Diabetes Nutrition Recommendations 2013

Transcription

1 Objectives Diabetes Nutrition Recommendations 2013 The University of Georgia Cooperative Extension Review 2013 nutrition recommendations for diabetes Introduce new nutrition education materials Activity Goals of nutrition therapy Turn to person next to you Introduce yourself In 5 minutes, write down all the goals of nutrition therapy you can think of Healthful eating pattern with variety of nutrient dense foods Appropriate portion sizes Individualized goals for weight, blood glucose, blood pressure and lipids Delay/prevention of complications General goals A1C < 7% BP - < 140/80 LDL - < 100 mg/dl Triglycerides - < 150 mg/dl HDL > 50 for women > 40 for men 1

2 Ideal Referral to RD or Diabetes Self-Management Education soon after diagnosis Series of 3-4 encounters with RD for minutes per visit Completed within 3-6 months Yearly follow-up More contact if needed Everyone on medical team needs to know enough to do basic nutrition therapy Assessment Diagnosis Intervention Monitoring and Follow-Up Evaluation Modification Methodology Weight Control 10 volunteers have nutrition recommendation cards Each will give the recommendation based on their knowledge or a good guess Who should control their weight? Why? What should be the weight loss goal? When is weight loss most effective? 2

3 Answers Meds can make it easier or harder A healthy weight is important for everyone with diabetes Goal: Lose pounds Reduces insulin resistance, lowers LDL cholesterol, blood pressure and triglycerides Greatest benefit in those newly diagnosed with type 2 Weight loss more difficult Insulin Insulin secretalogues Thiazolidinediones Weight loss easier or weight neutral Metformin Incretin-based therapies Sodium-glucose co-transporters How should carbohydrate be handled? Answers: Is there an ideal percentage? What are the best sources? Two main sources Starches Sugars Research has not found the perfect percentage for everyone 3

4 Best Sources Vegetables Fruits Dairy Foods Whole grains Options Flexible Carb Counting Those on flexible insulin regimens Consistent Carbohydrate Those on fixed medication regimens Can sugar be used? Answers: Are Sugar Substitutes Safe? What about Fructose? Sugary foods can be included in moderation Must substitute gram for gram for other carb containing food Or increase insulin to cover carbohydrate Calories often higher 4

5 Sugar Substitutes Fructose All approved as safe by FDA Just sweeten None totally replaces sugar s texture, moistness, color May control calories and carbs Free from fruit is OK High fructose corn syrup may increase weight gain and increase CVD risk NO Sugary Drinks! Treating low blood glucose Fructose from fruit less effective in treating hypos Better treatment glucose and sucrose Fruit juice NOT best choice to treat lows Should the glycemic index or load be used for planning meals? 5

6 Glycemic index Glycemic index/load may help lower blood glucose after meals May reduce after meal blood glucose INDEX Compares rise of blood glucose after 50 g. of carbohydrate consumed from a food to rise after 50 g. of carbohydrate from glucose or white bread Example: 50 g. glucose GI= g. from 1 1/4 cup of plain macaroni GI = 47 Glucose load Example of glycemic load Grams of carbohydrate per serving x GI 100 GI for carrots = 49 Grams of carbohydrate in ½ cup of cooked carrots = 5 g. 5 x 49 =

7 How much is high? Index High 70 or higher Intermediate Low 0-55 Load High 20 or higher Intermediate Low 10 or less How much fiber should a person with diabetes consume? Answer: Same as person without diabetes 14 g. per 1000 calories g. per day How much protein is needed? 7

8 Answer: Protein needs are the same Even for those having kidney problems Increases insulin response do not use carb and protein containing foods to treat low blood glucose Best choices Seafood and fish Nuts Beans and peas Which Fats and Oils Should Be Used and How Much? Answer: Use oils and tub margarine, nuts and seeds Foods with stanols and sterols may lower cholesterol Less than 10% of calories from saturated fat Little if any trans fats No perfect % of calories Is it safe for a person with diabetes to drink? 8

9 Answer: Yes, with precautions One Drink equals Women 1/day Men 2/day OR Less! Eat when drinking if on medicine that increases risk for hypoglycemia Answer: How much sodium should a person with diabetes consume? 2300 mg/day or less 9

10 Will supplements help control diabetes? Answer: Not enough evidence to recommend any - including herbal supplements, Vitamin D, chromium and magnesium Food First! Answer: No pattern is best for everyone What eating pattern is best for diabetes? Individualize with help of Registered Dietitian Base on blood glucose readings Possible Mediterranean Diet D.A.S.H. Diet 10

11 Nutrition considerations for various diabetes medications New Nutrition Education Materials How to add so less GI distress When to take in relation to meals Distribution of carbohydrate and meals Risk of hypoglycemia alone and with other diabetes drugs Take Home Message Recommendations like U.S. Dietary Guidelines Main message consume nutrient dense foods in portions that achieve healthy weight Individualize to fit food preferences, culture, life style Blood pressure control and blood glucose control BOTH important! 11