1800 Calorie ADA Diet No Longer Used:
Staff In-service
Use
A registered dietitian should deliver this in-service to medical staff (nurses, physician
assistants, and nursing assistants). The presenter should include samples of incorrect diet
orders and explain how to correct the orders.
Note to presenter: You may need or want to alter this in-service to meet your specific
facility’s needs.
Introduction
In 1995, the American Diabetes Association® changed its recommendations for diabetes
management. Among the sweeping changes made was the individualization of the diet
for diabetes management. Recommendations included focusing on maintaining a healthy
weight and monitoring blood sugar and blood lipids. Changes also included doing away
with the term “ADA diet” and no longer using specific calorie levels for diet
prescriptions, especially in institutional settings.
Instead of the ADA diets, most health care facilities now use consistent carbohydrate
diets. However, many health professionals and institutions continue to order ADA diets
and are slow to adopt this change.
Quick readings
American Diabetes Association. Nutrition recommendations and interventions for
diabetes. a position statement of the American Diabetes Association. Diabetes Care
[serial online]. 2007;30(suppl 1):S48-S65. Available at:
http://care.diabetesjournals.org/cgi/content/full/30/suppl_1/S48. Accessed July 30, 2012.
American Diabetes Association. Standards of medical care in diabetes—2012. Diabetes
Care [serial online]. 2012;35(suppl 1):S11-S63. Available at:
http://care.diabetesjournals.org/content/35/Supplement_1/S11.full. Accessed July 30,
2012.
Objectives
Following the in-service, staff will know:
 How nutrition guidelines for diabetes have changed in the past decade
 The basic nutrition recommendations
 What diets are available to prescribe for patients with diabetes in their facility
Outline
I.
Where did the 1800 Calorie ADA diet go?
a. In 1995, the American Diabetes Association and American Dietetic Association
(now known as the Academy of Nutrition and Dietetics) developed a new set of
diabetes guidelines, indicating the individualization of diabetes management
b.
c.
d.
e.
f.
based on medical needs and likeliness of a patient to change habits to manage
diabetes
These guidelines recognized that managing diabetes is more than just controlling
sugar in the diet
Among the recommendations were guidelines for blood lipid management to help
reduce risk of heart disease
The guidelines also stated that a person with diabetes can include simple sugars
(cake, candy, pie, cookies, etc) as part of a healthy diet and that doing so may
improve the likelihood of compliance to dietary restrictions
According to the 1995 guidelines and those released every year since, it is no
longer appropriate to use the term ADA diet
Since 1995, these guidelines were re-released every year with minor changes
II. Why did the American Diabetes Association make these changes?
a. The American Diabetes Association sets guidelines based on research and clinical
practice based on scientific research; when the research indicates changes are
needed, the guidelines change accordingly
III. What are the current nutrition guidelines for diabetes?
a. These vary depending on whether you are preventing diabetes or treating diabetes,
and whether you are treating type 1 or type 2 diabetes
b. Clinical practice guidelines encourage patients to:
– Achieve and maintain blood glucose levels in the normal range or as close to
normal as possible
– Achieve and maintain a lipid and lipoprotein level that reduces the risk for
cardiovascular disease
– Achieve or maintain blood pressure levels in the normal range or as close to
normal as possible
IV. What is necessary to achieve these goals?
a. Follow the basic nutrition guidelines for carbohydrate, protein, and fat
consumption
b. Substitute sucrose-containing foods for other carbohydrates in the meal plan or
cover with insulin or other medication:
– Limit these foods, because they contain few nutrients
– Include these foods or drinks occasionally to help patients have a more healthy
diet overall
c. Include fruits, vegetables, whole grains, legumes, and low-fat milk, which are
healthy carbohydrate sources
d. Monitor carbohydrate intake, which is a key strategy in achieving glycemic
control
e. Individualize medical nutrition therapy when possible, taking individual
nutritional needs, cultural preferences, and willingness to change into account
f. Use sugar substitutes to sweeten foods and beverages and to provide more variety
in the diet
V. What diets for diabetes are used in acute or long-term care facilities?
a. Acute care facilities should use some form of consistent carbohydrate diet (ie,
provide the same number of carbohydrate exchanges meal to meal or day to day)
b. Long-term care facilities should use regular diets for most patients with diabetes:
– No evidence supports use of no concentrated sweets diets in long-term care
c. If certain patients in long-term care or rehab units require nutrition intervention, a
low concentrated sweets or no concentrated sweets diet sometimes is appropriate
IV. How should medical staff handle diet orders for ADA diets?
a. When a resident receives as order for an ADA diet, the medical staff should
convert it to a house diet that corresponds to the patient’s medical needs
b. Clarify existing diet orders, if necessary, to discontinue ADA diets
c. Educate fellow staff members about the inappropriate use of ADA diets
V. How should the dietary staff handle orders for ADA diets?
a. Develop a house policy on use of the terminology “ADA diets”
b. Assure that diets that are ordered by policy correspond to the menu extensions
provided with facility menus
c. When a diet order is received by the Dietary Department for an ADA diet, return
it for clarification
d. Provide a consistent carbohydrate diet as the regular diet
Activity
Provide medical staff with the following case study:
Mrs Smith was admitted to Sky Blue Long-term Care from the hospital with a 1800 ADA
diet order. Her diagnoses include diabetes mellitus and hypertension. She takes insulin.
How would you convert Mrs Smith’s diet order to a house diet?
Answer to case study
Answer will vary depending on your facility policy. However, even for those taking
insulin, a regular diet is appropriate for a long-term care patient.
1800 Calorie ADA Diet No Longer Used
Name: ___________________________________________
Date: ____________________________________________
Department: ______________________________________
1. True or false: The use of ADA diets is considered appropriate by the American
Diabetes Association.
2. The best diet for a patient with diabetes in an acute care facility is:
a. 2000 calorie ADA diet
b. Consistent carbohydrate diet
c. No concentrated sweets diet
d. None of the above
3. The American Diabetes Association’s treatment guidelines for diabetes include:
a. Achieve and maintain blood glucose levels in the normal range or as close to
normal as possible
b. Achieve and maintain a lipid and lipoprotein level that reduces the risk for
cardiovascular disease
c. Both a. and b.
d. None of the above
4. True or false: Diet orders in the facility should agree with the diets that are written on
the menu.
5. Which statement is true about foods containing sugar for patients with diabetes:
a. Individuals with diabetes should not eat or drink foods/beverages with sugar in
them
b. You can include sugar-containing foods in the diet of a person with diabetes
c. People with diabetes can eat foods with sugar, but cannot drink soda or other
sweetened beverages
d. Both a. and b.
Answer key
1.
2.
3.
4.
5.
False
b. Consistent carbohydrate diet
c. Both a. and b.
True
b. You can include sugar-containing foods in the diet of a person with diabetes
Review Date 7/12
D-0633