Mealplanning Strategies

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A meal plan is an individualized guide to daily food choices that incorporates an individual's food preferences, blood glucose targets, and nutrition goals of diabetes management. A meal plan is designed to achieve blood glucose goals by matching food intake—specifically, carbohydrate foods—to the action of oral medications and endogenous or exogenous insulin. An individualized meal plan also incorporates other specific nutrition goals, such as a reduction in calorie level or total and saturated-fat intake to promote weight loss or control serum lipid levels.

There is no one specific approach to meal planning that will meet the needs and nutrition goals of all diabetic patients. As part of the initial nutrition assessment, the registered dietitian determines the optimal meal-planning approach based on the needs and goals of the patient. The plan should be easily understood by the patient and serve as a useful guide to his or her daily food choices. Meal-planning methods are an important tool to help optimize glycemic and metabolic control for type 1 or type 2 diabetic patients on insulin therapy. Frequently used meal-planning methods are listed in Table 2.

Patients often begin diabetic meal planning with a simplified approach to their daily food choices based on a modification of the USDA Food Guide Pyramid (see Figure 1). First Steps in Diabetic Meal Planning is a pamphlet (developed jointly in 1995 by the American Dietetic Association and the American Diabetes Association) that bases the choice of food groups and portion control on the Food Guide Pyramid (6). Many diabetic patients quickly learn to use this

and controlling serum lipid levels by identifying portion size and emphasizing low-fat food choices and limited intake of added fats.

As patients move to more intensive diabetes management, they usually progress to a more intensive program of insulin therapy that includes more frequent injections and a combination of different types of insulin to achieve target blood glucose levels. A more individualized and detailed system of meal planning is often required. The American Diabetes Association Exchange Lists for Meal Planning (see Table 3) form the basis for carbohydrate counting and are frequently used when a patient desires a meal-planning approach that provides more detailed information on the macronutrient content of each food group and a more precise system for measuring food portions. The Exchange Lists for Meal Planning were revised in 1995 to combine the starch, fruit, and milk groups, along with the new other-carbohydrate group containing sweets and snack foods, into the Carbohydrate Group. The Meat and Meat Substitute Group was divided into categories of very lean, lean, medium, and high-fat, and the Fat Group was broken down into monounsaturated, polyunsaturated, and saturated lists to encourage a decreased intake of both total and saturated fat (7).

The Exchange Lists for Meal Planning encourage flexibility in food choices and provide a more precise system of portion control to match the carbohydrate content of meals and snacks with the insulin therapy. These are used to more; precisely define the carbohydrate content of each meal and snack for more effective use of the patient's intensified insulin program. The calorie level along with) the protein and both total and saturated-fat content of the meal plan can be more precisely defined using the exchange system.

"Carbohydrate counting" is a meal-planning system in which the primary emphasis is placed on the total carbohydrate content of foods rather than on other macronutrients. The total carbohydrate content of meals and snacks, regardless of the carbohydrate source, is assumed to have a greater effect on postprandial blood glucose levels than protein and fat do. Meal plans are developed with a

Table 3 Nutrient Content of Exchange Groups

Exchange group

Carbohydrate (g)

Protein (g)

Fat (g)

Starch

15

3

Trace

Fruit

15

0

0

Milk (skim)

12

8

0

Other carbohydrates

15

Varies

Varies

Vegetables

5

2

0

Meat (lean)

0

7

3

Fat

0

0

tu a

consistent carbohydrate content at each meal and snack to achieve target blood glucose levels and to form a basis for adjustments in insulin therapy. The total carbohydrate content of the meal or snack determines the amount of rapid- or short-acting insulin required for blood glucose control, while the intermediate-or long-acting insulin covers the glycemic effect of protein and fat intake. Adjustments in insulin therapy are made based on carbohydrate intake at meals and snacks, along with the results of blood glucose monitoring to achieve target blood glucose levels.

The carbohydrate content of each food is precisely measured by either counting carbohydrate grams or using a modification of the American Diabetes Association exchange system based on carbohydrate groups or exchanges (8). Patients choose to count either carbohydrate grams or carbohydrate groups in which one carbohydrate group is equal to 15 grams of carbohydrate. Meal planning is simplified because food selection is focused primarily on carbohydrates, and postprandial blood glucose levels are more consistent as a result of the more precise method to determine carbohydrate intake. Carbohydrate counting can be used to ensure a consistent carbohydrate intake for a diabetic patient on conventional insulin therapy or to make adjustments in pre-meal rapid- or short-acting insulin doses based on the amount of carbohydrate consumed by patients on intensive insulin programs.

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Diabetes 2

Diabetes 2

Diabetes is a disease that affects the way your body uses food. Normally, your body converts sugars, starches and other foods into a form of sugar called glucose. Your body uses glucose for fuel. The cells receive the glucose through the bloodstream. They then use insulin a hormone made by the pancreas to absorb the glucose, convert it into energy, and either use it or store it for later use. Learn more...

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