Exercise Stress Testing

Advise those with diabetes who have any other CAD risk factors to complete an exercise stress test to rule out underlying heart disease prior to starting a moderate-intensity exercise program.  Stress testing is generally not needed for those who will be engaging in relatively low-level activities such as walking or performing armchair exercises.

General Nutrition Goals

Due to the effects of obesity on insulin resistance, weight loss is an important therapeutic objective for overweight or obese individuals with pre-diabetes or diabetes. Short-term studies have demonstrated that a moderate weight loss  of 5% body weight can decrease insulin resistance, improve blood lipids, and reduce blood pressure. The controlled intake of carbs in meals and snacks works well for glycemic control. 

While losing weight, blood glucose levels should be monitored  to see how the diet plan is working along with other treatment regimens to control blood sugar levels. Following the Mediterranean Diet guidelines seem to be beneficial for improving blood lipids.

Since heart disease is the number one complication associated with diabetes, blood lipids are closely monitored. A low fat, low cholesterol, low saturated and trans fat diet is recommended to control lipid levels.

The age range for individuals diagnosed with Type 2 diabetes mellitus is greater (teens to elderly) and the nutritional recommendations should take the needs of these different age groups into consideration.

Finally, the nutrition goals must consider any diet changes for co-existing medical conditions such as hypertension or kidney disease.

Source:  Diabetes Care Vol 34 Suppl 1: American Diabetes Association Clinical Practice Recommendations, 2011

 

Calories and Carbohydrates

Calories:

To reach/maintain IBW

  weight maintenance: 30-35 kcal/kg/day (moderately active)

  overweight/obese: 15-25 kcal/kg/day

Carbs:

To control blood glucose; count in grams

  Fiber reocmmended

  Use glycemic index

  Allocated amounts, distributed throughout day

Calorie goals are individualized to meet weight management goals. Carbohydrate goals per meal are recommended based on calorie needs and to help with glycemic control. Very low carbohydrate diets are not recommended at this time. The RDA for digestible carbohydrate is 130 grams per day based on providing adequate glucose for the central nervous system. The long term metabolic effects of very low carb diets are unclear, and such diets eliminate many foods that are important sources of fiber, vitamins and minerals. High fiber foods are recommended for satiety and for blood glucose control. In addition, the glycemic index may provide benefits in meeting blood glucose targets.