O if ketones present contact health care team type 1

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Unformatted text preview: and Micro Nutrient Needs • same as general population • use DRI to estimate caloric needs • use AMDRs for macronutrients o some extra considerations for CHO and fat • use the EARs, RDAs, AIs, and ULs for micronutrients Carbohydrate vs Fat • AMDR recommendation: 45- 60% of kcal carbohydrate • is more carbohydrate, or more protein and fat better? • more CHO higher blood sugars? • more fat more blood lipids? (more cardiovascular complications) • if the fats are healthy, higher fats can work (ie. fatty fish) • if the CHO is healthy, higher CHO can work (ie. high fibre) • comes down to choice – what would work better for client? what is easier for client? Glycemic Index and Glycemic Load • GI is a measure of carbohydrate quality • classifies dietary carbohydrates based on glycemic response • low GI foods result in more stable postprandial blood glucose levels • glycemic load takes into account quality and quantity of carbohydrate • separates foods by how high a spike they cause in blood glucose levels • glycemic load – takes into account quantity of CHO higher load puts larger strain on beta cells (or requires more insulin) • low GI foods tend to have high fibre, minimal processing Glycemic Index • benefits o better glycemic control • barriers o complicated o look up all CHO foods o not easy to explain to patients o only appropriate for highly motivated patients only clients who are well controlled and motivated to do better o healthy eating with Just the Basics may be easier for many patients to understand Fibre • viscous (soluble) vs insoluble • both will: o slow digestion and absorption of CHO (high fibre foods are usually low GI foods) o increase satiety o decrease energy density • cereal fibre (mostly insoluble) may lower blood lipid levels, prevent cardiovascular disease • recommendations: 25g/day, more may be beneficial Sugar, Sugar Alcohol and Sweeteners • sucrose up to 10% of total energy • fructose (a low GI sugar) up to 60g/day (included in 10% of total energy from sucrose) o not easily converted to glucose o often converted to fat • sugar alcohols (sorbitol) o low calorie sweetener o 10g/day GI symptoms, can cause stomach upset o subtract half of amount when CHO counting • artificial sweeteners o unnecessary o some safety concerns in pregnancy (don’t know effects) o may make dietary change easier o may make “other foods” easier to fit into CHO goals Fat • 20- 35% of total energy • additional recommendations o <7% saturated fat – prevent high LDL- C levels o <10% PUFA rich in omega- 3 PUFA (especially fatty fish) o focus on MUFA – 10- 15% - decreases TG • heart healthy fats to decrease risk of cardiovascular disease • minimal trans fat Blood Lipids in Diabetes • high triglyceride levels can be caused by: o poor glucose control o high starch and sugar intakes o high alcohol intake • low HDL- cholesterol levels can be caused by: o poor glucose control • many people with diabetes also have high total cholesterol (TC) and high LDL- cholesterol levels • especially as people get older – concern for blood lipid levels • people who are diagnosed with type 1 when they are young may develop high blood lipid levels as they get older Blood Pressure and Diabetes • many people with diabetes have high blood pressure • address by eating a healthy diet (according to EWCFG) and reduce sodium Alcohol and Diabetes • recommendation – consistent with population (1- 2 drinks max per day) • extra considerations o may cause hypoglycemia, especially if fasted or with type 1 DM alcohol interferes with the body’s response to glucagon • blocks gluconeogenesis can occur up to 24 hours after drinking o may increase risk of macro and microvascular complications may be due to fact that alcohol increase triglyceride levels Beyond the Basics • a tool dietitians use to estimate kcal and macronutrient content of foods • tool dietitians use to plan diets for patients o diabetes o obesity • tool dietitians teach patients so they can manage/monitor their diets Beyond the Basics – Exchanges • tells you how many grams of CHO, protein, and fat in 1 serving of food (one exchange) •...
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