Diabetic Nutrition Therapy
Medical nutrition therapy is an integral component of
diabetes management and diabetes self management education for both the
type 1 and type 2 diabetic. It involves conducting a nutrition
assessment to evaluate the diabetic's food intake, metabolic status,
lifestyle, and willingness to make changes; goal setting; nutrition
education; and evaluation. To enhance compliance the medical nutrition
therapy plan should be individualized and take into consideration the
diabetics lifestyle, cultural background, and financial situation.
The American Diabetes Association's recommendations for diabetic
nutritional therapy are outlined below.
Carbohydrates:
• Terms such as simple sugars, complex carbohydrates, and fast acting
carbohydrates are not well-defined and use of these terms should be
avoided. The preferred terms are sugars, starch, and fiber.
• Foods containing carbohydrates from whole grains, fruits, vegetables,
and low fat milk should be included in a healthy diet.
• Total amount of carbohydrates in meals or snacks is more important
than source or type.
• Sucrose does not increase glycemia to a greater than isocaloric
amounts of starch. Sucrose and sucrose containing foods do not need to
be restricted, but if used, should be substituted for other carbohydrate
sources.
• Nonnutritive sweeteners are safe when consumed within acceptable daily
intake levels established by the Food and Drug Administration.
• Individuals using intensive insulin therapy should adjust their
before-meal insulin doses based on carbohydrate content of meals.
• As with the general public, consumption of dietary fiber should be
encouraged.
• Individuals using daily insulin injections should be consistent in
day-to-day carbohydrate intake.
Proteins:
• Although protein stimulates insulin secretion as potentially as a
carbohydrate, ingested protein does not increase plasma glucose levels
in controlled type 2 diabetes.
• For diabetics not in optimal glucose control, protein needs may be
greater (but not greater than usual intake) then the recommended dietary
allowances (RDA).
• Protein intake of 15% to 20% of total daily energy does not need to be
modified if renal function is normal.
• Long term effects of high protein, low carbohydrate diets are unknown.
Although they generate short term weight loss and improved glucose
levels, there is no evidence that weight loss is maintained.
Dietary Fats:
• Less than 10% of energy intake should come from saturated fats.
• Dietary cholesterol intake should be less than 300 mg/day.
• To lower low-density lipoprotein (LDL) cholesterol, saturated fat
intake can be reduced if weight loss is desired. If weight loss is not a
goal, saturated fat can be replaced with either carbohydrate or
monounsaturated fat.
• Intake of trans-unsaturated fatty acids should be minimized.
• Reduced fat diets contribute to modest weight loss and improvement of
dyslipidemia when maintained.
• Polyunsaturated fat intake should be approximately 10% of total energy
intake.
Energy Balance and Obesity:
• In insulin resistant diabetics, reduced energy intake and modest
weight loss improve short term insulin resistance and glucose control.
• Long term weight loss is best facilitated by structured programs that
emphasize lifestyle changes that include education, reduced fat (<30%
total kcalories) and energy intake, regular physical activity, and
regular personal contact.
• Exercise and behavior modification are most useful as adjuncts to
other weight loss strategies.
• Standard weight reduction diets, when used alone, are unlikely to
produce long term weight loss.
Micronutrients:
• There is no benefit from vitamin or mineral supplementation when there
are no underlying deficiencies. Exceptions include folate for prevention
of birth defects and calcium for the prevention of osteoporosis.
• Routine supplementation of the diet with antioxidants is not advised
because of uncertainties related to long term efficacy and safety.
Alcohol:
• If diabetics choose to drink alcohol, daily intake should be limited
to two drinks for men and one drink for women. One drink is defined and
12 oz of beer, 5 oz of wine, or 1.5 oz of hard liquor.
• Alcohol should be consumed with food to reduce risk of hypoglycemia.
• Alcohol should never be mixed with chlorpropamide (Diabinese).
• Abstention from alcohol is recommended for women during pregnancy and
those with medical problems such as pancreatitis, advanced neuropathy,
severe hypertriglyceridemia, or alcohol abuse. | 
