Building Competency in Diabetes Education THE ESSENTIALS

5-26 | CHAPTER 5

of carbohydrate will result in hyperglycemia. For people with diabetes who are overweight, intake of sweets can result in excess energy intake, especially since sweets often contain a significant amount of fat as well as carbohydrate.

Distribution of carbohydrate Ideally, carbohydrate intake should be evenly distributed throughout the day. This strategy is important for those who do not use multiple daily injections. For those with type 2 diabetes, the pancreas is not able to cope with a large carbohydrate load; spreading the carbohydrate evenly throughout the day will allow for sufficient energy intake without overburdening the pancreas. For those who use multiple daily injections, different amounts of carbohydrate can be eaten at each meal with care to match the meal insulin dose to the amount of carbohydrate consumed. Typically, three meals per day are recommended for general health. A standard rule does not exist regarding the inclusion of snacks. Snacks are often included in meal planning to prevent hypoglycemia. However, this often is not the best strategy. There has been some suggestion that increased meal frequency is beneficial for weight and glycemic control (103). The intention is that small amounts of energy are distributed several times throughout the day, and the amount of food typically eaten at a meal will be divided in two: a small meal and a snack. However, increased meal frequency is often interpreted by patients as “snacking” between large meals; their meal size stays the same, and a snack is simply added. This results in the undesirable consequence of increased energy intake, something that will not benefit those who require an energy-restricted diet to achieve a healthy body weight. Still, studies need to be conducted in patients with diabetes to define the possible metabolic advantages of increased meal frequency. For some people, it may be inconvenient to include a snack, or they may simply not want to have one. In these cases, it would be more appropriate to attempt to adjust insulin or insulin secretagogues to prevent hypoglycemia. For the patient who is overweight but would still like to incorporate snacks into a meal plan, portion control should be encouraged to limit energy intake. Patients who are at an ideal body weight should be able to include snacks as desired, as long as energy intake is appropriate, weight is maintained and self-monitoring of blood glucose (SMBG) results are used to adjust medication as required. Timing of carbohydrate intake Timing of meals is most important for those who take insulin so that the risk of both hypoglycemia and hyperglycemia can be decreased. It is recommended that carbohydrates be eaten at times that synchronize with the action of the injected insulin. Patients who take