Diabetes Medical Nutrition Therapy Dianne Davis, RD, LDN, CDE Becky Gregory, MS, RD, LDN, CDE Objectives State goals of diabetes Medical Nutrition Therapy (MNT) State how to use targeting glucose testing with MNT to improve patients glucose State 2 meal planning systems to quantify carbs Discuss practical ways to assist patients with nutrition 1
Goals of MNT Achieve and maintain: Blood glucose levels in the normal range A risk reducing lipid and lipoprotein profile Blood pressure levels in the normal range To prevent, or slow the rate chronic complications To address individual nutrition needs, taking into account personal and cultural preferences and willingness to change To maintain the pleasure of eating by only limiting food choices when indicated by scientific evidence Meal Planning Goal Exogenous Goal: Match carbohydrate with insulin Endogenous 2
Implementing the Meal Plan Part 1 Assess patient s lifestyle, preferred eating style Explain relationship between carb and BG Educate on carb foods Quantify carb intake from diet history Negotiate carb targets at meals Options to Quantify Carbs Plate Method Using carb servings Carb Gram Counting 3
Plate Method A plate is used to illustrate how much space different foods should occupy No weighing or measuring: guidelines for amounts of food is based on space contained on a plate One plate is used to illustrate breakfast, another lunch and dinner Must include carb control Carb Gram Counting Focuses on the grams of CHO at meals and snacks A specific number of grams of CHO negotiated Provides precision in calculating CHO Other nutrients can be included 4
Carb Gram Counting Patients may not have math skills required Show them how to use a calculator Review label reading Ask for return demonstration Three Main Errors Didn t look or apply serving size Improper calculations Distracted by other information 5
Implementing the Meal Plan Part 2 Patient goes home with meter and carb plan Negotiate when to test BG Focus on one meal Test before and 2 hrs after meal 6
Quantify Carbs Usual Meal Food & Amount 6 oz Chicken Breast 1 cup mashed potatoes 1/2 cup gravy 2 cups tossed salad 2 dinner rolls 16 oz. sweet tea 1 cookie Total Carbohydrate Servings 0 serving 2 servings (32 g) 1 serving (18 g) 0 servings 2 servings (36 g) 2 servings (24 g) 1 serving (19 g) 8 servings (129 g) Check Blood Glucose Check before and 2 hours after the meal Example: Before BG is 142 mg/dl After BG is 260 mg/dl Negotiate to reduce carbs Repeat experiment 260 7
Reduce Carb Servings Food & Amount 6 oz Grilled Chicken Breast 1 cup mashed potatoes 1/2 cup green beans 2 cups tossed salad 1 dinner rolls Sugar free tea 1 pear Total Carbohydrate Servings 0 serving 2 servings (32 g) 0 serving 0 servings 1 serving (18 g) 0 servings 1 serving (18 g) 4 servings (68 g) 1 3 2 8
Check Blood Glucose After Meal 2 hours after the meal blood glucose is 165 mg/dl 165 Overall Strategy 3 meals, no carbs between meals Include carbs, protein and non starchy vegetables Choose meal planning method based on patient 9
Encourage More Vegetables (non starchy) Brainstorm how to add veggies Frozen Making ahead Cold vegetables Fresh microwave Give recipes What do you have at home? Give Snack Ideas Low carb snacks 100 calories or less 2 Tablespoons of nuts Low fat cheese Raw vegetables Sugar free jello or popcicles Olives 10
Fear of Carbs Caution: patients often eliminate carbs Carbs are part of a healthy diet Show patients how to include healthy carbs at each meal Point out higher fiber, lower carb fruits and vegetables Type 2 and Fat Overweight Elevated lipids Elevated BP Work on one diet change at time 11
Don t Just Reduce Saturated Fats Replace with Good fats 12
Make it Easier Patients don t know how to plan Brainstorm for ideas Negotiate each change Make it practical Show packages and pictures Have patient write a grocery list Change the Focus Not on what they can t eat, but on what they CAN eat! 13