Dietary Treatment For Type Diabetes Mellitus

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An integral component of diabetes management by both the health-care professional and the patient with diabetes is the need to know the principles of dietary management of the condition. Nutrition is complex and a registered dietician is best placed to offer advice on recommended diets, although all team members need to be knowledgeable about nutrition therapy. The dietary recommendations for patients with type 1 diabetes mellitus (DM) do not differ greatly from those recommended for the general population. Dietary advice must be tailored to the given patient and certain population groups require special consideration, for example, particular ethnic minorities or children.

The total fat intake should not exceed 30% of total energy intake, and < 10% should come from saturated fats. Dietary cholesterol intake should be less than 300mg/day. Intake of trans unsaturated fatty acids should be kept to a minimum. Carbohydrates, predominantly complex carbohydrates, should comprise > 50% of the total energy intake. Foods containing carbohydrate from whole grains, fruits and vegetables should be included in the diet. The total amount of carbohydrate in meals or snacks is more important than the source, type or glycemic index of the carbohydrate. Non-nutritive sweeteners are safe when consumed within acceptable daily limits. Consumption of simple sugars, e.g. sucrose, is acceptable in moderate amounts, as they do not cause acute hyperglycemia

(unlike glucose which does) as long as they are consumed within a healthy diet. Dietary fiber should be increased, ideally to >30 g/day, and it is preferable that this be taken in the form of natural soluble fiber as found in legumes, grain cereals or fruit. Protein should comprise approximately 10-15% of total energy intake.

Moderate sodium restriction and the national general recommendations for alcohol ingestion should be followed, and 'diabetic foods' and 'diabetic beers' are best avoided. Regular main meals with between-meal and bedtime snacks remain the usual basis of dietary treatment for type 1 DM patients. The size and distribution of the meals should be dictated by the individual patient's preferences and habits, unless these give rise to major problems with glycemic control or weight gain.

An understanding of the carbohydrate content of foods remains necessary, but detailed and over-precise 'carbohydrate exchange lists' can be misleading. Although some centers have abandoned the use of formal carbohydrate exchange lists, others remain enthusiastic about their use to match insulin dose with quantity of carbohydrate ingested in an attempt to improve smooth blood glucose control and allow patients greater choice of food intake (see Dose Adjustment for Normal Eating program below).

One advantage to patients of the widely used basal-bolus insulin regimens is that meals no longer need to be taken at a fixed time to avoid hypoglycemia - a degree of flexibility is allowed by matching the bolus ingestion of rapidly acting insulin to the meal time.

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