Building Competency in Diabetes Education THE ESSENTIALS

BASAL-BOLUS INSULIN THERAPY | 12-90

NUTRITION

Goal-setting General healthy-eating principles still apply to the person using IT (see Chapter 5: Treatment Modalities: Lifestyle). Therefore, it is not the components of the diet that change with IT, but the translation of the nutrition recommendations into a meal-planning method. The nutrition plan should be developed to meet the physical, metabolic and lifestyle requirements of the person. The success of the nutrition intervention depends on how well it meets the unique requirements of the individual, and how well the person incorporates the nutrition plan into his or her life. Individual nutrition recommendationsmust be based on a nutritional assessment and the specific goals identified by the patient with diabetes and the members of the DHC team. The person with diabetes should be asked to verbalize his or her specific goals. Ask the person to consider what meal-planningmethods have been successful for him or her in the past, and what he or she disliked about particular meal-planningmethods. Together, the dietitian and the patient can discuss strategies to incorporate the best of past experiences in order to meet defined goals. Carbohydrate counting Carbohydrate counting can be easy to use for both health-care professionals and people with diabetes. It allows variety in food choices to fit a person’s preferences and lifestyle. Carbohydrate counting can be used as a meal planning strategy for anyone, regardless of the type of diabetes. “Carbohydrate counting attempts to reduce regimen complexity while focusing on the major contributor to blood glucose levels” (147). Studies have shown that people with type 1 diabetes tend to consume diets that are low in fibre, and high in protein and saturated fat (148). Many people with diabetes are adopting a low-carbohydrate diet as a strategy to manage their BG. The use of low-carbohydrate diets (target <75 g/day) in people with type 1 diabetes may improve A1C (149,150). As a result of the lower carbohydrate intake, meals tend to be higher in fat and protein. People should be encouraged to choose healthy sources of fat and protein that are lower in saturated fat (see Chapter 5: Treatment Modalities: Lifestyle) Some protein and fat will be converted to glucose in the bloodstream, but if they are eaten in the recommended amounts (see Chapter 5: Treatment Modalities), they will have a minimal direct effect on BG levels (151-153). However, higher fat and protein meals may require additional insulin. There is no standard strategy for insulin dosing for protein and fat. For those using CSII, the delivery of insulin may be best given