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Nutritional Recommendations For Diabetes

Nutritional Recommendations For Individuals With Diabetes

Nutritional Recommendations For Individuals With Diabetes

Go to: INTRODUCTION This chapter will summarize current information on nutritional recommendations for persons with diabetes for health care practitioners who treat them. The key take home message is that the 1800 calorie ADA diet is dead! The modern diet for the individual with diabetes is based on concepts from clinical research, portion control, and individualized lifestyle changes. It cannot simply be delivered by giving a patient a diet sheet in a one-size-fits-all approach. The lifestyle modification guidance and support needed requires a team effort, best led by an expert in this area; a registered dietitian (RD), or a referral to a diabetes self-management education (DSME) program that includes instruction on nutrition therapy. Dietary recommendations need to be individualized for and accepted by the given patient. It’s important to note that the nutrition goals for diabetes are similar to those that healthy individuals should strive to incorporate into their lifestyle. Leading authorities and professional organizations have concluded that proper nutrition is an important part of the foundation for the treatment of diabetes. However, appropriate nutritional treatment, implementation, and ultimate compliance with the plan remain some of the most vexing problems in diabetic management for three major reasons: First, there are some differences in the dietary structure to consider, depending on the type of diabetes. Second, a plethora of dietary information is available from many sources to the patient and healthcare provider. Nutritional science is constantly evolving, so that what may be considered true today may be outdated in the near future. Different types of diabetes require some specialized nutritional intervention; however, many of the basic dietary princ Continue reading >>

Diabetic Diet

Diabetic Diet

A diabetic diet is a dietary pattern that is used by people with diabetes mellitus or high blood glucose to manage diabetes. There is no single dietary pattern that is best for all people with all types of diabetes. For overweight and obese people with Type 2 diabetes, any weight-loss diet that the person will adhere to and achieve weight loss on is effective.[1][2] Since carbohydrate is the macronutrient that raises blood glucose levels most significantly, the greatest debate is regarding how low in carbohydrates the diet should be. This is because although lowering carbohydrate intake will lead to reduced blood glucose levels, this conflicts with the traditional establishment view that carbohydrates should be the main source of calories. Recommendations of the fraction of total calories to be obtained from carbohydrate are generally in the range of 20% to 45%,[3][4][5] but recommendations can vary as widely as from 16% to 75%.[6] The most agreed-upon recommendation is for the diet to be low in sugar and refined carbohydrates, while relatively high in dietary fiber, especially soluble fiber. People with diabetes are also encouraged to eat small frequent meals a day. Likewise, people with diabetes may be encouraged to reduce their intake of carbohydrates that have a high glycemic index (GI), although this is also controversial.[7] (In cases of hypoglycemia, they are advised to have food or drink that can raise blood glucose quickly, such as a sugary sports drink, followed by a long-acting carbohydrate (such as rye bread) to prevent risk of further hypoglycemia.) Others question the usefulness of the glycemic index and recommend high-GI foods like potatoes and rice. It has been claimed that oleic acid has a slight advantage over linoleic acid in reducing plasma glucose.[ Continue reading >>

Type 1 Diabetes Nutrition

Type 1 Diabetes Nutrition

If you have type 1 diabetes, it is important to know how many carbohydrates you eat at a meal. This information helps you determine how much insulin you should take with your meal to maintain blood sugar (glucose) control. Carbohydrates are the main type of food that raises blood sugar. The starch, fruit and milk groups of the Food Group Pyramid for Diabetes are high in carbs. Foods in the Other Carbohydrates and Combination Food groups are also high in carbs. The vegetable group has a small amount of carbohydrates. The meat and fat groups have few or no carbs. The amount of carbohydrates you eat at each meal will determine how high your blood sugar rises after the meal. The other two major nutrients, protein and fat ,also have an effect on blood glucose levels, though it is not as rapid or great as carbohydrates. Most people with diabetes can control their blood sugar by limiting carbohydrate servings to 2-4 per meal and 1-2 per snack. A delicate balance of carbohydrate intake, insulin, and physical activity is necessary for the best blood sugar (glucose) levels. Eating carbohydrates increases your blood sugar (glucose) level. Exercise tends to decrease it (although not always). If the three factors are not in balance, you can have wide swings in blood sugar (glucose) levels. If you have type 1 diabetes and take a fixed dose of insulin, the carbohydrate content of your meals and snacks should be consistent from day to day. CHILDREN AND DIABETES Weight and growth patterns can help determine if a child with type 1 diabetes is getting enough nutrition. Changes in eating habits and more physical activity help improve blood sugar (glucose) control. For children with diabetes, special occasions (like birthdays or Halloween) require additional planning because of the extra sw Continue reading >>

Nutrition Recommendations And Interventions For Diabetes

Nutrition Recommendations And Interventions For Diabetes

A position statement of the American Diabetes Association 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. It is, therefore, important at all levels of diabetes prevention (see Table 1). MNT is also an integral component of diabetes self-management education (or training). This position statement provides evidence-based recommendations and interventions for diabetes MNT. The previous position statement with accompanying technical review was published in 2002 (1) and modified slightly in 2004 (2). This statement updates previous position statements, focuses on key references published since the year 2000, and uses grading according to the level of evidence available based on the American Diabetes Association evidence-grading system. Since overweight and obesity are closely linked to diabetes, particular attention is paid to this area of MNT. The goal of these recommendations is to make people with diabetes and health care providers aware of beneficial nutrition interventions. This requires the use of the best available scientific evidence while taking into account treatment goals, strategies to attain such goals, and changes individuals with diabetes are willing and able to make. Achieving nutrition-related goals requires a coordinated team effort that includes the person with diabetes and involves him or her in the decision-making process. It is recommended that a registered dietitian, knowledgeable and skilled in MNT, be the team member who plays the leading role in providing nutrition care. However, it is important that all team members, including physicians and nurses, be knowledgeable about MNT and support its implementation. MNT, a Continue reading >>

Gestational Diabetes And Nutritional Recommendations

Gestational Diabetes And Nutritional Recommendations

, Volume 4, Issue5 , pp 377386 | Cite as Gestational diabetes and nutritional recommendations The goals of medical nutrition therapy for gestational diabetes mellitus (GDM) are to meet the maternal and fetal nutritional needs, as well as to achieve and maintain optimal glycemic control. Nutrition requirements during pregnancy are similar for women with and without GDM. The American Diabetes Association and the American College of Obstetrics and Gynecology recommend nutrition therapy for GDM that emphasizes food choices to promote appropriate weight gain and normoglycemia without ketonuria, and moderate energy restriction for obese women. Current controversies in GDM nutrition therapy involve manipulation of dietary composition (amounts and types of carbohydrates and fats), gestational weight gain, and energy and carbohydrate restriction. Randomized controlled trials are needed to determine which dietary compositions and patterns promote normoglycemia as well as optimal maternal and infant outcomes. Until better evidence is available, nutrition therapy will remain a cornerstone of GDM management with potential benefits that cannot be fully realized in clinical practice. Gestational Diabetes MellitusObese WomanGestational DiabetesGestational Weight GainIdeal Body Weight These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves. This is a preview of subscription content, log in to check access Unable to display preview. Download preview PDF. Metzger BE, Coustan DR: Summary and recommendations of the Fourth International Workshop-Conference on Gestational Diabetes Mellitus. The Organizing Committee. Diabetes Care 1998, 21(suppl2):B161-B167. PubMed Google Scholar Gunderson EP: Continue reading >>

Sugars And Starch In The Nutritional Management Of Diabetes Mellitus

Sugars And Starch In The Nutritional Management Of Diabetes Mellitus

Sugars and starch in the nutritional management of diabetes mellitus From the Division of Endocrinology and Metabolism, Department of Medicine, University of Pittsburgh. Address reprint requests to DE Kelley, Division of Endocrinology and Metabolism, 810N Montefiore-University Hospital, 3459 Fifth Avenue, Pittsburgh, PA 15213. E-mail: [email protected] . Search for other works by this author on: The American Journal of Clinical Nutrition, Volume 78, Issue 4, 1 October 2003, Pages 858S864S, David E Kelley; Sugars and starch in the nutritional management of diabetes mellitus, The American Journal of Clinical Nutrition, Volume 78, Issue 4, 1 October 2003, Pages 858S864S, Nutritional recommendations, long recognized as an important aspect of diabetes mellitus treatment, have also been an area of persistent controversy, particularly regarding the proportions and types of carbohydrate and fat. This review addresses the role of sugars within medical nutrition therapy for diabetes mellitus. Nutritional recommendations for diabetes mellitus treatment were revised recently. The new guidelines do not specifically restrict intake of sugars, although general recommendations are made for including fiber, whole grains, vegetables, and fruits within dietary selections containing starches. For carbohydrates, the principle focus is on overall caloric amounts. In type 1 diabetes the most effective approach to the control of postprandial hyperglycemia continues to be adjustment of premeal doses of insulin on the basis of carbohydrate counting. In type 2 diabetes, in addition to a focus on caloric content of carbohydrate, consideration continues to be given to the role of the glycemic index as a determinant of postprandial hyperglycemia and overall metabolic control. Nevertheles Continue reading >>

Dietary Guidelines For Diabetes

Dietary Guidelines For Diabetes

What Other Things Can I Do to Improve My Healthy Eating? Many people think that having diabetes requires a special diet. The diabetes diet, however, is a healthy, enjoyable one, and suitable for the entire family. Learning what you can eat and how different foods affect your body is important. Although food is not the only factor that raises glucose, your food choices have a significant impact on your glucose, cholesterol, blood pressure and, of course, your overall health. This handout covers the basic principles of good nutrition. For a tailored plan, consult a dietitian-certified diabetes educator, or call the Center for Diabetes Services at (415) 600-0506. Carbohydrate turns into glucose. Sugars and starches are the carbohydrates in our diet. These foods are our main source of energy. Too much carbohydrate in the diet can raise your blood glucose levels too high. It is important to limit your total carbohydrate intake at each meal. What are Some Examples of Foods that Contain Carbohydrate? Rice, fruits, pretzels/popcorn, lentils, fruit juices, pasta/noodles, dried beans, sugar/honey, crackers, milk, desserts, bread, yogurt, sodas, cereals. These vegetables are starchy and raise blood glucose: potato, yams, peas, corn, lima beans. Note: High fiber food choices are encouraged (for example, whole grain breads and cereals; fresh fruits and vegetables; beans and legumes). Include carbohydrate in every meal and snack. Be sure to spread your carbohydrate intake evenly throughout the day. Do not skip meals. Even distribution of food helps prevent high and low blood glucose. Eat 3 meals a day, plus snacks as needed. Eating at regular intervals helps control hunger and prevents overeating at the next meal. Time your food intake to the action of your diabetes medication. What Continue reading >>

Nutrition Principles And Recommendations In Diabetes

Nutrition Principles And Recommendations In Diabetes

Medical nutrition therapy is an integral component of diabetes management and of diabetes self-management education. Yet many misconceptions exist concerning nutrition and diabetes. Moreover, in clinical practice, nutrition recommendations that have little or no supporting evidence have been and are still being given to persons with diabetes. Accordingly, this position statement provides evidence-based principles and recommendations for diabetes medical nutrition therapy. The rationale for this position statement is discussed in the American Diabetes Association technical review “Evidence-Based Nutrition Principles and Recommendations for the Treatment and Prevention of Diabetes and Related Complications,” which discusses in detail the published research for each principle and recommendation (1). Historically, nutrition recommendations for diabetes and related complications were based on scientific knowledge, clinical experience, and expert consensus; however, it was often difficult to discern the level of evidence used to construct the recommendations. To address this problem, the 2002 technical review (1) and this position statement provide principles and recommendations classified according to the level of evidence available using the American Diabetes Association evidence grading system. However, the best available evidence must still take into account individual circumstances, preferences, and cultural and ethnic preferences, and the person with diabetes should be involved in the decision-making process. The goal of evidence-based recommendations is to improve diabetes care by increasing the awareness of clinicians and persons with diabetes about beneficial nutrition therapies. Because of the complexity of nutrition issues, it is recommended that a registered d Continue reading >>

Diabetes Management Guidelines

Diabetes Management Guidelines

American Diabetes Association (ADA) Nutrition Guidelines for Adults With Diabetes Source: Evert AB, Boucher JL, Cypress M, et al. Nutrition therapy recommendations for the management of adults with diabetes. Diabetes Care. 2014;37(suppl 1):S120-S143. Available here. Refer to source document for full recommendations, including level of evidence rating. Jump to a topic Nutrition Therapy Energy Balance Macronutrients Eating Patterns Carbohydrates Sweeteners Protein Fats Dietary Omega-3 Micronutrients, Herbal Supplements Alcohol Sodium Priorities for All Patients Priorities by Medication Insulin Requirements Summary Component of overall treatment for all with types 1 and 2 diabetes No “one-size-fits-all” eating approach Chosen eating pattern should improve glucose, BP, and lipid Individualized nutrition therapy, ideally provided by registered dietitian Type 1 Flexible insulin therapy education program using carb counting meal planning Fixed-dose daily insulin Consistent carb intake (time, amount) Type 2 Portion control, healthful food choices for literacy concerns, older adults DSME and support at diagnosis and thereafter Overweight/obese adults with type 2 diabetes For weight loss: reduce energy intake while maintaining healthful eating pattern Optimal macronutrient intake to reduce weight not established Modest weight loss may improve glycemia, BP, lipids Particularly early in disease process Recommended for modest weight loss Intensive lifestyle interventions: nutrition therapy counseling, physical activity, behavior change Ongoing support No ideal percentage of calories from carbohydrate, protein, or fat for individuals with diabetes Macronutrient distribution to be based on individualized assessment of Consider personal preferences and metabolic goals when recommen Continue reading >>

Nutrition In Patients With Diabetes

Nutrition In Patients With Diabetes

Background Diabetes is a chronic illness that requires a holistic approach in terms of care to prevent both acute and long-term complications. Nutritional management for diabetic patients has been evolving for 100 years as the pathophysiological basis of the complications incurred from diabetes becomes more explicit. Medical nutrition therapy is extremely important for diabetic patients and prediabetic patients so that adequate glycemic control can be achieved. One-on-one consultations with a registered dietician well-versed in diabetic nutrition are most preferable, as has been shown in studies performed in Pakistan [1] and Hungary, [2] which proved the utility of a dietician in improving dietary adherence. Nutrition counseling should be sensitive to the personal needs of the patient and how much effort the patient is willing to put in to making the change to eating appropriately. Medical nutrition therapy for diabetics can be divided into (1) dietary interventions and (2) physical activity. Lifestyle and dietary modifications form the cornerstone of therapy in type 2 diabetic patients (insulin resistance). In type 1 diabetic patients, who have an insulin deficiency, a balance between insulin and nutrition needs to be obtained for optimal glycemic control. [3] Continue reading >>

Nutritional Considerations In Type 2 Diabetes Mellitus

Nutritional Considerations In Type 2 Diabetes Mellitus

INTRODUCTION Diet is one of the most important behavioral aspects of diabetes treatment. Basic principles of nutritional management, however, are often poorly understood by both clinicians and their patients. The role of nutrition and the development of a medical nutrition therapy (MNT) plan for a patient with type 2 diabetes are discussed here. Nutrition for patients with type 1 diabetes, as well as diets for the prevention of diabetes and for weight loss in general, are discussed separately. GOALS OF NUTRITIONAL THERAPY The nutrition prescription for patients with type 2 diabetes should optimally manage the "ABCs" of diabetes control: glycated hemoglobin (A1C), blood pressure, and low-density lipoprotein (LDL) cholesterol. The prescription must be tailored for the individual patient to further address existing or at-risk complications related to diabetes or other concomitant conditions. Continue reading >>

New Diabetes Nutrition Therapy Recommendations: What You Need To Know

New Diabetes Nutrition Therapy Recommendations: What You Need To Know

New Diabetes Nutrition Therapy Recommendations: What You Need to Know Alison B. Evert , MS, RD, CDE and Jackie L. Boucher , MS, RD, CDE Alison B. Evert, MS, RD, CDE, is the coordinator of diabetes education programs and a diabetes nutrition educator at the University of Washington Medical Center Diabetes Care Center in Seattle. She is also deputy editor of Diabetes Spectrum. Jackie L. Boucher, MS, RD, CDE, is vice president for education at the Minneapolis Heart Institute Foundation in Minnesota. The authors co-chaired the 2013 ADA Nutrition Therapy Recommendations Committee. Copyright 2014 by the American Diabetes Association. This article has been cited by other articles in PMC. The American Diabetes Association (ADA) has long recognized the integral role of nutrition therapy in overall diabetes management and recommends that each person with diabetes receive an individualized eating plan that has been developed in collaboration with his or her health care provider (HCP). 1 To ensure that members of the health care team are providing up-to-date, evidence-based clinical practice recommendations, the ADA issues official position statements on scientific or medical issues related to diabetes. Recently, the ADA published a position statement titled Nutrition Therapy Recommendations for the Management of Adults With Diabetes. 2 These recommendations replace those in previous position statements. This article reviews the development process for the 2013 nutrition recommendations, shares highlights from those guidelines, and discusses priority topics in the publication. Trustworthy Clinical Practice Guidelines/Position Statements The 2013 ADA nutrition statement was written at the request of the ADA Professional Practice Committee. In August 2012, the ADA convened a committ Continue reading >>

Evidence-based Nutrition Guidelines For The Prevention And Management Of Diabetes

Evidence-based Nutrition Guidelines For The Prevention And Management Of Diabetes

Evidence-based nutrition guidelines for the prevention and management of diabetes Evidence-based nutrition guidelines for the prevention and management of diabetes Our set of nutrition recommendations for adults with diabetes and those at risk of Type 2 diabetes have been written for healthcare professionals who are supporting them. A key strategy applied in these current guidelines was to formulate recommendations from the available evidence highlighting the importance of foods, rather than focusing on individual nutrients, wherever possible. An individualised approach to diet taking into consideration the persons personal and cultural preferences People eat more of certain foods such as vegetables, fruits, wholegrains, fish, nuts and pulses People eat less red and processed meat, refined carbohydrates and sugar sweetened beverages. These nutrition guidelines are relevant to people at risk of developing Type 2 diabetes and people with Type 1 and Type 2 diabetes. Special considerations have also been discussed for Gestational diabetes and Cystic Fibrosis- Related diabetes. Children are not included in the scope of these guidelines. The International Society of Paediatric and Adolescent Diabetes (ISPAD) clinical practice guidelines have been adopted by us. Wefirst published dietary recommendations for people with diabetes in 1982, with subsequent updates in 1992, 2003 and 2011. The previous evidence-based guidelines, published in 2011, had included studies published up to August 2010. The 2018 guidelines incorporate existing evidence and additional studies published between January 2010 and July 2017, although an exception was made to include a major UK study of diabetes remission, published in December 2017. Continue reading >>

Nutrition Therapy Recommendations For Diabetes

Nutrition Therapy Recommendations For Diabetes

Nutrition Therapy Recommendations for Diabetes Coordinator of Diabetes Education Programs Alison B. Evert, MS, RD, CDE, has indicated to Physicians Weekly that she has worked as a consultant for Medtronic Diabetes as a member of the Certified Diabetes Educator Advisory Board. Coordinator of Diabetes Education Programs Alison B. Evert, MS, RD, CDE, has indicated to Physicians Weekly that she has worked as a consultant for Medtronic Diabetes as a member of the Certified Diabetes Educator Advisory Board. The American Diabetes Association recently released nutrition therapy recommendations for the management of diabetes. Published in Diabetes Care, the new statement provides a set of recommendations based on reviews of recent clinical investigations ( Table 1) . The statement calls for all adults diagnosed with diabetes to eat a variety of nutrient-dense foods in appropriately portioned sizes as part of an eating plan. These plans must take into account individual preferences, culture, religious beliefs, traditions, and metabolic goals. The American Diabetes Association recognizes that nutrition therapy is provided by a variety of health professionals, and published research shows that it is effective when delivered by various health professionals. Studies suggest that nutrition therapy produces A1C reductions similar or greater than what is expected with treatment with currently available pharmacologic treatments for diabetes. Ideally, patients with diabetes should be referred to registered dietitians (RDs) for diabetes nutrition therapy or participate in diabetes self-management education (DSME) programs that include instruction on nutrition soon after their diagnosis, says Alison Evert, MS, RD, CDE, who was part of the writing group that developed the position statement Continue reading >>

Nutrition Therapy Recommendations For The Management Of Adults With Diabetes

Nutrition Therapy Recommendations For The Management Of Adults With Diabetes

A healthful eating pattern, regular physical activity, and often pharmacotherapy are key components of diabetes management. For many individuals with diabetes, the most challenging part of the treatment plan is determining what to eat. It is the position of the American Diabetes Association (ADA) that there is not a “one-size-fits-all” eating pattern for individuals with diabetes. The ADA also recognizes the integral role of nutrition therapy in overall diabetes management and has historically recommended that each person with diabetes be actively engaged in self-management, education, and treatment planning with his or her health care provider, which includes the collaborative development of an individualized eating plan (1,2). Therefore, it is important that all members of the health care team be knowledgeable about diabetes nutrition therapy and support its implementation. This position statement on nutrition therapy for individuals living with diabetes replaces previous position statements, the last of which was published in 2008 (3). Unless otherwise noted, research reviewed was limited to those studies conducted in adults diagnosed with type 1 or type 2 diabetes. Nutrition therapy for the prevention of type 2 diabetes and for the management of diabetes complications and gestational diabetes mellitus is not addressed in this review. A grading system, developed by the ADA and modeled after existing methods, was utilized to clarify and codify the evidence that forms the basis for the recommendations (1) (Table 1). The level of evidence that supports each recommendation is listed after the recommendation using the letters A, B, C, or E. A table linking recommendations to evidence can be reviewed at Members of the Nutrition Recommendations Writing Group Committee d Continue reading >>

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