E&M_Gizi^Nutritional Care for DM^

7/28/2019 E&M_Gizi^Nutritional Care for DM^

1/36

NUTRITIONAL CARE IN DM

Nutrition department

Medical schoolUniversity of Sumatera Utara


2/36

Epidemic Type 2 Diabetes

and the Hidden IGT Epidemic: 2004

97 million known cases97 million known cases


3/36



97 million known cases

97 million undiagnosed cases


4/36



97 million known cases

97 million undiagnosed cases,

314 million persons withImpaired Glucose Tolerance


5/36



. . . and the cardiovascular

disease

epidemic to follow through the

Metabolic Syndrome. . .


6/36

MNT is integral to total diabetes care &

management

Requires a coordinated team effort MNT requires an individual approach &

effective nutrition self-management

education


7/36

Goals of MNT for DMGoals of MNT that apply to all persons

with diabetes

1. Attain & maintain optimal metabolic outcomes

including :

- blood glucose levels in the normal range or as close

to normal as is safely possible to prevent or reduce

risk or complications of diabetes

- A lipid & lipoprotein profile that reduces risk forCV disease

- Blood pressure levels that reduce the risk for

vascular disease


8/36

2. Prevent & treat the chronic complications :Modify nutrient intake as appropriate for theprevention and treatment of obesity, CV

disease, hypertension & nephropathy3. Improve health through healthy food choices

& physical activity

4. Address individual nutritional needs, taking

into consideration personal & culturalpreferences & lifestyle while respecting theindividuals needs & willingness to change


9/36

Goals of nutrition therapy that apply

to specific situations

1. For youth with type 1 DM, provide adequate energy

to ensure normal growth and development; integrate

insulin regimen into usual eating & exercise habits

2. For youth with type 2 DM, facilitate changes in

eating and exercise habits that reduce insulin

resistance and improve metabolic status

3. For pregnant & lactating women, provide adequate

energy and nutrients needed for successful outcomes


10/36

4. For older adults, provide for the nutritional needs of

an aging individual

5. For individuals treated with insulin or insulin

secretagogues, provide information on prevention and

treatment of hypoglycemia and exercise-related blood

glucose problems and how to manage acute illness

6. For individuals at risk for DM, decreased risk by

increasing physical activity and promoting foodchoices that facilitate moderate weight loss or at

least prevent weight gain


11/36

Prioritizing nutrition therapy for

type 2 DM

To adopt lifestyle strategies that improve

the associated metabolic abnormalities of

glycemia, dyslipidemia & hypertension Lifestyle strategies independent of weight

loss that can improve glycemia include

reducing energy intake, monitoring CH

servings, limiting consumption of saturatedfats and increasing physical activity


12/36

carbohydrate

Total amount of

carbohydrate is more

important than the

source (starch orsugar)

The 1st priority for

food and meal

planning is the totalamount of

carbohydrate

=


13/36

Carbohydrate and Diabetes

Include foods containing carbohydrate from

whole grains, fruits, vegetables and low-fat

milk


14/36

Carbohydrates

ComplexSimple

Fiber


15/36

Severe restriction of dietary carb is not

indicated

Within the total caloric recommendation carb should be 45 60% of total energy

intake


16/36


Consistency in carbohydrate intake is

important from day to day

For people taking a fixed dose of insulin Insulin should be adjusted based on amount

of carbohydrate at meals

For people on varying doses at mealtimes


17/36


Several things affect how much blood

glucose increases after eating :

amount of carbohydrate type of sugar or starch

cooking and food processing

food form other foods in the meal that slow

digestion


18/36


Limited amounts of sugar or foods

containing sugar can be used without

affecting blood glucose when substituted for other

carbohydrates at the meal

Large amounts of sugar-containingfoods are not recommended


19/36

Sweeteners and Diabetes

Fructose use should be avoided becauseof possible adverse effects on blood lipids

Naturally occurring fructose in foods suchas fruits does not need to be restricted Sugar alcohol (lower glycemic response)

not non-caloric

All FDA-approved nonnutritive sweetenersare safe for people with diabetes whenconsumed within recommended levels


20/36


Fiber:

Fiber is encouraged for everyone:

20-35 grams/day

Good sources of fiber: Whole grain cereals

Fruits

Vegetables

Beans and peas


21/36


Fiber:

Only large amounts (50 grams/day)

have shown beneficial effect onglycemia, insulinemia and lipemia Primarily soluble fiber (barley, oatmeal,

beans, apples, broccoli)

Side effects make this difficult for many

people


22/36

Soluble fiber effects in diabetes :

- inhibiting starch hydrolysis & glucose

absorption- delayed gastric emptying

- reduced fasting glucose levels by

improving insulin sensitivity- promoting satiety


23/36

Protein and Diabetes

The recommendation in the absence of

renal insufficiency is (0.8g/kg BW/day)

10 20% of total energy intake Intakes >20% higher incidence of

albuminuria

Protein intake should be reduced

in the setting of renal insufficiency


24/36

Dietary Fat and Diabetes

Primary goal - Lower LDL cholesterol by:

Eating less saturated fat and

cholesterol

Eating less trans fats


25/36


Choose monounsaturated fat in place

of saturated:

olive oil, canola oil, peanut oil,

olives, avocados, nuts


26/36


Recommendation : 20-35% total calorie

Eat less total fat

Low-fat diets can help: with weight loss

improve cholesterol and other fats


27/36

Weight Loss and Diabetes

A small amount of weight loss can:A small amount of weight loss can:

improve insulin resistance

lower blood glucose

improve blood cholesterol

reduce blood pressure


28/36

Weight Loss and Diabetes

Successful weight loss usually requires:Successful weight loss usually requires:

a structured weight loss program

education reduced fat and calories

regular physical activity

frequent follow-up


29/36

Vitamins and Minerals and Diabetes

Vitamins and minerals supplementation is of

dubious benefit except in cases of documented

deficiency

High doses of vitamin and mineral supplements

can be toxic

Intake of vitamin & minerals should be

encourage through natural food sources, mostnotably vegetables & fruits


30/36

14

Regular meals based oncarbohydrate


31/36

Dietary Guidelines

Eat a diet low in saturated and totalfat.

Eat a diet moderate in sodium andsugar.

Eat 5 or more fruits and vegetables a

day. Choose a diet rich in whole grains.


32/36

Dietary Guidelines

Eat at the same time everyday , atleast within 1 hour of regular time.

Eat about the same amount ofcarbohydrate with each meal.


33/36

Dietary recommendation

Carbohydrate 45-60% total energy

Dietary fiber 14g/1000 kal

Total fat 20-35% total energy

saturated < 10%total energyPUFA (esp. n3) 7-10% total energy

MUFA 15-20% total energy

trans fat as low as possible

Cholesterol


34/36

Essential self-management nutrition

education skill

Sources of carb, protein & fat

Understanding nutrition labels

Modification of fat intake Use of blood glucose monitoring data for

problem solving related to food choices and

physical activity option Grocery shopping guidelines

Guidelines for eating out : restaurant, etc


35/36

Snack choices

Use of sugar-containing foods and

nonnutritive sweeteners Behavior modification techniques

Vitamin, mineral and botanical

supplements

Essential self-management nutrition

education skill


36/36

zt07

E&M_Gizi^Nutritional Care for DM^

Documents

Transcript of E&M_Gizi^Nutritional Care for DM^