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Nutrition
- behavioral, cognitive, socioeconomic, cultural, religious considerations
- ADA- healthy eating plan
- - maintain total calories within limits
- - portion control
- - healthy body weight
- - control blood glucose
- - maintain lipids and BP wnl
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Nutrition
type 1
- balance of food choices, insulin and exerise
- plan with insulin to maximize glucose
- minimize hypoglycemia
- manage glu, keep wnl, prevent hypo
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nutrition type 2
- wt loss
- reduced fats and simple sugars- dec calories
- combine with exercise
- 50-70% of total body weight will help to control glucose
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nutrition
meal planning
- starts with thorough review of diet history
- - preferences, lifestyle
- - need for weight loss or gain
- consistency, esp type 2 unless counting cho
- - meals and snacks, esp type 1
- goal to avoid sharp changes in glucose after eating
- create a balance
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nutrition
CHO 50-60%
- 3 types:
- - starches (complex carbs)- some veggies, dried beans, lentils, grains
- - sugars (simple carbs)- fast acting
- - fibers- plant foods
- whole grain best
- concentrated sweets- 10%
- easily digested converts into glucose easily
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nutrition
fats and proteins
- fats 20-30%
- - saturated fats- 10% (animal products)
- Protein- 10-20%- animal and non animal like legumes, nuts
- fiber- incr (at least 25G) may improve glu levels, and dec chol and LDL
- - soluble
- - insoluble
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nutrition
things to help guide pt
- strategies to help pts follow nutrition guidelines
- exchange list- foods similar group together- gives pts a general idea for interchanges
- nutrition labels- make sure they understand how to read lables
- education on portion size
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look at power pt for exchange list
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create your plate
- ADA
- portion sizes and healthy choices
- fill plate with non starchy veggies and small portions of starchy foods and meat
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CHO and insulin
- CHO counting- insulin amounts pre meal based on CHO intake (ie 1U per 15G)
- - 'CHO budget' target per a meal
- - may increase flexibility
- - type 1 and type 2
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plate
- largest section- non starchy veggies half cooked and uncooked
- one quadrant- starch- cereal, rice, grains, cooked beans
- other quadrant- meat in other section- size of your fist
- fruit, milk and water
- fats oils and sweets- very little- if you eliminate it u tend to want this
- you will get a question in regards to meal planning for DM
- know this, look at some options
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Nutrition glycemic index
other than meal plate
- amt of food increases blood glu compared to an equal amount of glucose
- combine starchy foods with proteins and fats
- raw, uncut foods lower glycemic index than cooked or chopped pureed
- whole fruits lower index than juices
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Nutrition other
- alcohol- bc of fat converts into fat..may not have enough insulin to convert fat so---
- - hypoglycemia
- - DKA- ketone acidosis
- Sweetners
- - moderation
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exercise
- lowers blood glucose
- decre CV risk
- plan at peak of glucose level- to prevent hypoglycemia
- stay consistent- start slow- go slow
- moderate intensity 30 mins x 5 day- same time each day
- - remember incr risk for MI, stroke
- consider overall health
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exercise 2
five things it does
- incre glucose uptake in cell
- improves insulin use- more efficient
- helps with wt loss- type 2
- improves chol
- increase insulin sensitivity- esp with type 2
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types of exercise
- examples of moderate exercise
- - active housework
- - walking briskly
- - roller skating
- golf
- - dancing
- - bicycling
- good foot wear bc of neuropathy
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exercise
hyperglycemia v hypoglycemia
- Hyperglycemia
- - avoid if glu > 250 or ketones in the urine
- - incre secretion of glucagon, GH and catecholamines (stress- stimulates SNS)- all incr glu
- Hypoglycemia
- - type 1- cho snack before and after- about 15g of carbs (effects can occur 48hrs after exercise so u need to eat after)
- - hypoglycemic after exercise
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