Psychological And Cognitive Function

Any level of psychological or cognitive deficit may lead to a poor or erratic diet affecting both nutritional state and glycaemic control. Memory lapses can result in missed meals and medication or an inadvertent repeated dose of some medications leading to, amongst other things, hypoglycaemia. Cognitive function is also impaired in people with diabetes due to increased incidence of cerebrovascular disease and depression (57,58). Psychological problems are both a predictor of mortality and of...

Dyslipidaemia And Other Cardiovascular Risk Factors

The dyslipidaemia of ESRF is characterised by raised plasma triglycerides with a normal cholesterol level. This form of dyslipidaemia becomes worse after starting CAPD. The lipid profile on CAPD is generally more atherogenic than with other dialysis modalities. A possible contributory factor for this atherogenic lipid profile is the glucose absorption from the dialysates giving rise to enhanced triglyceride synthesis. Chronic hyperinsulinaemia is a major component of the metabolic syndrome and...

Alcohol

Older people are more susceptible to the effects of alcohol and are likely to develop problems at relatively lower levels of consumption. The reduction in body water content and lean body mass with advancing age results in a smaller volume of distribution for the alcohol (30). Higher peak blood alcohol concentrations occur in older than younger subjects matched for body size and sex, yet ethanol clearance does not appear to be altered by age (31). Moderate intakes of alcohol appear to benefit...

Factors Influencing Nutritional Status In Dialysis Patients

Approximately 40 of dialysis patients exhibit some degree of protein and energy malnutrition and this is associated with an increased risk of morbidity and mortality. In the Modification in Renal Disease Feasibility Study (MDRD) in which 840 patients were prospectively studied, 42 of CAPD patients and 30 of HD patients were considered to be malnourished (15). Contributing factors to protein energy malnutrition occurring in dialysed patients are shown in Table 15.1. Table 15.1 Factors implicated...

Is Artificial Nutritional Support Necessary

Artificial nutritional support is only indicated for patients who are malnourished or who would become malnourished if not given artificial nutritional support. Artificial nutritional support has no clinical benefit if given for less than five days. In order to obtain benefit patients need to be fed for seven days or more (10). The major aims and objectives of nutritional support for patients with diabetes are 1. To maintain or improve nutritional status. 3. To optimise glycaemic control. 4. To...

Professional Practice

In order to develop consultation skills effectively we need to evaluate the way that we practise as an individual to let go of advice giving and let the patient take charge (33,35). Before we can practise differently we need to examine the way that we currently practise. We need to examine our own preconceptions first, and over time develop a less judgmental approach to our care. This means that behaviour change takes time both for the professional and the patient. Rollnick et al. (21) state...

Introduction

It is now widely accepted that increasing physical activity leads to great health benefits whether or not people have diabetes (1). Increased physical activity has been associated with physical, mental and social benefits including the following Reduction in all-cause mortality (2,3). Reduction in cardiovascular disease (CVD) including coronary heart disease (CHD), stroke and heart attack (4). Blood pressure reduction (5). Improved weight loss in the obese and weight maintenance in those of...

Nutritional Oral Supplements

If the nutritional requirements cannot be met with snacks and the hospital diet, food supplements may be required. Oral supplements can come in a range of savoury and sweet flavours. There are a variety of presentations including powder, pre-made carton sip feeds, glucose polymers (powders and syrups) and protein powders. These products may be nutritionally complete, i.e. suitable as a sole source of nutrition. The recommendation as to which oral supplements are to be chosen should be guided by...

Routes Used For Parenteral Nutrition

Parenteral nutrition is hyperosmolar and requires a large central vein. Central access can be achieved either by a peripherally inserted central catheter (PICC) threaded up into a larger central vein or by direct access to a central vein. Patients who are only receiving parenteral nutrition short term are more suitable for a PICC. (a) Short term, multilumen lines (b) Long term, e.g. Hickman line or Portacath 2. Peripheral access (at or below the antecubital fossa) (length of parenteral...

Risk Factors For Obesity

The patient's age is important in determining risk from obesity and generally there is greater risk from obesity in those under 40 years of age. Taking a weight history can ascertain the onset and duration of obesity as well as the pattern of weight gain and weight loss throughout the individual's life. Longitudinal studies have shown that weight gain confers a greater risk of cardiovascular disease than an unchanging level of obesity (40). In addition, the longer the duration of obesity the...

Benefits Of Weight Loss

Despite the expectations of the individual, the likelihood that an obese person will achieve sufficient weight loss to reach an 'ideal' body weight is remote (25). However, this does not imply that treating obesity is fruitless, as there is evidence that even a modest weight loss of 5-10 in obese diabetic subjects can produce clinical benefits. Improvements have been noted in all modifiable risk factors such as HbA1c levels, hypertension, dyslipidaemia, self-esteem and overall quality of life....

Cardiovascular Risk Factors

The role of exercise and the prevention of coronary heart disease in the general population have been well documented, but there is less evidence of a similar effect in people with diabetes. Modification of risk factors for CHD, including decreased total and LDL (low-density lipoprotein) cholesterol and triglyceride concentrations, have been demonstrated in Type 1 diabetes (20). People with Type 2 diabetes have two to four times the cardiovascular risk of those without diabetes and low...

Useful Resources

The British Dietetic Association's Nutritional Advisory Group for Elderly People (NAGE) publishes a range of resources to assist in the dietary management of older people. Further information can be obtained from the British Dietetic Association, 5th Floor, Charles House, 148 9 Great Charles Street, Birmingham B3 3HT or on the web site at www.bda.uk.com. Diabetes UK provides a range of resources for patients and health care professionals and can be contacted at 10 Queen Anne Street, London W1G...

Assessing Motivation To Lose Weight

When conducting an assessment of obesity, it is important to establish the ability and motivation of the individual to make lifestyle changes at that time. The style of the therapist can be crucial in facilitating behaviour change (48) and enhancing the confidence of the individual to be able to sustain changes. Key skills include the core counselling skills of listening and reflecting, motivational interviewing techniques, as well as strategies such as cognitive behavioural therapy (CBT).

Aims Of The Nutritional Recommendations

The goals of dietary advice are to achieve and maintain good health and quality of life, with avoidance and management of short-term symptoms, including hypoglycaemia and freedom from the long-term complications of the disease, for as long as possible. Evidence available from America from the Diabetes Control and Complications Trial in Type 1 diabetes (11) and also from the United Kingdom Prospective Diabetes Study in Type 2 diabetes (12) suggests that normalisation of metabolic markers like...

Acute Intercurrent Illness

As with any adult with diabetes who becomes ill, older people should be encouraged to take regular carbohydrate and sufficient drinks while continuing their medication. As their appetite may be reduced, small frequent drinks may be more tolerable and acceptable. Older people should be advised to prepare for illness by keeping suitable foods stored for such an eventuality, e.g. long-life or dried milk, tinned milk puddings, fortified drinks, tinned and dried foods, UHT fruit juice, porridge oats...

Aims Of Nutritional Management Of Childhood And Adolescent Type Diabetes

Provide appropriate energy and nutrients for optimal growth, development and health Achieve and maintain ideal body weight Achieve and maintain optimal glycaemic control on an individual basis, balancing food intake with metabolic requirements, physical activity and insulin treatment Prevent hypo- and or hyperglycaemia due to insulin, illness and exercise Reduce the risk of long-term micro- and macrovascular complications Preserve social and psychological well-being 'PROVIDE APPROPRIATE ENERGY...

Approaches To Weight Management

In theory, the management of the obese diabetic patient should not differ from that of the obese non-diabetic patient. However, it has been reported that weight loss is much more difficult for Type 2 diabetic subjects than obese non-diabetic subjects. For example, 12 overweight diabetic patients treated in a behavioural weight loss programme for 20 weeks lost significantly less weight than their non-diabetic spouses on the same programme (29). Although it appears that dietary adherence alone...

Bone Disease

Metabolic bone disease continues to influence morbidity and mortality after a successful transplant. Despite normalisation of phosphate excretion and improved activation of vitamin D, parathyroid hormone levels can remain elevated. Bone resorption continues due to the adverse effects of corticosteroids on osteoblast function and calcium absorption from the gut. Type 1 diabetic transplant recipients have been reported to have a higher fracture rate than non-diabetic recipients (40 vs 11 ) (29)....

Dialysis Initiation

Ideally, all diabetic patients approaching ESRF should be involved in the development of their own personalised care plan. This will enable a negotiation of the necessary dietary changes leading up to and extending to the initiation of elective dialysis (3). Dialysis guidelines from the National Kidney Foundation promote the early initiation of RRT for diabetic patients, due to an increased susceptibility to uraemic symptoms at lower serum creatinine levels than non-diabetic subjects (4). Early...

Current Recommendations For Carbohydrate Intake

For the past 20 years, most diabetes associations around the world have recommended high-carbohydrate diets that are low in fat and high in fibre for people with diabetes (15,16). The British Diabetic Association's recommendations state that carbohydrate should provide 50-55 of the total energy content of the diet while fat should contribute 30-35 of energy intake, of which < 10 should be saturated fat, < 10 polyunsaturated fat (PUFA) and 10-15 monounsaturated fat (MUFA) (17). However,...

D

Taking steps to tackle eating problems Source-. Reproduced from the British Dietetic Association s Nutrition Advisory Group for Elderly People (64). The most successful treatment for gastroparesis remains pharmacological. Dietary advice should focus on preventing weight loss and malnutrition. Eating and drinking separately and advice encouraging small frequent meals and snacks can improve symptoms. Supplements may be needed if specific nutrients are deficient or malabsorption is...

Diets For Weight Control Is The Amount And Type Of Carbohydrate Important

Weight loss is usually a major treatment goal in Type 2 diabetes, but the ideal dietary composition for weight control is still the subject of debate. Many health professionals are concerned that high-fat diets, irrespective of the type of fat, might promote weight gain. The prevalence of obesity is often lower in people with high carbohydrate consumption (expressed as a percentage of energy) than in those with high fat intakes (but this is not always true). In animal studies, high-fat diets...

Dietary History

A history of eating behaviour and if appropriate a current diet history can provide information as to the eating patterns and food preferences of the individual and can be used to begin to identify the changes needed. Encouraging patients to monitor their own food intake and activity patterns can be helpful in providing feedback to the patient on how to improve the nutritional quality of the diet and how to identify and overcome barriers that lead to overeating. Consideration should also be...

Eggs

In 2001 the American Heart Association relaxed its recommendations concerning the restriction of eggs and other high-cholesterol foods for the general healthy population, allowing people on plasma cholesterol-lowering diets five to six eggs a week. However, in a recent meta-analysis concern remains in the diabetic population where higher egg consumption was associated with an apparent increased risk of CHD (40). Further research is called for and continuing egg restriction for people with...

Energy Requirements In Pregnancy

Pregnancy is an anabolic state requiring energy for the products of conception, the foetal-placental unit and the increase in maternal tissues. Newly synthesised maternal tissues account for a 15-26 increase in metabolic rate in pregnancy (26). The total calculated energy cost for pregnancy is around 355 640 kJ (85 000 kcal) and this translates into an extra 1191.3 kJ (285kcal) a day (27,28). These theoretical energy costs, originally derived in the 1960s by Hytten and Leitch, have been...

Evaluating Effects Of Decisions And Actions

When focusing on dietary management of diabetes, discussions of issues other than food will achieve a clearer picture of the events or triggers related to certain eating behaviours, and allow better understanding of why the patient eats in a particular way. Exploring 'what if situations helps to equip the patient with more life-management skills, especially once they have a greater understanding of their own behaviour. For patients, their real concerns are being listened to and knowing they are...

Fat And Plasma Lipids

A high intake of saturated fatty acids has been associated with an increased incidence of CHD, presumably because a high saturated fat intake increases LDL-cholesterol and reduces HDL-cholesterol (27). The lipid-lowering effects of monounsaturated fatty acids (MUFAs) compared to n-6 polyunsaturated fatty acids (PUFAs) are well studied, suggesting that PUFAs may be more potent at lowering plasma LDL-cholesterol and TG (27). There is accumulating evidence in the literature that increasing the...

Frequency And Duration

The exercise guidelines issued by the American College of Sports Medicine (ACSM) in 1978 recommend at least three sessions of 20-40 min of vigorous activity each week. This was revised in 1990 and 30 min of moderate activity daily is now recommended (25). In 1994, the UK Health Education Authority (HEA) adopted an international consensus statement and recommended the following at a frequency of 5 or more days each week (1). The majority of research has concentrated upon the effect of physical...

Garlic

Garlic shows some promise for improving some cardiovascular risk factors. Studies suggest small short-term benefits of garlic on some lipid and antiplatelet factors (41). However, conclusions about the true effects of garlic are limited by the marginal quality and short duration of many studies. Debate also continues regarding the quantity of garlic needed to see an effect, with some studies reporting an intake as high as three bulbs per day. The implication for clinical practice is that this...

General Dietary Recommendations For

A dogmatic approach to the dietary advice for GDM should be avoided as only four randomised trials of primary dietary management of GDM against no treatment were considered to be of sufficient standard to include in a recent Cochrane systematic review (57). This pooled data analysis of 612 women failed to show any benefit of dietary intervention on final birthweight, risk of LGA infants and or Caesarean deliveries (57). However, ignoring all clinical and observational nutritional studies that...

Glycaemic Control

Achieving good glycaemic control is important for all patients with ESRF as this can retard the progression of the microvascular and macrovascular complications (5). Good glycaemic control at the start of dialysis has also been shown to improve mortality risk. For patients on continuous ambulatory peritoneal dialysis (CAPD) hyperglycaemia increases circulating advanced glycation end products (AGE), which have been implicated in causing endothelium and peritoneal membrane damage with loss of...

Haemodialysis

Haemodialysis requires the surgical construction of an arterio-venous fistula that is usually sited in the non-dominant forearm using the cephalic vein and either the radial or brachial artery. After six to eight weeks the fistula has usually thickened sufficiently to allow it to be cannulated with two large-bore needles that take blood to and from the dialysis machine. Blood is pumped through a semi-permeable membrane filter in the dialysis machine allowing removal of excess solutes and fluid....

Info

Figure 11.3 Reduction in glycosylated proteins (glycosylated haemoglobin or fructosamine) on low GI in nine studies comparing high-carbohydrate, low- versus high-GI diets Source Redrawn from Brand-Miller etal. (38). consumption of high-carbohydrate diets, even one high in refined sugar, was more effective in promoting long-term weight loss than higher fat diets (47,57,58). Despite this, results from several recent intervention trials have indicated that high-MUFA diets are just as effective as...

Intensity

Physical activity, exercise and sport can all be classified as either light, moderate or vigorous. Light activities require little exertion and do not cause a significant change in breathing. Moderate activities require sustained muscular movements and will result in heavier breathing and a feeling of warmth. Vigorous activities require sustained muscular movements and result in a feeling of being sweaty or out of breath. Examples of different activities and their intensity are shown in Table...

Macronutrient Composition Of The Diet

The main dietary components of the diet for an individual with diabetes should be carbohydrate-containing foods with a low glycaemic index and cis-monounsaturated fat. Although it is important to give people with diabetes advice to modify their dietary intakes so that they shift the balance of their nutritional intake in the direction of the recommendations, the relative proportions of macronutrients may vary depending on the markers of diabetes control for the individual. A combination of...

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. In the past, the main educational tool in the dietary education of people with diabetes, particularly for Type 1 diabetes, was the exchange system. Measurement of carbohydrate intake by using an exchange...

Monounsaturated Fats

In the Mediterranean, where the prevalence of coronary heart disease is lower, the typical diet is high in monounsaturated fatty acids (54). The beneficial effects of monounsaturated fats include the fact that they are more resistant to lipid peroxidation and increased MUFA intakes have also been associated with lower daytime blood pressures. There have been studies in both diabetic and non-diabetic populations which show falls in total cholesterol with no changes in HDL levels or triglyceride...

Morbidity And Mortality

Transplantation provides the best renal replacement option for diabetic patients with ESRF, improving the quality of life (3,4), and resulting in less neuropathy and anorexia. Unfortunately, renal transplantation does not improve pre-existing metabolic conditions such as dyslipidaemia or bone disease. These continue to progress and contribute to the long-term morbidity and mortality. The medications used to prevent graft rejection also contribute to metabolic risk factors, including weight gain...

Nonnutritive Sweeteners

Intense or non-nutritive sweeteners are sugar-free and calorie-free. Permitted sweeteners in the UK and Europe include aspartame, saccharin, acesulfame potassium, cyclamate, sucralose and alitame. These substances are very often used in combination as table-top sweeteners or in food products in order to produce a better flavour synergy or heat stability. There has been ongoing public debate about the safety of these substances, but there is no conclusive evidence to suggest that particular...

Nutritional Assessment

Before nutritional support is initiated the indications, aims objectives and ideal route of nutritional support need to be determined based on both the nutritional assessment of the patient and the clinical features of the condition being treated. There is no clinically applicable gold standard for assessing nutritional status (9) and, of necessity, assessment is commonly based on subjective parameters. The initial nutritional assessment is vital as it will influence an important aspect of the...

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...

Oral Hypoglycaemia Agents

OHAs are relatively contraindicated during critical illness. Metformin is not usually a suitable drug for ill patients. It is contraindicated for patients undergoing any form of imaging that requires contrast media. It is also not suitable for patients with a moderate degree of renal or hepatic disease. The OHAs most suitable for hospital use are the short-acting insulin secretagogues, e.g. repaglinide or nateglinide. Long-acting sulphonlyurea drugs should be avoided as they are a potent cause...

Prevention Of Hyperphosphataemia

Patient awareness of phosphate-containing foods is essential in order to limit phosphate intake. Dairy products have two to three times more phosphate than equal quantities of protein derived from meat and therefore need to be limited. Milk intake should not exceed 1-3 pt day and other dairy-containing foods such as chocolate, cheese and yoghurt should be restricted. Other highphosphate foods such as offal and offal-containing products, veal and fish with edible bones, such as sardines,...

Sensory Losses

Loss of taste and smell can influence the enjoyment of food and decrease motivation to eat and drink. Such sensory losses occur naturally as a function of age (49) as well as with certain diseases, such as cancer. Adding ready-to-use flavour enhancers containing monosodium glutamate (MSG) may improve dietary intake and thus reverse weight loss, improve immunity, functional status and quality of life (34,50,51). When the thirst sensation is decreased, dehydration can occur. Many elderly patients...

Soya Protein Flavonoids And Phytooestrogens

The efficacy of soya and soya derivatives in lowering total cholesterol and LDL-cholesterol was recently supported by the US Food and Drug Administration (FDA) approving a health claim about the role of soya protein in reducing the risk of CHD. In 1999 the FDA finalised a rule that authorises the use on food labels and in food packages under FDA jurisdiction of the health claims concerning the association between soya protein and reduced risk of CHD '25g of soya protein a day, as part of a diet...

Stanols And Sterols

Foods enriched with plant stanols and sterols have recently been introduced to the market. Plant sterols and stanols, which are structurally closely related to cholesterol, effectively inhibit the absorption of cholesterol. Plant sterols occur naturally in vegetable oils such as soybean and rapeseed, whereas plant stanols are found in tall oil, a side-product of paper manufacture. Manufactured products containing these products include spreads, cereal bars, cheeses, milk, ice cream and...

SUMMARY

As the prevalence of diabetes grows so will the need for renal replacement therapies. The dietary management of patients as they approach ESRF should focus on minimising uraemic symptoms while ensuring a sufficient protein and energy intake to prevent malnutrition. Both the nutritional status and the glycaemic control of an individual as they start dialysis are independent important predictors of their future morbidity and mortality. Achieving glycaemic control in patients undergoing regular...

The Importance Of Achieving Good Glycaemic Control In Hospital

Out of hospital the focus for good glycaemic control is to minimise long-term microvascular and macrovascular diabetic complications. In hospital, over the short term, the rationale for good glycaemic control is to ensure a metabolic environment that promotes the best possible immune activity and wound healing. Hyperglycaemia has a detrimental effect on the immune system, adversely affecting chemotaxis, granulocyte adhesion, phagocytosis, intra-cellular killing and complement function (5,6)....

The Need And Feasibility Of Future Dietary Studies In Pregnancy

There remains a lack of good randomised studies on the dietary management of diabetic pregnancies. Such studies are required for both short-term pregnancy outcomes and long-term outcomes for the mother and her child. One of the main difficulties in conducting such studies is the control arm even when no dietary advice is given, women once diagnosed with GDM make lifestyle changes based on family beliefs or information gathered from a variety of sources. Also if the health care providers are...

The Optimal Mix Of Dietary Carbohydrate And Fat For

The diet for the diabetic mother needs to limit excess maternal-foetal transfer of glucose. As post-prandial hyperglycaemia is the time of maximal maternal-foetal glucose transfer, treatment interventions need to target this period (6). Controversy exists on how best to achieve this. Some authorities recommend limiting carbohydrate at the expense of increasing dietary fat, while others favour high-carbohydrate diets with a low glycaemic response. It is the authors' belief that promoting diets...

The Role Of The Dietitian In Diabetes Care

Ideally, it is the role of the dietitian to provide the dietetic intervention. A vital part of the dietetic consultation is the assessment of readiness to change eating behaviour (19). Exploration of barriers to change and awareness of psychosocial issues form part of the dietary consultation process. In the short term, food intake needs to be regulated and balanced against medication, in order to optimise blood glucose control. This also includes assessment of whether current medication...

Variations In Glycaemic Index

Perhaps the best example of the ability of differences in glycaemic index of CHO-enriched diets to modify glycaemic control and lipoprotein metabolism in patients with Type 2 diabetes is the report by Jarvi and colleagues (38). These investigators compared the metabolic effects of two diets, each containing 55 of total calories as CHO, in 20 patients, consuming each of the test diets for 24 days. The glycaemic indices were calculated to vary from 57 to 83 as compared to white wheat bread. The...

Which Diet Is Best For Improving Insulin Sensitivity

The body's sensitivity to the hormone insulin predicts how well it handles a meal containing carbohydrate, i.e. how easily and quickly it restores normal glucose levels after consumption. In insulin-resistant states, large amounts of insulin are needed to restore euglycaemia and glucose and or insulin levels may still be high 2h later. In Type 2 diabetes, insulin resistance is often severe and is combined with impairments in insulin secretory capacity. Obesity, particularly abdominal obesity,...

Jo Sutton

I have been invited to share with you some of my thoughts and experiences on working in and living with diabetes, so that you may gain another perspective in diabetes care. Through my professional knowledge and personal experience I hope to give you a greater insight into this condition, that will aid you in the education and support of people with diabetes. I have included various topics, not just food and nutrition, to emphasise the importance of taking a holistic approach to diabetes...

Longterm Dietary Advice For The Mother And Her Child

As most women with GDM are obese and all have at least one child at increased risk of adolescent obesity and diabetes, providing dietary education and advice that extends beyond the pregnancy is extremely important. Lifestyle changes encompassing diet and exercise have been shown to reduce the risk of GDM in subsequent pregnancies as well as delaying the progression to Type 2 diabetes (59,95,96). Women with a history of GDM are an ideal group to target, not only because of their own heightened...

Preconception Nutritional Counselling In Diabetic Pregnancies

All women attempting pregnancy should take a minimum of 400 mg folic acid supplements a day to prevent neural tube defects 8 . The higher dose of 5 mg folic acid a day is frequently recommended for diabetic women, despite any actual trial evidence for this, the rationale being that neural tube defects are commoner in this group. In Britain, where the dietary folate intakes are relatively low despite numerous public health campaigns, less than 10 of women actually take folate supplements in...

Carbohydrate And Insulin Sensitivity

Daly et al. 28 have recently reviewed the evidence and clinical implications of dietary carbohydrates and insulin sensitivity. This is a controversial area. Extensive studies in animals show a detrimental effect of diets very high in fructose or sucrose, particularly in association with induction of hypertrigly-ceridaemia. The more limited results in human studies show conflicting results, partly because of heterogeneity of design. Certain groups of subjects such as the elderly, sedentary...

Hunt P. 1995 Dietary Counselling Theory Into Practice. J Inst Health Educ 33 4-8

Davidson C, Kowalska AZ, Nutman PN, Pearson GC. Dietitian-patient communication a critical appraisal and approach to training. Human Nutr Appl Nutr 1987 41A 381-389. 2. Vickery CE, Hodges PAM. Counselling strategies for dietary management expanded possibilities for effecting behaviour change. J Am Diet Assoc 1986 86 924-928. 3. Rollnick S. Behaviour change in practice targeting individuals. Int J Obes 1996 20 Suppl 1 S22-S26. 4. Coles C. Diabetes education theories of practice. Pract...

Vitamin And Minerals

The National Diet and Nutrition Survey of people aged 65 years and over provides valuable data on the current eating practices and nutritional status of elderly people in the UK 16 . Areas of concern highlighted in this report were the inadequate intakes of folate, vitamin D, vitamin C, vitamin K, iron and magnesium. Of the survey population 10-40 were shown to have multiple vitamin deficiencies and 10 were anaemic. Levels of deficiencies were higher when an individual was receiving...

References

Brydon P, Smith T, Proffitt M, Gee H, Holder R, Dunne F. Pregnancy outcome in women with Type 2 diabetes mellitus needs to be addressed. Int J Clin Prac 2000 54 418-419. 2. Casson IF, Clarke CA, Howard CV et al. Outcomes of pregnancy in insulin dependent diabetic women results of a five year population cohort study. Br Med J 1997 315 275-278. 3. Hawthorne G, Robson S, Ryall E, Sen D, Roberts SH, Ward Platt MP. Prospective population based survey of outcome of pregnancy in diabetic women...

Delayed Gastric Emptying

Hyperglycaemia delays gastric emptying 62 as do multiple other factors, many of which remain poorly understood. Physiological inhibitory pathways exist that control gastric emptying and involve small intestinal receptors that are stimulated by nutrients in the lumen of the gut. Posture, meal size and meal composition all influence gastric emptying through activating these receptors. Dietary fat empties at a slower rate than protein or carbohydrate and liquids empty faster than solids. A modest...

The Objectives Of The Dietary Management Of Diabetes

The goals of dietary management are clear beyond dispute and they apply equally to both Type 1 and Type 2 diabetes. They should achieve Near normal blood glucose with minimal risk of hypoglycaemia Reduced risk of microvascular and macrovascular complications as assessed by a variety of direct and surrogate measures, including blood lipids, clotting factors, blood pressure Weight loss in overweight patients Normal growth and development in children Healthy outcomes for mother and child in...

Ketoacidosis

Alcohol ingestion can cause ketoacidosis in people with diabetes and non-diabetics, as a result of relative insulin deficiency. Starvation, causing a depletion of glycogen stores and alcohol metabolism, leads to an increase in NADH NAD ratio which inhibits gluconeogenesis. This is responsible for causing an increased glucagon insulin ratio, which increases ketogenesis 16,17 . Diabetic ketoacidosis is a potentially life-threatening condition and requires prompt diagnosis and treatment of...

Dp

Other titles in the Wiley Diabetes in Practice Series Diabetes in Pregnancy An International Approach to Diagnosis and Management Edited by Anne Dornhorst and David R. Hadden 047196204X Edited by Simon Court and Bill Lamb 0471970034 Brian M. Frier andB. Miles Fisher 0471982644 Edited by Bill Burr and Dinesh Nagi 0471984965 Edited by Frank Snoek and T. Chas Skinner 0471977039 Edited by A. J. M. Boulton, Henry Connor and P. R. Cavanagh 0471489743 Nutritional Management of Diabetes Mellitus Edited...

Energy Requirements for Dialysis Patients

Energy requirements to achieve neutral nitrogen balance in stable diabetic dialysis patients are similar to those of healthy non-diabetic adults 35kcal kg body weight , with lower requirements for subjects over 65 years of age 30-35kcal kg body weight 19 . Patients on CAPD receive part of their energy requirements from dialysate glucose see below 20 . If CAPD patients have difficulty in meeting their recommended dietary energy intakes due to early satiety, they should be encouraged to eat after...

Reoxidation Of Nadh And Reduction Of Nadph

NADH is generated in the first two reactions of alcohol metabolism as outlined above. It is necessary for NADH to then be reoxidised to NAD so that it can be involved in further oxidation reactions in the cytosol The cytosolic NADH is reoxidised by the mitochondrial electron transport system, so substrate shuttles need to be used to transport the H atoms to the mitochondria. Under some conditions, the rate of transfer of H atoms by these shuttles is less than the rate of NADH generation, so...