2. Goals of MNT
Maintain blood glucose levels as near to normal as
possible by balancing food intake with medication
and activity level
Glucose control to prevent or reduce risk of
complications
Improve cholesterol and triglyceride levels
Control blood pressure
Manage weight
3. Goals of MNT
Prevent and treat chronic complications through
lifestyle changes in addition to MNT (watch protein
intake related to kidney function)
Feel better
Improve overall health
4. Guidelines for Meal Planning
Coordinate meals with insulin/medications
Pay attention to total energy intake
According to the Mayo Clinic, your daily intake of
calories should consist of:
Carbohydrates 45% to 65%
Proteins 15% to 20%
Fats 20% to 35%
Watch sodium intake
Balance meals with exercise
5. Meal Spacing
Evenly spacing out your meals and snacks throughout
the day will help keep your blood sugar levels stable.
General guidelines say to wait at least 2 hours (but no
more than 5 hours) between meals and snacks during
the day.
6. Carbohydrate Intake
Eat about 2-3 carbohydrate servings (30-45 grams) at
each meal for women and 3-4 carbohydrate servings
(45-60 grams) at each meal for men.
Both men and women should limit carbohydrates at
snacks to 1-2 carbohydrate servings (15-30 grams).
7. Protein Intake
Consider adding a little lean protein to every meal and
snack.
Small portions of protein do not raise BG levels
Protein may help slow down the rate at which
carbohydrates are digested, and typically help individual
feel full longer.
8. Fat Intake
Those with diabetes are at increased risk of heart
disease and stroke because diabetes can accelerate
the development of clogged and hardened arteries.
<7% of calories from saturated fats
Avoid trans fats
Chose monounsaturated (such as olive and canola
oils) and/or polyunsaturated (found in nuts and
seeds).
<300 mg cholesterol
9. Fiber Intake
Eating fiber-rich foods can help keep BG stabilized because
it slows the rate at which carbohydrates are digested.
Insoluble fiber (found in whole-wheat flour, wheat bran,
nuts and many vegetables)
Soluble fiber (found in oats, peas, beans, apples, citrus
fruits, carrots, barley and psyllium)
Ingestion of large amounts of soluble fiber (approx. 50g)
appears to improve BG levels.
25-35 g/day
10. Patient Education
Teaching which foods are carbohydrates (fruits,
grains, starchy vegetables, milk, sweets)
Average portion sizes
How many servings to select at meals
Frequent follow-ups with RD
11. Carbohydrate Counting
Calculate the total grams of carbohydrate (regardless
of source)
Advantages:
Places emphasis on carbs
Nutrition fact labels make any food ok
More flexibility in menu planning
16. Sample Meal Plan
Lunch Carbohydrate Count
1 cup skim milk 1.0 (15 grams)
2 slices bread 2.0 (30 grams)
Low-fat mayo 0
3 oz. turkey 0
Lettuce and tomato 0
Lunch Total: 3 (45 grams)
Snack 2 Carbohydrate Count
6 oz. light yogurt 1.0 (15 grams)
Snack Total: 1.0 (15 grams)
17. Sample Meal Plan
Dinner Carbohydrate Count
1 medium sweet potato 2.0 (30 grams)
1 tsp margarine 0
1 cup skim milk 1.0 (15 grams)
4 oz. baked chicken breast 0
1/2 cup cooked broccoli 0
1 cup salad 0
2 Tbsp low-fat dressing 0
Dinner Total: 3 (45 grams)
Snack 3 Carbohydrate Count
1 small apple, sliced 1.0 (15 grams)
2 Tbsp peanut butter 0
Snack Total 1.0 (15 grams)
18. Net Carbs
Grams of fiber may be subtracted from total
carbohydrate if food contains 5g or more
fiber/servings.
IE: All-Bran Multi-Grain Crackers
18 crackers = 19 g carbs, 5 g fiber
So would count as 14 g of carbohydrate
20. Alcohol
Include only when BG in good
control
Alcohol lowers BG
Research has shown that acute
consumption increases insulin
secretion, causing low blood sugar,
and can also impair the hormonal
response that would normally
rectify the low blood sugar.
Drinking as little as 2 ounces of
alcohol on an empty stomach can
lead to very low blood sugar levels
21. Alcohol
Beverage Serving Size Calories Carbohydrates
Beer, regular 12 oz 150 13 g
Beer, light 12 oz 100 5g
Beer, non-alcoholic 12 oz 75 16 g
Distilled spirits* 1.5 oz 100 trace
Martini 5 oz 310 4g
Wine, red 4 oz 80 2g
Wine, white 4 oz 80 1g
22. Exercise
Helps keep weight down
Helps keep blood pressure down
Can help raise HDL cholesterol, lower
LDL cholesterol
Helps body use insulin more
effectively
Can lower BG levels
(May need to adjust carbohydrate
intake/insulin dose to avoid
hypoglycemia)
23.
24. MNT for Hypoglycemia
Immediate treatment with
carbohydrates is essential
If the BG falls below 70 mg/dL, treat with
15g of carbohydrates:
3 glucose tablets
Fruit juice or regular soft drinks, ½ cup
6 saltine crackers
1 tablespoon syrup or honey
25. MNT for Hypoglycemia
Wait 15 minutes and retest. If the BG level remains
<70 mg/dL, treat with another 15g carbohydrates
Repeat testing and treatment until the BG level
returns to within normal range
Evaluate the time to next meal or snack to determine
need for additional food
26. Summary
Type II Diabetes affects millions of adults & children in
the US
1st priority is to adopt lifestyle interventions that
improve abnormalities of glycemia, dyslipidemia, and
hypertension.
Consistent & regular meal patterns & meal
compositions
Patient education is key!
Hinweis der Redaktion
These interventions should be implemented as soon as the diagnosis of diabetes is made.If you adhere to your meal plan for portion sizes and eating times you should eat the same mix of carbohydrates, proteins and fats each day. Your blood sugar control will be ideal, as will your weight. The more you vary from your food plan, the Mayo Clinic informs, the more your blood glucose will fluctuate.
Eating at regular intervals will help to prevent your blood sugar level from going either too high or too low
A general recommendation is to:
Meat & Meat Alternatives = nuts, eggs, tofu, etc.Amount determined by patient’s healthcare professional
Consume healthy fats in moderation7% of calories from saturated fats = 14 grams on a 1800 calorie/day diet
Insoluble fiber increases the movement of materials through your digestive system.Soluble fiber is more important for diabetics. It dissolves in water to form a gel-like material and can help lower cholesterol levels.However, it is unknown if regularly consuming that much fiber each day is realistic for most people.
Follow-ups with an RD can provide problem-solving techniques, encouragement, and support that lifestyle changes require.
Certain foods do not tend to raise blood sugar levels and can be used to help “fill in” your meal plan with little worry about their blood sugar affects. Have few carbohydrates and calories, count as “0” carb choicesPORTION CONTROL IS KEYLimit to 3 choices a day
-Controlled diabetes when A1c is less than 7%Moderate consumption = 1 drink/day for women, 2/day for menAlcohol consumption (in excess) can lead to problems with weight control
Dizziness, confusion, blurred vision all symptoms of hypoglycemia as well as intoxicationSome alcoholic beverages can raise your blood sugar because of their high carbohydrate content. To prevent your blood sugar from going to high, avoid sweet wines, liqueurs, and sweetened drinks like daiquiris, margaritas, pina coladas, etc. and choose lower-carb drinks.
These five benefits have a DIRECT bearing on how successfully you manage your diabetes. Exercise also has other general health benefits - you sleep better, your mental state improves, etc.
If it is more than 1 hr to next meal, test again 1 hr after treatment to see if additional carbohydrates are needed.
If you adhere to your meal plan for portion sizes and eating times you should eat the same mix of carbohydrates, proteins and fats each day. Your blood sugar control will be ideal, as will your weight.