Goals of nutrition therapy that apply to adults with diabetes
However, this principle does not account for the so-called beneficial elements, whose presence, while not required, has clear positive effects on plant growth. In developed countries, the diseases of malnutrition are most often associated with nutritional imbalances or excessive consumption. In some American schools, students are required to take a certain number of FCS or Health related classes. Read nutrition labels carefully for serving sizes and carbohydrate counts. Applied sciences Food science Nutrition Self care.
3 in 5 babies not breastfed in the first hour of life
Many customers call to say thank you for giving them their lives back and lifting the burden off their loved ones. We are hearing from many of our customers who halted their activities before taking Melabic. Now with stable blood sugar and feeling more confident they are back enjoying life.
I have been on Melabic for years now and it has helped me not only keep my blood sugar in check but my energy levels have increased giving me a chance to do the things I love. And they are all wondering about one big question — How did they manage without Melabic until now? If you have been dealing with increased thirst, unexplained weight loss, fatigue and irritability, It is strongly encouraged you try Melabic! Diabetes sometimes just leaps out at you. Your body might know what is going on but until your doctor sits you down and says "You have Diabetes" it can be a shock.
Life can change in an instant once you finally face the facts about your high blood sugar and insulin levels. How can you make it go away? Once you experience all the benefits of Melabic you will then realize you do not have to continue to suffer and that you do have a choice.
Now it is completely understandable you have probably tried a number of various remedies in the past to counter balance what is happening in your body. Perhaps you've tried some pills or capsules. And yet none of them gave you piece of mind knowing how dangerous and toxic so many of the medications on the market are.
This is where Melabic comes into the picture. Just take it daily and pretty soon your body will be finally receiving the many nutrients it needs that it has been deprived of. You will be able to forget about so many harmful side effects diabetes can have on your life.
Before I share with you the ingredients of Melabic, I want you to become aware of some information the drug and supplement companies do not like made common knowledge. The reason this is important is because these products are produced with little or no supervision. You have no guarantee about the purity or quality of these ingredients. Sooner or later, that gun is going to go off. None of our ingredients come from China.
We have a strict Quality Assurance Program that gives you peace of mind that you are getting the absolute best ingredients for your body. This means you are getting a completely natural product in a plant-based capsule that is suitable for vegans. Cinnamon supports healthy blood sugar levels as well as helps reduces your total cholesterol, particularly your bad LDL cholesterol and can help lower triglyceride fats. Gymnema Sylvestre is known as gur-mar, or "sugar destroyer.
When taken internally, it helps to control blood-sugar levels in diabetes. The leaves of Gymnema sylvestre perform two significant functions relative to diabetes. First, they suppress blood glucose, especially after eating. Secondly, they are insulinotropic and promote insulin secretion. By this two-pronged approach, Gymnema sylvestre proves a valuable aid in diabetes control. ALA helps your cells' ability to turn sugar into energy and decreases the need for your body to make insulin.
It also helps reduces HbA1c — a chemical that forms when sugar permanently attaches to your blood cells - helps protect against glycation — the most serious result of high blood sugar. How dangerous is glycation? Glycation destroys tissues in the kidney and retina, along with destroying insulin-producing beta cells. Glycation hardens your arteries and forms plaque, leading to high blood pressure, heart attacks and strokes.
Fenugreek is a tall annual herb that is native to the Mediterranean, Ukraine and India. The plant bears pods filled with numerous light brown, diamond-shaped seeds that possess a sweet maple aroma and are commonly used in cookery and flavouring.
Studies reveal that fenugreek helps regulate blood glucose. The glucose-regulating, antidiabetic properties of fenugreek seed are linked to a novel free amino acid, 4-hydroxyisoleucine. This compound stimulates insulin secretion, thereby limiting the extent to which blood glucose is elevated. Miracle Ingredients 5, 6, 7. Your body needs Zinc to make, move and use insulin. Zinc also protects your insulin producing cells.
Chromium "unlocks the door" to energy-producing cells. Chromium is needed to process glucose, and boosts the enzyme that makes it possible for your liver to use glucose. Biotin regulates metabolism of carbohydrates and improves fasting blood sugar levels. Banaba leaves are a popular plant medicine in the Philippines. It's Corsolic Acid, and it's known as "natural plant insulin"! In , he discovered that the banaba plant lowered blood sugar levels in all patients.
Not only is banaba good for lowering blood sugar — it has an interesting side-effect, too: Bitter melon is the common name for Momordica charantia, also known as African cucumber, balsam pear and bitter gourd. The plant is aptly named, as all parts of the plant, including the fruit, taste bitter. Widely sold in Asian groceries as a vegetable, bitter melon is employed as a folk remedy primarily for regulating blood sugar in cases of diabetes, as well as for colitis and dysentery, intestinal worms, jaundice and fevers.
Current understanding of the phytochemicals in bitter melon suggests that these multiple uses are well founded. When you can no longer do the things you enjoy or even function, life is frustrating when it is out of control.
Diabetes is especially bad because unless your lifestyle changes it may never go away. Melabic helps hundreds of thousands overcome diabetes and high blood sugar with natural ingredients at a precisely dossed proprietary formula.
It finds every place in your body that needs relief and goes to work. And it will keep working as long as you keep taking it every day. Just to say l am thrilled at the results I am getting from Melabic. I am now able to get back to the sport I love as I have recovered from poor circulation in my calves that gave me great pain. With my sugar levels stable I feel I can exercise consistently with no pain. I started taking Melabic and following your advice, since then I have dropped 20 pounds and my blood sugar levels have dropped by 60 points.
Since being on Melabic for a little over a month, I must confess that this great product of yours has made a great difference to my health. Are you kidding me, I asked my Dr. I have been a using Melabic for a year now from when my glucose readings were and now hover around I am looking forward to the day I can say good bye to my insulin injections.
Just to say that I am already experiencing benefit from Melabic — my blood sugar levels were between 9 and Other changes are very noticeable loss of appetite and from time to time a need for a sugar supplement a couple of small squares of chocolate does the trick. This morning, my reading was , but was much higher before starting Melabic. I think Melabic has great potential and am glad I started with the program. I was always feeling tired but now I feel like a new man.
I take my three Melabic per day and follow your program and my sugar levels have stabilized. Thank you so much — I feel on top of the world. I have introduced my neighbor to the product and she says she can tell the difference already. I highly recommend it. Since being on Melabic for a little over a month, i must confess that this great product of yours has made a great difference to my health.
I started taking it as soon as I received it. Before my blood sugar as reading and he was going to start me on insulin injections.. After 1 month my blood sugar is , and no longer am i going to need insulin injections. Thank you for helping me get my diabetes under control. I thank God I found your product.
My father has diabetes so the 4 of us "kids" were always somewhat scared of developing this disease. Well my biggest fear came true. On January 1, I started my 12 hr night shift with slightly blurred and hazy vision. I just knew then that this was telling me some bad news. I checked my blood sugar and it was As I squinted and saw that number pop up on the screen my eyes welled up with tears. I calmed myself and when I later had a chance I googled Very little has changed in diabetic treatment over the last 31 years This mindset leaves minimal HOPE for us The money back guarantee was the clincher for me.
I bought some right away and started taking 2 pills 3 times a day because I am over pounds. I am happy to report my glucose was today. I watch what I eat without being obsessed. It hasn't even been a month yet. I am beating this curse with no pills and no insulin shots and feel to good about it. The peace of mind alone is worth the price. I tell everyone I meet about this product and will continue to do so. While I was a bit skeptical of Melabic, I ordered some, and received them promptly.
I was amazed to see results in one day! I had been using around units per day, now I take 20 — 30 units per day , and my sugar counts are great! Most days I wake up under Occasionally, to I am exercising faithfully, and , at the age of 60, I am amazed at the muscle growth I am experiencing.
I feel so much better, and have alot more energy , and endurance. I was almost hopeless over turning my life around but now I am enjoying life and work again. My cholesterol and triglycerides are plummeting. I am a sushi lover, and usually eat way too much. Unfortunately, there are no studies examining the effects of dietary intervention on circulating levels of antioxidants and inflammatory biomarkers in diabetic volunteers.
The few small clinical studies involving diabetes and functional foods thought to have high antioxidant potential e. Clinical trial data not only indicate the lack of benefit with respect to glycemic control and progression of complications but also provide evidence of the potential harm of vitamin E, carotene, and other antioxidant supplements 1 , 72 , In addition, available data do not support the use of antioxidant supplements for CVD risk reduction Chromium, potassium, magnesium, and possibly zinc deficiency may aggravate carbohydrate intolerance.
Serum levels can readily detect the need for potassium or magnesium replacement, but detecting deficiency of zinc or chromium is more difficult In the late s, two randomized placebo-controlled studies in China found that chromium supplementation had beneficial effects on glycemia 76 — 78 , but the chromium status of the study populations was not evaluated either at baseline or following supplementation.
Data from recent small studies indicate that chromium supplementation may have a role in the management of glucose intolerance, gestational diabetes mellitus GDM , and corticosteroid-induced diabetes 76 — However, other well-designed studies have failed to demonstrate any significant benefit of chromium supplementation in individuals with impaired glucose intolerance or type 2 diabetes 79 , Similarly, a meta-analysis of randomized controlled trials failed to demonstrate any benefit of chromium picolinate supplementation in reducing body weight The FDA concluded that although a small study suggested that chromium picolinate may reduce insulin resistance, the existence of such a relationship between chromium picolinate and either insulin resistance or type 2 diabetes was uncertain http: There is insufficient evidence to demonstrate efficacy of individual herbs and supplements in diabetes management In addition, commercially available products are not standardized and vary in the content of active ingredients.
Herbal preparations also have the potential to interact with other medications Therefore, it is important that health care providers be aware when patients with diabetes are using these products and look for unusual side effects and herb-drug or herb-herb interactions. Individuals using rapid-acting insulin by injection or an insulin pump should adjust the meal and snack insulin doses based on the carbohydrate content of the meals and snacks.
For individuals using fixed daily insulin doses, carbohydrate intake on a day-to-day basis should be kept consistent with respect to time and amount. For planned exercise, insulin doses can be adjusted. For unplanned exercise, extra carbohydrate may be needed. The first nutrition priority for individuals requiring insulin therapy is to integrate an insulin regimen into their lifestyle.
For individuals receiving basal-bolus insulin therapy, the total carbohydrate content of meals and snacks is the major determinant of bolus insulin doses Insulin-to-carbohydrate ratios can be used to adjust mealtime insulin doses. Several methods can be used to estimate the nutrient content of meals, including carbohydrate counting, the exchange system, and experience-based estimation. Improvement in A1C without a significant increase in severe hypoglycemia was demonstrated, as were positive effects on quality of life, satisfaction with treatment, and psychological well-being, even though increases in the number of insulin injections and blood glucose tests were necessary.
For planned exercise, reduction in insulin dosage is the preferred method to prevent hypoglycemia For unplanned exercise, intake of additional carbohydrate is usually needed. More carbohydrate is needed for intense activity. A American Diabetes Association statement addresses diabetes MNT for children and adolescents with type 1 diabetes Individuals with type 2 diabetes are encouraged to implement lifestyle modifications that reduce intakes of energy, saturated and trans fatty acids, cholesterol, and sodium and to increase physical activity in an effort to improve glycemia, dyslipidemia, and blood pressure.
Plasma glucose monitoring can be used to determine whether adjustments in foods and meals will be sufficient to achieve blood glucose goals or if medication s needs to be combined with MNT. Healthy lifestyle nutrition recommendations for the general public are also appropriate for individuals with type 2 diabetes. Because many individuals with type 2 diabetes are overweight and insulin resistant, MNT should emphasize lifestyle changes that result in reduced energy intake and increased energy expenditure through physical activity.
Because many individuals also have dyslipidemia and hypertension, reducing saturated and trans fatty acids, cholesterol, and sodium is often desirable. Therefore, the first nutrition priority is to encourage individuals with type 2 diabetes to implement lifestyle strategies that will improve glycemia, dyslipidemia, and blood pressure. Although there are similarities to those above for type 1 diabetes, MNT recommendations for established type 2 diabetes differ in several aspects from both recommendations for type 1 diabetes and the prevention of diabetes.
MNT progresses from prevention of overweight and obesity, to improving insulin resistance and preventing or delaying the onset of diabetes, and to contributing to improved metabolic control in those with diabetes. With established type 2 diabetes treated with fixed doses of insulin or insulin secretagogues, consistency in timing and carbohydrate content of meals is important. However, rapid-acting insulins and rapid-acting insulin secretagogues allow for more flexible food intake and lifestyle as in individuals with type 1 diabetes.
Increased physical activity by individuals with type 2 diabetes can lead to improved glycemia, decreased insulin resistance, and a reduction in cardiovascular risk factors, independent of change in body weight.
Resistance training is also effective in improving glycemia and, in the absence of proliferative retinopathy, people with type 2 diabetes can be encouraged to perform resistance exercise three times a week Adequate energy intake that provides appropriate weight gain is recommended during pregnancy.
Weight loss is not recommended; however, for overweight and obese women with GDM, modest energy and carbohydrate restriction may be appropriate. MNT for GDM focuses on food choices for appropriate weight gain, normoglycemia, and absence of ketones.
Because GDM is a risk factor for subsequent type 2 diabetes, after delivery, lifestyle modifications aimed at reducing weight and increasing physical activity are recommended. Prepregnancy MNT includes an individualized prenatal meal plan to optimize blood glucose control. Due to the continuous fetal draw of glucose from the mother, maintaining consistency of times and amounts of food eaten are important to avoidance of hypoglycemia.
Plasma glucose monitoring and daily food records provide valuable information for insulin and meal plan adjustments. MNT for GDM primarily involves a carbohydrate-controlled meal plan that promotes optimal nutrition for maternal and fetal health with adequate energy for appropriate gestational weight gain, achievement and maintenance of normoglycemia, and absence of ketosis. Specific nutrition and food recommendations are determined and subsequently modified based on individual assessment and self-monitoring of blood glucose.
A recent large clinical trial reported that treatment of GDM with nutrition therapy, blood glucose monitoring, and insulin therapy as required for glycemic control reduced serious perinatal complications without increasing the rate of cesarean delivery as compared with routine care Maternal health—related quality of life was also improved.
Hypocaloric diets in obese women with GDM can result in ketonemia and ketonuria. Insufficient data are available to determine how such diets affect perinatal outcomes.
Daily food records, weekly weight checks, and ketone testing can be used to determine individual energy requirements and whether a woman is undereating to avoid insulin therapy.
Carbohydrate should be distributed throughout the day in three small- to moderate-sized meals and two to four snacks. An evening snack may be needed to prevent accelerated ketosis overnight. Carbohydrate is generally less well tolerated at breakfast than at other meals. Regular physical activity can help lower fasting and postprandial plasma glucose concentrations and may be used as an adjunct to improve maternal glycemia.
If insulin therapy is added to MNT, maintaining carbohydrate consistency at meals and snacks becomes a primary goal. Although most women with GDM revert to normal glucose tolerance postpartum, they are at increased risk of GDM in subsequent pregnancies and type 2 diabetes later in life.
Lifestyle modifications after pregnancy aimed at reducing weight and increasing physical activity are recommended, as they reduce the risk of subsequent diabetes 26 , Breast-feeding is recommended for infants of women with preexisting diabetes or GDM; however, successful lactation requires planning and coordination of care In most situations, breast-feeding mothers require less insulin because of the calories expended with nursing.
Lactating women have reported fluctuations in blood glucose related to nursing sessions, often requiring a snack containing carbohydrate before or during breast-feeding Obese older adults with diabetes may benefit from modest energy restriction and an increase in physical activity; energy requirement may be less than for a younger individual of a similar weight.
A daily multivitamin supplement may be appropriate, especially for those older adults with reduced energy intake. Physical activity is needed to attenuate loss of lean body mass that can occur with energy restriction.
Exercise training can significantly reduce the decline in maximal aerobic capacity that occurs with age, improve risk factors for atherosclerosis, slow the age-related decline in lean body mass, decrease central adiposity, and improve insulin sensitivity—all potentially beneficial for the older adult with diabetes 89 , However, exercise can also pose potential risks such as cardiac ischemia, musculoskeletal injuries, and hypoglycemia in patients treated with insulin or insulin secretagogues.
Reduction of protein intake to 0. MNT that favorably affects cardiovascular risk factors may also have a favorable effect on microvascular complications such as retinopathy and nephropathy. Progression of diabetes complications may be modified by improving glycemic control, lowering blood pressure, and, potentially, reducing protein intake. In several studies of subjects with diabetes and microalbuminuria, urinary albumin excretion rate and decline in glomerular filtration were favorably influenced by reduction of protein intake to 0.
Although reduction of protein intake to 0. In individuals with diabetes and macroalbuminuria, reducing protein from all sources to 0. Although several studies have explored the potential benefit of plant proteins in place of animal proteins and specific animal proteins in diabetic individuals with microalbuninuria, the data are inconclusive 1 , Observational data suggest that dyslipidemia may increase albumin excretion and the rate of progression of diabetic nephropathy Elevation of plasma cholesterol in both type 1 and 2 diabetic subjects and plasma triglycerides in type 2 diabetic subjects were predictors of the need for renal replacement therapy Whereas these observations do not confirm that MNT will affect diabetic nephropathy, MNT designed to reduce the risk for CVD may have favorable effects on microvascular complications of diabetes.
For patients with diabetes at risk for CVD, diets high in fruits, vegetables, whole grains, and nuts may reduce the risk. In normotensive and hypertensive individuals, a reduced sodium intake e. In most individuals, a modest amount of weight loss beneficially affects blood pressure. In the EDIC Epidemiology of Diabetes Interventions and Complications study, the follow-up of the DCCT Diabetes Control and Complications Trial , intensive treatment of type 1 diabetic subjects during the DCCT study period improved glycemic control and significantly reduced the risk of the combined end point of cardiovascular death, myocardial infarction, and stroke Adjustment for A1C explained most of the treatment effect.
The risk reductions obtained with improved glycemia exceeded those that have been demonstrated for other interventions such as cholesterol and blood pressure reductions. There are no large-scale randomized trials to guide MNT recommendations for CVD risk reduction in individuals with type 2 diabetes.
However, because CVD risk factors are similar in individuals with and without diabetes, benefits observed in nutrition studies in the general population are probably applicable to individuals with diabetes. The previous section on dietary fat addresses the need to reduce intake of saturated and trans fatty acids and cholesterol. Hypertension, which is predictive of progression of micro- as well as macrovascular complications of diabetes, can be prevented and managed with interventions including weight loss, physical activity, moderation of alcohol intake, and diets such as DASH Dietary Approaches to Stop Hypertension.
The DASH diet emphasized fruits, vegetables, and low-fat dairy products; included whole grains, poultry, fish, and nuts; and was reduced in fats, red meat, sweets, and sugar-containing beverages 7 , , The effects of lifestyle interventions on hypertension appear to be additive.
Reduction in blood pressure in people with diabetes can occur with a modest amount of weight loss, although there is great variability in response 1 , 7. Regular aerobic physical activity, such as brisk walking, has an antihypertensive effect 7. Although chronic excessive alcohol intake is associated with an increased risk of hypertension, light to moderate alcohol consumption is associated with reductions in blood pressure 7.
Heart failure and peripheral vascular disease are common in individuals with diabetes, but little is known about the role of MNT in treating these complications. Alcohol intake is discouraged in patients at high risk for heart failure. Ingestion of 15—20 g glucose is the preferred treatment for hypoglycemia, although any form of carbohydrate that contains glucose may be used.
In individuals taking insulin or insulin secretagogues, changes in food intake, physical activity, and medication can contribute to the development of hypoglycemia. The acute glycemic response correlates better with the glucose content than with the carbohydrate content of the food 1. Although pure glucose may be the preferred treatment, any form of carbohydrate that contains glucose will raise blood glucose Adding protein to carbohydrate does not affect the glycemic response and does not prevent subsequent hypoglycemia.
Adding fat, however, may retard and then prolong the acute glycemic response. During hypoglycemia, gastric-emptying rates are twice as fast as during euglycemia and are similar for liquid and solid foods. During acute illnesses, insulin and oral glucose-lowering medications should be continued. During acute illnesses, testing of plasma glucose and ketones, drinking adequate amounts of fluids, and ingesting carbohydrate are all important.
Acute illnesses can lead to the development of hyperglycemia and, in individuals with type 1 diabetes, ketoacidosis. During acute illnesses, with the usual accompanying increases in counterregulatory hormones, the need for insulin and oral glucose-lowering medications continues and often is increased. In adults, ingestion of — g carbohydrate daily 45—50 g every 3—4 h should be sufficient to prevent starvation ketosis 1. Establishing an interdisciplinary team, implementation of MNT, and timely diabetes-specific discharge planning improves the care of patients with diabetes during and after hospitalizations.
Hospitals should consider implementing a diabetes meal-planning system that provides consistency in the carbohydrate content of specific meals. Hyperglycemia in hospitalized patients is common and represents an important marker of poor clinical outcome and mortality in both patients with and without diabetes Optimizing glucose control in these patients is associated with better outcomes An interdisciplinary team is needed to integrate MNT into the overall management plan , Diabetes nutrition self-management education, although potentially initiated in the hospital, is usually best provided in an outpatient or home setting where the individual with diabetes is better able to focus on learning needs , There is no single meal planning system that is ideal for hospitalized patients.
However, it is suggested that hospitals consider implementing a consistent-carbohydrate diabetes meal-planning system , This systems uses meal plans without a specific calorie level but consistency in the carbohydrate content of meals. The carbohydrate contents of breakfast, lunch, dinner, and snacks may vary, but the day-to-day carbohydrate content of specific meals and snacks is kept constant , Special nutrition issues include liquid diets, surgical diets, catabolic illnesses, and enteral or parenteral nutrition , Liquids should not be sugar free.
Patients require carbohydrate and calories, and sugar-free liquids do not meet these nutritional needs. Care must be taken not to overfeed patients because this can exacerbate hyperglycemia. After surgery, food intake should be initiated as quickly as possible.
Progression from clear liquids to full liquids to solid foods should be completed as rapidly as tolerated. The imposition of dietary restrictions on elderly patients with diabetes in long-term care facilities is not warranted. Residents with diabetes should be served a regular menu, with consistency in the amount and timing of carbohydrate.
An interdisciplinary team approach is necessary to integrate MNT for patients with diabetes into overall management.
In the institutionalized elderly, undernutrition is likely and caution should be exercised when prescribing weight loss diets. Although the prevalence of undiagnosed diabetes in elderly nursing home residents is high, not all of such individuals require pharmacologic therapy , Older residents with diabetes in nursing homes tend to be underweight rather than overweight Low body weight has been associated with greater morbidity and mortality in this population , Experience has shown that residents eat better when they are given less restrictive diets , Specialized diabetic diets do not appear to be superior to standard diets in such settings , Meal plans such as no concentrated sweets, no sugar added, low sugar, and liberal diabetic diet also are no longer appropriate.
These diets do not reflect current diabetes nutrition recommendations and unnecessarily restrict sucrose. These types of diets are more likely in long-term care facilities than acute care. Making medication changes to control glucose, lipids, and blood pressure rather than implementing food restrictions can reduce the risk of iatrogenic malnutrition. The specific nutrition interventions recommended will depend on a variety of factors, including age, life expectancy, comorbidities, and patient preferences Major nutrition recommendations and interventions for diabetes are listed in Table 3.
Monitoring of metabolic parameters, including glucose, A1C, lipids, blood pressure, body weight, and renal function is essential to assess the need for changes in therapy and to ensure successful outcomes.
Many aspects of MNT require additional research. Classification of overweight and obesity by BMI, waist circumference, and associated disease risk. Mooradian, and Madelyn L. We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail. We do not capture any email address. Skip to main content. Diabetes Care Jan; 31 Supplement 1: This article has a correction. Errata - August 01, Department of Agriculture Medical nutrition therapy MNT is important in preventing diabetes, managing existing diabetes, and preventing, or at least slowing, the rate of development of diabetes complications.
Goals of MNT that apply to individuals with diabetes Achieve and maintain Blood glucose levels in the normal range or as close to normal as is safely possible A lipid and lipoprotein profile that reduces the risk for vascular disease Blood pressure levels in the normal range or as close to normal as is safely possible To prevent, or at least slow, the rate of development of the chronic complications of diabetes by modifying nutrient intake and lifestyle To address individual nutrition needs, taking into account personal and cultural preferences and willingness to change To maintain the pleasure of eating by only limiting food choices when indicated by scientific evidence Goals of MNT that apply to specific situations For youth with type 1 diabetes, youth with type 2 diabetes, pregnant and lactating women, and older adults with diabetes, to meet the nutritional needs of these unique times in the life cycle.
B Nutrition counseling should be sensitive to the personal needs, willingness to change, and ability to make changes of the individual with pre-diabetes or diabetes.
A For weight loss, either low-carbohydrate or low-fat calorie-restricted diets may be effective in the short term up to 1 year. A For patients on low-carbohydrate diets, monitor lipid profiles, renal function, and protein intake in those with nephropathy , and adjust hypoglycemic therapy as needed. E Physical activity and behavior modification are important components of weight loss programs and are most helpful in maintenance of weight loss.
B The importance of controlling body weight in reducing risks related to diabetes is of great importance. A Individuals at high risk for type 2 diabetes should be encouraged to achieve the U. B There is not sufficient, consistent information to conclude that low—glycemic load diets reduce the risk for diabetes. E Observational studies report that moderate alcohol intake may reduce the risk for diabetes, but the data do not support recommending alcohol consumption to individuals at risk of diabetes.
B No nutrition recommendation can be made for preventing type 1 diabetes. E Although there are insufficient data at present to warrant any specific recommendations for prevention of type 2 diabetes in youth, it is reasonable to apply approaches demonstrated to be effective in adults, as long as nutritional needs for normal growth and development are maintained.
E The importance of preventing type 2 diabetes is highlighted by the substantial worldwide increase in the prevalence of diabetes in recent years. Diabetes in youth No nutrition recommendations can be made for the prevention of type 1 diabetes at this time 1. B Monitoring carbohydrate, whether by carbohydrate counting, exchanges, or experienced-based estimation remains a key strategy in achieving glycemic control.
A The use of glycemic index and load may provide a modest additional benefit over that observed when total carbohydrate is considered alone. B Sucrose-containing foods can be substituted for other carbohydrates in the meal plan or, if added to the meal plan, covered with insulin or other glucose-lowering medications.
A As for the general population, people with diabetes are encouraged to consume a variety of fiber-containing foods. B Sugar alcohols and nonnutritive sweeteners are safe when consumed within the daily intake levels established by the Food and Drug Administration FDA. A Control of blood glucose in an effort to achieve normal or near-normal levels is a primary goal of diabetes management.
Amount and type of carbohydrate. A Intake of trans fat should be minimized. E Two or more servings of fish per week with the exception of commercially fried fish filets provide n-3 polyunsaturated fatty acids and are recommended.
B The primary goal with respect to dietary fat in individuals with diabetes is to limit saturated fatty acids, trans fatty acids, and cholesterol intakes so as to reduce risk for CVD. E In individuals with type 2 diabetes, ingested protein can increase insulin response without increasing plasma glucose concentrations.
A High-protein diets are not recommended as a method for weight loss at this time. Optimal mix of macronutrients Although numerous studies have attempted to identify the optimal mix of macronutrients for the diabetic diet, it is unlikely that one such combination of macronutrients exists. Alcohol in diabetes management Recommendations If adults with diabetes choose to use alcohol, daily intake should be limited to a moderate amount one drink per day or less for women and two drinks per day or less for men.
E To reduce risk of nocturnal hypoglycemia in individuals using insulin or insulin secretagogues, alcohol should be consumed with food. E In individuals with diabetes, moderate alcohol consumption when ingested alone has no acute effect on glucose and insulin concentrations but carbohydrate coingested with alcohol as in a mixed drink may raise blood glucose. B Abstention from alcohol should be advised for people with a history of alcohol abuse or dependence, women during pregnancy, and people with medical problems such as liver disease, pancreatitis, advanced neuropathy, or severe hypertriglyceridemia.
Micronutrients in diabetes management Recommendations There is no clear evidence of benefit from vitamin or mineral supplementation in people with diabetes compared with the general population who do not have underlying deficiencies. A Routine supplementation with antioxidants, such as vitamins E and C and carotene, is not advised because of lack of evidence of efficacy and concern related to long-term safety.
A Benefit from chromium supplementation in individuals with diabetes or obesity has not been clearly demonstrated and therefore can not be recommended. E Uncontrolled diabetes is often associated with micronutrient deficiencies Antioxidants in diabetes management. Chromium, other minerals, and herbs in diabetes management. E Individuals using rapid-acting insulin by injection or an insulin pump should adjust the meal and snack insulin doses based on the carbohydrate content of the meals and snacks.
A For individuals using fixed daily insulin doses, carbohydrate intake on a day-to-day basis should be kept consistent with respect to time and amount. C For planned exercise, insulin doses can be adjusted. E The first nutrition priority for individuals requiring insulin therapy is to integrate an insulin regimen into their lifestyle.
Nutrition interventions for type 2 diabetes Recommendations Individuals with type 2 diabetes are encouraged to implement lifestyle modifications that reduce intakes of energy, saturated and trans fatty acids, cholesterol, and sodium and to increase physical activity in an effort to improve glycemia, dyslipidemia, and blood pressure.
E Plasma glucose monitoring can be used to determine whether adjustments in foods and meals will be sufficient to achieve blood glucose goals or if medication s needs to be combined with MNT.
E Healthy lifestyle nutrition recommendations for the general public are also appropriate for individuals with type 2 diabetes. Nutrition interventions for pregnancy and lactation with diabetes Recommendations Adequate energy intake that provides appropriate weight gain is recommended during pregnancy.
E Ketonemia from ketoacidosis or starvation ketosis should be avoided. E Because GDM is a risk factor for subsequent type 2 diabetes, after delivery, lifestyle modifications aimed at reducing weight and increasing physical activity are recommended. A Prepregnancy MNT includes an individualized prenatal meal plan to optimize blood glucose control. Nutrition interventions for older adults with diabetes Recommendations Obese older adults with diabetes may benefit from modest energy restriction and an increase in physical activity; energy requirement may be less than for a younger individual of a similar weight.
E A daily multivitamin supplement may be appropriate, especially for those older adults with reduced energy intake. B MNT that favorably affects cardiovascular risk factors may also have a favorable effect on microvascular complications such as retinopathy and nephropathy. C Progression of diabetes complications may be modified by improving glycemic control, lowering blood pressure, and, potentially, reducing protein intake.
B For patients with diabetes at risk for CVD, diets high in fruits, vegetables, whole grains, and nuts may reduce the risk. C In normotensive and hypertensive individuals, a reduced sodium intake e. A In most individuals, a modest amount of weight loss beneficially affects blood pressure.
C In the EDIC Epidemiology of Diabetes Interventions and Complications study, the follow-up of the DCCT Diabetes Control and Complications Trial , intensive treatment of type 1 diabetic subjects during the DCCT study period improved glycemic control and significantly reduced the risk of the combined end point of cardiovascular death, myocardial infarction, and stroke B In individuals taking insulin or insulin secretagogues, changes in food intake, physical activity, and medication can contribute to the development of hypoglycemia.
Acute illness Recommendations During acute illnesses, insulin and oral glucose-lowering medications should be continued. A During acute illnesses, testing of plasma glucose and ketones, drinking adequate amounts of fluids, and ingesting carbohydrate are all important. B Acute illnesses can lead to the development of hyperglycemia and, in individuals with type 1 diabetes, ketoacidosis.
Patients with diabetes in acute health care facilities Recommendations Establishing an interdisciplinary team, implementation of MNT, and timely diabetes-specific discharge planning improves the care of patients with diabetes during and after hospitalizations. E Hospitals should consider implementing a diabetes meal-planning system that provides consistency in the carbohydrate content of specific meals.
E Hyperglycemia in hospitalized patients is common and represents an important marker of poor clinical outcome and mortality in both patients with and without diabetes Patients with diabetes in long-term care facilities Recommendations The imposition of dietary restrictions on elderly patients with diabetes in long-term care facilities is not warranted. C An interdisciplinary team approach is necessary to integrate MNT for patients with diabetes into overall management.
B Although the prevalence of undiagnosed diabetes in elderly nursing home residents is high, not all of such individuals require pharmacologic therapy , View inline View popup. Table 1— Nutrition and MNT. Table 2— Classification of overweight and obesity by BMI, waist circumference, and associated disease risk. Table 3— Major nutrition recommendations and interventions.
Footnotes Originally approved Evidence-based nutrition principles and recommendations for the treatment and prevention of diabetes and related complications. Nutrition principles and recommendations in diabetes Position Statement. Diabetes Care 27 Suppl. The evidence for the effectiveness of medical nutrition therapy in diabetes management. How effective is medical nutrition therapy in diabetes care? J Am Diet Assoc Am J Clin Nutr When to start cholesterol-lowering therapy in patients with coronary heart disease: Whitworth JA, Chalmers J: Clin Exp Hypertens National Heart, Lung, and Blood Institute: Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies.
Long-term effectiveness of weight-loss interventions in adults with pre-diabetes: Am J Prev Med Weight management through lifestyle modification for the prevention and management of type 2 diabetes: Efficacy of pharmacotherapy for weight loss in adults with type 2 diabetes mellitus: Arch Intern Med Translating lifestyle intervention to practice in obese patients with type 2 diabetes: The comparison of four weight reduction strategies aimed at overweight patients with diabetes mellitus: Control Clin Trials Am J Public Health A randomized trial of a low-carbohydrate diet for obesity.
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