Meal Plan Collection

Whats in a Healthy Meal Plan

Many people find that it helps not to think of their meal plan as a diet. After all, no one could follow a diet for the rest of their lives. If you are on a diet, it's easy to go off your diet. And once off, it's even easier to stay off. Well, I've already blown my diet for today, so another slice of cheesecake won't hurt, you might think. But that will only make matters worse. Instead, think of your meal plan as a new way of eating. But in In working out your nutrition plan, your dietitian or diabetes educator can work with you to achieve your goals. If you have type 2 diabetes and are overweight, maybe you want to shed a few pounds. Or maybe you want to manage your blood glucose levels through careful meal planning. If you have type 1 diabetes, you may want to learn to balance food intake with insulin. Or you may want to find out how your diet fits in with intensive management. Once you decide on your weight, activity, and blood glucose goals (see Chapter 2), you need to work out a...

Nutrition and meal planning in gestational diabetes

MNT is the cornerstone of treatment for gestational diabetes (GDM). Within 48 h of diagnosis, a woman should see a diabetes educator, preferably a registered dietitian for meal planning to assist with blood glucose control (31). Education can be conducted in a class or an individual counseling session. The ideal amount of carbohydrate is unknown but is generally limited to 40-45 of the total calories needed for the day (32). For obese women one can reduce the amount of carbohydrate to 35-40 (23). The meal plan needs to be individualized to a woman's eating style and food preferences. Forty percent of an average 2,000 calorie meal plan would yield 200 g of carbohydrate per day, which is well above the recommended 175 g. Focusing on one nutrient, carbohydrate helps control postprandial blood glucose and aids in making the meal plan. Basic carbohydrate counting is used to achieve a consistent carbohydrate meal plan with three meals and four to five snacks per day. We recommend checking...

My Meal Plan in Exchanges

It's often helpful to use a little chart like this one to help you make a meal plan that's nutritious, that's good for taking care of your diabetes, and that has foods in it that you like. It's often helpful to use a little chart like this one to help you make a meal plan that's nutritious, that's good for taking care of your diabetes, and that has foods in it that you like. ly Meal Plan

Medical Nutrition Therapy Your Meal Plan

Keep in mind that a healthy meal plan for you is just a healthy meal plan. You don't have to worry about following some strange diet involving weird foods that no one else in your family will want to touch. You will be developing a healthy living strategy that will benefit all the members of your household. Often, family members will not even realize that they are eating a diabetes meal plan. After first consulting with your diabetes care provider, you will most likely set up a visit with your dietitian to develop your mealtime strategy. You may feel that you don't really need a dietitian. Maybe you've seen sample meal plans recommended for people with diabetes that look easy enough to use. But remember, your meal plan is not a short-term diet that you can follow for a few weeks. You have developed a new way of eating that will stay with you throughout your life. Your dietitian or diabetes educator can help you tailor a meal plan to suit your tastes. And as you reach your goals or...

Meal Plan RecoMmendatioNs

It is important to establish a meal plan to help meet calorie and macronutrient recommendations for pregnancy. A macronutrient balance of 45-55 of carbohydrate, 20-25 protein, and 30-40 fat is essential in meeting the nutrient needs of both mom and baby (6). The timing of meals and snacks is important to optimize blood glucose control and to provide the fetus with glucose needs for growth. Planning a daily food intake of three meals and two to four snacks, including a bedtime snack, will help meet these goals.

Benefits of weight loss

The structured meal plans and or meal replacements, as opposed to traditional diets, give greater freedom and flexibility to substitute different types of meals and have been shown to be more effective in weight management. The success of structured meal plans over traditional diets was thought to be due to increased patients' empowerment with improved self monitoring and meal planning skills (Wing and Jeffery, 2001).

Eating Disorders And Depression An Introduction

Although recent innovations in diabetes management have enabled many individuals to adopt a more flexible eating plan, carbohydrate counting still commonly underlies diabetes meal planning. Individuals with diabetes, particularly those with DM2 and or metabolic syndrome, often receive medical recommendations to reduce body weight and to limit cholesterol and carbohydrate intake. Diabetes meal plans are now more flexible than many weight-loss diets, but they still increase the focus on food and calories, and may be experienced as restrictive. Although an optimal diabetes meal plan is well balanced and has adequate calories, the restriction of certain foods resembles that of many

There are some key differences between my approach and the standard approaches

One major difference between my methods and other methods is the way I arrive at my meal plans. Many people follow the exchanges program and it is highly promoted by the medical establishment. I think it is too imprecise and allows foods that I think are bad choices. What I do and recommend is using nutrition tracking software to analyze, plan and record meals.

Behavioural treatments

Both the provision of food products and structured meal plans have been reported to improve weight loss results. Jeffrey et al. (1993) found that patients who were prescribed standard reduced calorie diets, and were provided most of the food for this diet, lost significantly more weight after six and 18 months of treatment than did patients who were randomized to a self-selected decreased calorie diet. Wing et al. (1996) expanded these results by reporting that the provision of structured meal plans (i.e. what to eat for specific meals) produced similar results without providing the foods.

Management Strategies

Sodium should be restricted in patients with hypertension. Alcohol restriction is recommended, especially for those with obesity, hypertriglycer-idaemia or hypertension. Meal plans should be simple, flexible, and adaptable to the elderly patient's way of life and food preferences. Patients should be referred to a dietitian to facilitate successful dietary management.

Medical Nutrition Therapy

Approximately 70 to 80 of patients can achieve adequate glycemic control when MNT is aggressively applied. Meal plans vary with the practitioner, but often include three meals and one to two snacks per day. Caloric restriction is often necessary in obese women, to prevent hyperglycemia. Since insulin resistance is highest in the morning, carbohydrate intake at breakfast is usually limited. Caloric intake, allotment and distribution need to be taken into consideration.

Diet and Modification of Nutrient Absorption

In diabetic children the caloric needs depend on the rate of growth and activity pattern. Children 4-6 years old require 90 cal kg day and children 7-10 years old require 80 cal kg day. It is important to allow an adequate caloric intake in juvenile diabetes. Caloric requirement in children may also be calculated by adding to the baseline value of 1,000 cal day the amount of 100-125 cal for every year of age up to 12 years. Youngsters should consume 3 meals daily with 2 or 3 snacks (eaten at the same time each day) to minimize glycemic fluctuations and the risk of hypoglycemic episodes. After the caloric content and the composition of the diet are established, the prescription of a diet was in the past made by utilizing the data in the Exchange Lists for Meal Planning published by the American Diabetes Association. A more useful approach might be to use the precalculated diets (of various caloric content) prepared by several diabetes associations or other authoritative sources....

Eating Disorders And Depression Screening And Treatment

In women with diabetes, several warning signs may suggest the presence of either depression or an eating disorder. These include the following overall deterioration in psychosocial functioning (including school attendance and performance, work functioning and interpersonal relationships) worsening in metabolic control increasing neglect of diabetes management, including blood sugar monitoring, insulin titration and adherence to other medications erratic clinic attendance significant weight gain or weight loss increased concern about meal planning and food composition and somatic complaints, including low energy, fatigue, disrupted sleep and increased worries about physical health. In some cases, family members will raise concerns about depression or disturbed eating before the individual with diabetes does so. If worsening metabolic control is due to intentional insulin omission, the individual may appear surprisingly unconcerned, and may initially deny that she has engaged in this...

Glycemic response to foods

Carbohydrate foods can have a varied response in postprandial blood glucose results. Therefore, it is helpful to include glycemic response in the meal planning discussion. Glycemic response is defined as either glycemic index (GI) or as glycemic load (GL) (3). GI is a measurement of the increase of blood glucose within 2 h after eating a given amount of carbohydrate, 50 g compared to its response to a reference carb (glucose or white bread). The GI is a meal planning tool that ranks carbohydrates according to their effect on blood glucose when foods of equivalent carbohydrate are compared. Foods that ranked high on the scale cause a quick rise in blood glucose after eating, whereas foods that ranked low cause a gradual rise in blood glucose (3).

Deficiencies Highlighted in Reports from Other Countries

When to call a physician, or surveillance of complications were least often present. In general the care provided did not meet local or national standards of diabetes care, but care practices were better when registered dietitians were involved in meal planning and where written institutional policies were actually present.

People who can help you

A diabetes educator may be a nurse, a dietitian, or another kind of health care worker. Diabetes educators teach you about meal planning, diabetes medicines, physical activity, how to check your blood glucose, and how to fit diabetes care into your everyday life.

Dealing with Your Childs Diabetes

You will also want to talk to your child's care provider and diabetes educator. Try to schedule an appointment that is long enough so that all your questions and concerns can be addressed. In general, you will need to know how to check your child's blood glucose, how to give insulin, how to use a meal plan, and how to figure out an insulin dose and give injections. You will also want to know the extent to which your child can begin to take responsibility for her own care. If your child is only 2 years old, it is unrealistic to expect her to give herself insulin or test for blood glucose, but if your child is 10, she may very well be capable of checking her blood. Children mature at different rates. Some may be ready to give their own injections at age 7, but others may not be able to do it until age 11 or older. In doing your research and helping your child develop a treatment plan, don't forget that every child is different. What works for one child...

Monitoring glycemic control urineblood glucose metabolic targets

In a study of 201 insulin-requiring patients with diabetes, intensive self-monitoring of blood glucose demonstrated significant reductions in A1C 12 . Self-monitored blood glucose testing provides educational opportunities for patients, complementing the education process by providing information representative of the impact of multiple variables on glucose levels, including meal planning and or specific foods, exercise, stress, and medications. However, a recently-completed trial, the Diabetes Glycaemic Education and Monitoring (DiGEM) study, determined that for reasonably well-controlled, non-insulin treated patients there is no adequate evidence that self-monitoring blood glucose improves glycemic control 13 . Nonetheless, substantial evidence exists confirming the value of self-monitoring in insulin-treated patients.

Other intervention studies

In another Italian intervention study 122 non-insulin-treated type 2 diabetes patients, half of them women, were randomized into two groups (Trento et al., 2002). In the intervention group, patients were divided into small groups including nine or ten patients. Educational sessions were held every 3 months including topics about meal planning, burden of overweight, smoking cessation, and physical exercise. In the control group, patients continued individual consultation. After 4-year follow-up, statistically significant decrease in body weight was found in the intervention group (2.5 kg, P < 0.001) but not in the control group (weight decrease 0.9 kg, NS). Also, fasting blood glucose was measured, but it did not show statistically significant change in either of these groups. Weight reduction in the control and the intervention groups in the above three obesity intervention studies are given in Figure 5.2.

[ Table of contents Previous chapter Next chapter

Diet is a vital component in your overall diabetes control program. Your diabetes educator, dietitian, and doctor will develop a personal meal plan to help you attain appropriate blood sugar (glucose) and blood fat (cholesterol and triglyceride) levels. If you have non-insulin dependent diabetes, sticking to your meal plan helps you achieve and maintain your correct weight, and balances the foods you eat with the insulin your body produces. If you have insulin dependent diabetes, you must stick to your meal plan to insure a balance between injected insulin and the foods you eat.

Your doctor can help you adjust these guidelines to meet your individual needs

Now that you understand how to group foods and how much to eat, you're ready to enjoy meals based on the meal plan recommended by your doctor, dietitian, or other health care provider. Ask your dietitian to write down the number of servings you need for your daily meal plan on this Food Guide Pyramid

And preexisting diabetes

The focus of this chapter is MNT in pregnancy complicated by preexisting diabetes. However, the value of preconception counseling in women with preexisting diabetes cannot be ignored. All women with diabetes should receive MNT counseling prior to and throughout pregnancy, ideally provided by a registered dietitian who is well versed in diabetes and pregnancy. The role of the dietitian is to assess nutrition knowledge and determine a meal plan approach based on individual preferences to meet MNT goals of (1) providing adequate calories and nutrients that are important for optimal maternal and fetal outcomes and good glycemic control to minimize pregnancy complications, (2) balancing food, activity, and insulin doses to achieve adequate weight gain and to meet glucose goals to maximize perinatal outcomes, and (3) promoting healthy lifestyle behaviors that will contribute to lifelong health.

Foods For Occasional

The foods on this list can be included in your meal plan, despite their sugar or fat content, provided you maintain blood-glucose control. Average exchange values are listed for each item because these foods are concentrated sources of carbohydrates, the serving are small. Check with your dietitian for advice on how often and when you can enjoy these foods.

Check your blood glucose as recommended

You'll want to know how well you're taking care of your diabetes. The best way to find out is to check your blood to see how much glucose is in it. If your blood has too much or too little glucose, you may need a change in your meal plan, physical activity plan, or medicine.

Following Your Eating Plan

Before you cook, make sure that the recipes fit into your eating plan. If you have already eaten your carbohydrate portions for the day, make sure that the food you're about to eat has little carbohydrate in it. The same is true for protein and, of course, fat. If you think moderation as you make your meal plan, you'll keep to the portions you need to eat and no more.

Pregnancy and Gestational Diabetes

Gestational diabetes shows itself a little more than halfway through the pregnancy. The baby is mostly developed and puts its energy into getting bigger. If you have too much glucose in your blood, the baby will take in the glucose, produce more insulin, and grow too big. Delivering a baby too large for its age is dangerous for baby and mother. For this reason, you will need a meal plan. About three-quarters of women with gestational diabetes manage their blood glucose levels with a meal plan. Regular exercise can also help to lower blood glucose levels.

Take other tests for your diabetes Urine tests

Ask your doctor what your A1C test showed. A result of under 7 usually means that your diabetes treatment is working well and your blood glucose is under control. If your A1C is 8 or above, it means that your blood glucose may be too high. You'll then have a greater risk of getting diabetes problems, like kidney damage. You may need a change in your meal plan, physical activity plan, or diabetes medicine. By keeping daily records of your blood glucose checks, you can tell how well you're taking care of your diabetes. Show your blood glucose records to your health care team. They can use your records to see whether you need changes in your diabetes medicines or in your meal plan. If you don't know what your results mean, ask your health care team.

Treatment Issues For Schoolaged Children

Overall, the diabetes treatment team must try to teach problem-solving skills to the parent(s) and child to allow flexibility in the diabetes treatment plan. Similar to the preschool period, diabetes management therapy for the school-aged child is often reactive rather than predictive. During the elementary school years the family continues to be the 'patient'. Parents are an important part of every medical office visit, and parents maintain telephone communication for follow-up at home. At the same office visit, the child and family may see more than one member of the diabetes care team. Because the child grows rapidly during this developmental period, frequent adjustments are needed in the meal plan. Therefore, school-aged children should see the nutritionist at least once each year. The mental health specialist on the team can be especially important in the prevention and negotiation of conflicts over diabetes care issues between the parents and others (such as school personnel)...

Once You Are Pregnant

Your dietitian will help you tailor your meal plan to your recommended weight gain. A weight gain of 22 to 32 pounds over the 9-month period is normal. Women who are underweight to begin with may be advised to gain more. And women who are very overweight may be advised to limit their weight gain. Checking your urine for ketones each morning will help you know if you are getting the carbohydrates and insulin you need.

Components Of The Physiologic Insulin Regimen

The term bolus insulin incorporates both prandial and correction doses of insulin. Bolus insulin is preferentially provided as one of the rapid-acting insulin analogs, e.g., aspart, glulisine and lispro, or may be provided as short-acting regular insulin. Prandial or meal insulin refers to insulin which covers the postmeal glycemic excursion. Efforts are made to match meal insulin doses to anticipated carbohydrate intake, which will be achieved either by a consistent carbohydrate meal plan or by carbohydrate counting. The latter refers to counting the number of grams of carbohydrate to be taken in a meal and calculating an appropriate dose of insulin to take with the food. An individualized carbohydrate to insulin ratio is based upon an estimate of known insulin sensitivity. (Further details are discussed below in the section on pattern management.)

Psychosocial And Behavioral Considerations

It must also be recognized that adherence is not always consistent across all aspects of the diabetes regimen. Some people might always take their medication as prescribed, yet have more difficulty with dietary requirements. Others might follow their meal plan carefully but be slow to do monitoring. Still others might do the monitoring but fail to record insulin doses.

Depression And Diabetes

Both biological and psychological mechanisms have been postulated to account for the relationship between depression and impaired metabolic control in diabetes. The impact of depression on blood sugar levels may be due to its adverse effect on treatment adherence, including managing diabetes self-care tasks and attending medical appointments (98). The relationship between depression and poor compliance with diabetes treatment may be reciprocal. Depression can lead to lower self-efficacy and to self-neglecting and self-defeating behaviors, such as poor adherence to blood glucose monitoring, meal plan and exercise recommendations, while variations in blood sugar level can contribute to depressive symptoms (99). It has also been postulated, but not confirmed, that the metabolic abnormalities associated with diabetes lead to changes in brain structure and function, which then render individuals more susceptible to developing a depressive disorder (100).

Applying the SGI Table

Once you establish your own SGI factors you have a unique view of how specific foodstuffs affect your own body. In some cases one can anticipate the SGI value from a similar type of food. For example the SGI for cabbage is expected to be similar to that for cauliflower. If there is any doubt then a test is recommended. Occasionally I introduce a completely new type of food into my diet. If it is a high-carbohydrate food, I first consult the basic GI data 8 and page 15. Personal SGI testing requires a certain commitment of time, but then so does diabetes control in general. I now have an adequate database to predict results such that I only need to test once a day, unless something unusual happens to my meal plans.

JoAnne M Rizzotto Judy Giusti and Laurie Higgins

Nutrition Requirements and Meal Planning with Pregnancy Meal Plan Recommendations Nutrition and Meal Planning in Gestational Diabetes Follow-up Pregnancy complicated by diabetes presents unique challenges for women with preexisting diabetes and those with gestational diabetes. All women with preexisting diabetes, who are of childbearing years, should receive preconception counseling to prepare for pregnancy. Prenatal counseling and care should include a team consisting of healthcare providers who are well versed in the care of diabetes and pregnancy. Women with diabetes should receive Medical Nutrition Therapy (MNT) counseling prior to and throughout pregnancy. The goals of MNT and meal planning are (1) to provide adequate calories and nutrients to achieve target pregnancy weight gain and glycemic control and (2) to promote lifelong healthy lifestyle behaviors. These goals will optimize maternal, fetal, and perinatal outcomes and minimize pregnancy complications. They require...

Adjusting Insulin for Variations in Food Intake

In order that postprandial BG levels will be optimized, it is necessary for the provider and the patient to have an understanding of the relationship between the caloric content, and in particular the carbohydrate content of the meal, as the latter is the major contributor to the postprandial glycemic excursion. Prandial insulin dose will be matched with the anticipated or actual carbohydrate content of the meal. In the consistent carbohydrate meal plan, the number of grams of carbohydrate included in a given meal from day to day will be kept constant, thus allowing a prespecified insulin dose prescribed to be taken with the meal to control the postmeal glucose excursion. The nutritionist diabetes educator will typically provide a meal plan that incorporates in the range of 30 to 45 g of carbohydrate with each of breakfast and lunch and 45 to 60g of carbohydrate daily with dinner, depending on the patient's total daily caloric intake. The bedtime snack will contain 15 or more grams of...

Preconception counseling

During preconception nutrition counseling, the registered dietitian should assess current eating habits, nutritional adequacy and knowledge as well as cultural and ethnic preferences, work schedules, and financial considerations. A meal plan with sufficient calories and nutrients for optimal blood glucose control should be provided prior to pregnancy with a focus on carbohydrate counting. Nutrition requirements for preconception planning are individually determined based on the woman's weight, height, age, and activity.

Because I had gestational diabetes I might get diabetes when Im older

Although virtually every aspect of your life may seem turned on its head after the birth of a new baby, the four basic management tools remain the same insulin or oral diabetes medication (oral diabetes medications cannot be used while you are breastfeeding), blood glucose monitoring, meal planning, and exercise. Exercise may be the last thing you are thinking about after the baby is born. But as soon as you feel well enough and you have your doctor's okay, taking your baby for a daily walk can help you feel better and more relaxed.

Carbohydrate counting

The ICR is often combined with a correction dose of insulin. This is known as the insulin sensitivity factor (ISF). The ISF tells how many mg dl one unit of insulin will lower blood glucose. Additional insulin can be added to a meal bolus to correct high premeal blood glucose. One method to determine the ISF is the 1800 rule. Eighteen hundred divided by the TDD determines the ISF. For example, someone who takes a TDD of 60 units will have an ISF of 30 which means that one unit of insulin will lower blood glucose by 30 mg dl. Together the ICR and the ISF constitute the premeal insulin dose. Advanced carbohydrate counting is based on the ability of the individual to understand intensive insulin therapy, target blood glucose levels, keep detailed food records, and be willing to make daily self-care decisions. Record keeping is crucial to fine-tuning the ICR and ISF to achieve target range postprandial blood glucose goals. Education by a diabetes educator is invaluable to the success of...

Insulin Pump Treatment or Continuous Subcutaneous Insulin Infusion

Previous basal insulin or a dose increase does not solve this problem, the modern CSII treatment with pre-programmed increase in the late night early morning can minimize the dawn blood glucose increase. Clinical guidelines are the first step in making standards of care explicit. Table 3 gives the indications for CSII in T1DM suggested by a Danish expert committee 32 . CSII should be cancelled in case of recurrent ketoacidosis, if HbA1C increases, recurrent local infections reactions, and when lacking compliance 32,33 . There ought to be demands on the CSII treatment teams about knowledge and education, experience and organization and monitoring 32,33 . The total insulin requirement per 24 h usually decreases 15-20 after starting with CSII. Approximately 40-50 of the daily insulin doses are given as the basal rate, but some patients require up to 60 . The remainder is given as premeal bolus doses. The insulin requirement in adults is about 20 lower between 01 and 03 A.M. compared with...

Protein

The type of protein one consumes during pregnancy is important. Foods that contain all nine essential amino acids are called complete proteins. Sources of complete protein include lean cuts of meat, chicken, eggs, fish, cheese, and yogurt (3). Incomplete proteins are lacking in one or more essential amino acids. Some examples of incomplete proteins are dried beans, peas, lentils, and soy products, such as, tofu, tempeh, low-fat soymilk, soy burgers, and nuts and seeds. While vegetarian diets using complementary mixtures of plant proteins provide the same protein quality as animal products, special attention should be paid to vegetarian meal planning during pregnancy (14).

Mealplanning

There are a number of teaching systems available for meal planning but they are all subject to limitations. The emphasis should be on appropriate advice conveyed in the most appropriate way for a particular individual. There should not necessarily be a focus on one specific teaching system.

Diet

The American Diabetes Association dietary guidelines are used for dietary counseling. In addition to incorporating sound nutritional principles concerning the fat, fiber, and carbohydrate content, the importance of consistency in meal size and regularity in the timing of meals is emphasized. The prohibition of simple sugar in the diet has been de-emphasized, but it should still comprise no more than 10 of total carbohydrate intake. The success of the nutritional program may ultimately depend on the degree to which the meal planning is individualized and tailored to well-established eating patterns in the family. Moreover, flexibility can be enhanced if blood glucose monitoring results are used to evaluate the impact of change in dietary intake. As with other aspects

Nutritive Sweeteners

Polyols or sugar alcohols like sorbitol, xylitol, mannitol and isomalt are bulk or nutritive sweeteners which contain calories and raise blood glucose levels. They must still be accounted for in meal planning. They have a slightly lower glycaemic response than sucrose and a slightly lower calorie value (2.4kcal g) because they are not completely digested and absorbed. Polyols may therefore cause diarrhoea, particularly if consumed in large amounts (> 25 g). Although they have a lower cardiogenic effect compared to sucrose, polyols offer no special benefit to people with diabetes.

Your Dietitian

It is recommended that you see a dietitian whenever you are having problems reaching your blood glucose targets. It is a good idea to see a dietitian once a year even if you aren't having problems with diabetes care. A registered dietitian is a member of your health care team who has training and expertise in food and nutrition. For both type 1 and type 2 diabetes, whether or not you take insulin or other medication, a balanced meal plan is critical to living well with diabetes. You and your dietitian can develop a meal plan that has food you enjoy and that will help you balance your food and exercise. You may want help in adapting your diet to special goals, such as losing weight, reducing dietary fat or sodium, or complementing a regular exercise program. Your dietitian can help ensure that your diet achieves these goals and that it accommodates your likes and dislikes, culture, schedule, and lifestyle. Does your meal plan need a change or adjustment If you can answer yes to any of...

Exchange Lists

The Exchange Lists are the basis of a meal planning system designed by a committee of the American Diabetes Association and the American Dietetic Association. While designed primarily for people with diabetes and others who must follow special diets, the Exchange Lists are based on principles of good nutrition that apply to everyone. 1989 by the American Diabetes Association, Inc. and by the American Dietetic Association.

Type Diabetes

If you manage your diabetes with meal planning and exercise, adding an oral medication may help. If you already take oral medications, adding another pill or a once-a-day insulin injection may work. Ask your health care team whether it may be time for you to start insulin.

Meal Replacements

Meal replacements can help you lose weight by simplifying meal planning. They are convenient, are easy to purchase, are easy to store, require little if any meal preparation, and are reasonably priced, usually costing less than the meal that they replace. Using meal replacements reduces the number of decisions that you have to make about what to eat and reduces your exposure to tempting foods that might result in overeating. Most weight loss programs that use meal replacements recommend that you use them to replace two meals and one to two snacks per day when you are trying to lose weight and then transition to one meal replacement and one snack replacement per day to maintain weight. The research that has been done on the effectiveness of such meal-replacement programs has shown that people using meal replacements achieve more weight loss in the short term and for up to four years when compared to people on self-selected diets.

Insulin Plans

Type 2 diabetes can cause two different problems. In some people, not enough insulin is produced in relation to how much is needed by the body. Insulin is often needed along with meal planning and exercise. In addition, the cells in the body resist the action of the insulin that is produced. Diet and exercise and oral diabetes medications alone or with insulin may be needed. Therapies for type 2 diabetes may have to take into account both lack of insulin and resistance to insulin. Because their bodies make and release natural insulin, people with type 2 diabetes may be able to manage blood glucose by changing their eating and exercise habits. Others will need oral diabetes medication and still others will need insulin in addition to diet and exercise.

Food for sick days

If you are too sick to follow your meal plan, try to replace carbohydrates with liquids or soft foods. Carbohydrates provide sugar so that the body does not have to burn fat for energy. Burning fat produces ketones, which can be dangerous. Carbohydrates also prevent blood sugar from dropping too low. If you can keep food down, but still have no appetite, try l 2 cup cream soup, 1 2 cup cooked cereal, 1 cup plain yogurt, Jell-O, 1 2 banana, 1 scrambled egg, 1 2 cup custard, or l 2 cup sherbet. Once you're feeling better, try adding toast, vanilla wafers, and small amounts of food from your regular meal plan. Avoid spicy foods.

The Diabetic Diet

Your diabetic diet is a well-balanced meal plan tailored to your individual needs, tastes, activity level and life style. Meal times and types and amounts of foods are planned and adjusted just for you. You may need to learn more about foods, and you may have to make some changes in your eating habits. The better you understand your diet, the more flexibility you can enjoy. Your dietitian is there to get you started on your way to good nutrition and better health. He or she can help you tailor favorite recipes to fit your prescribed meal plan. Your dietary needs are not like anyone else's. That's why your dietitian's help is so important. Once you understand your dietary needs, you'll be able to design. your own menus and make safe judgments about your diet.

Eat Healthy Foods

You may already be using a meal plan low in saturated fat and cholesterol with lots of whole grains, fruits, and vegetables and a moderate amount of protein. Maybe you have cut down on salt to lower your blood pressure. If you have decided to lose weight, you also need to watch the total number of calories you eat. By making wise food choices, you can reap benefits far

During Pregnancy

During the first trimester, hypoglycemia may be a problem, due to morning sickness or nausea that causes you to eat less. Hypoglycemia may also occur because your baby takes sugar from your blood to support its own rapid growth. During the second and third trimesters, your insulin requirements double and triple. Frequent blood glucose monitoring, insulin adjustments, exercise, proper rest, and a good meal plan will help you stay in good control.

Insulin Therapy

Even a meal plan and exercise program alone, may be enough to keep your blood glucose levels in balance without added insulin. When your morning fasting blood glucose is closer to normal, it can make it easier to keep your blood glucose levels on target all day. If your fasting blood glucose level remains high, you may need insulin. If so, it will probably be given at night. Because your pancreas releases enough insulin to cover your meals, you only need help between meals. One or two injections of intermediate- or longer-acting insulin might work well for you. Another approach is to inject long-acting insulin at supper or bedtime to lower your fasting blood glucose levels in the morning. During the day, you can manage your blood glucose levels with meal planning and exercise and perhaps diabetes pills.

Nutrition Therapy

The meal plan during pregnancy is not designed for weight loss. The purpose is to help you eat the right food at the right time and in the right amount to manage your blood glucose. For many women, this is enough to keep blood glucose levels within the target range. Using moderate exercise to lower blood glucose levels can also help. Most women can swim or walk to keep active. You may also focus on limiting the

Getting Started

Recognize you as an individual and are willing to help you create a plan that fits your life. Don't agree to a meal plan containing foods you don't like or an exercise program you know you won't do. Tell your health care team what you can and are willing to do. Remember, it's your plan. Respond to your questions and concerns. You and your family members should be able to ask questions openly and trust that the health professional will take the time to listen and answer you patiently, completely, and honestly. Recommend the best possible strategies for the care and management of diabetes. All professionals should be aware of and follow standards of care recommended by the American Diabetes Association.

Combination Foods

Much of what we eat is mixed together in combination foods t do not fit into any one exchange list. Sometimes it's difficult to know the ingredients in a casserole or baked food item. This exchange list will help you fit combination foods into your meal plan. You can always check with your dietitian for information about any other foods you'd like to eat.

The bakery

You can really make a dent in your diet in the bakery section, where all the desserts are on display. These foods usually contain too much fat and carbohydrate however, you don't have to give up all your treats. The key is to figure a rich dessert into your meal plan, but only on an occasional basis. Remember to keep the portion small, in any case.

Food

Start with a meal plan that takes into account your usual food intake. Your meal plan should have about the same number of calories, carbohydrates, and meal timing that you are already used to. With these strategies in mind, you and your nutritional counselor can come up with a meal plan that uses basic carbohydrate counting as a system for quantifying food intake. You may find it easier at first to draw from a list of measured food exchanges. This will make it easier to match insulin doses to your carbohydrate intake. It will probably take a few months for you to get used to matching your food intake with your insulin dose to achieve your target blood glucose levels. In general, if you are counting carbohydrate choices, you will use a meal plan that lists the serving size of one carbohy A good way to begin is with a fixed meal plan. And you will probably want to keep a detailed log of the food you eat, your activity level, your blood glucose readings, and the amount of insulin you...

Shopping Wisely

Sorting out all the various food claims as you make your way through the grocery aisles may at first require a little detective work. What do they mean by low fat Is this a food that I can easily accommodate in my meal plan, or is it going to be loaded with lots of extras (like added sugars that will throw my The chili label on page 253 shows that if you are on a 2,000-calories-a-day meal plan, a cup of chili gives you 8 grams of fat (3 grams are saturated fat), 72 calories from fat, and 13 percent of your recommended fat allowance for the day. Healthy Food Shopping. Here are some tips for buying foods that will fit in with your healthy meal plan. Try to choose foods that are rich in vitamins, minerals, and fiber and low in fat and cholesterol. Keep in mind that the ingredients list on all food labels is in order of greatest amount by weight. That is, those ingredients that make up the largest percentage of the product are listed first and those that make up a smaller percentage of...

Meat Lists

Include mostly lean and medium-fat meats, poultry, fish, and meat substitutes in your meal plan. By decreasing your fat intake, you can decrease your risk for heart disease. Items from the high-fat list are high in saturated fat, cholesterol, and calories, so limit your high-fat choices to 3 times per week. Remember that meat and meat substitutes contribute no fiber to your meal plan.

Problem Solving

You never know when you might get stuck in traffic or delayed at work. If you plan to go out for brunch, eat an early-morning snack. Then, use your lunchtime meal plan and what is left of your usual breakfast plan. If dinner is to be very late, have your bedtime snack at your normal dinnertime. If you are taking insulin, you will need to adjust your rapid- or

How Much Monitoring

Blood glucose levels in people with type 2 diabetes are often more stable over the course of a day. If you take oral diabetes medications, you don't need as many blood checks as someone taking insulin. You can't use the results to fine-tune your next dose. You will monitor frequently while you are trying to find the best dose of medication for you or when there's a change in your care plan (such as a new exercise routine). Finding the best dose of oral medication can be as tricky as finding the right amount and timing for insulin injections. While you are making adjustments, you could be surprised by unexpected hypo-glycemia. During this period, check your blood glucose once or twice a day (before breakfast and one other time during the day). Occasionally, you may want to check 2 hours after meals to see how well the medication is working with your meal plan. Your monitoring records will help you and your health care team decide what changes, if any, are needed. But once your blood...

Practice Options

Members of the various health disciplines who practice diabetes education bring their particular focus to the educational process. This widens or narrows the scope of practice for individual educators as is appropriate within the boundaries of each health profession, which may be regulated by national or state agencies or accrediting bodies. Regardless of discipline, the diabetes educator must be prepared to provide clients with the knowledge and skills to effectively manage his or her diabetes. Diabetes educators must possess a body of knowledge that spans across disciplines in order to provide comprehensive DSMT. For example, dietitians who are diabetes educators provide instruction for insulin injection, insulin dosing, and medication side effects as well as providing nutrition counseling. Exercise physiologists in the diabetes educator role may help clients develop a meal plan, and pharmacists may provide counseling and instruction about foot care.

Nutrition

With health-care providers when they receive information, support, and resources, especially when our messages are positive, nonjudgmental, and understanding of the difficulties of changing behavior (8). Patients should be referred to a dietitian who is knowledgeable and skilled in developing an individualized diabetes meal plan.

Exercise

Health-care providers must recommend exercise to their patients. The success rate is not very good for patients continuing an exercise plan, but if it is not discussed, the success rate is even poorer (13). Exercise is extremely difficult to maintain as is diet but if patients are not encouraged, they surely will not see any necessity for it. It should be addressed at every visit as a part of the visit. Sometimes hearing things over and over does eventually make a difference to a patient. Even if the motivation wears off, the patient will usually follow a plan for a while and if they are seen every 3 months, they may have more time that they exercise than they do not exercising. In a study at the Joslin Diabetes Center located at the University Health Care Center in Syracuse, NY, patients were asked to develop their own meal and exercise plan. At 2 and 6 months respectively, 89 and 92 of the participants felt that they were following the meal plan either some or most of the time. One...

Carbohydrates

The first step in learning how to count carbohydrates is learning which foods are rich in carbs. Many foods contain carbohydrate, for example, whole grains, beans, fruit, milk, and some vegetables. So, when developing a healthy meal plan, it is important to have a variety to optimize nutrient intake. Nutrition Resources for Carbohydrate Counting and Meal Planning

Caloric Intake

A dietary assessment to evaluate usual intake can be combined with the caloric recommendations to arrive at a personalized meal plan. The meal plan is then evaluated by monitoring desired outcomes in terms of blood sugar and lipid levels but also growth and body weight. Infants and small children may need specific caloric prescriptions to achieve normal growth and development, however, in general, most individuals with type 1 diabetes inherently adjust their food intake to meet energy needs. As a result, carbohydrate may be the only nutrient requiring modification and monitoring. For example, a carbohydrate-counting plan outlining specific carbohydrate goals may be accompanied by general guidelines for reducing SFA and consuming moderate amounts of protein.

Getting Admitted

Tell them what medications you are taking for diabetes and any other medications you are taking, including any over-the-counter drugs. It helps to keep a list of these ahead of time, including how often you take them and in what doses. Explain any allergies or other conditions you may have that could affect the actions of medications. Speak up about any other medical conditions you may have, including complications of diabetes. High blood pressure may require special treatment before and during surgery. Heart disease medications may require adjustment. Tell them about any recent or frequent low blood glucose reactions. Bring your self-monitoring records with you. Tell them about your meal plan. Ask to see the hospital's dietitian and explain what type of meal plan you're using, including any special modifications such as less salt, less cholesterol, or less fat. Other aspects of your care may change as well. Your meal plan will be adjusted to give you adequate nutrition for heal