Posts Tagged With: diabetes

Newly Diabetic? Carbs are not the enemy.

I sat in on several lengthy diabetic diet education sessions recently through my dietetic internship.  Though some had Type 1, others had Type 2, some were newly diagnosed, diagnosed in the past year, or diagnosed over 3 years ago, there was a common misconception I noticed during these sessions and others as well.  Carbs are not the enemy! Many newly-diagnosed diabetics may think they have to avoid carbohydrates as much as possible. The problem with this is, when you avoid carbohydrates, what you end up eating a lot of is protein and fats.  Diabetics and non-diabetics alike should be getting 45-60% of their calories from carbohydrates. If you cut your carbohydrates down to 30%, for example, then what happens is your calories from protein increases, and calories from fat increases – sometimes up to 40-45%! Diabetics, just like anyone else, should be eating a healthy diet that contains no more than 30% calories from fat.  Basic nutrition is still important to remember.

Consistency is really the key.  Patients with diabetes want to avoid the highs (hyperglycemia) and the lows (hypoglycemia) because that up-and-down pattern is really what causes all the complications associated with diabetes, such as neuropathy and vision loss.  Healthcare professionals will tell the patient how many carbs to get each meal, such as 60g of carbs 3 meals a day, plus 15g of carbs mid-afternoon and 15g of carbs before bed.  The patient could have their carbohydrate grams from bread, grains, starchy vegetables, fruit, or milk. Any combination as long as it reaches that goal set by the healthcare professional (doctor, dietitian, certified diabetes educator).

Keeping that in mind, if its late and night and a diabetic is hungry for a snack, its important to remember basic health. It may seem like a simple thing to go for a Slim Jim or Pork Rinds due to their 0-carb appeal. However with over 500mg of sodium per serving, and their high fat content, it’s a better idea to go with something more healthy. A snack with carbs are acceptable, as long as its covered with insulin.  If adding another shot of insulin into the day doesn’t sound appealing, a low-fat cheese stick, hard-boiled egg, or a lettuce salad with ranch are some carb-free options.

So remember: carbs are not the enemy. Aim for 45-60% calories from carbohydrates such as whole grains, fruit, starchy vegetables, and low-fat dairy. Fill in the rest with lean meats and healthy fats that come from plant sources such as sunflower seeds, walnuts, or canola oil.  When hunger strikes between meals, above all choose a healthy snack. And if that snack has 15g of carbohydrates or more, remember to match it with the appropriate amount of insulin.

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Which Patients See a Dietitian in a Hospital?

Monongalia General Hospital is an 189 bed acute-care community hospital and level 4 West Virginia trauma center.  With only 2 FTE clinical dietitians working each day, it’s impossible (and unnecessary) for a dietitian to visit every patient in the hospital. But who gets to the see a dietitian, and how is that decided? While it may be different at other hospitals, this is the consult system Mon Gen uses:

1- A physician or nurse orders a consult.  This could be because the physician feels the patient needs nutrition education, the patient is high-risk, or any reason they see fit.

2- A system consult is automatically ordered.  On a patient’s chart, there is a section with several boxes of criteria. If one or more of these criteria is met, the charting system automatically orders a consult. The criteria include unintentional weight loss of more than 10 pounds in 3 months, constipation, bed sores, and more.

3- The patient meets nutrition screening criteria. Dietitians can see patients that meet a specific diagnosis and/or treatment with component of nutrition therapy, including but not limited to:

  • Malnutrition, cancer, undergoing chemotherapy, radiotherapy, major surgery, oncology unit patient
  • Newly diagnosed diabetes mellitus, or uncontrolled
  • Unstable chronic renal disease
  • Unstable liver disease
  • GI: Crohn’s disease, ulcerative colitis, short bowel syndrome, GI fistula, small bowel obstruction
  • Failure to thrive
  • CVA (cerebrovascular accident or stroke) with severe dysphagia
  • Significant education needs

When these methods of ordering a consult with a dietitian are used, clinical dietitians are able to use their time wisely to see the patients who need the most help.

You ordered a consult??

Categories: Clinical Nutrition | Tags: , , , , , , , , , , , | 3 Comments

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