E&M_Gizi^Nutritional Care for DM^
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Transcript of E&M_Gizi^Nutritional Care for DM^
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NUTRITIONAL CARE IN DM
Nutrition department
Medical schoolUniversity of Sumatera Utara
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Epidemic Type 2 Diabetes
and the Hidden IGT Epidemic: 2004
97 million known cases97 million known cases
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Epidemic Type 2 Diabetes
and the Hidden IGT Epidemic: 2004
97 million known cases
97 million undiagnosed cases
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Epidemic Type 2 Diabetes
and the Hidden IGT Epidemic: 2004
97 million known cases
97 million undiagnosed cases,
314 million persons withImpaired Glucose Tolerance
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Epidemic Type 2 Diabetes
and the Hidden IGT Epidemic: 2004
. . . and the cardiovascular
disease
epidemic to follow through the
Metabolic Syndrome. . .
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MNT is integral to total diabetes care &
management
Requires a coordinated team effort MNT requires an individual approach &
effective nutrition self-management
education
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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
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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
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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
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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
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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
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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
=
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Carbohydrate and Diabetes
Include foods containing carbohydrate from
whole grains, fruits, vegetables and low-fat
milk
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Carbohydrates
ComplexSimple
Fiber
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Severe restriction of dietary carb is not
indicated
Within the total caloric recommendation carb should be 45 60% of total energy
intake
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Carbohydrate and Diabetes
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
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Carbohydrate and Diabetes
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
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Carbohydrate and Diabetes
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
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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
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Carbohydrate and Diabetes
Fiber:
Fiber is encouraged for everyone:
20-35 grams/day
Good sources of fiber: Whole grain cereals
Fruits
Vegetables
Beans and peas
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Carbohydrate and Diabetes
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
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Soluble fiber effects in diabetes :
- inhibiting starch hydrolysis & glucose
absorption- delayed gastric emptying
- reduced fasting glucose levels by
improving insulin sensitivity- promoting satiety
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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
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Dietary Fat and Diabetes
Primary goal - Lower LDL cholesterol by:
Eating less saturated fat and
cholesterol
Eating less trans fats
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Dietary Fat and Diabetes
Choose monounsaturated fat in place
of saturated:
olive oil, canola oil, peanut oil,
olives, avocados, nuts
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Dietary Fat and Diabetes
Recommendation : 20-35% total calorie
Eat less total fat
Low-fat diets can help: with weight loss
improve cholesterol and other fats
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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
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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
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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
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Regular meals based oncarbohydrate
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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.
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Dietary Guidelines
Eat at the same time everyday , atleast within 1 hour of regular time.
Eat about the same amount ofcarbohydrate with each meal.
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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
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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
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Snack choices
Use of sugar-containing foods and
nonnutritive sweeteners Behavior modification techniques
Vitamin, mineral and botanical
supplements
Essential self-management nutrition
education skill
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