DIET PLANNING FOR

DISEASES
BY NIMTAZ WALJI
MA-Education, Health Promotion and International Development
BSc (Med) (Hons) Nutrition & Dietetics
BSc Human Biosciences (Physiology & Psychology majors)

17/04/2023- 20/04/2023 NIMTAZ WALJI UDOM

 TYPE 1 DM
Primary B-cell destruction leading to insulin deficiency

Immune mediated diabetes mellitus and idiopathic diabetes mellitus

Often present with hyperglycemia, excess thirst (polydipsia), frequent urination (polyuria),
significant weight loss, dehydration, electrolyte disturbance, ketoacidosis

Onset is often sudden preceded by an asymptomatic period. why?

Dependant on exogenous insulin. Why?

Most diagnoses before age of 30yrs but can occur even in older age

Peak incidence around 10-12yrs in girls and 12-14yrs in boys

Insulin injections vs pump

Risk factors- genetic, autoimmune and environmental

More common in African and Asian origin

Honeymoon phase after diagnosis?

Challenges anticipated with type 1 DM?

Mahan & Escott-Stump, 2008
 TYPE 1 DM
DIAGNOSIS
What differentiates a type 1 diabetes mellitus diagnosis from a type 2 diabetes
mellitus diagnosis?
 TYPE 1 DM
DIAGNOSIS
Stage 1 Stage 2 Stage 3

Multiple autoantibodies

Dysglycemia: IFG and/or IGT

Multiple FPG 100–125 mg/dL (5.6–6.9 Clinical symptoms

autoantibodies mmol/L)
Diabetes by standard
No IGT or IFG 2-h PG 140–199 mg/dL (7.8–11.0 criteria
mmol/L)

A1C 5.7–6.4% (39–47 mmol/mol)

or ≥10% increase in A1C

Standards of Medical Care in Diabetes, ADA position statement 2020

 TYPE 1 DM
DIET PLANNING
Main goal- matching insulin regime to meal pattern

Is it necessary to have fixed eating schedules?

Eating schedule depends on insulin regimen

Usually a fixed basal of long acting + a split bolus dose of short acting with meals but
sometimes also a fixed dosage

Advantages of a flexible insulin schedule:

• Can adjust into their eating habits and physical activity schedule
• Allows flexibility on when and what to eat
Major determinant of rapid insulin is total carbohydrate per meal *but also affected by other
food groups like protein and fat

Those with fixed insulin- will need day to day consistency in timing and carbohydrate
amounts
Mahan & Escott-Stump, 2008
ISPAD CLINICAL PRACTICE CONSENSUS GUIDELINES, 2018
 TYPE 1 DM
DIET PLANNING
Select appropriate meal planning approach

• Carbohydrate counting- allows glycemic control as well as provides more choices of

preference

• Other approaches?
Can we incorporate sugar? If yes, how much? What are some challenges of not
incorporating sugar?

10% of total energy intake

Which other dietary guidelines need to be incorporated?

CVD diet guidelines? *higher risk of CVD than their age and sex matched youth

Mahan & Escott-Stump, 2008

ISPAD CLINICAL PRACTICE CONSENSUS GUIDELINES, 2018
 TYPE 1 DM
EXERCISE
Physical activity is recommended for all youth with type 1 diabetes with the goal of

60 min of moderate- to vigorous-intensity aerobic activity daily

with vigorous muscle-strengthening and bone-strengthening activities at least 3 days

per week

Positive impact of metabolic and psychological health and helps with weight
management

Frequent glucose monitoring before, during and after exercise and appropriate
adjustments insulin and dietary intake is CRUCIAL

Dependant on type and intensity of exercise

Important to educate youth as well as parents/caregivers

Standards of Medical Care in Diabetes, ADA position statement 2022

 TYPE 1 DIABETES
MONITORING
Monitoring blood glucose- 6-10times/day

*Including prior to meals and snacks, at bedtime, and as needed for safety in specific
situations such as exercise, driving, or the presence of symptoms of hypoglycemia

Pay attention with weight trends. Why?

Can affect glycemic, blood pressure, lipids, general health

Therefore preventing excess weight gain is desirable. Only aim for normal growth
and development requirements.

Mahan & Escott-Stump, 2008

 DIABETES IN ADOLESCENTS
When planning diets, bear in mind:
growth and development requirements
appropriate BMI-for-age. How is this determined?
as well as issues relating to metabolic control (puberty, growth hormones)
puberty- emotional and social challenges; physiological challenges
school/college schedules, sport, work etc
insulin doses change with changing weight
higher insulin demands during pubertal growth then lower again

Other important considerations:

higher than average incidence of eating disorders in adolescents with diabetes
education needs to be expanded towards the whole care team
involvement of physician/paediatrician, dietician, nurse, behaviour specialist
importance of practical, emotional and moral support
children and adolescents who have had diabetes for > 5 years should be routinely and regularly screened for signs of
early nephropathy, retinopathy, neuropathy, dyslipidemia and hypertension, starting at age 12 years, as such diabetic
complications can occur at a young age.
Mahan & Escott-Stump, 2008
ISPAD CLINICAL PRACTICE CONSENSUS GUIDELINES, 2018
 DIABETES IN ADOLESCENTS
GLYCEMIC TARGETS
Diabetes Canada Clinical
American Diabetes Association
Practice Guidelines
position statement 2022
(2018)

≤ 7 (most children)
*less stringent guidelines of 7.5-8%
HbA1c (%) ≤ 7.5 to prevent hypoglycaemia
*<than 6.5% if can be achieved
without significant hypoglycaemia

Fasting Blood Glucose CGM are recommended to be

4-8 used in conjunction with A1c levels
(mmol/L)
where possible (% below target,
Random Blood within target and above target)
5-10
Glucose (mmmol/L)

*adjust targets to prevent

*individualised and reassessed
episodes of severe
over time
hypoglycaemia
 DIABETES IN ADOLESCENTS
ISPAD CLINICAL PRACTICE CONSENSUS GUIDELINES, 2018
Main goals:

Maintenance of normal growth and development, maintenance of body weight, preventing acute and chronic

complications

Important considerations for nutritional advice- cultural, ethnic and family traditions, as well as the cognitive

and psycho- social circumstances of the child/adolescent and family

The optimal macronutrient distribution varies depending on an individualised assessment of the young person

Matching of insulin dose to carbohydrate intake on intensive insulin regimens allows greater flexibility in

carbohydrate intake and meal times, with improvements in glycemic control and quality of life.

Mealtime routines and dietary quality are important for optimal glycemic outcomes

Carbohydrate counting is best introduced at onset of type 1 diabetes

Preprandial insulin dosing should be encouraged from diabetes onset for children of all ages

Fixed insulin regimens require consistency in carbohydrate amount and timing to improve glycemic control and

reduce the risk of hypoglycemia

The use of the glycemic index provides additional benefit to glycemic control over that observed when total

carbohydrate is considered alone

Dietary fat and protein impact early and delayed postprandial glycemia
 DIABETES IN ADOLESCENTS
ISPAD CLINICAL PRACTICE CONSENSUS GUIDELINES, 2018
Prevention of overweight and obesity in pediatric type 1 diabetes is a key strategy of care and should involve a
family based approach.
Repeated episodes of diabetic ketoacidosis or worsening glycemic control may be a sign of disordered eating
Nutritional advice should be provided on how to successfully manage both regular and unanticipated physical
activity; and how to meet individual goals in competitive sports .
Nutritional management of type 2 diabetes requires a family and community approach to address the
fundamental problems of excessive weight gain, lack of physical activity and the increased risks of
cardiovascular disease.
To enable appropriate matching of carbohydrate intake to the insulin profile, carbohydrate may be measured
in grams, portions or exchanges. A variety of educational tools are available in many countries to assist health
professionals and families understand healthy eating concepts (such as the healthy plate model) and to enable
carbohydrate quantification.
Prevention and management of hypoglycemia, particularly during and after exercise should be discussed.
Drinks high in sugar and foods with high amounts of saturated fat should be generally avoided.
If financial constraints make food scare or erratic, this is an added burden that should be discussed openly and
potential solutions identified.
 TYPE 1 DIABETES IN ADOLESCENTS
DIET PLANNING
Nutrition assessment
Initial goal may be to restore and maintain appropriate body weight (4-6weeks)
Nutrient requirements similar to children without diabetes aimed at improving diabetes
outcomes and reducing cardiovascular risk
Hence can use DRI/RDA (Institute of Medicine, 2002)
However, preferable to use diet history considering growth and development are at par
Energy requirements depend on:
Age, physical activity, growth rate, evaluation of height, weight, BMI
Therefore review yearly (minimum)
In most practical cases, more often
Avoid:
Withholding food
Making patient eat without an appetite
Mahan & Escott-Stump, 2008
 TYPE 2 DIABETES IN ADOLESCENTS
DIET PLANNING
Highly prevalent in obese youth
Follows a similar progressive pattern as in adult
Focus on

• Preventing EXCESS weight gain

• Promotion of normal growth and development
• Blood glucose and A1c control
• Nutrition assessment
Energy needs to match age, growth rate, energy expenditure etc
Also address co-morbidities
Studies have shown poor compliance to meeting dietary recommendations
Role of behaviour modification therapy for improving dietary habits?
Multivitamin with DRI of chromium, magnesium, zinc, vitamin D may be warranted
Mahan & Escott-Stump, 2008
 DIABETES IN ADOLESCENTS
ISPAD Clinical Practice Consensus Guidelines 2018
Nutritional management in children and adolescents with diabetes
*previously used 2006 version

Total daily energy intake should be distributed as follows:

Carbohydrate 45-50%
Moderate sucrose intake (up to 10% total energy)
Fat <35%
<10% saturated fat and trans fatty acids
<10% polyunsaturated fat
>10% monounsaturated fat (up to 20% total energy)
ω-3 fatty acids (cis configuration): 0.15 g/d.
Protein 15-20%
Fibre: Target in grams – for children above 1 yr, an amount of ~ 13 g/1000kCal
Alternatively, for children above 2 yr, age in years + 5 = grams of fiber per day
Salt: < 6 g/d

NOTE- all macronutrient distributions are guides only, adjust according to patients individualised
needs- metabolic control, patient previous diet history, dietary preferences etc
 DIABETES IN ADOLESCENTS
How to monitor the diabetic goals of growth and development, maintenance of body
weight
Growth charts
Some causes of poor weight gain:
Poor glycemic control
Inadequate insulin
Over-restriction of calories
Other: thyroid abnormalities and malabsorption
Causes of excess weight gain:
Excessive caloric intake
Over-treating hypoglycaemia
Over insulinization
Other: low physical activity, hypothyroidism
Mahan & Escott-Stump, 2008
 ADDITIONAL READING
https://diabetesjournals.org/care/article/45/Supplement_1/S208/138922/14-
Children-and-Adolescents-Standards-of-Medical

Analyse and compare with ISPAD 2018 guidelines

 GESTATIONAL DIABETES
First onset during pregnancy
Usually diagnosed in 2nd or 3rd trimester
Risk for mother, fetus and neonate
Aim to normalise maternal glucose levels to avoid complications for the infant
90% become normoglycemic post delivery while 5-10% become type 2 DM
20-50% chance of becoming type 2 DM in 5-10 years

Mahan & Escott-Stump, 2008

 GESTATIONAL DIABETES
DIAGNOSIS
GDM diagnosis can be done with either of the 2 strategies
The “one-step” 75-g OGTT derived from the IADPSG criteria, or
The older “two-step” approach with a 50-g (nonfasting) screen followed by a 100g
OGTT for those who screen positive
Read on the updated screening criteria for GDM and evaluate how this has changed
over the last 10-12 years. Why?

Standards of Medical Care in Diabetes, ADA position statement 2022

 GESTATIONAL DIABETES
DIAGNOSIS
One step strategy

Perform a 75-g OGTT, with plasma glucose measurement when patient is fasting and at 1 and 2 h, at 24–28 weeks
of gestation in women not previously diagnosed with diabetes.

The OGTT should be performed in the morning after an overnight fast of at least 8 h.
The diagnosis of GDM is made when any of the following plasma glucose values are met or exceeded:
Fasting: 92 mg/dL (5.1 mmol/L)
1 h: 180 mg/dL (10.0 mmol/L)
2 h: 153 mg/dL (8.5 mmol/L)

Two step strategy

Step 1: Perform a 50-g GLT (nonfasting), with plasma glucose measurement at 1 h, at 24–28 weeks of gestation in
women not previously diagnosed with diabetes.
If the plasma glucose level measured 1 h after the load is ≥130, 135, or 140 mg/dL (7.2, 7.5, or 7.8 mmol/L,
respectively), proceed to a 100-g OGTT. If ≥200mg/dL- diagnosed and no need for further testing.

Step 2: The 100-g OGTT should be performed when the patient is fasting.
The diagnosis of GDM is made when at least two* of the following four plasma glucose levels (measured fasting
and at 1, 2, and 3 h during OGTT) are met or exceeded (Carpenter-Coustan criteria [244]):
Fasting: 95 mg/dL (5.3 mmol/L)
1 h: 180 mg/dL (10.0 mmol/L)
2 h: 155 mg/dL (8.6 mmol/L)
3 h: 140 mg/dL (7.8 mmol/L)
Standards of Medical Care in Diabetes, ADA position statement 2022
 GUIDELINES FOR WEIGHT GAIN IN PREGNANCY
Institute of Medicine released these guidelines for weight gain during pregnancy in 2009
WEIGHT Prepregnancy BMI Total weight gain 1st Trimester gain 2nd and 3rd Trimester

weekly gain
Underweight < 18.5 12.7 - 18 kg Calculations assume a 0.45 (0.45-0.59) kg
Normal weight 18.5 – 24.9 11.4 - 15.9 kg 0.5–2 kg weight gain in 0.45 (0.36-0.45) kg

the first trimester (based

on Siega-Riz et al., 1994;

Abrams et al., 1995;

Carmichael et al., 1997)

Overweight 25 – 29.9 6.8 - 11.4 kg 0.27 (0.22-0.32) kg
Obese > 30 5 - 9 kg 0.22 (0.18-0.27) kg
Twin pregnancies

WEIGHT Prepregnancy BMI Total weight gain

*Underweight < 18.5 22.6 - 28.1 kg *adapted from a different reference source
Normal weight 18.5 – 24.9 16.8 - 24.5kg

Overweight 25 – 29.9 14 - 22.7kg

Obese > 30 11.4 - 19kg
 GESTATIONAL DIABETES
NUTRITIONAL NEEDS
General Recommendation Carbohydrate-Specific
Organization Reference
for GDM Recommendations

Caloric intake should be

calculated based on pre-
Carbohydrate intake
pregnancy BMI and
should be limited to 35%–
desirable weight gain;
45% of total calories, with M. Hod et al./International
International Federation Caloric intake may be
a minimum of 175 g CHO Journal of Gynecology and
of Gynecology and reduced by 30%, but not
per day, distributed in Obstetrics 131 S3 (2015)
Obstetrics below 1600−1800 kcal/d;
three small-to-moderate S173–S211
for women with diabetic
sized meals and 2−4
nephropathy, protein may
snacks.
be lowered to 0.6−0.8 g/kg
ideal body weight.

Medical nutrition therapy

is recommended for all Carbohydrate should be
Blumer I., Hadar E., Haddan
pregnant women with limited to 35% to 45% of
DR., et al., Diabetes and
overt or gestational total calories, distributed
Pregnancy: An Endocrine
Endocrine Society diabetes to help achieve in 3 small-to-moderate-
Society Clinical Practice
and maintain desired sized meals and 2 to 4
Guideline. J Clin Endo
glycemic control while snacks including an
Metab 2013:98:4227–4249.
providing essential evening snack
nutrient requirements.
Mustad et al., 2020
 GESTATIONAL DIABETES
NUTRITIONAL NEEDS
General Recommendation Carbohydrate-Specific
Organization Reference
for GDM Recommendations

Complex CHO are

recommended over simple Obstetrics & Gynecology.
Eat regular meals CHO because they are 131(2):e49–e64, FEBRUARY
American College of throughout the day; three digested more slowly, are 2018 OI: 10.1097/
Obstetrics and meals and two–three less likely to produce AOG.0000000000002501
Gynecologists snacks per day. Gain significant postprandial PMID: 29370047 Issn Print:
healthy amount of weight. hyperglycemia, and 0029–7844 Publication
potentially reduce insulin Date: February 2018
resistance.

NICE National Institute for

Health and Care Excellence
Advise women to eat a Guideline. Diabetes in
National Institute for
healthy diet during Foods with a low glycemic pregnancy: Management
Health and Care
pregnancy, refer all women index should replace those from preconception to the
Excellence (NICE)
with gestational diabetes with a high glycemic index. postnatal period.
guidelines
to a dietitian. Published: 25 February
2015 www.nice.org.uk/
guidance/ng3

Mustad et al., 2020

 GESTATIONAL DIABETES
NUTRITIONAL NEEDS
General Carbohydrate-Specific
Organization Reference
Recommendation for Recommendations
GDM Feig DS, Berger H., Donovan L.,
et al., Diabetes and Pregnancy.
Women should consume a Diabetes Canada 2018. Clinical
minimum of 175 g/day of CHO, Practice Guidelines for the
Meal planning for women
distributed over 3 moderate-sized Prevention and Management of
with GDM should
Diabetes Canada meals and 2 or more snacks (1 of Diabetes in Canada:
emphasize a healthy diet
which should be at bedtime), Pharmacologic Glycemic
during pregnancy.
replacing high-GI foods with low- Management of Type 2
GI ones. Diabetes in Adults. Can J
Diabetes 2018;42(Suppl
1):S255–S282.
All pregnant women should eat a
A registered dietitian Duarte Gardea et al., Academy
minimum of 157 g CHO and 28 g
nutritionist (or of Nutrition and Dietetics
fiber. The amount and type of
international equivalent) Gestational Diabetes Evidence-
CHO should be individualized
American should provide Medical Based Nutrition Practice
based on nutrition assessment,
Academy of Nutrition Therapy that Guideline Journal of the
treatment goals, blood glucose
Nutrition and includes an individual Academy of Nutrition and
response and patient needs.
Dietetics nutrition prescription Dietetics. September 2018
Three meals and 2 or more snacks
and nutrition counseling Volume 118, Issue 9, Pages
helps to distribute CHO intake
for all women diagnosed 1719–1742. https://doi.org/
and reduce postprandial blood
with GDM. 10.1016/j.jand.2018.03.014
glucose elevations.
Mustad et al., 2020
 GESTATIONAL DIABETES
NUTRITIONAL NEEDS

General Recommendation Carbohydrate-Specific

Organization Reference
for GDM Recommendations

American Diabetes
All pregnant women should
Association. 14.
eat a minimum of 175 g
The food plan should be Management of Diabetes in
total CHO and 28 g fiber.
based on a nutrition Pregnancy: Standards of
American Diabetes For women with GDM, the
assessment with guidance Medical Care in Diabetes.
Association amount and type of CHO
from the Dietary Reference 2019 Diabetes Care
will impact glucose levels,
Intakes. 2019;42(Suppl. 1): S165–
especially post-meal
S172|https://doi.org/
excursions.
10.2337/dc19-S014

Mustad et al., 2020

 GESTATIONAL DIABETES
NUTRITIONAL NEEDS SUMMARY
Medical nutrition therapy is recommended for all women with GDM
Individualised nutrition prescription and counselling
Meal plan based on nutrition assessment with reference to DRIs
Gain healthy amount of weight
ADA recommends a 30% calorie restriction to reduce hyperglycemia and without ketonemia and to reduce
rate of maternal weight gain.
Minimum of 1600-1800kcal
Weight loss is not recommended
Overall healthy diet
Eat regular meals
3 meals plus 2 or more snacks (2 – 3 hour intervals)
35-45% carbohydrate, minimum 175g/day, 28g fiber
Amount and type of carbohydrate to be individualised based on nutrition assessment, goals, blood glucose
response, needs
Complex carbohydrates recommended over simple carbohydrates
Replace high GI foods with low GI ones
Provide a lower carbohydrate breakfast (15-30g or 1-2 starches)
Divide the remaining CHO evenly through rest of the day
Evening snack usually needed to prevent accelerated ketosis overnight (2 starches required)
 GESTATIONAL DIABETES
DIET PLANNING
Goals-

• Optimal nutrition for maternal and child health

• Adequate energy for appropriate weight gain

• Achievement and maintenance of normoglycemia

• Preventing ketosis
Individualised meal plan designed based on

• Blood glucose levels

• Fasting ketones

• Apetite

• Weight gain

• Other influencing factors: pregnancy symptoms

CHO controlled meal plan
Mahan & Escott-Stump, 2008
 GESTATIONAL DIABETES
CALCULATIONS
Previous Guidelines (Jovanovic-Peterson, 1991) suggested calculation of energy intake according
to the pre-pregancy BMI as per the table below, which is still used in certain centres:

Pre-pregnancy BMI Kcal/present pregnant

weight
<18.5 >35 kcal/kg
18.5 – 24.9 30 – 35 kcal/kg
25 – 29.9 20 – 30 kcal/kg
> 30 15 – 20 kcal/kg

Alternate methods for calculating energy requirements in pregnancy range from 20-35kCal/kg
pregravid IBW to 25-35kCal/kg present pregnant body weight, including for obese women
(Gabbe and Graves, 2003; Gunderson, 2004).
 GESTATIONAL DIABETES
CALCULATIONS
Composition:
35-45% complex high fibre CHO (but meet at least the DRI for pregnancy of 175g/day)

20 – 25% protein (or 1.3 g/kg or DRI for pregnancy of 71g/day)

30 – 40% fat (mono – or polyunsaturated emphasised)

Important nutrients:
Calcium : 3 milk portions
Folate: emphasise good food sources
Iron: emphasise food sources and use supplement when needed
 GESTATIONAL DIABETES
OTHER
Encourage gentle exercise for weight management and glucose control (with
nutrition)
Brisk walk after meals often recommended
Breast feeding encouraged- can reduce post partum insulin requirements, improve
metabolic profile of the mother, may retard future onset of diabetes (McManus, 2001)

Mahan & Escott-Stump, 2008

 DIABETES
SHORT-TERM COMPLICATIONS
 HYPOGLYCEMIA
Hypoglycaemia meals BG of <3mmol/L (TZ NCD guideline, 2013); <70mg/dL or 3.9mmol/L (ADA)

May present as

• Feeling shaky

• Being nervous or anxious

• Sweating, chills and clamminess

• Irritability or impatience

• Confusion

• Fast heartbeat

• Feeling lightheaded or dizzy

• Hunger

• Nausea

• Color draining from the skin (pallor)

• Feeling sleepy

• Feeling weak or having no energy

• Blurred/impaired vision

• Tingling or numbness in the lips, tongue or cheeks

• Headaches

• Coordination problems, clumsiness

• Nightmares or crying out during sleep

• Seizures

It may lead to seizures, coma and very rarely death.

TZ NCD Guideline, 2013

 CAUSES OF HYPOGLYCEMIA
Eating less food than usual, skipping a meal, irregular eating

Eating a different meal than usual (e.g. a veg soup in place of a full dinner meal)

Weight loss (hence medication dose needs adjustment)

Taking a higher dose than prescribed (e.g. injecting more insulin)

Higher level of physical activity

Alcohol

TZ NCD Guideline, 2013

 MANAGING HYPOGLYCEMIA
Take 15g of CHO and repeat test after 15minutes, repeat these steps until it reaches
70mg/dL or 3.9mmol/L

Once normalised, eat a meal or snack

Foods/drinks that can be used

1/2 cup of juice or soda

1 tbs of sugar/honey

Candies- check labels

1 cup of milk
 HYPERGLYCEMIA
May present as

Frequent urination

Tiredness

Stomach pain, nausea, vomiting

Dry mouth

Blurry vision

Increased thirst

Dry itchy skin

Shortness of breath

Causes

Eaten too much or not the right type of food

Medication no longer enough

Forgotten to take medication

Low physical activity

Infection/illness
TZ NCD Guideline, 2013
 DIABETIC KETOACIDOSIS (DKA)
From hyperglycemia

Life threatening but reversible

If untreated can lead to comma or death

Acute illnesses such as colds, diarrhoea if managed inappropriately can lead to DKA

Severe disturbance in CHO, protein and fat metabolism

Caused by insufficient insulin - leads dependence on fat for energy - ketones are
formed

Acidosis- caused by excess production and less use of acetoacetic acid and 3-B-
hydroxybutyric acid from fatty acids

Ketones spill into urine (hence the ketone urine test)

Mahan & Escott-Stump, 2008
 DIABETIC KETOACIDOSIS
Characterised by

• Elevated blood glucose (>250mg/dl but <600mg/dl)

• Presence of ketones in the blood and urine

• Electrolyte imbalance

Symptoms

• Polyuria

• Polydipsia

• Hyperventilation

• Dehydration

• Fruity odor of ketones

• Fatigue

Treatment

• Supplemental insulin

• Fluid and electrolyte replacement

• Medical monitoring
Mahan & Escott-Stump, 2008
 LONG-TERM COMPLICATIONS
Macrovascular diseases - metabolic syndrome, CVD

Microvascular diseases - nephropathy, retinopathy, neuropathy

Mahan & Escott-Stump, 2008

 TUTORIAL 1- TYPE 1 DM
General history (including social
history)
Medical History
Anthropometry
Biochemistry
Clinical evaluation
Dietary history
Nutritional diagnosis
Set nutritional goals and
objectives
Calculate requirements
Using exchanges, convert to a
diet plan keeping diet hx in mind
Counselling
Follow up- monitoring and
evaluation
 Age, day to day activity, sport, living situation/environment
General history (including social
(with parents, boarding, food prep), ethnic/cultural
history)
background, smoking, alcohol, tobacco
Previous medical hx and admissions, family hx of type 1
Medical History diabetes, presenting signs and symptoms on admission,
hormonal issues, hx of eating disorders
Anthropometry Weight, height, BMI, weight hx (especially loss)
Lipid profile, blood sugars, protein urea, renal profile, other
Biochemistry
organs?
LOA, nausea, vomiting, lethargy, polydipsia, polyphagia,
Clinical evaluation
polyuria
Dietary history 24 hr recall (different scenarios), ff
Nutritional diagnosis e.g. Uncontrolled blood sugars

Set nutritional goals and objectives Growth and development, weight management, tight blood
glucose control
Calculate requirements DRI/RDA, diet hx, requirement for wt gain or loss
Using exchanges, convert to a diet TO MATCH INSULIN SCHEDULE
plan keeping diet hx in mind
Counselling
Follow up- monitoring and Growth and development, menstruation, weight, dietary
evaluation compliance, blood sugars
 TUTORIAL 2- TYPE 1 DM
A 16yr old girl of Indian origin was recently diagnosed with type 1 DM. She had presented with an episode of DKA. On
taking her history, it was discovered that she had lost 12% of her body weight in the last 6 months. Her diet hx showed
her intake to be 2000kcal/day with 70% used in form of carbohydrates (mostly refined). Her weight on presentation
was 54kg, height was 163.5cm

Analyse her anthropometric measures and advise on her growth pattern

Calculate her caloric requirements

What would be an ideal macronutrient distribution

 TUTORIAL 3- GESTATIONAL DIABETES
General history (including social
history)
Medical History
Anthropometry
Biochemistry
Clinical evaluation
Dietary history
Nutritional diagnosis
Set nutritional goals and
objectives
Calculate requirements
Using exchanges, convert to a
diet plan keeping diet hx in mind
Counselling
Follow up- monitoring and
evaluation
 TUTORIAL 4- GESTATIONAL DIABETES
Prepare a standard exchange table for the following caloric values using a
macronutrient distribution of 45% carbohydrates, 20% protein and 35% fat

kCal/kJ MILK (skim) STARCH MEAT FAT FRUIT VEG

1400/5900

1600/6700

1800/7600

2000/8400

2200/9200

2400/10000
 TUTORIAL 4- GESTATIONAL DIABETES
Prepare a standard exchange table for the following caloric values using a
macronutrient distribution of 45% carbohydrates, 20% protein and 35% fat

kCal/kJ MILK (skim) STARCH MEAT FAT FRUIT VEG

1400/5900 3 6 3 6 2 3

1600/6700 3 7 4 8 2 3

1800/7600 3 8 5 9 2 3

2000/8400 3 10 6 10 2 3

2200/9200 3 11 7 10 2 3

2400/10000 3 13 7 11 3 3
 REFERENCES
American Diabetes Association Professional Practice Committee; 2. Classification and Diagnosis of Diabetes:
Standards of Medical Care in Diabetes—2022. Diabetes Care 1 January 2022; 45 (Supplement_1): S17–S38. https://
doi.org/10.2337/dc22-S002

American Diabetes Association; Standards of Medical Care in Diabetes—2020 Abridged for Primary Care Providers.
Clin Diabetes 1 January 2020; 38 (1): 10–38. https://doi.org/10.2337/cd20-as01

Lifestyle and Non-communicable Diseases. Symptoms, Effects and Prevention. Education to the Community, 2014-
https://hssrc.tamisemi.go.tz/storage/app/uploads/public/5cf/a3d/8cd/5cfa3d8cd261b544310595.pdf

Mahan, L. K., Escott-Stump, S., & Krause, M. V. (2008). Krause's food & nutrition therapy. 12th ed. Philadelphia, Pa. ;
Edinburgh: Elsevier Saunders

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