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NUTRITION THERAPY

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... of carbohydrate in a meal can influence the postprandial glycemic response. Replacing high-glycemic-index foods with low-glycemic-index foods in mixed meals ... – PowerPoint PPT presentation

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Title: NUTRITION THERAPY


1
NUTRITION THERAPY
  • 2003 Clinical Practice Guidelines
  • for the Prevention and Management
  • of Diabetes in Canada

2
NUTRITION THERAPY BASICS
  • Nutrition therapy is an integral part of the
    treatment of diabetes and patient
    self-management.
  • It is well documented that nutrition therapy can
    improve glycemic control, usually lowering A1C by
    1 or 2.

3
NUTRITION THERAPY BASICS
  • Nutrition therapy and meal planning should be
    individualized to accommodate the persons
    preferences, age, needs, culture, lifestyle and
    readiness to change.
  • People with diabetes should follow a healthy diet
    recommended for the general population in
    Canadas Guidelines for Healthy Eating.
  • People with diabetes should be encouraged to meet
    their nutritional needs by consuming a
    well-balanced diet. Routine vitamin and mineral
    supplementation is generally not recommended.

4
NUTRITION THERAPY BASICS
  • Consistency in meal patterns may help control
    blood glucose and weight.
  • While small, frequent meals may reduce glycemic
    excursions, frequent food intake may lead to
    excess energy intake and weight gain.
  • Inclusion of snacks should be individualized as
    part of a persons meal plan. People with
    diabetes should be counselled to consume snacks
    only if required due to the demands of
    antihyperglycemic therapy.

5
CARBOHYDRATES
  • Individuals on insulin therapy should adjust
    their insulin based on the carbohydrate content
    of their meals. Education on matching insulin
    and carbohydrate content (carbohydrate counting)
    is recommended.

6
CARBOHYDRATES
  • Both the amount and source of carbohydrate in a
    meal can influence the postprandial glycemic
    response. Replacing high-glycemic-index foods
    with low-glycemic-index foods in mixed meals
    reduces acute blood glucose responses in people
    with type 1 and type 2 diabetes.
  • Sucrose intake of up to 10 total daily energy
    is acceptable.

7
CARBOHYDRATES
  • Sugar alcohols (maltitol, sorbitol, etc.) vary in
    the degree to which they are absorbed, and affect
    blood glucose. Consumption of gt 10 g per day may
    produce adverse gastrointenstinal symptoms.
  • Sweeteners (saccharin, aspartame, cyclamates,
    etc.) have been shown to be safe when used by
    people with diabetes.

8
FATS
  • People with diabetes should limit fat to lt 30 of
    energy.
  • Saturated and trans fatty acids combined should
    be restricted to lt 10 of energy.
  • Meal plans should favour monounsaturated fats
    where possible.

9
PROTEIN
  • There is no evidence to suggest that the usual
    protein intake of 15-20 of daily energy should
    be modified in people with diabetes.

10
ALCOHOL
  • When consumed with food, moderate amounts of
    alcohol (1 - 2 standard drinks) do not cause
    hyperglycemia or hypoglycemia.
  • Alcohol consumption should be limited to no more
    than 2 standard drinks per day and lt 14 standard
    drinks per week for men and lt 9 for women.

11
NUTRITION SUMMARY
  • Eat a variety of foods.
  • Emphasize cereals, breads and other whole grain
    products, fruits and vegetables.
  • Choose lower fat dairy products, leaner meats and
    foods prepared with less fat.
  • Achieve and maintain a healthy body weight
    through regular physical activity and healthy
    eating.
  • Limit salt, alcohol and caffeine.

12
NUTRITION SUMMARY
  • Carbohydrates 50 - 55 of energy
  • Proteins 15 - 20 of energy
  • Fats lt 30 of energy

13
NUTRITION THERAPY- RECOMMENDATIONS
  • Nutrition counselling by a registered dietitian
    is recommended for people with type 2 diabetes
    Grade C, Level 3 and people with type 1
    diabetes Grade D, Consensus to lower A1C
    levels.
  • Counselling is equally effective when given in a
    small group or one-on-one setting Grade B, Level
    2.

14
NUTRITION THERAPY- RECOMMENDATIONS
  • To meet their nutritional needs, individuals with
    diabetes should be encouraged to follow Canadas
    Guidelines for Healthy Eating Grade D,
    Consensus.
  • People with diabetes should choose
    low-glycemic-index foods in place of
    high-glycemic-index foods within the same
    category of foods more often to help optimize
    glycemic control Grade B, Level 2.

15
NUTRITION THERAPY- RECOMMENDATIONS
  • Sucrose and sucrose-containing foods can be
    substituted for other carbohydrates as part of
    mixed meals up to a maximum of 10 of energy,
    provided adequate control of BG and lipids is
    maintained Grade B, Level 2.
  • All people with diabetes should consider
    restricting combined saturated fats and trans
    fatty acids to lt 10 of energy. Meal plans
    should favour monounsaturated fats, when
    possible, and include foods rich in
    polyunsaturated omega-3 fatty acids and plant
    oils Grade D, Consensus.

16
NUTRITION THERAPY- RECOMMENDATIONS
  • For people with diabetes on intensive insulin
    treatment regimens, education on matching insulin
    to carbohydrate content (e.g. carbohydrate
    counting) is recommended Grade D, Consensus.
  • The diabetes healthcare team should discuss
    alcohol use with people with diabetes Grade D,
    Consensus. People with type 1 diabetes should
    be informed of the risk of morning hypoglycemia
    resulting from alcohol consumed 2 to 3 hours
    after the previous evenings meal Grade C, Level
    3.

17
NUTRITION TOOLS
  • Further details and tools are available from the
    Canadian Diabetes Association and at
    www.diabetes.ca
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