Lecture 4b

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Lecture 4b 28 January 2013   Nutritional
intervention in Type 1 diabetes  
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Diabetes To flow through Mellitus
Honey-sweetness taste of urine   Prevention Ni
trosamines Cows milk
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Post Onset Usual food intake and pattern should
be determined and used as the basis for insulin
requirement prescriptions  
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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
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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
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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
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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
range
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Glycemic index debate -low glycemic index
supposedly helpful in reducing glucose
load via reduced insulin response required

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

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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

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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
heartbeat
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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
carbohydrates
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Illness -blood glucose levels often rise
dramatically -increase medication -reduce
carbohydrate intake
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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
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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
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• Nutritional intervention in Type 2 diabetes
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• Prevention
• Emphasis on maintenance of desired weight and
  glucose, lipid and blood pressure goals
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• Eat to avoid obesity
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• Exercise

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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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