Diabetes Nutrition Q&A for Health Professionals

by Joyce Green Pastors R.D. (Editor), Marilynn S. Arnold M.S. (Contribution by), Anne Daly M.S. (Contribution by), Marion J. Franz M.S. (Contribution by), Hope S. Warshaw R.D. (Contribution by)

Overview

Provides answers to questions concerning food and diabetes. Advice for patients on what to eat, when to eat, and how to eat the foods they love.

Product Details

ISBN-13:	9781580403504
Publisher:	American Diabetes Association
Publication date:	12/25/2003
Sold by:	Barnes & Noble
Format:	eBook
Pages:	185
File size:	3 MB

About the Author

Joyce Green Pastors, R.D., M.S., C.D.E., practices at the Virginia Center for Diabetes Professional Education in Charlottesville.

Marilynn S. Arnold, M.S., R.D., C.D.E. is in private practice.

Anne Daly, M.S., R.D., B.C-A.D.M., C.D.E. practices at the Springfield Diabetes and Endocrine Center.

Both Marion Franz, M.S., R.D., C.D.E. and Hope S. Warshaw, M.MSc., R.D., C.D.E. have private practices.

Table of Contents

	Foreword	xiii
	About the Authors	xv
	Introduction	xvii
	Medical Nutrition Therapy Goals
	What are the primary medical nutrition therapy (MNT) goals for people with type 1 and type 2 diabetes?	1
	Which MNT goal is likely to be affected first by lifestyle interventions?	2
	What is a "healthy diet"?	3
	Medical Nutrition Therapy Outcomes
	What are the expected outcomes from MNT on glycated hemoglobin A1C and fasting plasma glucose, and when should they be evaluated?	5
	What are the expected outcomes on lipids and hypertension from MNT, and when should they be evaluated?	6
	Nutrient Recommendations
	Carbohydrate
	How much carbohydrate does a person with diabetes really need?	8
	Are sugars a "fast-acting carbohydrate"?	9
	Are some foods that contain carbohydrate better for people with diabetes than others?	11
	Does a high-carbohydrate eating plan increase triglyceride levels?	12
	What is the glycemic index? Will eating low-glycemic index foods improve glucose control?	14
	What is the glycemic load? How can information on glycemic load be used?	16
	What are the advantages and disadvantages of so-called "sugar-free" foods that use one or more polyols (sugar alcohols) and/or no-calorie sweeteners (sugar substitutes) as a sweetening ingredient for people with diabetes?	17
	If people choose to use foods sweetened with polyols and/or no-calorie sweeteners, how should you teach them to fit these foods into their food plan?	20
	Does a high-fiber diet improve glycemia, lipids, and insulin levels?	22
	If a realistic amount of fiber (20 g/day) doesn't help improve blood glucose levels, why should I encourage people to consume more fiber?	24
	Protein
	How do protein foods affect glucose and insulin levels?	25
	Do people with diabetes require more protein than people without diabetes?	27
	Does eating high-protein foods increase risk for renal disease?	28
	Is it beneficial to reduce protein intake in the treatment of renal disease?	29
	What are nutrition and physical activity recommendations for metabolic syndrome?	31
	Fat
	What are the differences between the nutrition recommendations of the American Diabetes Association, the American Heart Association, and the National Cholesterol Education Program Adult Treatment Panel III? What are the similarities?	32
	What are the effects of monounsaturated fats and polyunsaturated fats on lipid levels?	34
	Does a higher fat intake contribute to a higher caloric intake?	35
	What advice can I give to individuals to help them reduce their fat intake and/or to eat more healthy fats?	36
	What are the advantages and disadvantages of lower-fat and fat-free foods for people with diabetes?	38
	Should I recommend one of the margarine-like spreads that contain plant stanol esters (Benecol) or plant sterol esters (Take Control)?	39
	What is the benefit of increasing omega-3 fatty acid intake? How much is recommended? Are supplements like fish oil or omega-3 capsules better than eating foods that contain omega-3 fatty acids? What about the concerns regarding the mercury content of fish?	40
	What are trans fats, and should people with diabetes lower their trans fat intake?	42
	Alcohol
	What are the recommendations for alcohol intake in people with diabetes? What effect does alcohol ingestion have on glucose and insulin levels?	43
	Are there health benefits from moderate intake of alcoholic beverages?	45
	What is the effect of alcohol on blood pressure and triglycerides?	45
	What are the most important concepts to teach people with type 1 and type 2 diabetes about alcohol consumption?	46
	Supplements
	How should I find out whether people are taking vitamin and mineral supplements? What should I do if they are taking supplements that are contraindicated for them or if they are taking unsafe doses?	48
	Are antioxidant supplements, such as vitamin E, of benefit to people with diabetes?	50
	Sodium
	Does everyone with diabetes need to restrict their sodium intake?	52
	Nutrition Assessment
	How can I assess the readiness of an overweight person to make changes in their lifestyle to improve their diabetes control?	54
	Because of time limitations in my practice setting, I am unable to do a comprehensive nutrition assessment and provide guidance on meal planning in one visit--what should I do?	55
	Patient Education Goal Setting
	How do I effectively set nutrition goals with a person who has diabetes?	57
	Educational Intervention
	Meal Planning Approaches
	What is the latest thinking about nutrition plans in hospitals and long-term care facilities for patients with diabetes? Should we be using approaches such as no concentrated sweets, Exchange Lists, calorie levels, consistent carbohydrate, or carbohydrate counting?	59
	What are the benefits of carbohydrate counting?	60
	When choosing a meal planning approach, what are some indicators that carbohydrate counting will be helpful?	62
	What is basic carbohydrate counting vs. advanced carbohydrate counting?	63
	What does it take for a person with diabetes to become skilled in carbohydrate counting?	65
	If there are no specific recommendations regarding the percentage or grams of carbohydrate, how should I start to determine the amount of carbohydrate a person should eat?	66
	What should my priorities be when I'm providing initial MNT to a newly diagnosed person with type 1 and type 2 diabetes?	67
	Teaching Strategies
	What can we do to maximize the effectiveness of MNT?	68
	What advice can I offer to people with diabetes who struggle with overeating after their evening meal?	70
	Is it true that any food can be worked into a diabetes meal plan?	72
	Patient Follow-Up and Evaluation
	To produce the best clinical and educational outcomes, how much and with what frequency do we need to provide MNT and/or diabetes self-management training?	73
	Physical Activity
	Do people with diabetes need snacks for physical activity?	75
	How does physical activity decrease the risk of cardiovascular disease?	77
	What types of physical activity improve cardiovascular risk factors?	80
	Who needs a stress test before beginning a physical activity regimen?	82
	Which is more effective for weight loss--physical activity or a calorie-restricted eating plan?	83
	Are intermittent or short bouts of physical activity really effective for people with diabetes?	84
	Why is physical activity so important?	85
	When discussing the benefits of being physically active, people commonly tell me, "I don't have time!" or "I don't like to exercise!" How can I get people interested in being physically active and help them to stick with it?	86
	Medication
	What are the nutrition implications of the different oral agents?	87
	How important is it to match the eating plan with the insulin regimen?	87
	I frequently receive referrals to teach carbohydrate counting to an individual planning to use an insulin pump. What is different about working with a person using an insulin pump versus someone using multiple daily injection therapy?	92
	Pattern Management
	Why might someone have an insulin reaction less than an hour after a large meal?	93
	How important is it to space meals and eat them on time?	94
	Why should we teach people with type 2 diabetes who take insulin how to adjust insulin using correction bolus doses of rapid-acting insulin based on mealtime glucose level and estimated carbohydrate intake (pattern management)?	96
	Why is the combination of an insulin-to-carbohydrate ratio/correction factor approach better for calculating mealtime insulin doses than a sliding scale approach?	96
	What strategies can be used to determine an optimal medication plan that considers patients' food habits, preferences, and lifestyle?	98
	Obesity/Weight Maintenance
	What is the current thinking on the use of high-protein, low-carbohydrate diets for people with diabetes?	100
	What are the best indicators for assessing health risk from obesity?	103
	What is the National Weight Control Registry, and what have we learned from it?	104
	What are some positive and negative predictors for successful weight loss/maintenance?	106
	What is the recommended weight loss goal?	107
	What are the benefits of weight loss for people with diabetes?	108
	Who should be considered for bariatric surgery, and what are the primary issues people should consider?	109
	How can depression affect eating behaviors, and what is the best approach for an obese person who is depressed?	111
	Special Populations
	Older People
	If an older adult with type 2 diabetes is not using insulin, is there any reason to ask the person to do self-monitoring of blood glucose?	113
	What happens when an older person does not drink adequate fluids, and what should we recommend?	114
	Gestational Diabetes
	Should I be recommending a maximum amount of carbohydrate and restriction of fruit/fruit juice at breakfast for women with gestational diabetes mellitus?	115
	Common Concerns/Issues
	Eating Away from Home
	What are the most important skills to teach people for eating meals away from home? When should this information be taught?	116
	What nutrition information is available for restaurant foods today?	119
	Do you have any suggestions for people who don't have much time or interest in preparing meals?	120
	Hypoglycemia/Hyperglycemia/Sick Days
	What is the difference between diabetic ketoacidosis and hyperosmolar hyperglycemic state?	121
	How should sick days be managed in people with diabetes?	123
	What do people with diabetes need to understand about managing hypoglycemia?	125
	What is the best treatment for hypoglycemia?	127
	What can people with diabetes do to manage their blood glucose levels on days when the timing of food intake is inconsistent?	129
	Portion Control
	Why is portion control important, and what are the concepts and skills to convey to patients about it?	130
	Nutrition Label
	What are the most important elements of and concepts to teach about the food label?	132
	Snacking
	Should people with diabetes be encouraged or discouraged to snack between meals to help control their blood glucose levels?	136
	Does protein need to be included in snacks for people using insulin?	138
	Prevention of Diabetes
	What important messages have been learned from the Diabetes Prevention Program?	139
	What tips can I offer parents to prevent obesity in their children?	141
	Resources
	Dietitian Access/Referral
	How can I help people with diabetes access the services of a dietitian with expertise in diabetes management?	144
	How can I reinforce the importance of consistently working with a dietitian with expertise in diabetes?	145
	What information does a dietitian need to assess someone's dietary needs and make appropriate recommendations?	147
	Educational Resources
	How do I find nutrition resources to teach and give people with diabetes?	148
	I counsel people from a variety of ethnic groups and different cultures. How can I familiarize myself with their food habits, and what resources can I use to teach them about the foods they eat?	149
	Are there web sites that provide reliable information about nutrition and diabetes?	150
	How can I help people with diabetes get the support they need?	152
	Reimbursement
	Because of the Medicare reimbursement guidelines for diabetes education, we are only teaching group classes. How can I effectively individualize a nutrition plan for each person with diabetes in a group setting?	154
	Is MNT and/or diabetes self-management training reimbursed/covered by private payors, managed care, Medicare, and/or Medicaid?	155
	Does the nutrition service(s) provided within a diabetes self-management training program and reimbursed by Medicare differ from the nutrition service(s) provided by a dietitian as MNT and reimbursed by Medicare?	157
	Do health plans reimburse for medical care, MNT, and diabetes self-management training for a person who has pre-diabetes and/or metabolic syndrome?	158
	Does insurance reimburse for MNT to treat obesity?	160
	References	162