1. Jennifer Regester, RD, CDN, CDE
Medical Nutrition Therapy for Diabetes Does a perfect eating plan exist?
Jennifer Regester, RD, CDN, CDE

2. The modern American weapon of mass destruction!!!!

4. Nutrition Assessment Type of diabetes, any complications
Blood sugar control
Past medical history
Anthropometrics- height, weight, BMI, body composition
Biochemical- labs
Medications, including supplements
Dietary 24 hour recall (meals, snacks, and beverages)
Favorite foods
Food allergies
Eating patterns and habits
Physical activity
Readiness to change
Attitude

5. Nutrition Assessment Most Common Diabetes Overweight/Obesity
Hypertension
High Cholesterol
Renal Disease
HIV/AIDS
Pregnancy
Emotional eating
Least Common
Underweight
Gastrointestinal issues
Celiac disease
Food allergies
Eating disorders
Sports nutrition
Vegetarianism
Bariatric surgery

6. MNT Goals for Diabetes Achieve and maintain:
Blood glucose levels in the normal range
Lipid profile that reduces risk for cardiovascular disease
Blood pressure levels in the normal range
2. To prevent (or slow) the rate of development of chronic complications by modifying nutrient intake and lifestyle

7. MNT Goals for Diabetes
To address individual nutrition needs, taking into consideration personal and cultural preferences and willingness to change
4. To maintain the pleasure of eating by only limiting food choices when indicated by scientific evidence

8. MNT Recommendations Monitor carbohydrate intake for glycemic control
Include a variety of carbohydrates from fruit, vegetables, whole grains, legumes, and fat-free/low-fat dairy products
The use the glycemic index may provide a modest benefit
Avoid excess energy intake

9. Special Considerations
Overweight/Obese
Type 1 Diabetes
Type 2 Diabetes
Gestational Diabetes

10. Special Considerations
Weight loss
Weight loss has been shown to improve insulin resistance
Encourage dietary changes, increased physical activity, and behavior modification
Weight loss medications may be considered and can help with an additional 5-10% weight loss with lifestyle modifications
Bariatric surgery

11. Special Considerations
Type 1 Diabetes
Insulin therapy may be integrated into an individual’s dietary and physical activity pattern
Adjust rapid-acting insulin doses based on carbohydrate content in meals and snacks
When on fixed daily insulin doses keep carbohydrate content consistent with respect to time and amount
Adjust insulin for planned exercise. For unplanned exercise, extra carbohydrate may be needed

12. Special Considerations
Type 2 Diabetes
Encourage lifestyle modifications to improve glycemia, dyslipidemia, and blood pressure
Reduce caloric intake, saturated and trans fats, cholesterol, and sodium
Increase fiber, nutrient-rich foods
Increase energy expenditure

13. Special Considerations
Pregnancy
Adequate caloric intake and nutrients needed to provide appropriate weight gain for mother and fetus
Focus on food choices for a healthy and steady weight gain, glycemic control, and absence of ketones
Aim to develop healthy habits and lifestyle modifications (diet and exercise) for after delivery

14. Meal Planning Strategies
Timing of meals
Healthy choices and balanced meals
Variety including nutrient-rich foods and high-fiber foods
Moderation using portion control
Limit refined sugars
Carbohydrate counting
Prescribed meal plan
Exchange system
Carbohydrate servings
Label reading
Glycemic index
Insulin to carbohydrate ratio + correction factor (if applicable)

15. Breakdown of Macronutrients
Total carbohydrate: 45-65% of total calories
Total Protein: 10-35% of total calories
Total fat: 20-35% of total calories

16. Nutrition Counseling Patient’s lifestyle Work schedule Family life
Support system
Education level
Knowledge about diabetes and nutrition
Record keeping abilities
Attitude
Ability to adapt to change
Reaction to advice
Goal setting

17. How to be a “Nutritionist” when you do not have an RD
“So what do I eat?”
How to be a “Nutritionist” when you do not have an RD
“Nutrition Recommendations and Interventions for Diabetes”. American Diabetes Association. Diabetes Care. 2008;31(suppl 21):S61-S78.

18. Doctor’s Advice
“Nutrition is an important part of taking care of your diabetes”
Avoid telling patients to diet and lose weight without resources
Do not recommend fad diets, try to encourage healthy lifestyle changes instead
Be specific- “try to be active at least 30 minutes most days of the week”
Keep it positive

19. Basic Nutrition Advice
Timing of meals and snacks (no more than 4 hours without eating)
Get a variety of healthy, high-fiber foods
Limiting refined carbs and added sugars
Watch portion sizes and read labels
Keep a food journal
Learn to make lifestyle changes and not diet for a short period of time

20. How to Read a Nutrition Label

21. MyPyramid

22. Portion Control

23. Portion Control

24. The Plate Method

25. Follow-up Resources www.diabetes.org www.dlife.com
Refer patients to RDs

26. Does a perfect eating plan exist?

27. References
Franz, Marion J., MS, RD, LD, CDE. “Medical Nutrition Therapy for Diabetes Mellitus and Hypoglycemia of Nondiabetic Origin”. Krause’s Food, Nutrition, and Diet Therapy. Saunders: Philadelphia. 2004: p
“Nutrition Recommendations and Interventions for Diabetes”. American Diabetes Association. Diabetes Care. 2008;31(suppl 21):S61-S78.
Carey, Rita E., Ms, RD, CDE. “Wanted: The Best Diabetes Diet for Optimal Outcomes”. Today’s Dietitian ;11(No. 8): p
Escott-Stump, Sylvia. “Type 1 Diabetes Mellitus”. Nutrition Diagnosis-Related Care. Philadelphia: Lippincott Williams & Wilkins, p
Escott-Stump, Sylvia. “Type 2 Diabetes Mellitus”. Nutrition Diagnosis-Related Care. Philadelphia: Lippincott Williams & Wilkins, p
Escott-Stump, Sylvia. “Gestational Diabetes”. Nutrition Diagnosis-Related Care. Philadelphia: Lippincott Williams & Wilkins, p