This document discusses medical nutrition therapy for diabetes, including nutrition assessment goals, recommendations, considerations for special populations like those who are overweight or have type 1, type 2, or gestational diabetes. It covers assessing nutrition needs, monitoring carbohydrates, meal planning strategies like portion control and carbohydrate counting, and basic follow-up nutrition advice and resources for patients. The conclusion questions if a perfect eating plan exists for diabetes management.

1. Medical Nutrition Therapy
for Diabetes
Does a perfect eating plan exist?
Jennifer Regester, RD, CDN,
CDE

4. Nutrition Assessment
• Type of diabetes, any
complications
• Blood sugar control
• Past medical history
• Anthropometrics- height,
weight, BMI, body
composition
• Biochemical- labs
• Medications, including
supplements
• Dietary 24 hour recall
(meals, snacks, and
beverages)
• Favorite foods
• Food allergies
• Eating patterns and
habits
• Physical activity
• Readiness to change
• Attitude

5. Nutrition Assessment
Most Common
• Diabetes
• Overweight/Obesity
• Hypertension
• High Cholesterol
• Renal Disease
• HIV/AIDS
• Pregnancy
• Emotional eating
Least Common
• Underweight
• Gastrointestinal issues
• Celiac disease
• Food allergies
• Eating disorders
• Sports nutrition
• Vegetarianism
• Bariatric surgery

6. MNT Goals for Diabetes
1. Achieve and maintain:
• Blood glucose levels in the normal range
• Lipid profile that reduces risk for
cardiovascular disease
• Blood pressure levels in the normal range
2. To prevent (or slow) the rate of
development of chronic complications by
modifying nutrient intake and lifestyle

7. MNT Goals for Diabetes
3. To address individual nutrition needs,
taking into consideration 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

8. MNT Recommendations
• Monitor carbohydrate intake for glycemic
control
• Include a variety of carbohydrates from
fruit, vegetables, whole grains, legumes,
and fat-free/low-fat dairy products
• The use the glycemic index may provide a
modest benefit
• Avoid excess energy intake

9. Special Considerations
Overweight/Obese
Type 1 Diabetes
Type 2 Diabetes
Gestational Diabetes

10. Special Considerations
• Weight loss
– Weight loss has been shown to improve insulin
resistance
– Encourage dietary changes, increased physical
activity, and behavior modification
– Weight loss medications may be considered and can
help with an additional 5-10% weight loss with lifestyle
modifications
– Bariatric surgery

11. Special Considerations
• Type 1 Diabetes
– Insulin therapy may be integrated into an individual’s
dietary and physical activity pattern
– Adjust rapid-acting insulin doses based on
carbohydrate content in meals and snacks
– When on fixed daily insulin doses keep carbohydrate
content consistent with respect to time and amount
– Adjust insulin for planned exercise. For unplanned
exercise, extra carbohydrate may be needed

12. Special Considerations
• Type 2 Diabetes
– Encourage lifestyle modifications to improve
glycemia, dyslipidemia, and blood pressure
– Reduce caloric intake, saturated and trans fats,
cholesterol, and sodium
– Increase fiber, nutrient-rich foods
– Increase energy expenditure

13. Special Considerations
• Pregnancy
– Adequate caloric intake and nutrients needed to
provide appropriate weight gain for mother and fetus
– Focus on food choices for a healthy and steady
weight gain, glycemic control, and absence of ketones
– Aim to develop healthy habits and lifestyle
modifications (diet and exercise) for after delivery

14. Meal Planning Strategies
• Timing of meals
• Healthy choices and
balanced meals
• Variety including
nutrient-rich foods
and high-fiber foods
• Moderation using
portion control
• Limit refined sugars
• Carbohydrate
counting
– Prescribed meal plan
– Exchange system
– Carbohydrate servings
– Label reading
– Glycemic index
– Insulin to carbohydrate
ratio + correction
factor (if applicable)

15. Breakdown of Macronutrients
• Total carbohydrate:
45-65% of total
calories
• Total Protein: 10-
35% of total
calories
• Total fat: 20-35%
of total calories
% CHO, PRO, FAT
CHO
PROTEIN
FAT

16. Nutrition Counseling
• Patient’s lifestyle
• Work schedule
• Family life
• Support system
• Education level
• Knowledge about
diabetes and nutrition
• Record keeping
abilities
• Attitude
• Ability to adapt to
change
• Reaction to advice
• Goal setting

17. “So what do I eat?”
How to be a “Nutritionist” when
you do not have an RD

18. Doctor’s Advice
• “Nutrition is an important part of taking care of
your diabetes”
• Avoid telling patients to diet and lose weight
without resources
• Do not recommend fad diets, try to encourage
healthy lifestyle changes instead
• Be specific- “try to be active at least 30 minutes
most days of the week”
• Keep it positive

19. Basic Nutrition Advice
• Timing of meals and snacks (no more
than 4 hours without eating)
• Get a variety of healthy, high-fiber foods
• Limiting refined carbs and added sugars
• Watch portion sizes and read labels
• Keep a food journal
• Learn to make lifestyle changes and not
diet for a short period of time

20. How to Read a Nutrition Label
http://www.dtc.ucsf.edu/images/charts/nutrition_facts1.gif

21. MyPyramid
http://www.mypyramid.gov

22. Portion Control
http://www.ncescatalog.com

23. Portion Control
http://www.snacksense.com/files/u1/portions_v4.jpg

24. The Plate Method
http://www.tops.org/images/plate.gif

25. Follow-up Resources
• www.diabetes.org
• www.dlife.com
• www.diabeticlivingonline.com
• www.calorieking.com
• www.sparkpeople.com
www.friedmandiabetesinstitute.com
Refer patients to RDs

26. Does a perfect eating plan exist?

27. References
1. Franz, Marion J., MS, RD, LD, CDE. “Medical Nutrition Therapy for Diabetes
Mellitus and Hypoglycemia of Nondiabetic Origin”. Krause’s Food, Nutrition, and
Diet Therapy. Saunders: Philadelphia. 2004: p. 792-837.
2. “Nutrition Recommendations and Interventions for Diabetes”. American Diabetes
Association. Diabetes Care. 2008;31(suppl 21):S61-S78.
3. Carey, Rita E., Ms, RD, CDE. “Wanted: The Best Diabetes Diet for Optimal
Outcomes”. Today’s Dietitian. 2009;11(No. 8): p. 24-30.
4. Escott-Stump, Sylvia. “Type 1 Diabetes Mellitus”. Nutrition Diagnosis-Related
Care. Philadelphia: Lippincott Williams & Wilkins, 2002. p. 379-385.
5. Escott-Stump, Sylvia. “Type 2 Diabetes Mellitus”. Nutrition Diagnosis-Related
Care. Philadelphia: Lippincott Williams & Wilkins, 2002. p. 388-393.
6. Escott-Stump, Sylvia. “Gestational Diabetes”. Nutrition Diagnosis-Related Care.
Philadelphia: Lippincott Williams & Wilkins, 2002. p. 394-396.