Educational Resources on Nutrition Care for Diabetes

In general, it would be preferable to state the actual barrier to self-care specifically rather than labeling the individual as non-compliant. Using the framework of our Nutrition Care Process would be appropriate.

Example: Excessive intake of carbohydrates at meals related to the client working multiple jobs with limited time for shopping/food preparation and client preference for higher carbohydrate convenience foods, as evidenced by elevated postprandial glucose levels and deterioration in A1C over past 3 months.

The guidelines state that people with diabetes should follow the same guidance as for the general population without diabetes (National Academy of Medicine states that 20–35% of calories from fat for all adults is acceptable.) Further, the guidelines state there is not an ideal percentage of fat and this can be individualized based on goals and preferences. Trans fat should be avoided. As saturated fat is decreased, it should be replaced with mono or polyunsaturated fats instead of refined carbohydrates.

There is a lot of discussion about diabetes “remission” (instead of reversal.) This is because type 2 diabetes is a progressive condition and generally the glucose control deteriorates over time. The positive results from the Diabetes Prevention Program Outcomes Study (DPPOS) and the longer-term diabetes prevention studies do seem to indicate that early aggressive lifestyle changes may delay type 2 for many years. Current data suggests remission rates are closely linked to weight loss achieved and maintenance of weight loss over time.

There have been some anecdotal reports of new cases of type 1 diabetes in those with no previous personal history or family history of diabetes but no conclusive data at this time. As far as type 2 diabetes, the glucose levels will be elevated with any infection and steroids used to treat lung issues can increase glucose as well. Data is being compiled and we will have to wait for results to learn if COVID-19 infection is related to new cases of diabetes.

In order to be reimbursed, all programs must be recognized by the CDC and use the program outlined in the requirements for recognition. You can view all recognized organizations on the CDC website.

Please see the evidenced-based recommendations included here for several popular eating patterns:

Nutrition Therapy for Adults with Diabetes or Prediabetes: A Consensus Report Diabetes Care 2019 May;42(5):731-754

Paleo Diet: Only a few small studies lasting less than 3 months. Mixed results on weight loss, A1c and lipids in those with type 2 diabetes.

There is no ideal percentage of carbohydrates for those with diabetes or prediabetes.

In general, most people with diabetes eat about 45% of calories from carbohydrates. Guidelines recommend that RDNs meet clients where they are with consideration for life circumstances, preferences, willingness to change, financial barriers, current eating pattern and metabolic goals. Helping those with prediabetes to achieve and maintain weight loss is primary goal for any eating pattern they choose

In my own practice, I ask clients to alternate checking two-hour postprandial readings. One or two days a week check post-breakfast and document what they ate, then one or two days a week post-lunch, etc. This can reveal a pattern or enlighten the client as to which food choices are driving postprandial glucose readings higher.

Variants are shown in common genetic tests, 23andMe, Ancestry, Nutrigenomic.

The 23&andMe testing is optional (additional charge) and could help identify those who share common genes and risk factors associated with type 2 diabetes. Right now, the test results are based on genetic information and answers to lifestyle questions. The developers suggest clinical correlation and discussion with healthcare providers regarding weight, lipids and glucose levels for those identified at risk. The researchers are seeking to expand the database to include a wider range of ethnic backgrounds for more specific diverse genetic information.

Please see the evidenced-based recommendations included here for several popular eating patterns:

Nutrition Therapy for Adults with Diabetes or Prediabetes: A Consensus Report

Diabetes Care 2019 May;42(5):731-754

From the Consensus Report:

In Prediabetes – 6 h eating window with no food after 3 pm v 12 h eating window showed improved insulin sensitivity, Beta cell response, BP, oxidative stress and appetite with 6 h window.

There is no ideal percentage of carbohydrate for those with diabetes or prediabetes.

In general, most people with diabetes eat about 45% of calories from carbohydrates. Guidelines recommend that RDNs meet clients where they are with consideration for life circumstances, preferences, willingness to change, financial barriers, current eating pattern and metabolic goals. Helping those with prediabetes to achieve and maintain weight loss is the primary goal for any eating pattern they choose.