TOPIC 6 : MEAL PLANNING OF DIABETES MELLITUS AND METABOLIC SYNDROME

General Objectives:
After completion of skill laboratory practice the student will be able to design meal
planning on patients with diabetes mellitus and metabolic syndrome

Specific Objectives:
At the end of skill laboratory practices, the student will be able to understand the concept
of meal planning on patients with diabetes mellitus and metabolic syndrome

Syllabus Description
Sub Model Objective
After finishing skill practice of clinical examination, the students will be able to design
meal planning on patients with diabetes mellitus and metabolic syndrome

Expected Competencies
Student will be able to design meal planning on patients with diabetes mellitus and
metabolic syndrome

Methods
1. Presentation
2. Demonstration
3. Coaching
4. Self practices

Laboratory Facilities:
Class Room
Reading Material
Trainers
Food record of a patient
Daftar Komposisi Bahan Makanan (list of food composition)
Audiovisual Aids (LCD, OHP, Video)
Student Learning Guide
Scale
Stadiometer

Venue
Training room( Skills Laboratory)

Evaluation
1. Written test
2. Observed testing.
LEARNING GUIDE
Meal Planning DM
I INTRODUCTION score
0 1 2
1 Greet the patient and introduce the examiner’s self, develop a good
rapport with the patient
2 Ask the patient’s identity
- The patient’s name, age, occupation and address
3 Informed consent
 Purpose
 Procedure
 Agreement
II CHIEF COMPLAINT
(Patient come with the diagnosis of DM or Metabolic Syndrome)
4 Ask the patient why she/he come to clinic, previous diagnosis, body
weight, body height) then count the patient Ideal Body Weight (IBW)
using modified Broca formulation (90%(Body height-100))
5 Ask the patient what treatment he/she had received:
- Oral anti hyperglicemic agent
- Insulin
- Lifestyle management
6 Assess the total daily calories needed based on Ideal Body weight
needed (using TEE formulation) TEE=BMR+SF + AF+TEF

Harris-Bennedict formulation
BMR for men :
66,5 + (13,7 x IBW[Ideal Body Weight]) + (5 x BH[body height]) – (6,7 X
Age))

BMR for women :

BMR = 655.1 + (9.5 x weight in kg) + (1.8 x height in cm) – (4.7 x age in
years)
SF ( Stress Factor) based on clinical condition

AF (Activity Factor) based on daily activities

TEF (Termic effect of food) mean for mostly Indonesian 20% BMR
7 Assess how much calories for daily protein needed (10-20% of TEE)
calculate also the daily protein needed already meet the daily protein
needed based on calculation of 0,8 gr- 1 gr protein / Kg Bb actual / day
8 Assess how much calories for daily fat needed (20-25% of TEE)
9 Assess how much calories for daily carbohydrate needed (55-65% of TEE)
10 Convert the calories of carbohydrate into measuring unit (gram, ons, kg)
11 Convert the calories of protein into measuring unit (gram, ons, kg)
12 Convert the calories of fat into measuring unit (gram,ons, kg)
13 Recommend the patient to consult a nutritionist for the settings menu
14 Tell the patient not to consume sucrose (white sugar) more than 5 % of
TEE
15 Tell the patient not to consume salt more than 2300 mg/day
16 Recommend the patient to consume 20-35 grams of fiber/ day (5 portion
of vegetable and fruits)
17 Tell the patient that artificial sweetener is allowed in condition
accordance with Accepted Daily Intake (ADI)
18 Recommend the patient not to use fructose as artificial sweetener
19 Explain to patients that calorie artificial sweeteners ( fructose , isomalt
, lactitol , maltitol , mannitol , sorbitol and xylitol ) must be calculated in
the total daily intake , while the non-calorie artificial sweeteners (
aspartame , saccharin , acesulfame potassium , sukralose , neotame )
need not be calculated to the total daily intake