Page 515 - Nutrition Essentials for Nursing Practice

C H A P T E R 1 9 Nutrition for Patients with Diabetes Mellitus 503

■ Meet the individual’s cultural and personal needs while respecting preferences and
willingness to change

■ Maintain the pleasure of eating by not limiting any foods unless indicated by scientific
evidence

Nutrition therapy is an essential component of diabetes management regardless of the cli-
ent’s weight, blood glucose levels, or use of medication. People with diabetes generally have
the same nutritional requirements as the general population; therefore, dietary recommen-
dations to promote health and well-being in the general public—lose weight if overweight,
eat less saturated fat and cholesterol, eat more fiber and less sodium—are also appropriate
for people with diabetes. Because coronary heart disease (CHD) is the leading cause of
death among people with diabetes, it makes sense that nutrition recommendations issued
by the ADA to prevent and treat diabetes are remarkably similar to recommendations put
forth by the American Heart Association (AHA) for the primary and secondary prevention
of CHD (Chapter 20). Nutrition recommendations for diabetes management are summa-
rized in Table 19.2.

Calories and Weight Loss

Body Mass Index Consistent with interventions to prevent diabetes, recommendations to manage type 2
(BMI): an index of diabetes in overweight and obese people focus on lifestyle modifications that lead to weight
weight status loss—namely, a lower calorie intake, healthy food choices, and increased physical activity.
determined by dividing Short-term studies show that moderate weight loss (5% of body weight) in people with
weight in kilograms by type 2 diabetes improves insulin resistance, glycemic control, lipid levels, and blood pres-
height in meters sure. However, many patients have unsuccessfully tried to lose weight even before being
squared. Current stan- diagnosed with diabetes, and achieving long-term weight loss is difficult for most people.
dard for “normal” BMI If lifestyle modifications fail to produce weight loss, additional weight loss strategies may be
is 18.5 to 24.9; over- considered. Weight loss medications, when combined with a healthy diet and exercise, can
weight is 25.0 to 29.9; promote a 5% to 10% weight loss. Drug labels state that the medications should only be used
and obesity begins at in people with diabetes who have a body mass index (BMI) Ͼ27 (Bantle et al., 2008).
30.0, with Ն40.0 con-
sidered extreme obesity.

Table 19.2 Nutrition Recommendations for Managing Diabetes

Recommendations Based on Strong Evidence Recommendations Based on Limited or
Conflicting Evidence

Calories Lose weight if overweight or obese. For patients on low-carbohydrate diets,
Carbohydrates Restricted-calorie diets that are either low- monitor lipid levels, renal function, and
protein intake (in patients with
carbohydrate or low-fat diets may be nephropathy) and adjust hypoglycemic
effective for up to a year. therapy, as needed.
Physical activity and behavior modification
are important for weight loss and vital for
maintaining weight loss.

Carbohydrates from fruits, vegetables,
whole grains, legumes, and low-fat milk
are part of a healthy diet.

Monitoring carbohydrate intake is essential
to achieve glycemic control.

Attention to glycemic index may provide a
modest additional benefit above simply con-
suming a consistent carbohydrate intake.

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