Timed Effect on Blood Sugar Levelstreatment.sbmu.ac.ir/uploads/Diabetes_workshop._File_2.pdf · Modern nutrition in health & disease Krauses food & nutrition therapy ... Nutrition

Carbohydrate…. rapid digestion, total absorption/conversion to glucose (100%)

Protein…………..…………slow digestion, partial conversion to glucose* (~40%)

Fat…………………………….slow digestion, little conversion to glucose** (<20%)

Meal 1 Hr 2 Hrs 3 Hrs 4 Hrs 5 Hrs 6 Hrs 7 Hrs 8 Hrs

CHO

Pro

Fat

BG

Timed Effect on Blood Sugar Levels

1

Types of Carbohydrate

The three main types of carbohydrate are: Starch (also known as complex carbohydrates)

Sugar

Fiber

Foods that contain carbohydrate are: Grains and starchy vegetables

Beans and legumes

Fruit

Dairy products like milk and yogurt

Sweets and snack foods like chips

2

Carbohydrate and diabetes

• Although low carbohydrate diets might seem to be a logical approach to loweringpostprandial glucose, the ADA specifically states that "low-carbohydrate diets (restrictingtotal carbohydrate to < 130 g/day) are not recommended in the management of diabetes"(ADA, 2006).

• The glycemic effect of carbohydrate foods cannot be predicted based on their structure(i.e., starch versus sugar) owing to the efficiency of the human digestive tract in reducingstarch polymers to glucose. Starches are rapidly metabolized into 100% glucose duringdigestion, in contrast to sucrose, which is metabolized into

. Fructose has a lower glycemic index (GI).

• The basic guidelines for the amount of carbohydrate to eat at meals and snacks, e.g., 3 to4 carbohydrate choices/meal (60 g/meal ± 15 g) and 1-2 carbohydrate choices (15-30 g)at snacks.

3

Glycemic Index and Glycemic load

The glycemic index (GI) measures the relative area under the postprandial glucose curve of 50 g of digestible carbohydrates compared with 50 g of a standard food, either glucose or white bread.

Low GI ( less than 55 )

Moderate GI ( 55 to 70 )

High GI (more than 70 )

Estimated glycemic load (GL) of foods , meals , and dietary patterns iscalculated by multiplying the GI by the amount of carbohydrates in each foodand then totaling the values for all foods in a meal or dietary pattern.

Low GL ( 10 or less )

Moderate GL ( 11 to 19 )

High GL (more than 20 )

4

GL GLGI

Krau

se’s

fo

od

an

d n

utr

itio

n t

her

apy,

20

12

GI

5

No ideal distribution of macronutrients (carbohydrate, protein, fat) for a diabetes nutrition prescription has been identified.

A healthy eating pattern is recommended.

6

Nutrition Recommendations

Total Daily Energy Intake

Carbohydrate : 45-65%

• (The recommended dietary allowance (RDA) for digestible carbohydrate is 130 g/day )

• Fiber : total 25-30 g/d (15-25 g/1000 kcal)

Protein : 15-20% or 12-16%

Fat : Total fat 25-35%

• Polyunsaturated fatty acids up to 10%

• Monounsaturated fatty acids up to 20%

• Saturated fats < 7% (Saturated and trans fatty acids< 10% )

• Cholesterol (mg/d) <200 mg/d7

• CHO = 55-65%

• Pro = 12-16%

• Fat < 30%

• CHO = 45-65%

• Pro = 20-35%

• Fat = 10-35%

Modern nutrition in health & disease Krauses food & nutrition therapy

• CHO = 50-60%

• Pro = 10-20%

• 25% < Fat < 35%

IOM

8

Certain high risk groups may benefit from an appropriate vitamin-mineral supplement

♣ Growing and developing children and youths

♣ Women during pregnancy and lactation

♣ Individuals eating < 1200 kcal / day

♣ Elderly individuals (especially people with low SES)

♣ Patients in ICU or long term nursing facilities

♣ Total vegetarians

♣ Patients with poor glycemic control

9

مرور فهرست جانشینیکالری چربی پروتئین کربوهیدرات گروه غذائی

80 1-0 3 15 نشاسته

60 - - 15 میوه

100120

160

3-05

8

88

8

1212

12

شیر

بدون چربی•کم چربی•کامل•

متغیر متغیر متغیر 15 سایر کربوهیدراتها

25 - 2 5 سبزیجات

5575

100

35

8

77

7

--

-

گوشت و جانشین های آن

(لخم)کم چرب•متوسطچربی•پر چرب•

45 5 - - گروه چربی

12

Nutrition Therapy Recommendations

Topic Recommendations Evidence Rating

Diabetes Care Volume 38,

Supplement 1, January 2015

13



Diabetes Care Volume 38,Supplement 1, January 2015

14




15




16




17




18




19




موارد احتیاط عوارض بالینیکاربرد اثرات درمانی مکانیسم عمل نام دارو دسته دارویی

موارد احتیاط عوارض بالینیکاربرد اثرات درمانی مکانیسم عمل نام دارو دسته دارویی

Dr. Amiri, Nutritionist 26

27

Re

lati

ve In

sulin

Eff

ect

Time (Hours)

0 2 4 6 8 10 12 14 16

Long (Glargine)

18 20

Intermediate (NPH)

Short (Regular)

Rapid (Lispro, Aspart , Glulysine)

Insulin Time Action Curves


Injection sites

• It is usually recommended to be injected on these areas:

Abdomen

Outer top of the thighs

Outer arms

Buttocks





Diabetes Care Volume 38, Supplement 1, January 2015

توضیحات (mg/dl)قند قبل از ورزش

تا زمان رسیدن قند خون به مقادیر هدف ! ممنوع.نباید ورزش کرد 80کمتر از

نکات ذکر شده در مورد مصرف کربوهیدرات و کاهش انسولین مصرفی

250–80

بود نباید )+( اگر . باید کتون ادرار اندازه گیری شودبودن می توان ورزش کرد ( -)در صورت . ورزش کرد

.ولی نیازی به مصرف کربو هیدرات اضافی نیست 300–250

!ممنوع ورزش 300از بیشتر

خون قبل از ورزشقند

Effect of physical activity

Insulin Signaling Pathways That Regulate Glucose Metabolism in Muscle Cells and Adipocytes. Implications for Insulin Resistance and Diabetes Mellitus –nejm 1999.

Insulin dose reduction guidelines

for planned postprandial exercise

• Bolus insulin:

• ↓ Pre-exercise bolus insulin by 10-80% according to duration and intensity, when activity follows a meal

• Following prolonged exercise, subsequent meal boluses may need to be ↓‘d by 25-50%

• Basal insulin:

• Injected morning basal insulin may need to be ↓‘d by 10-50% for planned or continuing activity in the afternoon

• Injected bedtime basal insulin may need to be ↓‘d by 10-30% following prolonged endurance exercise

• Pump basal rates should be decreased by an appropriate amount prior to the start of activity (30 - 60 min.) and may need to be continued for several hours after

Exercise: General Recommendations

38

Important notes:

♣ The first priority for persons requiring insulin therapy is to integrate an insulin

regimen into the patient's lifestyle.

♣ After an initial food/meal plan is determined (with the patient's input), it should be

reviewed with the health professional who is planning the insulin regimen.

♣ With the many insulin options now available, an insulin regimen can usually be

developed that will conform to the patient's preferred meal times and food choices.

Flexible insulin regimens using basal (background) insulin and bolus (mealtime)

insulin or insulin pumps give the patient freedom in timing and composition of

meals and are the preferred mode of therapy to maximize blood glucose control and

minimize complications.


♣ The total amount of carbohydrate in the meal (and snacks, if desired) is

the major determinant of the bolus rapid-acting insulin dose and post-

prandial glucose response.

♣ After determining the amount of insulin required to cover the patient's

usual meal carbohydrate, patients can be taught how to adjust bolus

insulin doses based on the amount of carbohydrate they are planning to

eat (insulin-to-carbohydrate ratio).

♣ For persons receiving fixed insulin regimens and not adjusting mealtime

insulin doses, consistency of day-to-day carbohydrate amounts at meals

is important.

Important notes:


♣ All persons with type 1 diabetes and many persons with type 2 diabetes who

no longer produce adequate endogenous insulin need replacement of insulin

that mimics normal insulin action.

♣ After eating, plasma glucose and insulin concentrations increase rapidly,

peak in 30 to 60 minutes and return to basal concentrations within 2 to 3

hours in non-diabetics.

♣ To mimic this, rapid-acting insulin, such as lispro, aspart, or glulisine, is

given at mealtime; doses are adjusted based on the amount of carbohydrate in

the meal.

♣ Basal or background insulin, such as determir, glargine, or NPH, is required

in the post-absorptive state to restrain endogenous glucose output primarily

from the liver and to limit lipolysis and excess flux of free fatty acids to the

liver.

Important notes:


The type and timing of insulin regimens should be individualized

based on eating and exercise habits and blood glucose

concentrations.

Important notes:


In persons with type 1 or type 2 diabetes who adjust their mealtime

insulin or who are on insulin pump therapy, insulin doses should

be adjusted to match carbohydrate intake (insulin-to-carbohydrate

ratios).


What is Insulin to carbohydrate ratio (ICR)?

سبت و تعیین بهترین نفرم ثبت غذاهااستفاده از : روش اول

ممکن برای هر وعدۀ غذا

تعداد واحد انسولین برای= هر واحد کربوهیدرات

تعداد واحد انسولین رگوالر در هر وعده

تعداد واحد کربوهیدرات در آن وعده

محاسبه نسبت انسولین به کربوهیدراتروشهای


مقدار انسولین رگوالر روزانه استفاده از : روش دوم

تعداد واحد انسولین برای هر واحد= کربوهیدرات

کل واحدهای روزانه انسولین رگوالر

متوسط واحد کربوهیدرات مصرفی در طول روز



30قانون استفاده از : روش سوم 30کل مقدار انسولین روزانه تقسیم بر



Insulin Sensitivity Factor (ISF)

1800


Documents

Timed Effect on Blood Sugar Levelstreatment.sbmu.ac.ir/uploads/Diabetes_workshop._File_2.pdf · Modern nutrition in health & disease Krauses food & nutrition therapy ... Nutrition