Diabetes nutritional approach Flashcards
(57 cards)
Goals of diet therapy
- long-term and short-term diet
- To encourage the attainment or maintenance of a healthy body weight
- To achieve the best possible metabolic control without seriously compromising quality of life
- To delay or prevent complications associated with diabetes
To provide specific guidelines for different stages in the lifecycle - To promote self-care by providing the necessary knowledge, skills, resources and support
- To encourage overall health by practical instructions in optimal nutrition
Since diabetes is a risk factor for __ we also want to control __ (mostly __)
Since diabetes is a risk factor for CVD we also want to control lipid profile (mostly LDL-C)
What are the components of metabolic control and targets for each
- Glycemic control: near-normal or targets
- Lipid profile: primary target LDL-C ≤2.0 mmol/L
- Blood pressure <130/80
Nutrition checklist (7)
- REFER for nutrition counselling by a registered dietitian
- FOLLOW Eating Well with Canada’s Food Guide
- INDIVIDUALIZE dietary advice based on preferences and treatment goals
- CHOOSE low glycemic index carbohydrate food sources
- KNOW alternative dietary patterns for type 2 diabetes
- ENCOURAGE matching of insulin to carbohydrate in type 1 diabetes
- ENCOURAGE nutritionally balanced, calorie-reduced diet in patients with overweight or obesity
Nutritional management of hyperglycaemia in t2Dm
- Clinical assessment
Healthy behaviour interventions by Registered Dietitan - Initiate intensive healthy behaviour interventions or energy restriction and increased physical activity to achieve/maintain a healthy body weight
- Provide counselling on a diet best suited to the individual based on values, preferences, and treatment goals using the advantages/disadvantages
- If not at target:
- Continue healthy behaviour interventions and add pharmacotherapy
- Timely adjustments to healthy behaviour interventions and/or pharmacotherapy should be made to attain A1C within 2 to 3 months for healthy behaviour interventions alone or 3 to 6 months for any combination with pharmacotherapy
What is the main marker for hyperglycaemic control
A1c
What should be advised to people with BMI>25? Why?
Nutritionally balanced, calorie-reduced diet should be followed to achieve and maintain a lower, healthier body weight
because
Weight loss of 5-10% of initial body weight -> Improved insulin sensitivity, glycemic control, blood pressure control, lipid levels
Macronutrient Distribution (% Total Energy) for diabetes
Carbohydrates: 45-60%
Protein: 15-20% (or 1-1.5g /kg BW)-> should be maintained or increased in energy reduced diets.
Fat: 20-35%
What is the minimum intake of CHO
Minimum intake of 130 g/d
Why would it be advised to consume >45% of CHO?
What should it include/ not include
> 45% to prevent high intake of saturated fats and higher risk of CVD
Higher range should include low GI index and high fiber intake
<10% of added sugar (sucrose)
Glycemic index vs glycemic load
G index: scale 0-100 compared to glucose standard
Glycemic load: Area under the curve (AUC) in blood glucose response of a given food compared to standard (glucose or white bread) for the same content in g CHO.
-> accounts for available CHO in portion
What is the formula for glycemic load? How would you calculate GL of 200g of pasta that has 50g of cho?
GI= AUC pasta / AUC glucose or white bread X 100= 46
GL= g CHO in normal serving x GI / 100
GL pasta= 50 g X 46 /100 = 23
Glycemic index vs load scales cut-offs
Glycemic index (GI)
Low: ≤ 55
Medium: 56-69
High: ≥ 70
Glycemic load (GL)
Low: ≤ 10
Medium: 11-19
High: ≥ 20
Dietary factors affecting the glycemic response
Dietary fibers Food form- e.g wheat flour vs bulgur Cooking and processing Digestibility Other nutrients present (protein and fat) Interprandial differences Fast/ slow eater Glucose tolerance effect- GI is determined in people with normal response and healthy weight
What are the benefits of replacing high Gi foods with low GI foods? Should all patients be advised to do so?`
Replacing high GI with low GI carbohydrates in mixed meals:
- improvement of glycemic control in type 1 and type 2 DM
- Studies showed increased HDL-C, decreased CRP, hypoglycemic events in T1DM, and medications
Recommended but teaching should be based on patient’s interest and ability.
What are the fiber intake recommendations for DM?
Higher total intake recommended in DM:
30-50 g/d or 15-25 g/1000 kcal
- 1/3 of total should be soluble viscous fibre (10-20 g/day) because of higher benefit
benefits of fiber intake in diabetes
Evidence for more benefits from soluble fiber:
- slows gastric emptying and glucose absorption
- Improvement in A1C, Fasting BG and lipid profile
How to increase fiber intake?
Consume more pulses, whole grains, fruits and veggies
Recommendations for added sucrose intake? Why is it so?
<10% of total energy is acceptable
>10% increases BG and TG in some
Added sucrose vs added fructose
Added fructose
in place of sucrose may help lower A1C and unlikely harmful
What does excess fructose lead to?
> 10% increase TG in T2DM
- High-fructose corn syrup (HFCS) shows not different than sucrose in cardiometabolic outcomes
- Sugar-sweetened beverages: high intake associated with hypertension and risk of CHD
- When excess energy: adverse metabolic profile
Natural fructose from fruits consensus
Natural fructose from fruits: no harm
Caution with high GI fruits: pineapple, mango, papaya, melons
What is the amount of CHO in low CHO diets?
CHO of 4% to 45% of total energy
Are low CHO diets beneficial in DM?
Systematic reviews have not shown consistent improvements in:
- A1C
- Blood lipid profile and BP
- Maintenance of weight loss in the long-term (>12 mo)
Concern of ketoacidosis with insulin therapy or SGLT2 inhibitors
Limited studies in type 1 DM: improved A1C in those who are adherent, but modest adherence overall
Concern with blunted response to glucagon injection in treatment of hypoglycemia
