Building Competency in Diabetes Education THE ESSENTIALS

5-18 | CHAPTER 5

PROTEIN

Protein provides 15 to 20% of daily energy requirements.

There is no evidence that protein intake, for most individuals, in the range of 15 to 20% of total energy intake needs to be modified for people with diabetes (35). Approximately 58% of protein ingested will be converted to glucose in the bloodstream (25). Therefore, if protein intake is 15 to 20% of total energy and approximately 58% of that will be converted to glucose in the blood, then the glucose contribution of protein will be <10%. In this situation, it would not be expected that protein would have a significant impact on glycemic control. However, people who take insulin may need to consider the protein contribution to BG when eating either high-protein, low-carbohydrate meals or higher amounts of protein than usual. Canada’s Food Guide recommends replacing animal protein with plant protein, and several randomized trials have shown that doing this can improve albuminuria or proteinuria, LDL-C, TG, CRP (68-70), A1C and FPG (71). It may be wise to avoid consuming >20% of total energy intake as protein, since the long-term effects of this on the development of nephropathy has yet to be determined (40). As well, the body has a limited capacity to eliminate the end products of essential amino acid metabolism; therefore, excess intake can lead to toxicity (72). For those with diabetes who have chronic kidney disease, it is suggested that they aim for a protein intake that does not exceed the recommended dietary allowance of 0.8 g per kg body weight per day (73). Greater intake of plant protein sources may require closer monitoring of potassium as chronic kidney disease (CKD) progresses (32). Low protein diets can lead to malnutrition (74), therefore, both the quantity and the quality of protein intake is important to meet the requirements for essential amino acids. Additional protein is required for the growth and development of infants, children and adolescents, and for fetal development and milk production in pregnant and lactating women. Athletes and people who are ill may also require more protein.