‫بسم هللا الرحمن الرحيم‬

NUTRITIONAL CARE IN DM

Nutrition department
Medical school
University of Sumatera Utara
Epidemic Type 2 Diabetes
and the Hidden IGT Epidemic: 2004
97 million known cases
Epidemic Type 2 Diabetes
and the Hidden IGT Epidemic: 2004
97 million known cases
97 million undiagnosed cases
Epidemic Type 2 Diabetes
and the Hidden IGT Epidemic: 2004
97 million known cases
97 million undiagnosed cases,
314 million persons with
Impaired Glucose Tolerance
Epidemic Type 2 Diabetes
and the Hidden IGT Epidemic: 2004
. . . and the cardiovascular
disease
epidemic to follow through the
Metabolic Syndrome. . .
 MNT is integral to total diabetes care &
management
 Requires a coordinated team effort
 MNT requires an individual approach &
effective nutrition self-management
education
 Goals of MNT for DM
Goals of MNT that apply to all persons
with diabetes
1. Attain & maintain optimal metabolic outcomes
including :
- blood glucose levels in the normal range or as close
to normal as is safely possible to prevent or reduce
risk or complications of diabetes
- A lipid & lipoprotein profile that reduces risk for
CV disease
- Blood pressure levels that reduce the risk for
vascular disease
2. Prevent & treat the chronic complications :
Modify nutrient intake as appropriate for the
prevention and treatment of obesity, CV
disease, hypertension & nephropathy
3. Improve health through healthy food choices
& physical activity
4. Address individual nutritional needs, taking
into consideration personal & cultural
preferences & lifestyle while respecting the
individual’s needs & willingness to change
 Goals of nutrition therapy that apply
to specific situations

1. For youth with type 1 DM, provide adequate energy

to ensure normal growth and development;
integrate insulin regimen into usual eating &
exercise habits
2. For youth with type 2 DM, facilitate changes in
eating and exercise habits that reduce insulin
resistance and improve metabolic status
3. For pregnant & lactating women, provide adequate
energy and nutrients needed for successful
outcomes
4. For older adults, provide for the nutritional needs of
an aging individual
5. For individuals treated with insulin or insulin
secretagogues, provide information on prevention and
treatment of hypoglycemia and exercise-related blood
glucose problems and how to manage acute illness
6. For individuals at risk for DM, decreased risk by
increasing physical activity and promoting food
choices that facilitate moderate weight loss or at
least prevent weight gain
Prioritizing nutrition therapy for
type 2 DM

 To adopt lifestyle strategies that improve

the associated metabolic abnormalities of
glycemia, dyslipidemia & hypertension
 Lifestyle strategies independent of weight
loss that can improve glycemia include
reducing energy intake, monitoring CH
servings, limiting consumption of saturated
fats and increasing physical activity
carbohydrate

 Total amount of carbohydrate is more

important than the source (starch or sugar)
 The 1st priority for food and meal planning
is the total amount of carbohydrate
 Carbohydrate and Diabetes
 Include foods containing carbohydrate
from whole grains, fruits, vegetables and
low-fat milk in your diet
 Carbohydrates
Simple

Complex

Fiber
Carbohydrate and Diabetes

 The amount of carbohydrate at a meal

affects your blood glucose more
than the type
 Sugar and starch have similar effects on
blood glucose

=
Carbohydrate and Diabetes

 Consistency in carbohydrate intake is

important from day to day
 For people not taking diabetes
medication
 For people taking a fixed dose of insulin
 Insulin should be adjusted based on
amount of carbohydrate at meals
 For people on varying doses at meal
times
Carbohydrate and Diabetes

 Several things affect how much your

blood glucose increases after you eat:
 amount of carbohydrate
 type of sugar or starch
 cooking and food processing
 food form
 other foods in the meal that slow
digestion
Carbohydrate and Diabetes

 Limited amounts of sugar or foods

containing sugar can be used without
affecting blood glucose
 when substituted for other carbohydrates
at the meal
 Large amounts of sugar-containing
foods are not recommended
Substituting Sweets

Usual diet: 45 grams Substitute ice-cream

carbohydrate for 15 grams of
(or 3 Carbohydrates carbohydrate (or 1
Choices) Carbohydrate Choice)
1 slice bread 1/2 cup ice-cream
1/3 cup rice 1/3 cup rice
1/2 cup fruit 1/2 cup fruit
3 ounces chicken 3 ounces chicken
Vegetable salad Vegetable salad
 Carbohydrate and Diabetes
To observe effect of new food on blood
glucose:
 check blood glucose 2 hours after meal for
several days
 substitute food containing sugar for other
carbohydrate in meal
 check blood glucose 2 hours
after meal and compare
Sweeteners and Diabetes

Sugar alcohols (polyols):

sorbitol, mannitol, xylitol
 Used as sweeteners and bulking
agents
 Safe to use

 May cause diarrhea, especially in

children
Fructose:
Sweeteners and Diabetes
Low calorie sweeteners:
are safe for people with diabetes
when consumed within
recommended levels
Cans of soda Packets
(maximum/day) (maximum/day)
Acesulfame K 25 18
Aspartame 15 86
Saccharin 2 7.5
Sucralose 4.5 60
Carbohydrate and Diabetes

Fiber:
 Fiber is encouraged for everyone:

20-35 grams/day
 Good sources of fiber:
 Whole grain cereals
 Fruits
 Vegetables
 Beans and peas
Carbohydrate and Diabetes

Fiber:
 Only large amounts (50 grams/day)
have shown improvement in blood
glucose and cholesterol
 Primarily soluble fiber (barley, oatmeal,
beans, apples, broccoli)
 Side effects make this difficult for many
people
Protein and Diabetes

 Protein has very little effect on blood

glucose
 Avoid large amounts of protein
 may promote kidney disease
 Restrict protein only if you have
early kidney disease
Protein and Diabetes

 Protein does not slow the absorption of

carbohydrate
 Adding protein to snacks does not help
prevent hypoglycemia
 Fruit or crackers are good snack foods
Protein and Diabetes

 Safety of high protein, low

carbohydrate weight loss diets are
unknown
 do not promote long-term weight loss
 may increase LDL cholesterol
 Dietary Fat and Diabetes

 Primary goal - Lower LDL

cholesterol by:
 Eating less saturated fat and
cholesterol
 Eating less trans fats
Dietary Fat and Diabetes
Foods That Contain Saturated Fats:
 Meat and meat fats (bacon, lard)

 Dairy products (whole milk,

butter, cheese, cream, ice-cream)

 Palm and coconut oil

 Baked goods made from

these fats
Dietary Fat and Diabetes
Foods That Contain Trans Fats:
 Formed when a liquid oil is made more
solid
 Found in many types of stick
margarine, fast foods, and baked
goods like cookies, crackers, snack
foods, pastries and croissants
Dietary Fat and Diabetes

Foods That Contain Cholesterol:

 All animal foods

 Organ meats like liver

 Egg yolks
Dietary Fat and Diabetes

 Choose monounsaturated fat in place

of saturated:
 olive oil, canola oil, peanut oil,
olives, avocados, nuts
Dietary Fat and Diabetes

 Eat less total fat

 Low-fat diets can help:
 with weight loss
 improve cholesterol and other fats
Dietary Fat and Diabetes

 Eat 2-3 servings fish per week

 contain a type of fat protective against
heart disease
 fatty fish especially beneficial
Weight Loss and Diabetes

A small amount of weight loss can:

 improve insulin resistance

 lower blood glucose

 improve blood cholesterol

 reduce blood pressure

Weight Loss and Diabetes

Successful weight loss usually requires:

 a structured weight loss program

 education

 reduced fat and calories

 regular physical activity

 frequent follow-up
Vitamins and Minerals and
Diabetes

 Vitamins and minerals from foods

important
 High doses of vitamin and mineral
supplements can be toxic
Vitamins and Minerals and
Diabetes
People who may benefit from a
multivitamin supplement:
 persons deficient in a vitamin or
mineral
 elderly

 pregnant or nursing mothers

 strict vegetarians

 persons on calorie-restricted diet

Vitamins and Minerals and
Diabetes
 No clear benefit from vitamin and
mineral supplements except
 calcium for prevention of bone disease
 folate for prevention of birth defects
 Use of antioxidants is not advised
 vitamin C, E, selenium, beta carotene
 long-term safety and effectiveness
unknown
Alcohol and Diabetes

 If you choose to drink, limit to:

 1 drink/day for women
 2 drinks/day for men
 To reduce risk of hypoglycemia,
consume alcohol with food
Regular meals based on
carbohydrate

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Dietary Guidelines

 Eat a diet low in saturated and total fat.

 Eat a diet moderate in sodium and
sugar.
 Eat 5 or more fruits and vegetables a
day.
 Choose a diet rich in whole grains.
 Moderate use of alcohol
Dietary Guidelines

 Eat at the same time everyday , at

least within 1 hour of regular time.
 Eat about the same amount of
carbohydrate with each meal.
 Change in emphasis
• Move away from rigid guidelines
(30-35% energy from fat / 50% energy from CHO)

• Greater flexibility between energy from

CHO (45-60%) and fat (25-35%)
• The promotion of low GI CHO’s and
monounsaturated fats
• Sucrose up to 10% energy intake
Advice based on individual biochemical markers
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