Carbs Are the Key: Current Nutrition for Diabetes

1
Provided Courtesy of RD411.com Where health care
professionals go for information
Carbs Are the Key Current Nutrition for
Diabetes
D-0556
Contributed by Karen Auwaerter, RD Review Date
4/10
2
(No Transcript)
3
Remember when

• No sugar or sugary foods
• More complex carbohydrates, because they are
  digested more slowly and will not increase blood
  sugar as rapidly

4
Remember when(contd)

• American Diabetes Association (ADA) Nutrition
  Recommendations and Principles for People With
  Diabetes Mellitus, 1986
• People with diabetes can safely incorporate 1
  teaspoon of sugar into a meal, as long as blood
  sugar is under good control

5
Remember when(contd)

• Patients followed rigid meal plans and could not
  request any foods high in concentrated
  carbohydrates
• Calories were calculated to within 100 calories
  of the diet prescription (ie, 1800 ADA)
• Patients were told I am sorry, but that is not
  on your diet.

6
Remember when(contd)

• HS snack was automatic
• Snacks included protein, because it helped
  regulate blood sugar
• Patients typically were on NPH insulin or
  sulfonylureas (Diabinese, Glucotrol, Micronase)

7
Newer research

• Abraira C, Derler J. Large variations of sucrose
  in constant carbohydrate diets in type II
  diabetes. Am J Med. 198884193-200.
• Bantle JP, Swanson JE, Thomas W, Laine DC.
  Metabolic effects of dietary sucrose in type II
  diabetic subjects. Diabetes Care.
  1993161301-1305.
• Malerbi DA, Paiva ES, Duarte AL, Wajchenberg BL.
  Metabolic effects of dietary sucrose and fructose
  in type II diabetic subjects. Diabetes Care.
  1996191249-1256.

8
The research says

• Postprandial glucose levels and insulin responses
  to a variety of starches and sucrose are similar
  if the amount of carbohydrate is constant
• Day-to-day variations in energy and protein or
  fat intake are not significantly related to HbA1c

9
ADA Guidelines change to reflect new science

• Sugars and concentrated sweets are allowed as
  part of a healthy eating pattern for all persons
  with diabetes
• Sweets can replace other forms of carbohydrates
  in a meal pattern
• Most carbohydrates should come from nutritious
  sources, such as fruits and vegetables, grains,
  and low-fat or fat-free dairy foods

ADAAmerican Diabetes Association
10
The evidence says

• Foods containing carbohydrates (CHO) from whole
  grains, fruits, vegetables, and low-fat milk are
  important componentsinclude them in a healthy
  diet
• The total amount of CHO in meals or snacks is
  more important than the source or type

11
The evidence says(contd)

• Because sucrose does not increase glycemia to a
  greater extent than isocaloric amounts of starch,
  it is not necessary to restrict sucrose and
  sucrose-containing foods
• However, you must substitute sucrose and
  sucrose-containing foods for other CHO sources or
  cover them with insulin or other glucose-lowering
  medication

12
(No Transcript)
13
Position Statement, ADA, 2009

• Implementation of a consistent carbohydrate
  diabetes meal plan at health care facilities
• Elimination of the name ADA Diet and No
  Concentrated Sweets (NCS) Diet
• CHO content comparable from day to day at each
  breakfast, lunch, and dinner
• Diet approximately 50 CHO, 20 protein, 30 fat

ADAAmerican Diabetes Association
14
Position Statement, ADA, 2008

• Patients requiring clear or full liquids should
  receive approximately 200 grams (g) CHO daily
• Sugar-free liquids are not appropriate
• After surgery, initiate food intake as quickly as
  possible

Source American Diabetes Association, Bantle JP,
Wylie-Rosett J, et al. Nutrition recommendations
and interventions for diabetes a position
statement of the American Diabetes Association.
Diabetes Care serial online. 200831(suppl
1)S61-S78. Available at http//care.diabetesjour
nals.org/content/31/Supplement_1/S61.full.pdf.
Accessed March 30, 2010.
ADAAmerican Diabetes Association
15
Consistent CHO diet

• Typically 60 g CHO at each meal
• Occasional sweets counted into the total CHO
  (coffee cake, Fig Newtons)
• Increased amount of fresh vegetables, fresh
  fruit, and whole grains
• 60 g CHO in all liquid diets

16
Patient and staff education is key

• The old ADA Diet no longer exists
• Artificial sweeteners are allowed to help reduce
  total carbohydrate intake of a meal
• Foods with added sugars are acceptable, as long
  as they do not affect the overall carbohydrate
  balance of a meal

17
References

• American Diabetes Association, Bantle JP,
  Wylie-Rosett J, et al. Nutrition recommendations
  and interventions for diabetes a position
  statement of the American Diabetes Association.
  Diabetes Care serial online. 200831(suppl
  1)S61-S78. Available at http//care.diabetesjour
  nals.org/content/31/Supplement_1/S61.full.pdf.
  Accessed March 30, 2010.
• American Dietetic Association. Nutrition Care
  Manual. Available at http//www.nutritioncareman
  ual.org/auth.cfm?p2Findex.cfm3F. Accessed
  March 30, 2010.
• Executive summary standards of medical care in
  diabetes2010. Diabetes Care serial online.
  201033S4-S10. Available at http//care.diabetes
  journals.org/content/33/Supplement_1/S4.full.pdfh
  tml. Accessed March 30, 2010.

18
References (contd)

• Franz MJ, Bantle JP, Beebe CA, et al.
  Evidence-based nutrition principles and
  recommendations for the treatment and prevention
  of diabetes and related complications. Diabetes
  Care. 200225148-198.