Medical Nutrition Therapy

Medical nutrition therapy for Type 1 DM and Type 2 DM

General

1)      Objective:

To Achieve and maintain blood glucose levels in the normal range

Principles:

• By distributing carbohydrate appropriately throughout the day into small and frequency meal. For example, design 3 main meals with 1 or 2 snacks without excess calorie intake. 
• Avoid or minimize the use of high sweetened drink and alcoholic beverage. Specifically, limit the sucrose intake into 10% of total energy as excessive sucrose lead to weight gain.
• Consider only the sugar alcohol and nonnutritive sweeteners which are approved by FDA as they are considered safe to be consumed but within the recommended daily intake levels.
• By limiting or reducing intake of high glycemic index (GI) food. 
• Include a variety of high fiber food such fruit, vegetables, whole grains, and legumes with intake of 20-30 g/day can provide the feeling of satiety. ADA, 2008 stated that 25-30 g/day of soluble fibre intake during pregnancy can further reduce:
• -  total cholesterol by 2 - 3%
• -  low-density lipoprotein (LDL) cholesterol up to 7%
• By taking regular meals or snacks to avoid hypoglycaemia.
• An evening snack is required to prevent ketosis overnight especially for those pregnant and lactating women. (ADA, 2004)

 2)  Objective:

To achieve and maintain good lipid profile that helps to reduce the risk for macrovascular diseases.

Principles:

·         By distributing fat into 25-30% of total calories.

·         By reducing the intake of saturated fat to 7-10% of total calories.

·         By consuming 4-7% PUFA food.

·        Limit the intake of trans fat and cholesterol (to < 300 mg/day); < 200 mg/day for who has LDL (2.6  mmol/L or more)

·       By increasing the intake of food rich in MUFA, omega 3 fatty acid. Consume 2 or more servings of fish per week but not with fry method preparation.

(Alison Gray, RD, MBA et.al, 2011) 

3)      Objective: 

      To achieve and maintain normal blood pressure level (120/80mmHg).

Principles:

• By introducing DASH style dietary pattern including
• -Low salt intake (less than 6 g/day) or sodium (less than 2400 mg/day)
• Example of high sodium food: Soya sauce, ketchup & other sauces, pre-mixed cooking paste,  monosodium glutamate, salt preserved foods and processed foods.
• Reduce outside food.
• -Limiting the salt in cooking into ¼ to ½ teaspoonful of salt per person per day.
• -High potassium intake (fruit and vegetable)
• -Moderation of alcohol intake
• -High physical activity.
• By reducing the salt intake into < 6g/day.

4)      Objective:

To prevent (or slow down) the rate of development of chronic complications by modifying the lifestyle and nutrient intake.

Principles:

·         By avoiding excessive energy intake that may lead to various complications of diabetes mellitus.

·         By taking exercise consistently at least 150 min/week of moderate-intensity aerobic exercises (exercise that needs high demand of oxygen) such as dancing, yoga, swimming, playing badminton and many others.

·        By avoiding sedentary lifestyle such as smoking, unhealthy diet pattern and inactive physical activity.

·       Limit alcohol consumption into 2 unit/day for men and 1 unit/day for women. However, it is avoided for pregnant women and child and adolescence.

5)      Objective:

To improve health through healthy food choices and physical activity by addressing individual nutrition needs while taking into consideration of personal and cultural preferences and also willingness to change.

Principle:

• By suggesting suitable exercises and its guidelines depend on the patient’s capability and preference.
• By encouraging and motivating the patient to follow the exercise regimen and achieve the goal set.

6)      Objective:

To provide adequate energy and nutrient needed for

• Optimal growth and development in children and adolescents.
• Optimal obstetric outcomes in women.
• Nutritional and psychosocial needs in aging process.   

              Principle: 

• By suggesting daily multivitamin supplement with appropriate dose to reach optimal health status while is safe to be consumed if reduced nutrient intake.  
• By suggesting at least 1200mg per day of calcium to reduce the risk of getting osteoporosis among elderly.

7)      Objective:

     To educate patients treated with insulin agents or therapy on self-management blood glucose (SBGM) to prevent abnormal low glucose level in the blood. 

      Principle:

      By suggesting the frequency or when the time is necessary to measure blood glucose level. (ADA, 2009)

Ø  3-4 times daily SBGM is recommended for those taking insulin therapies. 

Recommendations for SBGM based on the mode of treatment and the mealtime:

8) Objective:

    To maintain proper weight gain during pregnancy.

    Weight loss is not recommended for overweight and obese women with GDM. Otherwise, it will increase the risk of preterm delivery.

    Principle:

    By maintaining all healthy food choices and lifestyle pattern that have mentioned above.

Source:

v    Medical nutrition therapy guidelines for type 2 diabetes. MOH, 2005. 

v    Alison Gray, RD, 2011, MBA - Senior Clinical Research Scientist, Lilly USA LLC; DC 2231. Chapter 18 – Medical Nutritional Therapy for the Patient With Diabetes

http://www.endotext.org/diabetes/diabetes18/diabetes18.htm

v ADA. Nutrition Recommendations and Interventions for Diabetes.Journal of care diabetes org. http://care.diabetesjournals.org/content/31/Supplement_1/S61.full