Monday, October 24, 2011

Secretes to success in your dietitians office

I have had the pleasure of working with many dietitians and I believe that their expertise, work and compassion provide the basic components needed for successful diabetes management. Without their help , your success with food management and diabetes control is almost impossible. They are basically just full of useful difficult to accomplish information that you and I need to know as patients.

After one little quote from the American Diabetes Association treatment guidelines , I will start revealing the secretes of how to get the most out of your visit with a dietitian.

"Although numerous studies have attempted to identify the optimal mix of macronutrients for meal plans of people with diabetes, it is unlikely that one such combination of macronutrients exists. The best mix of carbohydrate, protein,and fat appears to vary depending on individual circumstances. It must be clearly recognized that regardless of the macronutrient mix, total caloric intake must be appropriate to weight management goal. Further,individualization of the macronutrient composition will depend on the metabolic status of the patient (e.g., lipid profile, renal function) and/or food preferences. Plant-based diets (vegan or vegetarian) that are well planned and nutritionally adequate have also been shown to improve metabolic control

Basically the above quote points out that no one knows the exact proportions of different foods we should eat. Our specific food habits have to be evaluated and then adjusted to the requirements imposed on us by diabetes .We will focus on carbohydrates for this discussion because they have the most impact on our efforts to control blood glucose levels. Proteins and fats in our diet are also important but have less direct effect on our daily glucose levels.

The requirements imposed on us by diabetes is primarily the result of our pancreas failure to produce enough insulin to effectively use the glucose derived from the carbohydrates in our diet.

Basic ideas

#1 recognize foods that contain carbohydrates- fruit , vegetables , grains and milk

#2 control portion size-- understanding that 15 gms is one serving

#3 become more consistent with carbohydrate intake from day to day

# 4 start reading food labels

It is also a good idea to hear a lecture on diabetes diet in class and read about the diabetes diet on google , however that will not move the needed information into the getting it done portion of your brain.

Practice and multiple repetitions help turn ideas into usable tools.
practice and repetition converts
Remember your diet has to be adapted to you as an individual.

Now how to talk to your dietitian, right after you do a little home work.
Home work

Review - look under Diabetes resources , down loadable materials
My Carbohydrate guide. I like page 13 The" Handy" guide to portion sizes

Review - Mediterranean diet ideas from my blog a few days ago and try to find ways for
including These ideas into your life style.

Start - reading carbohydrate amounts on food labels for the commonly used foods in your current diet

Start - using measuring cups and comparing your fist size to 1 cup. Your hand could become a
useful always with you measuring tool to help with portion size .

Start - thinking about how many grams of carbohydrate do I need to eat each day. How much at
each meal

Start - keeping and easy to read food diary with portion sizes for at least 1 week before seeing you dietitian


The American Diabetes Association recommends a minimum of 120 to 130 grams o
I will share my simple tool for estimating the carbohydrates needed for a 40%
carbohydrate diet.

Goal weight = grams of carbohydrate per day

Example. 178 pounds = 178 grams of carbohydrate
( I will provide the complete formula if requested)

The American Diabetes Association recommends at least 120 to 130 grams of carbohydrate each day

the how to talk to a dietitian secretes exposed

Hand the dietitian your food diary records , tell her about you home work above and then say!

Can you help me adjust my eating habits and life style to meet the requirements imposed on me by having diabetes.

Consider adding some of the Mediterranean diet ideas to your plan.

Have fun ,read food labels

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Your comments and questions are appreciated. David Calder,MD