2. Topics to be covered
DM
Introduction
Nutritional needs of patients with
Diabetes
Nutritional assessment
Determination of body mass index
(BMI), waist-to-hip ratio
Meal planning methods
Problems associated with diet
therapy
2
Nutrition therapy for Diabetes Mellitus
3. Introduction
Nutrition therapy is an integral part of the treatment and
self-management of diabetes. The goals of nutrition therapy
are to maintain or improve quality of life and nutritional
and physiological health; and to prevent and treat acute-
and long-term complications of diabetes, associated
comorbid conditions and concomitant disorders.
Nutrition therapy for Diabetes Mellitus
3
5. NUTRITIONAL NEEDS OF PATIENTS WITH DIABETES
5
Calorie-controlled diets are planned by first calculating a
person’s energy needs and caloric requirements based on
age, gender, height, and weight. An activity element is then
factored in to provide the actual number of calories
required for weight maintenance. To promote a 0.5-1 kg
weight loss per week, 500 to 1000 calories are subtracted
from the daily total. The calories are distributed into
carbohydrates, proteins, and fats, and a meal plan is then
developed, taking into account the patient’s lifestyle and
food preferences.
Nutrition therapy for Diabetes Mellitus
6. Caloric Distribution
A meal plan for diabetes focuses on the percentages of calories that come from carbohydrates, proteins,
and fats.
Carbohydrates
• Carbohydrates consist of sugars (e.g., sucrose) and starches (e.g., rice, pasta, bread). Low glycemic
index diets (described later) may reduce postprandial glucose levels. Therefore, the nutrition guidelines
recommend that all carbohydrates should be eaten in moderation to avoid high postprandial blood
glucose levels.
• Foods high in carbohydrates, such as sucrose (concentrated sweets), are not totally eliminated from
the diet but should be eaten in moderation (up to 10% of total calories), because they are typically high
in fat and lack vitamins, minerals, and fiber.
Nutrition therapy for Diabetes Mellitus 6
NUTRITIONAL NEEDS OF PATIENTS WITH DIABETES
7. Fats : The recommendations regarding fat content of the diabetic diet include both reducing the total
percentage of calories from fat sources to less than 30% of total calories and limiting the amount of saturated
fats to 10% of total calories. Additional recommendations include limiting the total intake of dietary cholesterol
to less than 300 mg/day. This approach may help reduce risk factors such as increased serum cholesterol levels,
which are associated with the development of coronary artery disease-the leading cause of death and disability
among people with diabetes.
Protein: The meal plan may include the use of some non-animal sources of protein (e.g., legumes, whole
grains) to help reduce saturated fat and cholesterol intake. In addition, the amount of protein intake may be
reduced in patients with early signs of kidney disease.
Fiber: Increased fiber in the diet may improve blood glucose levels, decrease the need for exogenous insulin,
and lower total cholesterol and low-density lipoprotein levels in the blood.
Nutrition therapy for DiabetesMellitus 7
NUTRITIONAL NEEDS OF PATIENTS WITH DIABETES
9. NUTRITIONALASSESSMENT
Nutrition therapy for Diabetes Mellitus 9
• Nutritional assessment is the systematic process of collecting and interpreting information in order to make
decisions about the nature and cause of nutrition related health issues that affect an individual.
• Nutrition assessment, meal planning, weight control, and increased activity are the foundation of diabetes management. The
most important objectives in the dietary and nutritional management of diabetes are control of total caloric intake to attain
or maintain a reasonable body weight, control of blood glucose levels, and normalization of lipids and blood pressure to
prevent heart disease.
Nutritional management of diabetes includes the following goals:
• 1. To achieve and maintain: a. Blood glucose levels in the normal range or as close to normal as is safely possible
b. A lipid and lipoprotein profile that reduces the risk for vascular disease
c . Blood pressure levels in the normal range or as close to ( normal as is safely possible
• 2. To prevent, or at least slow, the rate of development of the chronic complications of diabetes by modifying nutrient
intake and lifestyle.
• 3. To address individual nutrition needs, taking into account personal and cultural preferences and willingness to change
• 4. To maintain the pleasure of eating by only limiting food choices when indicated by scientific evidence.
11. Nutrition therapy for Diabetes Mellitus 11
For patients who are obese and have diabetes (especially those with type 2
diabetes), weight loss is the key to treatment. (It is also a major factor in
preventing diabetes.) In general, overweight is considered to be a BMI of
25 to 29; obesity is defined as 20% above ideal body weight or a BMI
equal to or greater than 30.
Body Mass Index is a simple calculation using a person’s height and
weight. The formula is BMI = kg/m2 where kg is a person’s weight in
kilograms and m2 is their height in metres squared.
A BMI of 25.0 or more is overweight, while the healthy
range is 18.5 to 24.9. BMI applies to most adults 18-65
years.
DETERMINATION OF BODY MASS INDEX
(BMI), WAIST-TO-HIP RATIO
13. MEAL PLANNING METHODS
Diet plays a big role in controlling the diabetes. The diet could also be used alone alternatively together with insulin
doses or with oral hypoglycemic drugs. Diabetics always need to take care of their diet and about the food they eat.
Care has got to be taken because all foods contain not only carbohydrate, but also some energy value. Protein and fat
available within the food are converted to glucose within the body.
Goals of meal planning methods:
Maintain blood glucose levels to as near normal as safely possible to prevent or reduce the risk for complication of
diabetes.
Achieve a lipid profile and blood pressure that reduces the risk for cardiovascular disease.
Modify lifestyle as appropriate for the prevention and treatment of obesity, dyslipidemia, cardiovascular disease,
and neuropathy.
Address individual nutrition needs, taking into account personal and cultural preferences and willingness to change.
Improve health through healthy food choices and physical activity. Meal planning methods for diabetic mellitus
Nutrition therapy for Diabetes Mellitus 13
15. PROBLEMS ASSOCIATED WITH DIET THERAPY
• Diabetic’s dietary practices are mainly influenced by cultural backgrounds.
Concerning each of the dimensions of dietary practices, there were
significant positive relationships between knowledge regarding diabetic diet
and dietary practices.
• Knowledge is a salient factor related to dietary behaviors control. Moreover,
patients’ knowledge on a recommended diet indicates their understanding of
dietary guidelines which influenced their food selection and eating patterns.
• Dietary knowledge significantly influences dietary practices.
• There is increasing evidence that skipping breakfast is related with
overweight and other health issues. In addition, frequent eating or snacking
may also increase the body weight and risk of metabolic diseases.
Nutrition therapy for Diabetes Mellitus 15
16. CONCLUSION
The goals of nutrition therapy are to maintain or improve
quality of life and nutritional and physiological health; and
to prevent and treat acute- and long-term complications of
diabetes, associated comorbid conditions and concomitant
disorders.
Nutrition therapy for Diabetes Mellitus 16
