Diabetes Prevention and MNT

Question 1

What are the goals of DM MNT?

Answer 1

• Achieve or maintain
  
  • BG levels in normal range (dec microvascular complications)
  • lipid/lipoprotein profile to dec macrovascular complications
  • BP in normal range to dec coronary and peripheral artery disease
• prevent or slow rate of development of chronic complications of diabetes via nutrient intake and lifestyle
• take into account personal and cultural preference and willingness to change
• maintain pleasure of eating by only limiting food choices when
  indicated by scientific evidence

Question 2

What are the energy balance recommendations for DM pts?

Answer 2

• wt loss if BMI >25 kg/m2
• low CHO diet not recommended (<130 g/d)
• primary approach to wt loss
  - 30% of kcal from fat
  - regular PA
  - wt loss of 5-7% of starting wt

Question 3

What are prevention methods for DM2?

Answer 3

• wt loss of 7% of CBW and reg PA (150 min/wk)
• 14 g/1000 kcal/d of fiber
• 1/2 grains whole
• moderate alcohol but not strong enough intake to recommend consuming EtOH
• not sufficient evidence to suggest low GI foods for prevention

Question 4

What are some dietary methods of DM management?

Answer 4

CHO sources: fruits, vegs, whole grains, legumes, LF milk
No low CHO (<130 g/d)
Monitor CHO intake (exchange system, CHO counting)
Use of GI for additional CHO monitoring
Avoid sucrose containing foods
Fiber meeting DG
- sugar alcohols and NNS are safe w/in FDA guidelines
- aspartame, neotame, saccharin, Acesulfame K

Question 5

What is glycemic index? What factors in foods influence GI?

Answer 5

• measure of effects of CHO intake on BG (based on 50 g CHO
  load compared to glc or white bread standarad)
• lower GI: slower rates of digestion/absorption, higher: inc in BG
• Glycemic load: incorporates portion size
  Formula: (GI x amt of g CHO in serving) x 100
• Factors that influence GI
  
  • ripeness, processing, length of storage, cooking methods
  • can vary b/n people and day-to-day w/in same person
  • can be influenced by composition of previous meal

Question 6

What is the GI range for Low, Medium, and High GI foods and some examples?

Answer 6

Low GI (55 or less GI): fruits, vegs, whole grains, meats, milk, 		nuts, fructose, legumes, eggs
Medium GI (56-69): whole wheat products, sweet potato, sucrose
High GI (>70): baked potatoes, watermelon, white bread, white 		rice, corn flakes, glucose, breakfast cereals

Question 7

What is the benefit of GI?

Answer 7

• high GI foods push body to extremes, low GI foods slowly release BG into blood, keeps energy levels balanced = fuller longer
• Low GI diets: lose and maintain wt, increase insulin sensitivity,
  improve management of DM, dec risk of heart disease,
  improve cholesterol, reduce hunger, prolong physical
  endurance
• High GI foods help re-fuel CHO stores after exercise

Question 8

How does fat intake relate to DM management?

Answer 8

• limit SFA <200 mg/d

- 2 or more servings of fish per week (omegas)

Question 9

How does protein intake relate to DM management?

Answer 9

• protein can inc insulin response w/o increasing glc production
  
  • -> do not use to treat nighttime hypoglycemia
• high protein (>20%) diets not recommended

Question 10

How does high fat, protein, and fiber meals affect DM?

Answer 10

• High fat meal:
  
  • delays gastric emptying
  • may see inc BG 3-4 hr postprandial
• High protein meal:
  
  • decreases absorption rate
  • may see inc BG 3-5 hr postprandial
• High fiber (>5 g) meal
  
  • may delay glc absorption

Question 11

What is CHO counting?

Answer 11

• count grams CHO to be eaten, match insulin (ignore protein and fat)
• 1 choice = 15 g CHO (starch, fruit, or milk)
• free foods < 20 kcal or < 5g CHO/serving
  -1.5 cups veg = 15 g but 1/2 c = 5 g
  
  • not wise to ignore if calculating insulin needs
    each choice = 15n (+/- 7 g for range)

Question 12

What are the exercise recommendations for DM?

Answer 12

• same as those without DM
• > 30 minutes most days of the week
• at least 2 bouts resistance training
• DHHS:
  
  • 150 min moderate PA or 75 min vigorous PA/week

Question 13

What are the exercise benefits for DM1 and DM2?

Answer 13

DM1:
- all intensities w/o complications
- not integral part of controlling BG, but may help
- benefits: stress reduction, reduced insulin needs, CVD
risk reduction, improves well being
DM2:
- same benefits as DM1
- improves BG control
- improves insulin sensitivity
- inc glc uptake by muscle during and after exercise
- dec effect of counter regulatory hormones –> dec gluconeogenesis
- improves wt loss, dec need for OHA, CV benefits
** 15g CHO needed for every 30-60 min of activity (No CHO needed for < 30 min activity)
** do not exercise during peak insulin action
** do not inject insulin in muscles used during exercise

Question 14

How does being sick influence BG? How should you counteract these effects?

Answer 14

• fever, dehydration, infection, stress of illness –> increased CR hormones –> increased BG
• Managing:
  
  • monitor BG, test urine ketones
  • consume lots of liquids
  • continue insulin therapy
  • CHO: 10-15 g/hr, 50 g q 3-4 hr

Question 15

What are the benefits and disadvantages to the insulin pump?

Answer 15

Benefits: constant basal set, no shots, no needle disposal, no
refrigeration needed for insulin transport, very
personalized, can adjust amts right away

Disadvantages: technology can fail, teen girls can use to manage
wt (diabulemia), some may eat whatever they want as
they can easily maintain glc levels –> wt gain