Table of Contents
Nutrition Essay Therapy1
Body Weight Considerations2
Nutrient Composition of the Diet4
Vitamins and Minerals7
The most fundamental component of the diabetes treatment plan for all patients with type II diabetes is medical nutrition therapy. Specific goals of nutrition therapy in type II diabetes are to:1
Achieve and maintain as near-normal blood glucose levels as possible by balancing food intake with physical activity, supplemented by oral hypoglycemic agents or insulin (endogenous or exogenous) as neededOrder now
Normalize blood pressure
Normalize serum lipid levels
Help patients attain and maintain a reasonable body weight (defined as the weight an individual and health-care provider acknowledge as possible to achieve and maintain on a short- and long-term basis)
Promote overall health through optimal nutrition and lifestyle behaviors.
Because no single dietary approach is appropriate for all patients, given the heterogeneous nature of type II diabetes, meal plans and diet modifications should be individualized to meet a patient’s unique needs and lifestyle. Accordingly, any nutrition intervention should be based on a thorough assessment of a patient’s typical food intake and eating habits and should include an evaluation of current nutritional status.
Some patients with mild-to-moderate diabetes can be effectively treated with an appropriate balance of diet modification and exercise as the sole therapeutic intervention, particularly if their fasting blood glucose level is < 200 mg/dL. The majority of patients, however, will require pharmacologic intervention in addition to diet and exercise prescriptions. It is important to note that no pharmacologic treatment will be successful if the patient is not on some type of dietary and exercise regimen.
Dietary changes do not have to be dramatic to produce clinically important results in terms of lowering blood glucose and lipid levels. Regular monitoring of blood glucose, glycated hemoglobin, lipid levels, blood pressure, and body weight serves as an ongoing assessment of the nutrition intervention.
Because nutrition issues and meal planning are complex, a registered dietitian who is familiar with the current principles and recommendations for managing diabetes may be consulted after a patient is diagnosed with diabetes.
This health-care professional can be an essential member of the diabetes management team and performs valuable functions:
Conducts initial assessment of nutritional status:
Provides patient education regarding:
The basic principles of diet therapy for diabetes
Problem-solving techniques for changing eating behaviors
Develops an individualized meal plan:
Emphasizing one or two priorities
Minimizing changes from the patient’s usual diet (to encourage compliance)
Provides follow-up assessment of the meal plan to:
Determine effectiveness in terms of glucose and lipid control and weight loss
Make necessary changes based on weight loss, activity level, or changes in medication
Provides ongoing patient education and support (particularly for those on weight-loss regimens), helping patients learn to adjust their meal plans for various situations.
Body Weight Considerations
Weight loss frequently is a primary goal of nutrition therapy because 80% to 90% of people with type II diabetes are obese.2} Caloric restriction and weight loss, even as small as 5% to 10% of body weight, can result in:
Improved glucose control
Increased sensitivity to insulin
Lower lipid levels and blood pressure
The need for a corresponding lowering of the dosage of pharmacologic agents (eg, oral hypoglycemic medications and insulin).
Weight loss is associated with improved glucose uptake and insulin sensitivity as well as decreased hepatic glucose production. Consequently, the therapeutic regimen most useful for individuals with obesity and glucose intolerance is weight reduction via nutrition therapy and increased physical activity. If moderate weight loss does not improve metabolic parameters, however, pharmacologic therapy (oral hypoglycemic agents or insulin) may need to be added to the regimen.
Weight loss and subsequent weight maintenance can be the most difficult and challenging aspect of managing diabetes. Therefore, emphasis should be placed on achieving and maintaining normal blood glucose control as the goal of nutrition therapy, using nutritionally balanced meal plans that promote gradual weight loss as a means to achieve this metabolic goal. A reasonable approach that provides a combination of the following strategies increases the chances of a successful outcome:
Modest caloric restriction
Spreading caloric intake throughout the day
Increased physical activity
Behavior modification techniques for changing eating habits and .