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Lecture 4b


Title: PowerPoint Presentation Author: uccb Last modified by: Ed Barre Created Date: 1/3/2002 8:05:13 PM Document presentation format: On-screen Show (4:3) – PowerPoint PPT presentation

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Title: Lecture 4b

Lecture 4b 28 January 2013   Nutritional
intervention in Type 1 diabetes  
Diabetes To flow through Mellitus
Honey-sweetness taste of urine   Prevention Ni
trosamines Cows milk
Post Onset Usual food intake and pattern should
be determined and used as the basis for insulin
requirement prescriptions  
Energy -sufficient to meet growth in children
and pregnant women -amount required to
achieve and maintain healthy and realistic
body weight -have patient keep diet
records and adjust energy to meet two previous
points -type I tend to be thin
Protein -10-20 of dietary energy- some
suggestion that this heads off onset and
progression of renal disease   -onset of renal
disease- no more than 0.8 g/kg /day
Carbohydrate -small meals several times
throughout the day- why? -45 60 of daily
calories -regular physical activity if person
takes medication at a set time(s) and meals at
set times- there should be sufficient energy to
meet need for carbohydrate for physical
activity -consistent timing and composition of
meals to avoid hyper- or hypo-glycemia
Carbohydrate sources -encourage -whole grain
breads and cereals -legumes, fruits, and
vegetables -these (all above) foods good in
minerals, vitamins, fibre -can have
concentrated sweets as long counted in the 40-60
Glycemic index debate -low glycemic index
supposedly helpful in reducing glucose
load via reduced insulin response required

  • Glycemic index debate
  • some say that there is insufficient evidence that
    eating low glycemic index foods actually helps
  • -also argue that glycemic index is complicated to
  • that very few foods have had their glycemic index
    established and for the rest it is not
    intuitively obvious
  • -fear of adopting a low carbohydrate compared to
    a low glycemic index-problems with low

Fat -acceptable lipids-lt 30 from fat
(diet is lt 10 saturated fat, lt 300 mg
cholesterol daily) -elevated cholesterol,
LDLc (diet is lt 7 saturated fat lt 200 mg
cholesterol daily) -elevated
triglycerides-elevate oleic and decrease
saturates and carbohydrate

Sodium-hypertension -1500 mg sodium (3750 mg
NaCl) or less per day appropriate for all
people regardless of diabetic status Alcohol
one for females, two for males with meals
daily ok -alcohol and some oral
antidiabetic agents may cause nausea, vomiting,
headache, cramps, skin flushing, and rapid
Micronutrients-same as normals Missed Meals and
Illness   Missed meals-provide at least 1/2 of
carbohydrate and kcal within 3 hours after
missed meal   -if this is not done then
perhaps change insulin regimen, give IV
dextrose and/or change diet to increase simple
Illness -blood glucose levels often rise
dramatically -increase medication -reduce
carbohydrate intake
Treating Hypoglycemic 10-15 grams of
carbohydrate without fat (slows carbohydrate
absorption)   Enteral and parenteral
formulas indications as with other
people-adjust for higher blood glucose
Carbohydrate to insulin ratio -must eat a
consistent amount of carbohydrate, monitor blood
glucose, and keep records of food intake,
insulin use, physical activity and illness
  • Nutritional intervention in Type 2 diabetes
  • Prevention
  • Emphasis on maintenance of desired weight and
    glucose, lipid and blood pressure goals
  • Eat to avoid obesity
  • Exercise

Post-Onset Emphasis on maintenance of desired
weight and glucose, lipid and blood pressure
goals   Eat to reduce obesity   Exercise   Othe
rwise as per type 1
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