Nutrition Recommendations and Interventions for Diabetes

Involvement

Supplemental Nutrition Assistance Program (SNAP)
Measures being taken to reduce acute undernourishment and chronic hunger. Public health expenditure consists of recurrent and capital spending from government central and local budgets, external borrowings and grants including donations from international agencies and nongovernmental organizations and social or compulsory health insurance funds. Physical activity and behavior modification are important components of weight loss programs and are most helpful in maintenance of weight loss. The New York Times. Journal of the American Dietetic Association.

You are here:

NLiS Country Profile: Afghanistan

Imagine; pancakes, greek yoghurt and strawberries for breakfast followed by a tasty salad lunch of lettuce, tomato, snowpeas and carrots, with an olive oil dressing, feta cheese and turkey slices.

Did someone say diet? Learn more about Amazon Prime. This item does not ship to Canada. Please check other sellers who may ship internationally. Sold by Efficient Nutrition and Fulfilled by Amazon. Turn on 1-Click ordering for this browser. Unable to add item to List. Sorry, there was a problem. There was an error retrieving your Wish Lists.

Have one to sell? Image Unavailable Image not available for Color: Freshen your air today. Add all three to Cart Add all three to List.

Buy the selected items together This item: Sold by Efficient Nutrition and ships from Amazon Fulfillment. Sold by Life Simplify and ships from Amazon Fulfillment. Sponsored products related to this item What's this? Page 1 of 1 Start over Page 1 of 1. Customers who bought this item also bought. Don't see what you're looking for? There was a problem completing your request. Please try your search again later. Compare with similar items. Product information Package Quantity: Multicolor Product Dimensions 3.

Feedback If you are a seller for this product, would you like to suggest updates through seller support? Would you like to tell us about a lower price? Page 1 of 1 Start Over Page 1 of 1. The video content is inappropriate. The video content is misleading. The ad is too long.

The ad does not play. The ad does not inform my purchase. The video does not play. There is too much buffering. The audio is poor or missing. Video is unrelated to the product. Please fill out the copyright form to register a complaint. See questions and answers. Share your thoughts with other customers. Write a customer review. Rated by feature Easy to clean. Read reviews that mention food recipes eating helpful plan eat container portions lids program healthy follow receive items email included meals lost foods measuring.

There was a problem filtering reviews right now. Please try again later. This product is of good quality and of stated measurements. The program is very simple and really does work if you do it.

If I could change one thing about this system, I would create a portion control container for chocolate. Until then, I will just use the shoe box in my closet that the kids don't know about for that. It's been 7 days since my 7 pc Portion Control Containers Kit arrived and while I am still getting used to eating healthier foods in proper proportions, I'm actually doing better than I expected I would when I first opened the box!

I did not agree to receive this product in exchange for offering my honest, unbiased opinion because of an overweight issue, but rather because I tend to not eat properly and it's taking it's toll on my overall well being. I am a junk food junkie who snacks throughout the day, but usually on the wrong types of foods. I have also been losing weight over the past few months due to a newly prescribed medication and I need to gain back the pounds that the change in my metabolism, caused by the medication.

When I first received my order, my initial thought was this can't be right - the Box is not nearly as big as I expected it would be. I opened the box to find 7 containers that were much smaller than I had anticipated. The Lids on all 7 containers fit snug and there is a grooved indent on 2 of the corners of the lids to make them easier to remove.

What really impressed me was the placard included in the box which had very easy to understand instructions for how best to utilize the containers, as well as a long Grocery Shopping Guide listing of suggested healthy foods. Getting started was simple. Following the instructions I calculated my Caloric Baseline and then my Maintenance Calories The 3rd step is calculating my Calorie Target.

There are 3 formulas. One for maintaining current weight, one for weight loss and one for weight gain. Because I actually need to gain a few pounds, I was able to add calories to my Maintenance Calories for a total of Calories. Instructions told me to round down to I felt better about starting the program after reading the Identify Daily Intake Chart and realizing that I get to fill most of these small containers several times throughout the day.

A lot of the items on the Grocery Shopping Guide were things I already purchase, so I didn't need to change my shopping habits, aside from eliminating the junk food and frozen entrees I normally buy. I mainly needed to learn to eat the healthy foods in the proper proportions. I went online to find some recipes that fit in with my Daily Caloric Intake and so far I am doing pretty good at sticking to this program.

It's too soon to speak of results, but I feel better just knowing I am eating healthier foods. I followed the original Beachbody 21 day fix program for a year and loved it.

However my containers were getting old and missing lids. Overall, not bad and I know my coach gets a percentage, but I'm on a budget so I turned to Amazon. I ordered two sets, this Efficient brand and this one for a few bucks less https: Some of the Efficient brand lids fit the Beachbody brands, not all. The Efficient brand lids fit very well whereas the MealPreps do not. Efficient also emailed me a recipe and meal planner whereas MealPrep was a small booklet.

If I was new to the program Efficient has much more beginners info. Overall, I highly recommend this brand over MealPrep brand and if I need too, will order again. I have had the Beach Body 21 Day Fix containers and plan. Foods with low glycemic indexes include oats, barley, bulgur, beans, lentils, legumes, pasta, pumpernickel coarse rye bread, apples, oranges, milk, yogurt, and ice cream. Fiber, fructose, lactose, and fat are dietary constituents that tend to lower glycemic response.

Potential methodological problems with the glycemic index have been noted Several randomized clinical trials have reported that low—glycemic index diets reduce glycemia in diabetic subjects, but other clinical trials have not confirmed this effect Moreover, the variability in responses to specific carbohydrate-containing food is a concern Nevertheless, a recent meta-analysis of low—glycemic index diet trials in diabetic subjects showed that such diets produced a 0.

However, it appears that most individuals already consume a moderate—glycemic index diet 39 , Thus, it appears that in individuals consuming a high—glycemic index diet, low—glycemic index diets can produce a modest benefit in controlling postprandial hyperglycemia.

In diabetes management, it is important to match doses of insulin and insulin secretagogues to the carbohydrate content of meals. A variety of methods can be used to estimate the nutrient content of meals, including carbohydrate counting, the exchange system, and experience-based estimation.

By testing pre- and postprandial glucose, many individuals use experience to evaluate and achieve postprandial glucose goals with a variety of foods. To date, research has not demonstrated that one method of assessing the relationship between carbohydrate intake and blood glucose response is better than other methods. Palatability, limited food choices, and gastrointestinal side effects are potential barriers to achieving such high-fiber intakes.

Substantial evidence from clinical studies demonstrates that dietary sucrose does not increase glycemia more than isocaloric amounts of starch 1. Thus, intake of sucrose and sucrose-containing foods by people with diabetes does not need to be restricted because of concern about aggravating hyperglycemia.

Sucrose can be substituted for other carbohydrate sources in the meal plan or, if added to the meal plan, adequately covered with insulin or another glucose-lowering medication. Additionally, intake of other nutrients ingested with sucrose, such as fat, need to be taken into account, and care should be taken to avoid excess energy intake.

In individuals with diabetes, fructose produces a lower postprandial glucose response when it replaces sucrose or starch in the diet; however, this benefit is tempered by concern that fructose may adversely affect plasma lipids 1. Therefore, the use of added fructose as a sweetening agent in the diabetic diet is not recommended. There is, however, no reason to recommend that people with diabetes avoid naturally occurring fructose in fruits, vegetables, and other foods. Reduced calorie sweeteners approved by the FDA include sugar alcohols polyols such as erythritol, isomalt, lactitol, maltitol, mannitol, sorbitol, xylitol, tagatose, and hydrogenated starch hydrolysates.

Studies of subjects with and without diabetes have shown that sugar alcohols produce a lower postprandial glucose response than sucrose or glucose and have lower available energy 1. When calculating carbohydrate content of foods containing sugar alcohols, subtraction of half the sugar alcohol grams from total carbohydrate grams is appropriate. Use of sugar alcohols as sweeteners reduces the risk of dental caries.

However, there is no evidence that the amounts of sugar alcohols likely to be consumed will reduce glycemia, energy intake, or weight. The use of sugar alcohols appears to be safe; however, they may cause diarrhea, especially in children. The FDA has approved five nonnutritive sweeteners for use in the U. These are acesulfame potassium, aspartame, neotame, saccharin, and sucralose. Before being allowed on the market, all underwent rigorous scrutiny and were shown to be safe when consumed by the public, including people with diabetes and women during pregnancy.

Clinical studies involving subjects without diabetes provide no indication that nonnutritive sweeteners in foods will cause weight loss or weight gain It has been proposed that foods containing resistant starch starch physically enclosed within intact cell structures as in some legumes, starch granules as in raw potato, and retrograde amylose from plants modified by plant breeding to increase amylose content or high-amylose foods, such as specially formulated cornstarch, may modify postprandial glycemic response, prevent hypoglycemia, and reduce hyperglycemia.

However, there are no published long-term studies in subjects with diabetes to prove benefit from the use of resistant starch. Two or more servings of fish per week with the exception of commercially fried fish filets provide n-3 polyunsaturated fatty acids and are recommended.

The primary goal with respect to dietary fat in individuals with diabetes is to limit saturated fatty acids, trans fatty acids, and cholesterol intakes so as to reduce risk for CVD. Saturated and trans fatty acids are the principal dietary determinants of plasma LDL cholesterol. In nondiabetic individuals, reducing saturated and trans fatty acids and cholesterol intakes decreases plasma total and LDL cholesterol.

Reducing saturated fatty acids may also reduce HDL cholesterol. Studies in individuals with diabetes demonstrating the effects of specific percentages of dietary saturated and trans fatty acids and specific amounts of dietary cholesterol on plasma lipids are not available. Therefore, because of a lack of specific information, it is recommended that the dietary goals for individuals with diabetes be the same as for individuals with preexisting CVD, since the two groups appear to have equivalent cardiovascular risk.

In metabolic studies in which energy intake and weight are held constant, diets low in saturated fatty acids and high in either carbohydrate or cis -monounsaturated fatty acids lowered plasma LDL cholesterol equivalently 1 , However, high—monounsaturated fat diets have not been shown to improve fasting plasma glucose or A1C values. In other studies, when energy intake was reduced, the adverse effects of high-carbohydrate diets were not observed 53 , Individual variability in response to high-carbohydrate diets suggests that the plasma triglyceride response to dietary modification should be monitored carefully, particularly in the absence of weight loss.

Diets high in polyunsaturated fatty acids appear to have effects similar to monounsaturated fatty acids on plasma lipid concentrations 55 , 56 — Very-long-chain n-3 polyunsaturated fatty acid supplements have been shown to lower plasma triglyceride levels in individuals with type 2 diabetes who are hypertriglyceridemic.

Although the accompanying small rise in plasma LDL cholesterol is of concern, an increase in HDL cholesterol may offset this concern Glucose metabolism is not likely to be adversely affected. Very-long-chain n-3 polyunsaturated fatty acid studies in individuals with diabetes have primarily used fish oil supplements. In addition to providing n-3 fatty acids, fish frequently displace high—saturated fat—containing foods from the diet Two or more servings of fish per week with the exception of commercially fried fish filets 63 , 64 can be recommended.

Plant sterol and stanol esters block the intestinal absorption of dietary and biliary cholesterol. A wide range of foods and beverages are now available that contain plant sterols. If these products are used, they should displace, rather than be added to, the diet to avoid weight gain.

Soft gel capsules containing plant sterols are also available. In individuals with type 2 diabetes, ingested protein can increase insulin response without increasing plasma glucose concentrations. Therefore, protein should not be used to treat acute or prevent nighttime hypoglycemia. High-protein diets are not recommended as a method for weight loss at this time. Although such diets may produce short-term weight loss and improved glycemia, it has not been established that these benefits are maintained long term, and long-term effects on kidney function for persons with diabetes are unknown.

The RDA is 0. Good-quality protein sources are defined as having high PDCAAS protein digestibility—corrected amino acid scoring pattern scores and provide all nine indispensable amino acids. Examples are meat, poultry, fish, eggs, milk, cheese, and soy. In meal planning, protein intake should be greater than 0. A number of studies in healthy individuals and in individuals with type 2 diabetes have demonstrated that glucose produced from ingested protein does not increase plasma glucose concentration but does produce increases in serum insulin responses 1 , Abnormalities in protein metabolism may be caused by insulin deficiency and insulin resistance; however, these are usually corrected with good blood glucose control However, the effects of high-protein diets on long-term regulation of energy intake, satiety, weight, and the ability of individuals to follow such diets long term have not been adequately studied.

Dietary protein and its relationships to hypoglycemia and nephropathy are addressed in later sections. Although numerous studies have attempted to identify the optimal mix of macronutrients for the diabetic diet, it is unlikely that one such combination of macronutrients exists.

The best mix of carbohydrate, protein, and fat appears to vary depending on individual circumstances. For those individuals seeking guidance as to macronutrient distribution in healthy adults, the Dietary Reference Intakes DRIs may be helpful It must be clearly recognized that regardless of the macronutrient mix, total caloric intake must be appropriate to weight management goals.

Further, individualization of the macronutrient composition will depend on the metabolic status of the patient e. If adults with diabetes choose to use alcohol, daily intake should be limited to a moderate amount one drink per day or less for women and two drinks per day or less for men.

To reduce risk of nocturnal hypoglycemia in individuals using insulin or insulin secretagogues, alcohol should be consumed with food. In individuals with diabetes, moderate alcohol consumption when ingested alone has no acute effect on glucose and insulin concentrations but carbohydrate coingested with alcohol as in a mixed drink may raise blood glucose.

Abstention from alcohol should be advised for people with a history of alcohol abuse or dependence, women during pregnancy, and people with medical problems such as liver disease, pancreatitis, advanced neuropathy, or severe hypertriglyceridemia. If individuals choose to use alcohol, intake should be limited to a moderate amount less than one drink per day for adult women and less than two drinks per day for adult men.

One alcohol containing beverage is defined as 12 oz beer, 5 oz wine, or 1. Moderate amounts of alcohol, when ingested with food, have minimal acute effects on plasma glucose and serum insulin concentrations However, carbohydrate coingested with alcohol may raise blood glucose. For individuals using insulin or insulin secretagogues, alcohol should be consumed with food to avoid hypoglycemia. Evening consumption of alcohol may increase the risk of nocturnal and fasting hypoglycemia, particularly in individuals with type 1 diabetes Occasional use of alcoholic beverages should be considered an addition to the regular meal plan, and no food should be omitted.

Excessive amounts of alcohol three or more drinks per day , on a consistent basis, contributes to hyperglycemia In individuals with diabetes, light to moderate alcohol intake one to two drinks per day; 15—30 g alcohol is associated with a decreased risk of CVD The type of alcohol-containing beverage consumed does not appear to make a difference.

There is no clear evidence of benefit from vitamin or mineral supplementation in people with diabetes compared with the general population who do not have underlying deficiencies. Routine supplementation with antioxidants, such as vitamins E and C and carotene, is not advised because of lack of evidence of efficacy and concern related to long-term safety.

Benefit from chromium supplementation in individuals with diabetes or obesity has not been clearly demonstrated and therefore can not be recommended. Uncontrolled diabetes is often associated with micronutrient deficiencies Individuals with diabetes should be aware of the importance of acquiring daily vitamin and mineral requirements from natural food sources and a balanced diet. Health care providers should focus on nutrition counseling rather than micronutrient supplementation in order to reach metabolic control of their patients.

Research including long-term trials is needed to assess the safety and potentially beneficial role of chromium, magnesium, and antioxidant supplements and other complementary therapies in the management of type 2 diabetes 71a , 71b. In select groups such as the elderly, pregnant or lactating women, strict vegetarians, or those on calorie-restricted diets, a multivitamin supplement may be needed 1. Since diabetes may be a state of increased oxidative stress, there has been interest in antioxidant therapy.

Unfortunately, there are no studies examining the effects of dietary intervention on circulating levels of antioxidants and inflammatory biomarkers in diabetic volunteers. The few small clinical studies involving diabetes and functional foods thought to have high antioxidant potential e.

Clinical trial data not only indicate the lack of benefit with respect to glycemic control and progression of complications but also provide evidence of the potential harm of vitamin E, carotene, and other antioxidant supplements 1 , 72 , In addition, available data do not support the use of antioxidant supplements for CVD risk reduction Chromium, potassium, magnesium, and possibly zinc deficiency may aggravate carbohydrate intolerance.

Serum levels can readily detect the need for potassium or magnesium replacement, but detecting deficiency of zinc or chromium is more difficult In the late s, two randomized placebo-controlled studies in China found that chromium supplementation had beneficial effects on glycemia 76 — 78 , but the chromium status of the study populations was not evaluated either at baseline or following supplementation.

Data from recent small studies indicate that chromium supplementation may have a role in the management of glucose intolerance, gestational diabetes mellitus GDM , and corticosteroid-induced diabetes 76 — However, other well-designed studies have failed to demonstrate any significant benefit of chromium supplementation in individuals with impaired glucose intolerance or type 2 diabetes 79 , Similarly, a meta-analysis of randomized controlled trials failed to demonstrate any benefit of chromium picolinate supplementation in reducing body weight The FDA concluded that although a small study suggested that chromium picolinate may reduce insulin resistance, the existence of such a relationship between chromium picolinate and either insulin resistance or type 2 diabetes was uncertain http: There is insufficient evidence to demonstrate efficacy of individual herbs and supplements in diabetes management In addition, commercially available products are not standardized and vary in the content of active ingredients.

Herbal preparations also have the potential to interact with other medications Therefore, it is important that health care providers be aware when patients with diabetes are using these products and look for unusual side effects and herb-drug or herb-herb interactions.

Individuals using rapid-acting insulin by injection or an insulin pump should adjust the meal and snack insulin doses based on the carbohydrate content of the meals and snacks. For individuals using fixed daily insulin doses, carbohydrate intake on a day-to-day basis should be kept consistent with respect to time and amount. For planned exercise, insulin doses can be adjusted. For unplanned exercise, extra carbohydrate may be needed. The first nutrition priority for individuals requiring insulin therapy is to integrate an insulin regimen into their lifestyle.

For individuals receiving basal-bolus insulin therapy, the total carbohydrate content of meals and snacks is the major determinant of bolus insulin doses Insulin-to-carbohydrate ratios can be used to adjust mealtime insulin doses. Several methods can be used to estimate the nutrient content of meals, including carbohydrate counting, the exchange system, and experience-based estimation.

Improvement in A1C without a significant increase in severe hypoglycemia was demonstrated, as were positive effects on quality of life, satisfaction with treatment, and psychological well-being, even though increases in the number of insulin injections and blood glucose tests were necessary.

For planned exercise, reduction in insulin dosage is the preferred method to prevent hypoglycemia For unplanned exercise, intake of additional carbohydrate is usually needed. More carbohydrate is needed for intense activity.

A American Diabetes Association statement addresses diabetes MNT for children and adolescents with type 1 diabetes Individuals with type 2 diabetes are encouraged to implement lifestyle modifications that reduce intakes of energy, saturated and trans fatty acids, cholesterol, and sodium and to increase physical activity in an effort to improve glycemia, dyslipidemia, and blood pressure.

Plasma glucose monitoring can be used to determine whether adjustments in foods and meals will be sufficient to achieve blood glucose goals or if medication s needs to be combined with MNT. Healthy lifestyle nutrition recommendations for the general public are also appropriate for individuals with type 2 diabetes. Because many individuals with type 2 diabetes are overweight and insulin resistant, MNT should emphasize lifestyle changes that result in reduced energy intake and increased energy expenditure through physical activity.

Because many individuals also have dyslipidemia and hypertension, reducing saturated and trans fatty acids, cholesterol, and sodium is often desirable. Therefore, the first nutrition priority is to encourage individuals with type 2 diabetes to implement lifestyle strategies that will improve glycemia, dyslipidemia, and blood pressure. Although there are similarities to those above for type 1 diabetes, MNT recommendations for established type 2 diabetes differ in several aspects from both recommendations for type 1 diabetes and the prevention of diabetes.

MNT progresses from prevention of overweight and obesity, to improving insulin resistance and preventing or delaying the onset of diabetes, and to contributing to improved metabolic control in those with diabetes. With established type 2 diabetes treated with fixed doses of insulin or insulin secretagogues, consistency in timing and carbohydrate content of meals is important.

However, rapid-acting insulins and rapid-acting insulin secretagogues allow for more flexible food intake and lifestyle as in individuals with type 1 diabetes. Increased physical activity by individuals with type 2 diabetes can lead to improved glycemia, decreased insulin resistance, and a reduction in cardiovascular risk factors, independent of change in body weight.

Resistance training is also effective in improving glycemia and, in the absence of proliferative retinopathy, people with type 2 diabetes can be encouraged to perform resistance exercise three times a week Adequate energy intake that provides appropriate weight gain is recommended during pregnancy. Weight loss is not recommended; however, for overweight and obese women with GDM, modest energy and carbohydrate restriction may be appropriate. MNT for GDM focuses on food choices for appropriate weight gain, normoglycemia, and absence of ketones.

Because GDM is a risk factor for subsequent type 2 diabetes, after delivery, lifestyle modifications aimed at reducing weight and increasing physical activity are recommended. Prepregnancy MNT includes an individualized prenatal meal plan to optimize blood glucose control. Due to the continuous fetal draw of glucose from the mother, maintaining consistency of times and amounts of food eaten are important to avoidance of hypoglycemia.

Plasma glucose monitoring and daily food records provide valuable information for insulin and meal plan adjustments. MNT for GDM primarily involves a carbohydrate-controlled meal plan that promotes optimal nutrition for maternal and fetal health with adequate energy for appropriate gestational weight gain, achievement and maintenance of normoglycemia, and absence of ketosis.

Specific nutrition and food recommendations are determined and subsequently modified based on individual assessment and self-monitoring of blood glucose. A recent large clinical trial reported that treatment of GDM with nutrition therapy, blood glucose monitoring, and insulin therapy as required for glycemic control reduced serious perinatal complications without increasing the rate of cesarean delivery as compared with routine care Maternal health—related quality of life was also improved.

Hypocaloric diets in obese women with GDM can result in ketonemia and ketonuria. Insufficient data are available to determine how such diets affect perinatal outcomes. Daily food records, weekly weight checks, and ketone testing can be used to determine individual energy requirements and whether a woman is undereating to avoid insulin therapy. Carbohydrate should be distributed throughout the day in three small- to moderate-sized meals and two to four snacks.

An evening snack may be needed to prevent accelerated ketosis overnight. Carbohydrate is generally less well tolerated at breakfast than at other meals. Regular physical activity can help lower fasting and postprandial plasma glucose concentrations and may be used as an adjunct to improve maternal glycemia. If insulin therapy is added to MNT, maintaining carbohydrate consistency at meals and snacks becomes a primary goal. Although most women with GDM revert to normal glucose tolerance postpartum, they are at increased risk of GDM in subsequent pregnancies and type 2 diabetes later in life.

Lifestyle modifications after pregnancy aimed at reducing weight and increasing physical activity are recommended, as they reduce the risk of subsequent diabetes 26 , Breast-feeding is recommended for infants of women with preexisting diabetes or GDM; however, successful lactation requires planning and coordination of care In most situations, breast-feeding mothers require less insulin because of the calories expended with nursing.

Lactating women have reported fluctuations in blood glucose related to nursing sessions, often requiring a snack containing carbohydrate before or during breast-feeding Obese older adults with diabetes may benefit from modest energy restriction and an increase in physical activity; energy requirement may be less than for a younger individual of a similar weight.

A daily multivitamin supplement may be appropriate, especially for those older adults with reduced energy intake. Physical activity is needed to attenuate loss of lean body mass that can occur with energy restriction. Exercise training can significantly reduce the decline in maximal aerobic capacity that occurs with age, improve risk factors for atherosclerosis, slow the age-related decline in lean body mass, decrease central adiposity, and improve insulin sensitivity—all potentially beneficial for the older adult with diabetes 89 , However, exercise can also pose potential risks such as cardiac ischemia, musculoskeletal injuries, and hypoglycemia in patients treated with insulin or insulin secretagogues.

Reduction of protein intake to 0. MNT that favorably affects cardiovascular risk factors may also have a favorable effect on microvascular complications such as retinopathy and nephropathy.

Progression of diabetes complications may be modified by improving glycemic control, lowering blood pressure, and, potentially, reducing protein intake. In several studies of subjects with diabetes and microalbuminuria, urinary albumin excretion rate and decline in glomerular filtration were favorably influenced by reduction of protein intake to 0. Although reduction of protein intake to 0.

In individuals with diabetes and macroalbuminuria, reducing protein from all sources to 0. Although several studies have explored the potential benefit of plant proteins in place of animal proteins and specific animal proteins in diabetic individuals with microalbuninuria, the data are inconclusive 1 , Observational data suggest that dyslipidemia may increase albumin excretion and the rate of progression of diabetic nephropathy Elevation of plasma cholesterol in both type 1 and 2 diabetic subjects and plasma triglycerides in type 2 diabetic subjects were predictors of the need for renal replacement therapy Whereas these observations do not confirm that MNT will affect diabetic nephropathy, MNT designed to reduce the risk for CVD may have favorable effects on microvascular complications of diabetes.

For patients with diabetes at risk for CVD, diets high in fruits, vegetables, whole grains, and nuts may reduce the risk. In normotensive and hypertensive individuals, a reduced sodium intake e. In most individuals, a modest amount of weight loss beneficially affects blood pressure.

In the EDIC Epidemiology of Diabetes Interventions and Complications study, the follow-up of the DCCT Diabetes Control and Complications Trial , intensive treatment of type 1 diabetic subjects during the DCCT study period improved glycemic control and significantly reduced the risk of the combined end point of cardiovascular death, myocardial infarction, and stroke Adjustment for A1C explained most of the treatment effect. The risk reductions obtained with improved glycemia exceeded those that have been demonstrated for other interventions such as cholesterol and blood pressure reductions.

There are no large-scale randomized trials to guide MNT recommendations for CVD risk reduction in individuals with type 2 diabetes. However, because CVD risk factors are similar in individuals with and without diabetes, benefits observed in nutrition studies in the general population are probably applicable to individuals with diabetes. The previous section on dietary fat addresses the need to reduce intake of saturated and trans fatty acids and cholesterol. Hypertension, which is predictive of progression of micro- as well as macrovascular complications of diabetes, can be prevented and managed with interventions including weight loss, physical activity, moderation of alcohol intake, and diets such as DASH Dietary Approaches to Stop Hypertension.

The DASH diet emphasized fruits, vegetables, and low-fat dairy products; included whole grains, poultry, fish, and nuts; and was reduced in fats, red meat, sweets, and sugar-containing beverages 7 , , The effects of lifestyle interventions on hypertension appear to be additive. Reduction in blood pressure in people with diabetes can occur with a modest amount of weight loss, although there is great variability in response 1 , 7. Regular aerobic physical activity, such as brisk walking, has an antihypertensive effect 7.

Although chronic excessive alcohol intake is associated with an increased risk of hypertension, light to moderate alcohol consumption is associated with reductions in blood pressure 7. Heart failure and peripheral vascular disease are common in individuals with diabetes, but little is known about the role of MNT in treating these complications. Alcohol intake is discouraged in patients at high risk for heart failure.

Ingestion of 15—20 g glucose is the preferred treatment for hypoglycemia, although any form of carbohydrate that contains glucose may be used.

In individuals taking insulin or insulin secretagogues, changes in food intake, physical activity, and medication can contribute to the development of hypoglycemia.

The acute glycemic response correlates better with the glucose content than with the carbohydrate content of the food 1. Although pure glucose may be the preferred treatment, any form of carbohydrate that contains glucose will raise blood glucose Adding protein to carbohydrate does not affect the glycemic response and does not prevent subsequent hypoglycemia. Adding fat, however, may retard and then prolong the acute glycemic response.

During hypoglycemia, gastric-emptying rates are twice as fast as during euglycemia and are similar for liquid and solid foods. During acute illnesses, insulin and oral glucose-lowering medications should be continued. During acute illnesses, testing of plasma glucose and ketones, drinking adequate amounts of fluids, and ingesting carbohydrate are all important.

Acute illnesses can lead to the development of hyperglycemia and, in individuals with type 1 diabetes, ketoacidosis. During acute illnesses, with the usual accompanying increases in counterregulatory hormones, the need for insulin and oral glucose-lowering medications continues and often is increased. In adults, ingestion of — g carbohydrate daily 45—50 g every 3—4 h should be sufficient to prevent starvation ketosis 1. Establishing an interdisciplinary team, implementation of MNT, and timely diabetes-specific discharge planning improves the care of patients with diabetes during and after hospitalizations.

Hospitals should consider implementing a diabetes meal-planning system that provides consistency in the carbohydrate content of specific meals. Hyperglycemia in hospitalized patients is common and represents an important marker of poor clinical outcome and mortality in both patients with and without diabetes Optimizing glucose control in these patients is associated with better outcomes An interdisciplinary team is needed to integrate MNT into the overall management plan , Diabetes nutrition self-management education, although potentially initiated in the hospital, is usually best provided in an outpatient or home setting where the individual with diabetes is better able to focus on learning needs , There is no single meal planning system that is ideal for hospitalized patients.

However, it is suggested that hospitals consider implementing a consistent-carbohydrate diabetes meal-planning system , This systems uses meal plans without a specific calorie level but consistency in the carbohydrate content of meals.

The carbohydrate contents of breakfast, lunch, dinner, and snacks may vary, but the day-to-day carbohydrate content of specific meals and snacks is kept constant , Special nutrition issues include liquid diets, surgical diets, catabolic illnesses, and enteral or parenteral nutrition , Liquids should not be sugar free.

Patients require carbohydrate and calories, and sugar-free liquids do not meet these nutritional needs. Care must be taken not to overfeed patients because this can exacerbate hyperglycemia. After surgery, food intake should be initiated as quickly as possible. Progression from clear liquids to full liquids to solid foods should be completed as rapidly as tolerated. The imposition of dietary restrictions on elderly patients with diabetes in long-term care facilities is not warranted.

Residents with diabetes should be served a regular menu, with consistency in the amount and timing of carbohydrate. An interdisciplinary team approach is necessary to integrate MNT for patients with diabetes into overall management. In the institutionalized elderly, undernutrition is likely and caution should be exercised when prescribing weight loss diets. Although the prevalence of undiagnosed diabetes in elderly nursing home residents is high, not all of such individuals require pharmacologic therapy , Older residents with diabetes in nursing homes tend to be underweight rather than overweight Low body weight has been associated with greater morbidity and mortality in this population , Experience has shown that residents eat better when they are given less restrictive diets , Specialized diabetic diets do not appear to be superior to standard diets in such settings , Meal plans such as no concentrated sweets, no sugar added, low sugar, and liberal diabetic diet also are no longer appropriate.

These diets do not reflect current diabetes nutrition recommendations and unnecessarily restrict sucrose. These types of diets are more likely in long-term care facilities than acute care. Making medication changes to control glucose, lipids, and blood pressure rather than implementing food restrictions can reduce the risk of iatrogenic malnutrition.

The specific nutrition interventions recommended will depend on a variety of factors, including age, life expectancy, comorbidities, and patient preferences Major nutrition recommendations and interventions for diabetes are listed in Table 3. Monitoring of metabolic parameters, including glucose, A1C, lipids, blood pressure, body weight, and renal function is essential to assess the need for changes in therapy and to ensure successful outcomes. Many aspects of MNT require additional research.

Classification of overweight and obesity by BMI, waist circumference, and associated disease risk. Mooradian, and Madelyn L. We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail.

We do not capture any email address. Skip to main content. Diabetes Care Jan; 31 Supplement 1: This article has a correction. Errata - August 01, Department of Agriculture Medical nutrition therapy MNT is important in preventing diabetes, managing existing diabetes, and preventing, or at least slowing, the rate of development of diabetes complications.

Goals of MNT that apply to individuals with diabetes Achieve and maintain Blood glucose levels in the normal range or as close to normal as is safely possible A lipid and lipoprotein profile that reduces the risk for vascular disease Blood pressure levels in the normal range or as close to normal as is safely possible To prevent, or at least slow, the rate of development of the chronic complications of diabetes by modifying nutrient intake and lifestyle To address individual nutrition needs, taking into account personal and cultural preferences and willingness to change To maintain the pleasure of eating by only limiting food choices when indicated by scientific evidence Goals of MNT that apply to specific situations For youth with type 1 diabetes, youth with type 2 diabetes, pregnant and lactating women, and older adults with diabetes, to meet the nutritional needs of these unique times in the life cycle.

B Nutrition counseling should be sensitive to the personal needs, willingness to change, and ability to make changes of the individual with pre-diabetes or diabetes. A For weight loss, either low-carbohydrate or low-fat calorie-restricted diets may be effective in the short term up to 1 year.

A For patients on low-carbohydrate diets, monitor lipid profiles, renal function, and protein intake in those with nephropathy , and adjust hypoglycemic therapy as needed. E Physical activity and behavior modification are important components of weight loss programs and are most helpful in maintenance of weight loss. B The importance of controlling body weight in reducing risks related to diabetes is of great importance. A Individuals at high risk for type 2 diabetes should be encouraged to achieve the U.

B There is not sufficient, consistent information to conclude that low—glycemic load diets reduce the risk for diabetes. E Observational studies report that moderate alcohol intake may reduce the risk for diabetes, but the data do not support recommending alcohol consumption to individuals at risk of diabetes.

B No nutrition recommendation can be made for preventing type 1 diabetes. E Although there are insufficient data at present to warrant any specific recommendations for prevention of type 2 diabetes in youth, it is reasonable to apply approaches demonstrated to be effective in adults, as long as nutritional needs for normal growth and development are maintained.

E The importance of preventing type 2 diabetes is highlighted by the substantial worldwide increase in the prevalence of diabetes in recent years. Diabetes in youth No nutrition recommendations can be made for the prevention of type 1 diabetes at this time 1.

B Monitoring carbohydrate, whether by carbohydrate counting, exchanges, or experienced-based estimation remains a key strategy in achieving glycemic control. A The use of glycemic index and load may provide a modest additional benefit over that observed when total carbohydrate is considered alone. B Sucrose-containing foods can be substituted for other carbohydrates in the meal plan or, if added to the meal plan, covered with insulin or other glucose-lowering medications.

A As for the general population, people with diabetes are encouraged to consume a variety of fiber-containing foods. B Sugar alcohols and nonnutritive sweeteners are safe when consumed within the daily intake levels established by the Food and Drug Administration FDA. A Control of blood glucose in an effort to achieve normal or near-normal levels is a primary goal of diabetes management.

Amount and type of carbohydrate. A Intake of trans fat should be minimized. E Two or more servings of fish per week with the exception of commercially fried fish filets provide n-3 polyunsaturated fatty acids and are recommended. B The primary goal with respect to dietary fat in individuals with diabetes is to limit saturated fatty acids, trans fatty acids, and cholesterol intakes so as to reduce risk for CVD. E In individuals with type 2 diabetes, ingested protein can increase insulin response without increasing plasma glucose concentrations.

A High-protein diets are not recommended as a method for weight loss at this time. Optimal mix of macronutrients Although numerous studies have attempted to identify the optimal mix of macronutrients for the diabetic diet, it is unlikely that one such combination of macronutrients exists. Alcohol in diabetes management Recommendations If adults with diabetes choose to use alcohol, daily intake should be limited to a moderate amount one drink per day or less for women and two drinks per day or less for men.

E To reduce risk of nocturnal hypoglycemia in individuals using insulin or insulin secretagogues, alcohol should be consumed with food. E In individuals with diabetes, moderate alcohol consumption when ingested alone has no acute effect on glucose and insulin concentrations but carbohydrate coingested with alcohol as in a mixed drink may raise blood glucose. B Abstention from alcohol should be advised for people with a history of alcohol abuse or dependence, women during pregnancy, and people with medical problems such as liver disease, pancreatitis, advanced neuropathy, or severe hypertriglyceridemia.

Micronutrients in diabetes management Recommendations There is no clear evidence of benefit from vitamin or mineral supplementation in people with diabetes compared with the general population who do not have underlying deficiencies. A Routine supplementation with antioxidants, such as vitamins E and C and carotene, is not advised because of lack of evidence of efficacy and concern related to long-term safety.

A Benefit from chromium supplementation in individuals with diabetes or obesity has not been clearly demonstrated and therefore can not be recommended. E Uncontrolled diabetes is often associated with micronutrient deficiencies Antioxidants in diabetes management.

Chromium, other minerals, and herbs in diabetes management. E Individuals using rapid-acting insulin by injection or an insulin pump should adjust the meal and snack insulin doses based on the carbohydrate content of the meals and snacks. A For individuals using fixed daily insulin doses, carbohydrate intake on a day-to-day basis should be kept consistent with respect to time and amount. C For planned exercise, insulin doses can be adjusted. E The first nutrition priority for individuals requiring insulin therapy is to integrate an insulin regimen into their lifestyle.

Nutrition interventions for type 2 diabetes Recommendations Individuals with type 2 diabetes are encouraged to implement lifestyle modifications that reduce intakes of energy, saturated and trans fatty acids, cholesterol, and sodium and to increase physical activity in an effort to improve glycemia, dyslipidemia, and blood pressure. E Plasma glucose monitoring can be used to determine whether adjustments in foods and meals will be sufficient to achieve blood glucose goals or if medication s needs to be combined with MNT.

E Healthy lifestyle nutrition recommendations for the general public are also appropriate for individuals with type 2 diabetes. Nutrition interventions for pregnancy and lactation with diabetes Recommendations Adequate energy intake that provides appropriate weight gain is recommended during pregnancy. E Ketonemia from ketoacidosis or starvation ketosis should be avoided.

E Because GDM is a risk factor for subsequent type 2 diabetes, after delivery, lifestyle modifications aimed at reducing weight and increasing physical activity are recommended. A Prepregnancy MNT includes an individualized prenatal meal plan to optimize blood glucose control. Nutrition interventions for older adults with diabetes Recommendations Obese older adults with diabetes may benefit from modest energy restriction and an increase in physical activity; energy requirement may be less than for a younger individual of a similar weight.

Customers who viewed this item also viewed