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Foods containing carbohydrates from whole grains, fruits, vegetables and low-fat milk are important components and should be included in a healthy diet. A
Total amount of carbohydrate in meals or snacks is more important than source or type. A
Because sucrose does not increase glicemia levels at higher levels than similar amounts of starch energy, people with diabetes do not need to limit the consumption of sucrose and food containing sucrose. However, they should be replaced with other carbohydrate sources, or if they are added, they should be covered with insulin or other medicines that lower the glucose level. A
Non-nutritive sweeteners are safe when consumed within the acceptable daily intake levels established by the Food and Drug Administration. A
Individuals receiving intensive insulin therapy should adjust their premeal insulin doses based on the carbohydrate content of meals. B
Although the use of low-glycemic index foods may reduce postprandial hyperglycemia, there is not sufficient evidence of long-term benefit to recommend use of low-glycemic index diets as a primary strategy in food/meal planning. B
As with the general public, consumption of dietary fiber is to be encouraged; however, there is no reason to recommend that people with diabetes consume a greater amount of fiber than others. B
Individuals receiving fixed daily insulin doses should try to be consistent in day-to-day carbohydrate intake. C
Carbohydrate and monounsaturated fat together should provide about 60–70% of energy intake. However, the Emetabolic profile and need for weight loss should be considered when determining the monounsaturated fat content of the diet.
Sucrose and sucrose-containing foods should be eaten in the context of a healthy diet. E
In persons with controlled type 2 diabetes, ingested protein does not increase plasma glucose concentrations, although protein is just as potent a stimulant of insulin secretion as carbohydrate. B
For persons with diabetes, especially those not in optimal glucose control, the protein requirement may be greater than the Recommended Dietary Allowance, but not greater than usual intake. B
For persons with diabetes, there is no evidence to suggest that usual protein intake (15–20% of total daily Eenergy) should be modified if renal function is normal.
The long-term effects of diets high in protein and low in carbohydrate are unknown. Although such diets may produce short-term weight loss and improved glycemia, it has not been established that weight loss is maintained long-term. The long-term effect of such diets on plasma LDL cholesterol is also a concern. E
Less than <10% of energy intake should be derived from saturated fats. Some individuals, specifically persons with LDL cholesterol >2.5mmol/l) may benefit from lowering saturated fat intake to <7% of energy intake. A
Dietary cholesterol intake should be <300 mg/day. Some individuals, specifically persons with cholesterol >2.5mmol/l) may benefit from lowering dietary cholesterol to <200 mg/ day. A
To lower LDL cholesterol, energy derived from saturated fat can be reduced if weight loss is desirable or replaced with either carbohydrate or monounsaturated fat when weight loss is not a goal. B
Intake of trans unsaturated fatty acids should be minimized. Reduced-fat diets when maintained long-term contribute to modest loss of weight and improvement in dyslipidemia. B
Polyunsaturated fat intake should be ∼10% of energy intake. C
Energy balance and obesity
In insulin-resistant individuals, reduced energy intake and modest weight loss improve insulin resistance and glycemia in the short-term. A
Structured programs that emphasize lifestyle changes, including education, reduced fat (<30% of daily Aenergy) and energy intake, regular physical activity, and regular participant contact, can produce long-term weight loss on the order of 5–7% of starting weight.
Exercise and behavior modification are most useful as adjuncts to other weight loss strategies. Exercise is Ahelpful in maintenance of weight loss.
Standard weight reduction diets, when used alone, are unlikely to produce long-term weight loss. Structured intensive lifestyle programs are necessary. A
There is no clear evidence of benefit from vitamin or mineral supplementation in people with diabetes who do not have underlying deficiencies. Exceptions include folate for prevention of birth defects and calcium for prevention of bone disease. B
Routine supplementation of the diet with antioxidants is not advised because of uncertainties related to long-term efficacy and safety. B
If individuals choose to drink alcohol, daily intake should be limited to one drink for adult women and two drinks for adult men. One drink is defined as 355 mlof beer, one glass of wine, or 45 ml of distilled spirits. B
To reduce risk of hypoglycemia, alcohol should be consumed with food. B
Children and adolescents with diabetes
Individualized food/meal plans and intensive insulin regimens can provide flexibility for children and adolescents with diabetes to accommodate irregular meal times and schedules, varying appetite, and varying activity levels. E
Nutrient requirements for children and adolescents with type 1 or type 2 diabetes appear to be similar to other same age children and adolescents. E
Pregnancy and lactation
Nutrition requirements during pregnancy and lactation are similar for women with and without diabetes. E
Medical nutrition therapy for gestational diabetes focuses on food choices for appropriate weight gain, normoglycemia, and absence of ketones. E
For some women with gestational diabetes, modest energy and carbohydrate restriction may be appropriate. E
Energy requirements for older adults are less than for younger adults. Physical activity should be encouraged. A
In the elderly, undernutrition is more likely than overnutrition, and therefore caution should be exercised when prescribing weight loss diets. E
Glucose is the preferred treatment for hypoglycemia, although any form of carbohydrate that contains glucose may be used. A
Ingestion of 15–20 g of glucose is an effective treatment, but blood glucose may only be temporarily corrected. B
During acute illnesses, testing blood glucose and blood or urine for ketones, drinking adequate amounts of fluids, and ingesting carbohydrate are important. B
Initial response to treatment for hypoglycemia should be seen in10–20 min; however, blood glucose should be evaluated again in 60 min, as additional treatment may be necessary. E
In normotensive and hypertensive individuals, a reduction in sodium intake lowers blood pressure. A
A modest amount of weight loss beneficially affects blood pressure. The goal should be to reduce sodium intake to 2,400 mg (100 mmol) or sodium chloride (salt) to 6,000 mg/day. E
For persons with elevated LDL cholesterol, saturated fatty acids and trans-saturated fatty acids should be B limited to <10% and perhaps to <7% of energy.
Energy derived from saturated fat can be reduced if weight loss is desirable or replaced with either carbohydrates or monounsaturated fats if weight loss is not a goal. E
For persons with elevated plasma triglycerides, reduced HDL cholesterol, and small dense LDL cholesterol (the B metabolic syndrome), improved glycemic control, modest weight loss, dietary saturated fat restriction, increased physical activity, and incorporation of monounsaturated fats may be beneficial.
In individuals with microalbuminuria, reduction of protein to 0.8–1.0 g/ kg of body weight per day may slow the progression of nephropathy. C
The energy needs of most hospitalized patients can be met by providing 105 KJ– 146 KJ/Kg of bodyweight. E
Protein needs are between 1.0 and 1.5 g/kg body weight; the higher end of the range being for more stressed patients. E
Structured programs that emphasize lifestyle changes, including education, reduced fat and energy intake, regular physical activity, and regular participant contact, can produce long-term weight loss of 5–7% of starting weight and reduce the risk for developing diabetes. A
All individuals, especially family members of persons with type 2 diabetes, should be encouraged to engage in regular physical activity to decrease risk of developing type 2 diabetes. B
System of categorization of American Diabetes Association: A: highest category – is given when there are evidence of support from well-conducted studies; B: average categorization; C: lowest categorization; E: recommendations based on the consensus of experts based on clinical experience.