Medical Nutrition Therapy

for Diabetes
Does a perfect eating plan exist?

Jennifer Regester, RD, CDN, CDE

 Nutrition Assessment
• Type of diabetes, any • Dietary 24 hour recall
complications (meals, snacks, and
beverages)
• Blood sugar control
• Favorite foods
• Past medical history
• Food allergies
• Anthropometrics- height, • Eating patterns and
weight, BMI, body habits
composition • Physical activity
• Biochemical- labs • Readiness to change
• Medications, including • Attitude
supplements
 Nutrition Assessment
Most Common Least Common
• Diabetes • Underweight
• Overweight/Obesity • Gastrointestinal issues
• Hypertension • Celiac disease
• High Cholesterol • Food allergies
• Renal Disease • Eating disorders
• HIV/AIDS • Sports nutrition
• Pregnancy • Vegetarianism
• Emotional eating • Bariatric surgery
 MNT Goals for Diabetes
1. 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
 MNT Goals for Diabetes
3. 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
 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
Special Considerations

Overweight/Obese
Type 1 Diabetes
Type 2 Diabetes
Gestational Diabetes
 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
 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
 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
 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
 Meal Planning Strategies
• Timing of meals • Carbohydrate
• Healthy choices and counting
balanced meals – Prescribed meal plan
• Variety including – Exchange system
nutrient-rich foods – Carbohydrate servings
and high-fiber foods – Label reading
– Glycemic index
• Moderation using
– Insulin to carbohydrate
portion control
ratio + correction
• Limit refined sugars factor (if applicable)
 Breakdown of Macronutrients
• Total carbohydrate: % CHO, PRO, FAT
45-65% of total
calories
• Total Protein: 10-
35% of total CHO
PROTEIN
calories FAT
• Total fat: 20-35% of
total calories
 Nutrition Counseling

• Patient’s lifestyle • Record keeping

• Work schedule abilities
• Family life • Attitude
• Support system • Ability to adapt to
• Education level change
• Knowledge about • Reaction to advice
diabetes and nutrition • Goal setting
 “So what do I eat?”

How to be a “Nutritionist” when

you do not have an RD
 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
 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
 How to Read a Nutrition Label

http://www.dtc.ucsf.edu/images/charts/nutrition_facts1.gif
 MyPyramid

http://www.mypyramid.gov
 Portion Control

http://www.ncescatalog.com
 Portion Control

http://www.snacksense.com/files/u1/portions_v4.jpg
 The Plate Method

http://www.tops.org/images/plate.gif
 Follow-up Resources
• www.diabetes.org
• www.dlife.com
• www.diabeticlivingonline.com
• www.calorieking.com
• www.sparkpeople.com

www.friedmandiabetesinstitute.com
Refer patients to RDs
Does a perfect eating plan exist?
 References
1. 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. 792-837.
2. “Nutrition Recommendations and Interventions for Diabetes”. American Diabetes
Association. Diabetes Care. 2008;31(suppl 21):S61-S78.
3. Carey, Rita E., Ms, RD, CDE. “Wanted: The Best Diabetes Diet for Optimal
Outcomes”. Today’s Dietitian. 2009;11(No. 8): p. 24-30.
4. Escott-Stump, Sylvia. “Type 1 Diabetes Mellitus”. Nutrition Diagnosis-Related
Care. Philadelphia: Lippincott Williams & Wilkins, 2002. p. 379-385.
5. Escott-Stump, Sylvia. “Type 2 Diabetes Mellitus”. Nutrition Diagnosis-Related
Care. Philadelphia: Lippincott Williams & Wilkins, 2002. p. 388-393.
6. Escott-Stump, Sylvia. “Gestational Diabetes”. Nutrition Diagnosis-Related Care.
Philadelphia: Lippincott Williams & Wilkins, 2002. p. 394-396.