![]() Type 1 diabetes mellitus and diet. TYPE 1 DIABETES OVERVIEWDiet and physical activity are critically important in the management of the ABCs (A1. C, Blood pressure, and Cholesterol) of type 1 diabetes. To effectively manage glycated hemoglobin (A1. C) and achieve stable blood sugar control, it is important to understand how to balance food intake, physical activity, and insulin. Good news for dieters: 5:2 relaxes the rules and allows 800 calories a day. Making healthy food choices every day has both immediate and long- term effects. With education, practice, and assistance from a dietitian and/or a diabetes educator, it is possible to eat well and control diabetes. This topic discusses how to manage diet in people with type 1 diabetes. The role of diet and activity in managing blood pressure and cholesterol is reviewed separately. Many of these factors are controlled by the person with diabetes, including how much and what is eaten, how frequently the blood sugar is monitored, physical activity levels, and accuracy and consistency of medication dosing. Even small changes can affect blood sugar control. Eating a consistent amount of food every day and taking medications as directed can greatly improve blood sugar control and decrease the risk of diabetes- related complications, such as coronary artery disease, kidney disease, and nerve damage. Effective management of diabetes cannot be achieved without an appropriate diet. People with diabetes represent a large subsection of society and there. Lose weight and manage your diabetes with Nutrisystem DĀ®. No fads, no gimmicks. Just safe, effective weight loss. Take control of your diabetes today! In Just One Day This Simple Strategy Frees You From Complicated Diet Rules - And Eliminates Rebound Weight Gain. Mediterranean 5 day diet is very yummy and fun to follow. The 1000 calorie menu that this diet provides calls for extra virgin olive oil, fresh herbs, lots of fresh.In addition, these measures impact weight control. A dietitian can help to create a food plan that is tailored to your medical needs, lifestyle, and personal preferences. TYPE 1 DIABETES AND MEAL TIMINGConsistently eating at the same times every day is important for some people, especially those who take long- acting insulin (eg, NPH). If a meal is skipped or delayed, you are at risk for developing low blood glucose. People who use intensive insulin therapy (those on an insulin pump or multiple daily insulin injections) have more flexibility around meal timing. With these regimens, skipping or delaying a meal does not usually increase the risk of low blood sugar. High- fat meals ā Foods or meals that are high in fat (eg, pizza) may be eaten occasionally, although blood glucose levels should be monitored more closely. ![]() High- fat meals are broken down more slowly than low- fat meals. When using rapid- acting insulin (eg, Humalog, Novolog) before a meal, the blood sugar level may become low shortly after eating a high- fat meal and then rise hours later. People who use an insulin pump can use an extended insulin delivery regimen to better manage blood sugar levels after eating a high- fat meal. People who give insulin injections do not generally adjust their treatment based upon the fat content of their meal. TYPE 1 DIABETES AND CARBOHYDRATE CONSISTENCYCarbohydrates are the main energy source in the diet and include starches, vegetables, fruits, dairy products, and sugars. Most meats and fats do not contain any carbohydrates. Carbohydrates have a direct impact on the blood sugar level whereas proteins and fat have little to no impact. Eating a consistent amount of carbohydrates at each meal can help to control blood sugar levels, especially if you take long- acting insulin (eg, NPH). There are several ways to calculate carbohydrate content of a meal, including carbohydrate counting and exchange planning. Carbohydrate counting ā A dietitian usually helps to determine the number of carbohydrates needed at each meal and snack, based upon your usual eating habits, insulin regimen, body weight, nutritional goals, and activity level. In most people, between 4. The way carbohydrates are divided up for each meal or snack is based upon personal preferences, meal timing and spacing, and type of insulin regimen (table 1). The number of carbohydrates in a food can be determined by reading the nutrition label, consulting a reference book or website, carrying a database on a personal digital assistant (PDA), or using the Exchange system. Restaurants usually have this information available upon request. Eating more than one serving will increase the number of calories and carbohydrates consumed and the dose of insulin needed to cover the meal. For example, some prepackaged snacks contain two or more servings. To calculate the carbohydrate content of the entire package, multiply the number of servings by the number of carbohydrates. When a serving of food has more than 5 grams of fiber, the grams of fiber should be subtracted from the grams of carbohydrates to calculate the insulin dose (figure 1) . In this system, one serving of a carbohydrate (eg, one small apple) can be exchanged for any other carbohydrate (eg, 1/3 cup cooked pasta) because both servings contain approximately 1. You can also easily determine the carbohydrate content of your meals and snacks using the Exchange system (table 2). The exchange lists also identify foods that are good sources of fiber, and foods that have a high sodium content. A dietitian can help you determine how many servings of each group should be eaten at each meal and snack (table 2) and the typical carbohydrate content of each meal and snack. Intensive insulin therapy ā People who use an insulin pump or take multiple injections of rapid- acting insulin per day can adjust their pre- meal insulin dose based upon the number of carbohydrates they plan to eat and their pre- meal blood sugar. This requires the person to perform basic arithmetic. The pre- meal insulin dose is calculated by dividing the number of carbohydrates to be consumed by the number of carbohydrates covered by one unit of insulin (insulin- to- carbohydrate ratio). This dose is then adjusted based upon the pre- meal blood sugar reading (see correction factor below). Some insulin pumps can perform these calculations. This allows you to calculate the dose of rapid- acting insulin needed to cover a meal or snack. For example, if the insulin- to- carbohydrate ratio is 1 to 1. If you ate a meal with 7. Most insulin pumps are able to give tenths of a unit, so that 7. The correction factor can be determined by a dietitian or diabetes educator. For example, let's assume that the correction factor is 3. If the pre- meal blood sugar was 2. L and the goal blood sugar was 1. L, take 2. 40 minus 1. Then divide 1. 20 by 3. For patients whose blood sugar is measured in mmol/L, a different formula is used. Let's assume a correction factor of 2. If the pre- meal blood sugar was 1. L and the goal blood sugar was 6 mmol/L, take 1. Then divide 8 by 2 = 4 extra units of insulin to correct the high blood sugar. WHAT SHOULD I EAT? While protein and fat do not affect blood glucose levels significantly, they do contribute to the number of calories consumed. Eating a consistent number of calories every day can help to maintain body weight. An individual's recommended calorie intake is discussed below. However, monitoring carbohydrate intake (basic or advanced carbohydrate counting) is important in patients with diabetes, as carbohydrate intake directly determines postprandial blood sugar, and appropriate insulin adjustment for identified quantities of carbohydrate is one of the most important factors that can improve glycemic control. When considered in addition to total carbohydrates, meals with low glycemic index and glycemic load may provide a modest additional benefit for glycemic control. Saturated fat and trans fat contribute to coronary heart disease (CHD), while monounsaturated and polyunsaturated fats are relatively protective. Saturated fats (eg, in meats, cheese, ice cream) can be replaced with monounsaturated and polyunsaturated fatty acids (eg, in fish, olive oil, nuts). Trans fatty acid consumption should be kept as low as possible. People with diabetes are at increased risk for heart disease and stroke, and eating a diet low in saturated and trans fats and cholesterol can help to reduce cholesterol levels and decrease these risks. Furthermore, it is uncertain if a low- protein diet is significantly additive to other measures aimed at reducing cardiovascular risk and preserving renal function, such as angiotensin- converting enzyme (ACE) inhibition and aggressive control of blood pressure and blood glucose. Thus, protein intake goals should be individualized. An automatic reduction of dietary protein intake (eg, 1. The usual daily intake of protein should be approximately 1. Patients should be encouraged to substitute lean meats, fish, eggs, beans, peas, soy products, and nuts and seeds for red meat. For people with diabetes and heart failure, a low sodium diet may reduce symptoms. The US Food and Drug Administration (FDA) has tested and approved five artificial sweeteners: aspartame (Equal, Nutra. Sweet), saccharin (Sweet'N Low, Sugar Twin), acesulfame- K (Sunnet, Sweet One), neotame, and sucralose (Splenda). Stevia (sometimes called Rebaudioside A or rebiana) comes from the stevia plant and is now generally recognized as safe by the FDA as a food additive and tabletop sweetener. When something is generally recognized as safe by the FDA, it means that experts have agreed that it is safe for use by the public in appropriate amounts. Sugar alcohols (sorbitol, xylitol, lactitol, mannitol, and maltitol) are often used to sweeten sugar- free candies and gum and increase blood sugar levels slightly. When calculating the carbohydrate content of foods, one- half of the sugar alcohol content should be counted in the total carbohydrate content of the food. Eating too much sugar alcohol at one time can cause cramping, gas, and diarrhea. This is no longer necessary, although sugar should be eaten in moderation. If you take insulin, calculate your dose based upon the number of carbohydrates, which already includes the sugar content, as described above. Read the nutrition label carefully and compare it to other similar products that are not sugar- or fat- free to determine which has the best balance of serving size and number of calories, carbohydrates, fat, and fiber. Some sugar- free foods, such as diet soda, sugar- free gelatin, and sugar- free gum, do not have a significant number of calories or carbohydrates, and are considered .
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