Dietary Approach Flashcards
What are the goals of diet therapy?
Maintenance or attainment of a healthy body weight, achieve best possible metabolic control, delay or prevent complication associated with diabetes, promote self-care by providing knowledge, resources and support, to provide guidelines for different stages of the diabetes lifecycle
What recommendations are given to diabetic patients with a BMI >25?
Weight loss of 5 - 10% of initial body weight (more beneficial at a higher range) which will improve insulin sensitivity, glycemic control, regulate blood pressure and lipid levels
What are the steps of nutritional management of hyperglycemia in T2DM?
Assess clinical values and implementation of lifestyle changes (intensive lifestyle intervention or energy restriction and increased physical activity)
Provide counselling on diet based on individual preferences, abilities and treatment goals
If target is still not reached, continue lifestyle intervention in addition to pharmacotherapy
- Attainment of target A1C should try to be met within 3- 6 months with lifestyle changes and pharmacotherapy
Why should CHO intake fall within 45 - 60% of total energy?
<45% CHO may not provide enough vitamins and minerals and may lead to ketosis
Patients should aim to consume more low GI index foods and high fibre intake
<10% of added sugar
Differentiate between glycemic index and glycemic load
Glycemic index is the response of blood glucose of a given food compared to a standard for the same amount of g CHO
- High GI food will raise blood glucose rapidly followed by a quick decline
Glycemic load evaluates the available CHO in the serving
E.g cooked pasta has a low GI but a high GL
What are the benefits of replacing high GI food with low GI CHO?
Improvement of glycemic control in both T1DM and T2DM
Increased HDL-C, decreased CRP, hypoglycemia in T1DM and reduction in medication use
Recommended as a nutrition treatment but highly dependent on patients interest and ability
What is the recommended intake of dietary fibre for DM patients and why?
DM patients should aim to consume 25 - 50g/day since soluble fibre can slow gastric emptying and glucose absorption
Which dietary intervention should be recommended to increase HDL-C?
A high CHO diet with low GI index, it can also decrease CRP and hypoglycemia
Which dietary intervention bests lowers TG?
High fibre, Hi-MUFA, low-CHO, hi-protein , long chain omega-3 fatty acid
Is fructose a better alternative to added sucrose in diet?
Fructose may help lower A1C but consumption >10% will increase TG in T2DM
Natural fructose from fruits pose no risk but patients should be cautious of high GI fruits
Why should n-3 fatty acid be consumed in diabetic diet?
While omega-3 fatty acid does not have an effect on blood glucose, it can decrease TG and platelet aggregation lowering the risk of CVD
Supplementations are not recommended
Under what circumstances should diabetic patients consume 0.8g/kg/d of protein?
If they are at risk or have chronic kidney disease, protein should come from plants instead of animals in order to decrease albuminuria, LDC-C, TG and CRP
If they are not at risk for CKD, they should consume 1.0 -1.5g/kg/d during weight reduction period to maintain LBM
Should non-nutritive sweeteners be used?
It may help glucose control, but sugar alcohols should be limited as it can affect GI and it is not accounted for in CHO counting
What are the risks of alcohol consumption and diabetes?
Alcohol may mask the symptoms of hypoglycemia and increase ketones
T1DM should consume alcohol with meal or they may experience delayed hypoglycemia
Using insulin treatment what should patients be cautious of?
Snacks may be useful to prevent hypoglycemia, regularity of meal space (~4-6 hours) and CHO content may help glycemic control
