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Diabetes - Dietary and Lifestyle Recommendations
Diabetes - Dietary Recommendations

Aims & Summary

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Aims

The aim is to provide information for people with diabetes to make appropriate choices on the type and quantity of food.

Nutritional management is the cornerstone of successful management of diabetes. If the diet (and lifestyle) is not optimised then any amount of insulin or tablets will not achieve optimal control.

Goals of Nutritional Advice

Maintain or improve health and quality of life through the use of appropriate healthy food choices and through managing body weight.

Optimise glycaemic control reducing the risk of micro-vascular disease and hypoglycaemia

Reduce risks of macrovascular disease, including management of:

 

body weight

 

dyslipidaemia

 

hypertension

Optimise outcomes in diabetic nephropathy and other co-morbidities.

Meet the needs of all individuals, including those with other conditions such as coeliac disease, cystic fibrosis and irritable bowel syndrome.

 

Consideration should be given to:

personal and cultural preferences

beliefs and lifestyle

individual’s wishes and willingness to change

age

pregnancy status or plans

nephropathy

intercurrent illness

 

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Summary

Summary of Recommendations for a Cardioprotective Diabetes Diet.

Total carbohydrate - 40-60% of energy intake as part of healthy diet recommendation

Amount of carbohydrate consumed is a strong predictor of glycaemic response in type 2 diabetes and the main nutritional consideration for glycaemic control in type 1 diabetes.

Carbohydrate intake advice and strategies varies according to type and treatment of diabetes.

Regular and spaced meals will help with appetite regulation

The total exclusion of sugar is unnecessary

Sugary drinks are best avoided

Weight loss in the over weight/obese BMI categories improves glycaemic control in patient with type 2 diabetes

Calorie intake should be appropriate to each individual to achieve agreed target weight loss

Total fat < 35% of energy intake

Reduced fat intake, especially saturated fats and trans fatty acids

Replaced with unsaturated fats, preferably monounsaturated fats

Oily fish once or twice weekly

2-3g per days of plant sterol or stanols esters may be recommended.
Moderate protein. Usually not greater than 1g/Kg ideal body weight so equivalent of 15 - 20% of energy intake
There is no specific amount of fibre recommended. Dietary fibre has many health benefits such as gut health but do not, in isolated amounts, significantly improve glycaemic control.
Soluble fibre is encouraged for it’s low glycaemic index effect and beneficial effect on blood lipid profiles.

Vitamins and antioxidants encourage foods naturally rich in vitamins and antioxidants.  With a few exceptions there is no evidence for the use of supplements and some evidence that they may be harmful.

Moderate salt intake. Salt < 6g sodium chloride per day.

Salt substitutes / unrefined salt, ie rock salt etc are not recommended

Nutritive sweeteners

 

Fructose- no proven advantage over sucrose and no reason to avoid suitably spaced naturally occurring fructose in fruits.

 

Sugar alcohols, eg sorbitol, manitol, have a lower cariogenic effect but no other advantage over sucrose. It may cause diarrhoea and still have calories.

Non-nutritive sweeteners eg aspartame, acesulfame - k, saccharin, sucralose, Stevia

 

Useful in beverages

 

Potentially useful in the overweight

 

Safe if the Acceptable Daily Intake is not exceeded

 

Heavy users should use a variety of different products

 ‘Diabetic’ foods- unnecessary, expensive

 

May cause diarrhoea

 

Not recommended

 All food labels of products containing non-nutritive sweetener need to be checked as they can be used in conjunction with either nutritive sweeteners.

Herbal preparations-no convincing evidence of benefits

Alcohol intake within recommended safe limits

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