1. Postgraduate Diploma in Diabetes Education
(PDDE
Nutrition therapy: Dietary advice in
case of complications
lec. 1 Guide to recommending a
meal plan
1
Prepared by;
Dr. Siham M.O. Gritly
2. Course outline
• lec. 1 Guide to recommending a meal plan
• lec. 2-Estimated Energy Requirements
among Diabetic Patients
lec. 3 nutrition therapy that apply to specific
situations
• lec. 4 Dietary advice in case of complications
Dr. Siham M.O. Gritly 2
3. Nutrition therapy
• Nutritional therapy should be individualized
according to
• preferences,
• age,
• needs,
• religion,
• culture,
• lifestyle
3Dr. Siham M.O. Gritly
4. Goals of Nutritional therapy that apply to
individuals with diabetes
• Achieve and maintain
Blood glucose levels in the normal range
A lipid and lipoprotein profile that reduces the
risk for cardiovascular disease
Maintain blood pressure levels in the normal
range
Dr. Siham M.O. Gritly 4
5. • modifying nutrient intake and lifestyle To
prevent, or slow, the rate of development of the
chronic complications
• To address individual nutrition needs,
Dr. Siham M.O. Gritly 5
6. Diabetes food pyramid
Dr. Siham M.O. Gritly 6
the Diabetes Food
Pyramid divides food into
six groups, which vary in
size to show relative
amounts of servings for
each group
the groups are based on
protein content and
carbohydrates instead of
their food classification
7. A person with diabetes should eat more of the foods in
the bottom of the pyramid (grains, beans, vegetables)
than those on the top (fats and sweets).
Dr. Siham M.O. Gritly 7
8. Food pyramid:
Food guide
Adopted from: Food Guide Pyramid: A guide to dairy food choices. Bulletin 259,
Washington DC: US government printing
Food group Number of servings What is a serving?
Starches
and breads
6-11 1 Slice bread
½ cup cooked rice, cereal
¼ cup dry cereal,
½ cup pasta
3 biscuits
(eat whole-grain, fortified
or enriched
starches, bread, and cereals
Dr. Siham M.O. Gritly 8
9. Food pyramid:
Food guide
Food group Number of
servings
What is a serving?
Vegetables 3-5 ¼ cup vegetables cooked
1 cup vegetables raw
Fruits 2-4 1 cup fruit
½ cup fruit juice (fresh
frozen or canned
without sugar
1 medium piece fresh fruit
Dr. Siham M.O. Gritly 9
10. Food pyramid:
Food guide
Food group
Number of
servings What is a serving?
Milk and milk
products 2-3
1 cup skim / low fat milk
¾ cup plain or artificially sweetened
yogurt.
Meat and meat
substitutes
2-3 57-85 g cooked lean meat fish or
poultry
28.5 g meat is equivalent to:
1 egg
28.5 g cheese
¼ cup tuna, salmon or cottage cheese
1 tablespoon peanut-butterDr. Siham M.O. Gritly 10
11. Food pyramid:
Food guide
Food group Number of servings What is a serving?
Fat use carefully 1 teaspoon margarine
1 teaspoon
salad dressing
1 teaspoon oil or
mayonnaise
Dr. Siham M.O. Gritly 11
12. What is Serving Sizes
• Serving sizes are defined by the USDA Food Guide
Pyramid as a standard amount used to help give
advice about how much food to eat.
• It also helps us identify how many calories and
nutrients are in a food
Dr. Siham M.O. Gritly 12
13. serving size guidelines
• Measure a serving size of dry cereal or hot
cereal, pasta, or rice and pour it into a bowl or
plate. The next time you eat that food, use the
same bowl or plate and fill it to the same level.
• For one serving of milk, measure 1 cup and
pour it into a glass. See how high it fills the
glass. Always drink milk out of that size glass.
Dr. Siham M.O. Gritly 13
14. • Meat weighs more before it's cooked. For example, 4
ounces of raw meat will weigh about 3 ounces after
cooking. For meat with a bone, like a beef chop or
chicken leg, cook 5 ounces raw to get 3 ounces cooked.
• One serving of meat or meat substitute is about the
size and thickness of the palm of your hand or a deck
of cards.
• A small fist is equal to about 1/2 cup of
fruit, vegetables, or starches like rice.
• A small fist is equal to 1 small piece of fresh fruit.
• A thumb is equal to about 1 ounce of meat or cheese.
• The tip of a thumb is equal to about 1 teaspoon.
Dr. Siham M.O. Gritly 14
15. • serving size guidelines of fruits and vegetables a day?
• The National Cancer Institute defines a serving as:
• One medium-sized fruit (ex. apple, orange, banana,
pear)
• 1/2 cup of raw, cooked, canned or frozen fruits or
vegetables
• 3/4 cup (6 oz.) of 100 percent fruit or vegetable juice
• 1/2 cup cut-up fruit
• 1/2 cup cooked or canned legumes (beans and peas)
• 1 cup of raw, leafy vegetables (ex. lettuce, spinach)
• 1/4 cup dried fruit (ex. raisins, apricots, mango)
Dr. Siham M.O. Gritly 15
18. Dr. Siham M.O. Gritly 18
Fruits package their sugars with
fibers, vitamins, and minerals, making
them a sweet and healthy snack.
19. Adapted from; Ellie Whitney and Sharon Rady Rolfes; Under standing Nutrition, Twelfth Edition.
2011, 2008 Wadsworth, Cengage Learning
Dr. Siham M.O. Gritly 19
A half-cup of vegetables weighs
about 100 grams; one pea
weighs about ½ gram
One cup is about 240
milliliters; a half-cup of liquid
is about 120 milliliters
HIGHER ENERGY
DENSITY
This 144-gram breakfast
delivers 500 kcalories,
for an energy density of
3.5 (500 kcal ÷ 144 g =
3.5 kcal/g).
LOWER ENERGY DENSITY
This 450-gram breakfast delivers
500 kcalories, for an energy density of
1.1 (500 kcal ÷ 450 g = 1.1 kcal/g).
20. Portion Control
Dr. Siham M.O. Gritly 20
"Portion control" means: See how much
you eat. Decide how much to eat Cut
back on portion size
21. the difference between a portion and a
serving size
• A serving size is a recommended standard
measurement of food.
• A portion is how much food you eat, which
could consist of multiple servings.
• knowing the size of a serving can help
determine healthful portions
Dr. Siham M.O. Gritly 21
22. The plate method
Dr. Siham M.O. Gritly 22
Is a way to plan meals without
measuring (a qualitative diet
approach).
fill your plate (20 cm diameter)
to match the amount of
vegetables, starches, and meat,
and then add a piece of fruit
and/or a glass of milk.
Divide your plate in
quarters. Amount of vegetables
eaten, protein is optional
23. Filling a dinner plate (20 cm diameter)
excluding snacks will provide 1200 – 1500
calories per day depending on serving size
Dr. Siham M.O. Gritly 23
The plate method is ideal for most
non-insulin treated persons and some
with type 2 diabetes on fixed insulin
doses.
Advantages: it is simple, adaptable,
embodies principles of healthy eating,
and promotes memory and
understanding via visual messages.
Disadvantages: not flexible,
especially in insulin-treated persons
with diabetes who need to vary
carbohydrate intake/meals.
24. Guide to recommending a meal plan
Profile of person with diabetes Number of servings from each food
group
Recommend about 1200 – 1600
calories a day
if the person is:
• A small woman who exercises
• A small or medium woman who
wants to lose weight
• A medium woman who does not
exercise Much
To provide 1200 – 1600 calories
6 starches
3 vegetables
2 fruit
• 2 milk and dairy
• 2 meat or meat substitute
• Up to 3 fats
Dr. Siham M.O. Gritly 24
25. Guide to recommending a meal plan
Profile of person with diabetes Number of servings from each food
group
Recommend about 1600 –
2000 calories a day
if the person is:
• A large woman who wants to
lose weight
• A small man at a healthy
weight
• A medium man who does
not exercise much
• A medium to large man who
wants to lose weight
To provide 1600 – 2000
calories:
8 starches
4 vegetables
3 fruit
• 2 milk and dairy
• 2 meat or meat substitute
• Up to 4 fats
Dr. Siham M.O. Gritly 25
26. Guide to recommending a meal plan
Profile of person with diabetes Number of servings from each food
group
Recommend about 2000 – 2400
calories a day
if the person is:
• A medium to large man who
does a lot of
exercise or has a physically
active job
• A large man with a healthy
weight
• A large woman who does a
lot of exercise
To provide 2000 – 2400 calories
11 starches
4 vegetables
3 fruit
• 2 milk and dairy
• 2 meat or meat substitute
• Up to 5 fats
Dr. Siham M.O. Gritly 26
27. Weight units conversion
Weight units Weight units
1 kilogram= 2.2 pounds
1kilogram= 1,000 grams
454 grams= 1 pound
1 pound= 16 ounces
1 ounce= 28.4 grams
3.5 ounces= 100 grams
Dr. Siham M.O. Gritly 27
28. Insulin Dependent Diabetes Mellitus (IDDM)
or Type I Diabetes (Juvenile onset diabetes)
• In type 1 diabetes, the less common type, the
pancreas fails to produce insulin.
• commonly occurs in childhood and
adolescence, but it can occur at any age,
even late in life
Dr. Siham M.O. Gritly 28
29. Nutrition therapy for type 1 diabetes
• Nutrition therapy for type 1 diabetes focuses on;
• maintaining optimal nutrition status, basic
nutrient requirements
• controlling blood glucose,
• achieving a desirable blood lipid profile,
• controlling blood pressure,
• and preventing and treating the complications of
diabetes
Dr. Siham M.O. Gritly 29
30. • Nutrition therapy for type 1 diabetes
• the diet must provide a fairly steady
carbohydrate intake from day to day and at
each meal and snack to help minimize
fluctuations in blood glucose
Dr. Siham M.O. Gritly 30
31. • To avoid hypoglycemia, the person must
monitor blood glucose before and after activity
• Carbohydrate-rich foods should be readily
available during and after activity
Dr. Siham M.O. Gritly 31
32. Non-Insulin Dependent Diabetes
Mellitus (NIDDM) or Type II Diabetes.
• In type 2 diabetes, the more common type of
diabetes, the cells fail to respond to insulin.
This condition tends to occur as a consequence
of obesity.
• It is important to eat the suggested amount of
carbohydrate at each meal, along with some
protein and fat.
Dr. Siham M.O. Gritly 32
33. • Complex carbohydrates are considered healthier
mostly because they are digested by the body
slowly, providing a steady source of energy
• Carbohydrates are mainly found in the following
food groups:
• Fruit
• Milk and yogurt
• Bread, cereal, rice, pasta
• Starchy vegetables like potatoes
• They also contain valuable amounts of fiber
Dr. Siham M.O. Gritly 33
34. Recommendations for Type 2 Diabetes In
overweight people with type 2
• Recommendations for Type 2 Diabetes In
overweight people
• moderate weight loss (10 to 20 pounds) can help
improve insulin resistance, blood lipids, and
blood pressure.
• Together with diet, a regular routine of moderate
physical activity not only supports weight loss,
but also improves blood glucose control, blood
lipid profiles, and blood pressure.
Dr. Siham M.O. Gritly 34
35. references
• American Diabetes Association. Standards of medical
care in diabetes--2011. Diabetes Care. 2011 Jan;34
Suppl 1:S11-61
• American Diabetes Association. Nutrition
recommendations and interventions for diabetes: a
position statement of the American Diabetes
Association. Diabetes Care. 2008;31:S61-S78.
• American Diabetes Association. Carbohydrate
counting. Available at http://www.diabetes.org/food-
and-fitness/food/planning-meals/carb-
counting. Accessed December 8, 2012.
Dr. Siham M.O. Gritly 35
36. • American Diabetes Association. Standards of medical care in diabetes--2011.
Diabetes Care. 2011 Jan;34 Suppl 1:S11-61
• Sareen Gropper, Jack Smith and James Groff, Advanced Nutrition and Human
Metabolism, fifth ed. WADSWORTH
• Melvin H Williams 2010; Nutrition for Health, Fitness and Sport. 9th ed, McGraw
Hill
•
• Heymsfield, SB.; Baumgartner N.; Richard and Sheau-Fang P. 1999. Modern
Nutrition in Health and Disease; Shils E Maurice, Olson A. James, Shike
Moshe and Ross A. Catharine eds. 9th edition
• Guyton, C. Arthur. 1985. Textbook of Medical Physiology. 6th edition, W.B.
Company
• FAO/WHO/UNU expert consultation (WHO, 1985) report
• Ellie Whitney and Sharon Rady Rolfes; Under standing Nutrition, Twelfth Edition.
2011, 2008 Wadsworth, Cengage Learning
Dr. Siham M.O. Gritly 36
Editor's Notes
Adopted from: Food Guide Pyramid: A guide to dairy food choices. Bulletin 259, Washington DC: US government printing
Adopted from: Food Guide Pyramid: A guide to dairy food choices. Bulletin 259, Washington DC: US government printing
Adopted from: Food Guide Pyramid: A guide to dairy food choices. Bulletin 259, Washington DC: US government printing
Adopted from: Food Guide Pyramid: A guide to dairy food choices. Bulletin 259, Washington DC: US government printing