Healthy eating and weight control

Recommendations for healthy eating and weight control

• Eat a well-balanced, wide variety of foods

• Eat 2-4 daily servings of fruits

• Eat 3-5 daily servings of vegetables

• Limit salt, alcohol, saturated fats, cholesterol, foods containing sugar and fast foods

• Eat smaller portions and never skip meals

• Choose whole grain foods whenever possible

• Consult with a diabetes educator and/or registered dietitian for assistance in preparing an individualized meal plan. Carbohydrate counting, as a meal-planning alternative, can be discussed at this meeting, if desired.

General goals of medical nutrition therapy (MNT) for diabetes

• MNT should facilitate achievement of metabolic goals including glucose levels, lipid levels and blood pressure levels that minimizes a patient's risks of microvascular and macrovascular complications related to diabetes.

• MNT should be appropriate for optimum management of existing diabetes complications and risk factors for further complications.

• MNT should facilitate attainment of the maximum level of wellness for each individual

• MNT should be tailored to meet the personal needs of each patient [13].

Studies suggest that approximately 80% of people with type 2 diabetes are overweight or obese [14]. Experts agree that people with type 2 diabetes should be encouraged to achieve and maintain a desirable body weight. A majority of these experts agree with the following recommendations:

carbohydrates as 50-60% of intake;

• protein intake of 11-18% of total calories;

• limiting fat to 25-30% of calorie intake;

• use of low glycemic index foods;

• use of whole grains, legumes, vegetables and fruits [15]. Significant research has been done to confirm the correlation between weight loss and improved insulin sensitivity as well as improved glycemic control

Figure 2.4 Diabetes healthcare team members

Patient

"Expert"; personal abilities,

"feelings", "monitor" of: food,

exercise, glucose

4-

Nurse educator

Primary care provider Registered dietitian

Has specialized training in

Focused on patient- Trained and certified with

diabetes, teaches day-to

centered care and experience in diabetes

day management skills

well-trained in diabetes

treatment and medication

regimens

4-

Social worker Eye doctor

Dentist Podiatrist Excercise

Deals with Evaluates

Evaluates Treats corns, physiologist

the emotions eye health

dental health calluses as well Assists in

related to living annually

biannually as other foot planning fitness

with chronic

problems programs that

disease

will help provide

efficiency

in diabetes

management

Cardiologist, nephrologist, neurologist, pharmacist, pedorthist / orthotist

Community support: church groups, support groups, employer support

Note

Strategies for successful diabetes team management:

• The patient should be the team leader. This is a critical concept due to the chronic

nature of the disease. It requires lifelong self-management. Achievement of treatment

goals depends significantly on patient commitment to those goals.

• Patient self-management education should be an ongoing process consisting of both

formal and informal processes. The quality of patient education will be a determining

factor in patient outcomes.

• The Diabetes Team should consistently act to facilitate achievement of treatment

goals.

• All team members should maintain current and consistent knowledge of the disease,

the treatment process, the goals of treatment and the education and management

processes that facilitate those goals.

• Alternating visits between physicians and nurse practitioners.

• Routine nurse phone assessments of glycemic control.

• Dietitian visits for patients.

[16]. There are a number of strategies that can be encouraged to improve overall nutrition, facilitating weight loss. Among those are [17]:

♦ food logs that include all food intake over specified periods of time;

♦ nutritional counseling to improve meal planning and food choices as well as information on portion sizes;

♦ behavioral counseling to improve stimulus control;

♦ structured weight loss diets; and

♦ meal replacements.

In a recent study, significant improvement in A1C of 1.0-1.6 ± 0.3-0.4% related to an approximate 10% weight loss were achieved without use of antihyperglycemic pharmacologic interventions [18]. One study found that a maximum reduction in hyperglycemia of approximately 87% occurred during the first 10 days of a calorie-restricted diet, even though only a small percentage of weight loss had occurred [19]. The findings of a recent study by Kelley, et al. indicate that a short period of calorie restriction can result

Figure 2.5 The Food Pyramid t -v

Fats, oils and sweets

M and ot

Fruits

M and ot

Meat, meat substitutes and other proteins

Fruits

Breads, grains and other starches

Breads, grains and other starches in significant improvements in insulin sensitivity, insulin secretion and hepatic glucose production, supporting the theory that total daily calories may exert the greatest impact on glucose homeostasis in patients with type 2 diabetes [20].

Nutrition recommendations should be based on the Food Pyramid (see Figure 2.5) which allows for variations in the appropriate number of servings as determined by individual evaluations including nutritional status, likes and dislikes, and other health issues.

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