What is one impact of increasing fibre in the diet?
A
May have undesirable GI side-effects, must increase water intake
-Suggest introducing fibres slowly
21
Q
There are many dietary patterns which may have beneficial effects for diabetes, what is one overarching principle?
A
That these people have a chronic disease, and they need to adhere to this diet for life –> Pick a sustainable choice
22
Q
Targeted strategies for pre-diabetes?
A
- Weight loss or maintenance*
- Portion control(
- Guidance to include low GI CHO, reduce refined CHO
- PA
- *Consistent with all stages of diabetes
23
Q
Targeted strategies for early T2DM?
A
- Introduce high-fibre
- CHO distribution
- Healthy dietary pattern of choice
- PA
24
Q
Targeted strategies for those not on insulin?
A
- CHO distribution
- Low GI CHO
- High Fibre
- PA
25
Targeted strategies for those on basal insulin only?
- CHO consistency
- Low GI CHO
- High Fibre
- PA
26
Targeted strategies ofr basal-bolus therapy?
- CHO consistently initially then learn CHO counting
- Low GI CHO
- High fibre
- PA
27
(T/F) Adults with diabetes may substitute added sugars with other CHOs as part of mixed meals up to a maximum of 10% of total daily energy intake
T, as long as there is adequate control of BG, lipids and body weight
28
Why should low GI foods be selected?
- Optimize glycemic control
- Improve LDL-C
- Decrease CVD risk
29
Implications of mediterranean diet?
-Reduce major CV events and improve glycemic control
30
Vegan and vegetarian diet implications?
-Improve glycemic control
-Body weight
-Blood lipids (LDL)
and reduced MI
31
DASH implications?
- Improve glycemic control
| - LDL-c and reduce major CV events
32
Dietary pulses implications?
-Improve glycemic control, systolic BP and body weight
33
Fruit and vegetable implications?
-Improve glycemic control, reduce CVD mortality
34
Nut implications?
Improve glycemic control and LDL-C
35
People with diabetes using what kinds of medications should be educated about the risk of hypoglycaemia from using alcohol?
Those on insulin or insulin-secretagogues
36
What are the two types of CHO counting?
Basic and Advanced
37
When should advanced be used?
When the patient is on insulin
38
Discuss basic CHO counting
Encourages the inclusion of consistent amounts of CHO at meals and snacks
39
Discuss advanced CHO counting
-Teaches patient who are on MDI or insulin pump how to match insulin to CHO
40
What must we do before we begin CHO counting?
Determine the person's base knowledge (healthy eating, perceived notions, basic nutrition concepts, understanding medication)
41
Which concepts should be taught during CHO counting?
- Rationale for counting carbs
- Identify foods that contain carbs
- Understand that many foods containing carbs are healthy, and these do not have to be overtly limited
- Determine how much to eat per day
42
How many carb servings per meal? How many g/serving?
- 3-5 servings per meal
| - 15 g per serving
43
What would be an appropriate response to someone who believes cutting all carbs (i.e. ket/LCHF diets) will solve their diabetes?
- It's difficult to adhere to a low-carb diet
- The glucose that we are consuming is NOT the only impact on our blood sugar, the endogenous production remains
- Insulin is important for growth, protein synthesis and satiety
- Caution with those w/ eating disorders who withhold insulin
44
Key concepts to teach with advanced CHO counting?
- The onset, action, peak and duration of insulin action
- Difference between basal and bolus insulin
- Insulin carb ratio
- Correction bolus
- Adjusting for dietary fibre intake and foods that contain polyols (sugar alcohols)
45
How do we account for sugar alcohols in net carbs
Subtract 1/2 of them
46
Discuss sugar alcohols
- Only about 50% are absorbed, less kcals
- There may be GI side-effects when more than 10 g/day is consumed
- Sometimes not listed on nutrition facts, difficult to account for
- Often found in processed foods, special diabetic foods which are not necessarily what we want patients eating
47
Where are hidden carbs?
- Breading on meat
- Cornstarch mixed in dishes and soups
- Pasta sauce
- Croutons in salads
- Salad dressing
- Ketchup
48
What do studies show about patients and their ability to carb count after being counselled by a dietitian?
Almost as accurate as a computer program as estimating
49
What do studies show about patients ability to carb count, when they are not offered a revision by a dietitian?
Up to 20% error of CHO counting within the meal
50
What are the basics of diabetes meal planning?
- Timing
- CHO distribution
- Protein distribution
- Balanced meals
- Type of carb
- Type of fat
- Limit/avoid concentrated simple suagr
- Control portion size
51
What should be critiques during the 24 hour recall?
- The basics of diabetes meal planning
- Ensure meals are 4-6 hours apart
- Low glycemic?
- 3-5 CHO servings at 15 g each, at each meal?
- Before going to sleep, did they include a snack that included a protein source?
52
How should we plan meals for the day?
- Distribute CHO servings evenly
- All meals should have a protein source
- Breakfast may be lower CHO is higher blood glucose in AM
- Consider snacks, especially if aerobic exercise (may lower blood glucose)
53
Snacks should be minimum ___
3 hours from a meal
54
Meals can be _____ without a snack, or further apart with a snack
4-5
55
Portion guide for fruits, grains and starches?
Fist
56
Portion guide for vegetables?
As much as you can hold in both hands
57
Portion guide for meat and alternatives?
Palm of hand and thickness of little finger
58
Portion guide for fats?
Size of tip of your thumb
59
Examples of low-calorie sweeteners (LCS)?
- Sucralose
- Saccharin
- Aspartame
- Rebaudioside A
- Acesulfame-K
60
Which LCS is the sweetest?
- Sucralose (Splenda)
| - 600x as sweet as sucrose
61
What did numerous toxicology and clinical studies demonstrate about LCS?
That they are generally safe and well-tolerated
62
What are some proposed mechanisms that LCS may lead to weight gains and chronic disease?
- Sweet-tase receptor mediated changes in gut hormones
- Altered nutrient absorption via changing gut microbiota
- Impaired predictive relationship between sweet taste and calories
- Change in taste preferences and dietary patterns
63
What are some benefits of artificial sweeteners?
- More variety in food
- Does not raise blood glucose
- Does not contain calories
- Can help avoid dental caries, while still enhancing
64
How does artificial sweeteners allow for more variety in food?
-Enables people who are CHO, sugar or kcal conscious to take in a wide range of foods that they would either not be allowed to eat or could only eat in such tiny amounts that they were not satisfying
65
What are some health concerns of artificial sweetners?
- Can be associated with cancer (cellular damage)
- Can cause bloating
- Can be associated w/ hyperTG an GI symptoms
- May be associated with increased incidence of T2DM
- Can be associate with increased weight and obesity
- Provide no nutritional value
66
When does a snack need to be administered?
- Bedtime snack (if time between supper and bed is >3 hours)
- If patient has a gap of 5 hours (on insulin) or 6 hours (without insulin) between meals, then a snack should be planned?
67
What should be included with the bed time snack? Why?
- Protein to slow digestion
| - May reduce chance of having low blood sugar during the night and/or may improve morning blood sugars
68
When else should snacks be administered?
- When patients notice a recurring time of the day where BG low
- Starting new exercise, exercising for longer than normal, has fairly low blood sugar prior to starting intensive exercise
- Whenever a delay to next meal is possible (stuck in traffic, waiting at airport for flight)
69
What are appropriate snacks?
- Healthy source of CHO (high in fibre, avoid juice)
- Lean protein
- Whole grain toast + PB
- Whole grain crackers + cheese
- Oatmeal + nuts/raisins + milk
