Nutrition
Recommendations for
Diabetes Mellitus
Northeastern University
Table of Contents
Objectives
Medical Nutrition Therapy
Nutrient Distribution
Carbohydrates
Meal Planning
Healthy Eating Plate
References
Objectives
Inform health care providers of effective nutrition
recommendations for diabetic patients
Provide guidelines for serving sizes and meal content
Present sources of quality carbohydrates, fats, and
proteins
Use knowledge to create a basic nutrition outline for
patients
Medical Nutrition Therapy
(MNT)
Goals
Translate data and pertinent evidence into nutrition care
Develop healthy eating habits and lifestyle changes
Achieve normal levels of:
Blood glucose
Blood pressure
Lipids and lipoproteins
Prevent development of chronic complications
Meet individual nutritional requirements
Maintain pleasure of eating
Do not limit food choices
Medical Nutrition Therapy
(MNT)
Effectiveness
Reduction of HbA1c by 1-2%
Fasting plasma glucose level decreased by 50-100 mg/dL
Average weight loss of 5 kg after 3 months
Most effective when implemented early in the disease course
Still beneficial at any point during treatment
Greater impact on weight loss and metabolic control
compared to other interventions
Nutrient Distribution
Caloric intake: 50% carbohydrates, 30% fat, 20% protein
Percentages can be adjusted based on comorbidities
Patients with nephropathy should consume at most .8 g/kg in protein
Monitor lipid profiles of patients at risk for CVD and adjust accordingly
No evidence to show long term effectiveness of low-carb diets in diabetics
Very low-carb diets pose risk of ketosis
Micronutrient supplements are only advised for patients with a diagnosed
deficiency
Carbohydrates
Minimum of 130 g/day
Provides sufficient fuel for central
nervous system
Total carbohydrates in meals more
important than source
Added sugars should be less than
25% of total calories consumed
High soluble fiber diets beneficial
(>25 g/day)
Reduces postprandial glycemia
Lowers LDL cholesterol
Carbohydrates
1 Serving (15 g)
1 slice of bread or 1 tortilla
1/4 serving of medium french fries
1/2 cup of oatmeal
3/4 cup of unsweetened cereal
1/3 cup of pasta or rice
1/2 cup casserole
1/2 cup of beans, corn, potato
3 cups of popcorn
1/4 large baked potato
6 chicken nuggets
1 cup of soup
4-6 crackers
1 small fruit (apple)
3/4 oz. of chips
1/2 cup of ice cream
1/2 cup of canned or frozen fruit
2 inch square brownie or cake
1 cup of skim or 1% milk
2 small cookies
2/3 cup of plain fat-free yogurt
1 Tbsp. syrup, jelly, jam, honey
Meal Planning
Daily caloric intake deduced from patient
height, weight, and activity level
Usually around 1800-2000 kcal
Three meals per day with two snacks
Four servings of carbs per meal (60 g)
One serving of carbs per snack (15 g)
Consistent mealtimes
Each macronutrient should be
represented in every meal
Smaller portions to prevent weight gain
Cholesterol intake < 200 mg/day
Sodium intake < 2300 mg/ day
Meal Planning
Healthy Eating Plate
Suggested foods
Whole grains rather than enriched, white grains
Oats, whole wheat bread or pasta, popcorn
Quinoa, brown rice, whole grain cereal or crackers
Non-starchy vegetables
Negligible amount of carbs (~5 g per 2 servings)
Asparagus, green beans, broccoli, carrots, cauliflower
Spinach, lettuce, squash, tomatoes, mushrooms
High fiber foods
Fruits (with skin), whole wheat grains, vegetables
Legumes, nuts, seeds
Healthy Eating Plate
Fat/ Healthy Oils
Saturated fat intake should be <7% of total calories
All trans fatty acids should be eliminated
Trans fats shown to raise LDL and lower HDL levels
Foods high in Ω-3 polyunsaturated fatty acids encouraged
Fish, walnuts, soy, leafy greens
Foods prepared with unsaturated fatty acids rather than butter
Olive, sesame, peanut, canola oils
Foods with plant sterols should replace normal choices when possible
LDL lowering effects
Fortified spreads, yogurt, milk, dressings
Healthy Eating Plate
Healthy Protein
Poultry, lean pork, and fish
Negligible carbs and low in fat
Low amounts of red and
preserved meats
High in saturated fat and sodium
Plant sources
Soy, quinoa, legumes, nuts
Beverages
1% milk rather than skim
Gastric emptying delayed
Smaller spikes in blood sugar
3 L of water intake per day
Needed for high fiber diet
Moderate consumption of coffee and
tea okay
Non-sugar sweeteners
Still counts toward carb total
Alcohol use discouraged
Maximum one drink for female,
two for male
Always consume with food
References
Pastors J.G., Warshaw H., Daly A., Franz M., & Kulkarni K. (March 2002). The evidence for the effectiveness of
medical nutrition therapy in diabetes management. Diabetes Care, 25, 608–613. doi:
10.2337/diacare.
25.3.608
Franz M.J., Bantle J.P., Beebe C.A., Brunzell J.D., Chiasson J.L., Garg A., ... Wheeler M. (Janurary 2002).
Evidence-based nutrition principles and recommendations for the treatment and prevention of
diabetes and related complications. Diabetes Care, 25, 148–198. doi: 10.2337/diacare.25.1.148
American Diabetes Association. (2014). Carbohydrate Counting. Retrieved February 13, 2014, from
http://www.diabetes.org/food-and-fitness/food/what-can-i-eat/understanding-carbohydrates/
carbohydrate-counting.html
Food Insight. (2007, July 1). Functional Foods Fact Sheet: Plant Stanols and Sterols. Retrieved February 21, 2014,
from http://www.foodinsight.org/Resources/Detail.aspx?
topic=Functional_Foods_Fact_Sheet_Plant_Stanols_and_Sterols
Diabetes Care. (2008, January). Nutrition Recommendations and Interventions for Diabetes. Retrieved February
14, 2014, from http://care.diabetesjournals.org/content/31/Supplement_1/S61.full#ref-1
National Kidney Foundation, Inc. (2007). KDOQI Clinical Practice Guidelines and Clinical Practice
Recommendations for Diabetes and Chronic Kidney Disease. Retrieved February 14, 2014, from
http://www.kidney.org/professionals/kdoqi/guideline_diabetes/guide5.htm
[Healthy Eating Plate photograph]. (2014). The Nutrition Source. Retrieved February 15, 2014, from http://
www.hsph.harvard.edu/nutritionsource/
References
[Untitled photograph of a glucose molecule]. (n.d.). Retrieved February 13, 2014, from http://
lifefermented.wordpress.com/2013/06/11/diy-belgian-candy-syrup-1-sugar-science/
[Untitled photograph of a pancreas, stomach, and artery]. (n.d.). Retrieved February 13, 2014,
from http://healingisessential.com/tag/diabetes/
[Untitiled photograph of a triglyceride molecule]. (2006). Retrieved February 13, 2014, from
http://en.wikipedia.org/wiki/File:Trimyristin-3D-vdW.png
[Untitled photograph of body with healthy food]. (n.d.). Retrieved February 15, 2014, from
http://wanabfitnow.wordpress.com/2011/08/
[Untitled photograph of carbohydrate sources]. (n.d.). Retrieved February 13, 2014, from http://
www.macronutrients.net/carbohydrates/
[Untitled photograph of protein sources]. (n.d). Retrieved February 21, 2014, from http://
www.functionalfitmag.com/blog/2012/07/30/protein-foods-protein-powder-2/
[Untitled photograph of the DHRS7B protein]. (2012). Retrieved February 13, 2014, from http://
en.wikipedia.org/wiki/File:DHRS7B_homology_model.png
Reflective Letter
The audience I designed this document for is practicing physicians, mainly those who
treat patients with diabetes. The idea for this power point presentation came during a lecture in my
nutrition course. I assumed that all physicians knew the physiological mechanisms through which
diabetes occurs, but I wondered if they knew enough about nutrition to advise their patients on the
maintenance of the disease. Physicians will provide more balanced care if they were also able to give
nutritional advice.
This presentation provides physicians with guidelines for healthy foods, serving sizes,
and meal components. I know that most physicians do not have a lot of time to spend with each
patient. That is why I tried to make the presentation straightforward and concise, in order to relay
the most important facts quickly. I focused on listing foods in each category so anyone referencing
this presentation can also provide details regarding the makeup of a healthy diet. The information
will hopefully be easily internalized and transferred to patients. I hope this knowledge will be used to
facilitate healthier eating habits in diabetic patients.
This presentation may be encountered on a website which covers diabetes or nutritional
information, like the American Diabetes Association. I think it works well as a crash course in
nutrition; well rounded but not too complex. Since it is not a large file it is possible to download it or
send it in an email for future reference. Going along that idea, if one physician finds the presentation
useful then he can easily spread it to his peers. Individual slides might be printed off for reference
within a clinic like the serving size list.
Overall I think this presentation will go well in my professional portfolio. It shows range in my
ability to work with different genres and audiences.