DIABETES MEDICAL NUTRITION THERAPY: CORE CONCEPTS

DIABETES MEDICAL NUTRITION THERAPY:  CORE CONCEPTS DIABETES MEDICAL NUTRITION THERAPY:  CORE CONCEPTS - Start

Added : 2017-11-14 Views :76K

Download Presentation

DIABETES MEDICAL NUTRITION THERAPY: CORE CONCEPTS




Download Presentation - The PPT/PDF document "DIABETES MEDICAL NUTRITION THERAPY: COR..." is the property of its rightful owner. Permission is granted to download and print the materials on this web site for personal, non-commercial use only, and to display it on your personal computer provided you do not modify the materials and that you retain all copyright notices contained in the materials. By downloading content from our website, you accept the terms of this agreement.



Presentations text content in DIABETES MEDICAL NUTRITION THERAPY: CORE CONCEPTS

Slide1

DIABETES MEDICAL NUTRITION THERAPY: CORE CONCEPTS

Anne Daly, MS, RDN, BC-ADM, CDE

Southern Illinois

Univ

School of Medicine

Center for Family & Community Medicine

Slide2

OBJECTIVES OF TALK

To review the goals of medical nutrition therapy (MNT), evidence for effectiveness & key MNT messages for PWD

To describe commonly used nutrition interventions & discuss challenges PWD face in the real world to implement healthy lifestyles

Slide3

ABC’s of Diabetes Management

ABC’s

Significance

A-A1C

Average blood sugar level over the past three months

Keeping A1C closer to normal reduces the risk for long term complications

Performed 2-4 times per year

B-Blood Pressure

Controlling BP decreases risk for strokes, heart attacks, eye and kidney damage

Performed q visit

C-Cholesterol

High cholesterol adds to the risk of heart disease

Performed at least once per year

Slide4

MEETING DIABETES CARE GOALS IN U.S.

30-50% not meet goals A1c, BP, lipids

40-50% receive no DSME, vaccinations or dental exams

20% continue smoking

Centers for Disease Control 2012

Diabetes Care 2013

NEJM 2013; 368:1613-1624

Slide5

HUGE GAP BETWEEN PROMISE OF QUALITY CARE VS. REALITY OF DB CARE

HCP feel:Frustrated by pts inability to change behavior and follow prescribed diabetes care plans

Patients feel:

Overwhelmed

Guilty

Frustrated

Slide6

Diabetes Education Underutilized

Few people with diabetes receive diabetes education…

Slide7

THE RESEARCH SHOWS:

Slide8

DIABETES NUTRITION THERAPY

What to eat = most challenging part DB treatment plans

“One size fits all” approaches do not work

Individualized medical nutrition therapy (MNT) provided by RDN familiar with DB MNT

recommended all persons with T1, T2, pre-DB

All team members, including MDs, PAs, NPs,

PharmD

,

behavioralists

, need be knowledgeable about MNT, so can support its role, and ensure

pt

has adequate access to therapy support

Slide9

GOALS OF MEDICAL NUTRITION THERAPY

Healthful eating with variety nutrient dense foods in appropriate portions to attain target metabolic goals

Achieve and maintain body weight goals

Delay & prevent DB complications

Address individual

nutr

needs based on personal & cultural preferences, health literacy & numeracy, access to healthful foods, willingness & ability to make behavioral changes, barriers to change

Slide10

GOALS OF MNT CONTINUED

Maintain pleasure of eating, promote positive messages re: food choices, limiting food choices only when based on evidence

Provide practical tools for day-to-day meal planning, rather than focusing on individual macronutrients, micronutrients or single foods

Diabetes Care 2014; 37 (

Supp

1)S120-S143

Slide11

EVIDENCE OF EFFECTIVENESS OF MNT

Glycemic Control

~ 1% decrease A1c newly diagnosed T1D

~ 2% decrease A1c newly diagnosed T2D

~1% decrease A1c w average 4

yr

duration T2D

50-100 mg/dl decrease FBG

Outcomes known by 6 wks-3months

American Diabetes Association. Therapy for Diabetes Mellitus (6

th

ed

) 2014

Slide12

EVIDENCE OF EFFECTIVENESS MNT CONT

Lipids

Decrease TC 24-32 mg/dl

Decrease LDL 15-25 mg/dl

Decrease TG 15-35 mg/dl

Wo PA, HDL-C decreases; w PA, no decrease

Hypertension

5

mmHG

decrease systolic BP, 2 mm HG decrease (in pts with HTN)

Slide13

Nutrition therapy changes as type 2 diabetes progresses

Nutrition Therapy

Pre-diabetesEarly Type 2 DiabetesLater Type 2 DiabetesNutrition (food) focusHealthy eating guidelines-- My Plate / DASH Diet/ Mediterranean Diet Consistent carbohydrate intake*-- Carb distributed throughout the day-- 3 meals and 0-2 snacks/day Per meal: 2-4 carb choices (30-60 gm carb) Daily; at least 9 carb choices (130 gm carb)Insulin-to-carbohydrate ratios-- Initially a consistent carb intake with consistent insulin-- To maximize therapy, when patient is ready, advance from carb counting to insulin-to-carb ratioPhysical activityRegular activity Regular activity Regular activity (30 minutes moderate activity; minimum 5 days a week)Weight managementWeight loss (5-7% body weight)Weight management(Prevent weight gain or aim for weight loss of 5-7% body weight)Weight management(Prevent weight gain or aim for weight loss of 5-7% body weight)

Insulin Resistance

Insulin Deficiency

-10

-5

0

5

10

15

20

25

30

-15

Pre-diabetes

Years

Normal

insulin level

Later type 2 diabetes

Early type 2 diabetes

* Carbohydrate is in a wide variety of foods including grains, beans, starchy vegetables, fruits, juices, milk, yogurt, snacks and desserts

Slide14

KEY MESSAGES FOR ALL PEOPLE W DB

Manage portion sizes to help meet carb prescription, weight loss, and maintenance

Carbohydrate-containing foods/beverages and endogenous insulin production=greatest determinant pp BG; need know which foods contain carbs—whole grains, starchy veg, non-starchy veg, fruits, milk & milk products, sweets/desserts

Choose nutrient dense, high fiber foods when possible vs processed foods without added sodium, fat and sugars

Slide15

KEY MESSAGES ALL PEOPLE WITH DB CONT

Avoid sugar sweetened beverages,

ie

soda pop, sweet tea, juices, punches

Select leaner protein sources and meat alternatives

Limit alcohol to one drink/day for women, two drinks or less for adult men

Add 30 minutes of physical activity each day

Slide16

NUTRITION THERAPY PRINCIPLESFOR T1D AND INSULIN-REQUIRING T2D

Learn how to count carbohydrates to be able to “match” mealtime insulin to carbohydrate consumed

If on multiple daily injections (MDI) or pump:

Take mealtime insulin before eating

Meals can be consumed +/- 1 hour usual eating time

If do PA within 1-2

hrs

of mealtime insulin injection, dose may be decreased to decrease risk hypo

Slide17

NUTRITION THERAPY PRINCIPLES FOR T1D AND INSULIN-REQUIRING T2 D CONT

If on a premixed insulin plan:

Insulin needs be taken before eating

Meals need be eaten at similar times each day

Do not skip meals to reduce risk of hypoglycemia

Physical activity may result in hypo, depending on when performed; always carry quick-acting carbohydrate to reduce risk of hypoglycemia

If on a fixed insulin plan:

Eat similar amounts of carbohydrate each day to match set insulin doses

Slide18

NUTRITION THERAPY PRINCIPLES FOR T2D

Avoid excess intake of carbs at any one time; aim for consistent intake of carbs at similar times each day; use SBGM to evaluate distribution carbs

Limit saturated fat and trans fatty acids, cholesterol.

Avoid excess intake of sodium

If overweight or obese, modify calorie intake, using portion control & other strategies

Increase physical activity to reach 30 min 5 days/

wk

Monitor BG to determine whether food adjustments sufficient, or if medications need be added

Add and advanced diabetes medications, as needed

Slide19

Healthy Eating

http://www.ndep.nih.gov/diabetes/MealPlanner/pyramid.htm

Manage GlucoseTiming of meals 1. Eat at least 3 times daily 2. Be consistent 3. Do not skip meals 4. Eat breakfastHow much food 1. Smaller portions 2. Small plate 3. One serving 4. Eat slowly 5. Bad foods out of site 6. Gradually cut down sizeWhat type of food 1. Reduce amount of carbs 2. Increase fiber

Slide20

Carb (CHO) Counting: ~15 g carb = 1 Carb choice

Slide21

For detailed list of “carb” exchanges, see 

Now published as: Choose Your Foods: Exchange Lists for DiabetesPublished by the Academy of Nutritionand Dietetics and theAmerican Diabetes Association

Slide22

DIABETES MEAL PLANNING TOPICS

What is healthy eating—how to create the plate

Food groups--# servings recommended/day

Reading nutrition facts label—focus on serving size

Estimating/checking portion sizes

Carbohydrate consistency/carbohydrate counting

Calorie counting/weight loss strategies

Understanding dietary fats

Eating away from home

Recipe modifications

Sick days

Special occasions/holidays

Slide23

MNT AND MEDICATIONS MUST BE WELL MATCHED TO PHYSIOLOGY OF DB

PWD can eat their way thru any pills/meds we give them

Medication adherence overestimated; barriers include side effects, lack perceived effectiveness, cost, misunderstanding how take correctly

Use BG monitoring to see effects food and activity/sitting

Slide24

SUMMARY

Diabetes care in U.S. remains challenge

Referring PWD for both DSMT and MNT first step

Using multidisciplinary team approach recommended

PWD need ongoing support to manage daily self-care behaviors

Slide25


About DocSlides
DocSlides allows users to easily upload and share presentations, PDF documents, and images.Share your documents with the world , watch,share and upload any time you want. How can you benefit from using DocSlides? DocSlides consists documents from individuals and organizations on topics ranging from technology and business to travel, health, and education. Find and search for what interests you, and learn from people and more. You can also download DocSlides to read or reference later.
Youtube