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
Blood sugar control beverages)
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 individuals
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:
45-65% of total
calories
Total Protein: 10-
35% of total
calories
Total fat: 20-35% of
total calories
 Nutrition Counseling

Patients lifestyle Record keeping

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

How to be a Nutritionist when

you do not have an RD
 Doctors 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. Krauses 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. Todays 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.