TPN

Prevention

First, let’s look over some of the preventive care strategies that can be undertaken.

Coordination of professional care by a primary care physician with specialists to monitor common complications of diabetes may be warranted. An endocrinologist can assist with specific diabetes care to control blood sugars; an ophthalmologist can provide routine testing for early identification of sight complications; a podiatrist can evaluate for common manifestations of diabetes complications in feet; and a dentist can provide preventive care and education for oral hygiene. The American Diabetes Association recommends consultation and intervention planning with a Registered Dietitian/Nutritionist for lifestyle management.

Routine blood and other tests will help to monitor glycemic control, risk factors for complications, and any progression of diabetes complications. These tests include monitoring for blood glucose control through hemoglobin A1c, which we will discuss in more detail in the monitoring section. Blood pressure and blood lipid monitoring will help to adjust treatment strategies to prevent complications. Urinary protein tests, cardiac stress tests, and thyroid function tests can also reveal potential health problems that should be considered in patient education and treatment. Thyroid dysfunction can have a strong bearing on diabetes control and the risk for complications.

Dietary Modifications

The recommendations for diet for people living with diabetes really comes down to a healthy eating plan, which would benefit anyone, even without diabetes.(13) The important concepts include a variety of nutritious foods in moderation at routine mealtimes.(13,14)

Dietary carbohydrates, we will call this “carbs”, are a source of blood sugar and can be modulated. Some carbs enter the bloodstream quickly and raise blood sugar. Other carbs may enter more slowly and may help to keep blood sugar in check. It is important to remember that carbs are an important source of energy for the body and should not be avoided. We will talk about how different sources of carbohydrates affect blood sugar and best choices.

The type of carbohydrate matters. We can use a ranking of foods according to how much they raise blood sugars called the “glycemic index” to determine best choices. A low glyemic index (55 or less) will likely have less simple sugar, more fiber, and possibly more fat that will slow the absorption of carbohydrates into the bloodstream. A high glycemic index food (70 or above) may contribute to quicker increases in blood sugar, making it harder to control levels. However, it is not just the single food that counts, but the whole meal or snack. Low GI foods may help to keep higher GI foods in check.

It will be important to note that the application of the glycemic index in diet education can be complicated and daunting to patients.

It may also be important to consider the “glycemic load” or the measure of both glycemic quality of foods (which is the glycemic index) and the quantity of carbohydrates in the diet.

Dietary fat recommendations are based on heart-healthy choices for less saturated and trans fats.

Dietary protein should be consumed in moderation and other recommendations are based on any risk factors for additional problems, such as hypertension.

Rick Fields-Gardner