Nutrition and Diabetes
Posted on 11/18/2011
An excellent short-term glycemic response to caloric reduction in patients with diabetes mellitus who are even modestly overweight can be expected. On the basis of the degree of obesity and with the help of a dietitian, the patient should be provided with individualized culturally appropriate instructions to reduce intake by at least 250 to 500 calories a day. Such a decrease generally leads to an overall weight loss of 0.5 to 1.0 lb a week.
There should be periodic reinforcement by the dietitian and physician. In the absence of a dietitian, the patient’s basal metabolic rate can be estimated at 10 cal/lb (20 cal/kg) of ideal body weight. A caloric prescription less than this amount will perforce decrease energy intake below the total daily energy expenditure. Consensus guidelines recommend that the calories should consist of less than:
· 30% total fat,
· less than 10% saturated fat,
· less than 10% polyunsaturated fat,
· 10% to 15% monounsaturated fat,
· 10% to 20% protein, and 50% to 55% carbohydrate.
· Cholesterol – Less than 300 mg/day
· Sodium – same as general population
o Less than 3000 mg/day if no hypertension
o Less than 2400 mg/day with hypertension
o Less than 2000 mg/day with hypertension & nephropathy
· Alcohol – same as for the general population
o No more than 2 drinks a day for men
o No more than 1 drink a day for women
o Abstain from alcohol if pregnant
Table sugar and other concentrated forms of carbohydrates are allowable in small portions at any one time (e.g., 5 g or 1 tsp of table sugar). Adding high-fiber foods can also lower plasma glucose modestly.
In massively obese individuals with BMI greater than 40 who are very symptomatic from hyperglycemia, a very low calorie diet (400 to 800 total calories a day using special high-protein supplements) can be very effective for the initial 2 to 3 months, but this strategy requires close medical monitoring.
Weight losses of 5% to 10% (10 to 20 lb) produce significant decreases in FPG and HbA1c over 1 to 3 months. However, many patients are unable to maintain a calorie-restricted diet and even their initial weight loss.
Pharmacologic aids for weight loss can be considered in such cases, but their efficacy is limited. Even after the addition of a weight-loss drug to therapy, appropriate diet therapy is essential.
The patient should not be blamed for recidivism, because inability to lower body weight to ideal and keep it there may well be a central nervous system manifestation of or contributor to type 2 diabetes mellitus and out of the patient’s consistent control.
The goal is that people living with diabetes achieve optimal nutrition through healthy food choices. There is no longer anything called a “diabetic diet”. The recommendations for food intake are the same as for the general population. A healthy diet consists of eating a variety of grains, fruits and vegetables, along with low-fat dairy products, fish, lean meats and poultry.
Surgical therapy for obesity by reduction of gastric volume can effectively control type 2 diabetes mellitus and is gaining acceptance in very obese individuals who are unresponsive to other therapy.
