NUTRITION AND DIET THERAPY FOR DIABETIC CLIENTS GOALS OF NUTRITIONAL THERAPY QUANTITATIVE DIET Focuses on either exchanging

g certain foods containing the same food value or by fixed weight. In the exchange system, foods are grouped into common types, such as starches, fruits, dairy, meat, fats and sweets.

QUALITATIVE DIET Best for diabetics who have less frequent fluctuations in blood sugar and are better able to manage blood sugar. The qualitative diet focuses on avoidance of added sugar in foods, including coffee, ice cream, cereal, cookies and cakes, and limitation of foods that are high in starch.

Factors in Prescribing Diet 1. Patients Ethnic, Religious and Cultural Background To understand the reasons for nutritional and dietary customs in any religion requires a brief orientation of the rationale for such practices and laws. Many religious customs and laws may also be traced to early concerns for health and safety in consuming foods or liquids. Specific laws about what can be consumed remain in most religions today 2. Patients Height and Weight IDDM- normal height and weight charts for children provide a standard for adequate growth NIDDM- major goal is weight reduction and control 3. Patients occupation and normal activity level Food distribution needs should be planned ahead, especially by persons using insulin and adjusted according to each days scheduled activities. Meal Distribution The ratio of carbohydrates, fat and protein in the diet is based on current recommendations for total glucose regulation and lower fat intake to reduce risks of cardiovascular complications. CARBOHYDRATES A more liberal use of carbohydrates mainly in complex starch forms with fiber is recommended. About 50-60% of the total kcalories should come from carbohydrates.

PROTEIN For adults, 0.8g/kg is recommended for diabetes control. In general, about 12-20% of the total kcalories as protein is sufficient. High protein intakes is not recommended because of their saturated fat content. FATS No more than 25-30% of the clients total kcalories should come from fat, with saturated fat less than 10%. Control of fat related foods helps reduce the risk diabetes contributeds toatherosclerosis and CHD. Fiber Different kinds of dietary fiber in plant such as whole grains, vegetables and fruits influence the rate of absorption of the carbohydrate and alter its effect on blood sugar level. Food Exchange Groups Composition

Food Group

Unit of exchange

Carbohydrate (g)

Protein (g)

Fat (g)

kcal

Milk

1 Cup

Skim

12

80

Low fat Whole

12

120

12

120

Composition

Food Group

Unit of exchange

Carbohydrate (g) 5 15 15

Protein (g) 2 3

Fat (g) -

kcal

Vegetables cup Fruit Bread Varies Varies: 1 slice of bread 28 g

35 40 70

Meat Lean Medium Fat Higher Fat

7 7

3 5

50.5 75

100

Composition Food Group Unit of Carbohydrate Protein Fat kcal exchange (g) (g) (g) 1tsp 5 5 45 45

Fat Polyunsaturated Monounsaturated

Saturated

45

CALCULATION OF DIABETIC DIET Food Group Total Days exchanges Carbohydrates: 275g (50% kcal) Protein: 110 g (20%kcal) Fat: 75 g (30% kcal) 10 Breakfast Lunch Dinner PM HS

Milk

24

16

Vegetable

15

Fruit

45

Bread Meat Fat

13 7 6

195

39 49 35 30

3 1 1

3 2 1

3 3 2

2 1 1

MEAL PLANNING GUIDE

Moderate Activity

Exchange needs

30 minutes

1 bread OR 1 fruit

1 hour

2 bread + 1 meat OR 2 fruit + 1 milk

Strenuous Activity

Exchange needs

30 minutes

2 Fruit OR 1 bread + 1 fat

1 hour

2 bread + 1 meat + 1 milk OR 2 bread + 2 meat + 2 fruit