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Medical nutrition therapy for diabetes mellitus



The goals of medical nutrition therapy for diabetesmellitus are to improve overall metabolic outcomes (glucose and lipid levels)
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The goals of medical nutrition therapy for diabetes mellitus are to improve overall metabolic outcomes (glucose and lipid levels), provide appropriate energy to maintain desirable body weight, and improve overall health through optimal nutrition. The consistent-carbohydrate meal planning approach incorporates consistent carbohydrate intake, fat intake modifications, and consistent timing of meals and snacks (if needed). The AmericanDiabetes Association recommends the consistent-carbohydrate meal planning approach over the standardized energy-level meal patterns based on the exchange lists.

Indications and Nutrition Diagnosis

Diabetes is diagnosed and classified based on the results of appropriate medical and laboratory tests. After extensive review of the literature and improved standardization of the assay in 2009, the Expert Committee on Diagnosis and Classification of Diabetes Mellitus has approved the use of the A1C test for diagnosing diabetes mellitus. An A1C test of > 6.5% is the threshold used to diagnose diabetes mellitus

The classification of diabetes mellitus

    ·     type 1 diabetes (caused by beta-cell destruction that usually leads to absolute insulin deficiency)
        ·        type 2 diabetes (caused by progressive insulin secretory defect on the background of insulin resistance)



            ·        other specific types (due to other causes, e.g., genetic defects in beta-cell function, genetic defects in insulin action, diseases of the exocrine pancreas, or drug or chemical induced)
                ·        gestational diabetes mellitus (diabetesmellitus diagnosed during pregnancy)
                  The type of diabetes and the individual patient’s needs, as presented by the nutrition signs and symptoms, will determine the nutrition diagnosis, medical nutrition therapy, and approach to self-management training.

                  The following goals of medical nutrition therapy apply to all persons with diabetes
                    ·        Attain and maintain optimal metabolic outcomes including
                      a) A blood glucose level in the normal range, or as close to the normal range as safely possible, to reduce the risk of diabetic complications,
                      b) A lipid and lipoprotein profile that reduces the risk of macrovascular disease, and
                      c) Blood pressure levels that reduce the risk of vascular disease.
                      ·         
                              Prevent, treat, or delay the development of obesity, dyslipidemia, cardiovascular disease, hypertension, nephropathy, retinopathy, and neurologic complications associated with diabetes mellitus.
                            ·        Improve health through healthy food choices and physical activity.
                                ·        Address individual nutrition needs, taking into consideration the patient’s personal and cultural preferences and willingness to change.
                                    ·        Maintain the pleasure of eating by only limiting food choices when indicated by scientific evidence.
                                        ·        Contribute to normal outcomes of pregnancies for women with preexisting diabetes and gestational diabetes.
                                            ·        Provide adequate energy and nutrients for increased needs during pregnancy and lactation.
                                                ·        Provide adequate energy to maintain normal growth and development rates in children and adolescents with diabetes.

                                                  Fiber

                                                  According to The American Diabetes Association and evidence-based nutrition practice guidelines fiber consumption recommendations for people with diabetes are the same as for the general population. TheDietary Reference Intake (DRI) recommends consumption of 14 g dietary fiber per 1,000 kcal, or 25 g for adult women and 38 g for adult men. Benefits may occur with intake of 12 to 33 g fiber per day from whole foods or up to 42.5 g fiber day from supplements

                                                  Resistant Starch

                                                  Resistant starch (non-digestible oligosaccharides and the starch amylase) is not digested and therefore not absorbed as glucose in the small intestine. Legumes are the major food source of resistant starch in the diet; 100 g of cooked legumes contain 2 to 3 g of resistant starch, and 100 g (dry weight) of cornstarch contains about 6 g of resistant starch

                                                  Timing of Carbohydrate and Food Intake: Type 1 Diabetes




                                                  For individuals requiring insulin, the total carbohydrate content of meals and snacks is the first priority and determines the premeal insulin dosage and postprandial glucose response. The AmericanDiabetes Association recommends that people with type 1 diabetes or pregnant women who take insulin check their blood glucose levels three or more times daily, so that they can adjust food intake, physical activity level, and/or insulin dosage to meet blood glucose goals
                                                  Intensified insulin therapy (multiple daily injections or insulin pump therapy) 
                                                  The goal of intensified insulin therapy is to bring the blood glucose levels as close to the normal range as is feasible for the individual. Insulin infusion pumps mimic the normal physiologic insulin delivery and allow flexibility in meal size and timing. Individuals that use rapid-acting insulin by injection or an insulin pump should adjust their meal and snack insulin doses based on the carbohydrate content of the meals and snacks. 

                                                  Patients on multiple-dose insulin (MDI) or insulin pump therapy should do self-monitoring blood glucose (SMBG) at least prior to meals and snacks, occasionally postprandially, at bedtime, prior to exercise. In addition SMBG should be done when a patient suspects low blood glucose, after treating low blood glucose until they are normoglycemic, and prior to critical tasks such as driving.

                                                  Adjustments for exercise

                                                  Because the amount of physical activity may vary considerably from day to day, individuals with type 1 diabetes may need to make adjustments in energy intake and insulin dosage to avoid hypoglycemia. For individuals on these therapies, added carbohydrate should be ingested if pre-exercise glucose levels are < 100 mg/dL. When exercise is planned, the insulin dose may need to be adjusted to prevent hypoglycemia. Individuals taking sulfonylurea agents have a slightly increased risk of hypoglycemia during exercise, and supplemental energy intake may be required in some cases

                                                  Timing of Carbohydrate and Food Intake: Type 2 Diabetes

                                                  Treatment with sulfonylureas and other insulin secretagogues also requires consistency in meal timing and the carbohydrate content of meals. People with type 2 diabetes are more resistant to hypoglycemia than people with type 1 diabetes; however, when a person with type 2 diabetes who is treated with insulin or insulin secretagogues is unable to eat, dosages may need to be modified

                                                  Delayed meals

                                                  When the meal is delayed and the blood glucose level is normal, carbohydrate should be given. Usually 15 g of carbohydrate (one fruit or bread exchange) every 30 to 45 minutes until the meal is served, or 15 to 30 g of carbohydrate for a 1- or 2-hour delay, protects the patient from hypoglycemia.

                                                  Enteral nutrition

                                                   For tube feedings, either a standard enteral formula (50% carbohydrate) or a lower-carbohydrate content formula (33% to 40% carbohydrate) may be used. Care should be taken not to overfeed patients because of the risk of exacerbating hyperglycemia
                                                  Medical nutrition therapy for diabetes mellitus Medical nutrition therapy for diabetes mellitus Reviewed by gafacom on September 29, 2019 Rating: 5

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