Providing Eating and Drinking Advice

Reviewing dietary management

Make recommendations and review eating :
		at diagnosis
		on adjustment or change to insulin regimens
		on change in professional advisor
		every other year as a routine, or more often as required
		on request
Review dietary management regularly :
		Is healthy eating ( see box ) a normal part of life-style?
		Does calorie distribution reflect the patient's life-style and desires, as well as insulin regimen and local circumstances?
		Is calorie intake appropriate to desired body weight?
		Are regular meals and snacks taken at appropriate times?
		Is money being spent unnecessarily on special 'diabetes' food products?
		Is alcohol intake moderate? Could it be exacerbating hypertension or hypertriglyceridaemia? Could it be contributing to early or late hypoglycaemia? Is this understood by the person with diabetes?
		Do kidney damage or raised blood pressure suggest a benefit from special recommendations ( protein intake <0.8 g/kg, salt intake <7 g/day, respectively )?

Nutritional management is an integral part of initial and continuing education programmes

Meal patterns

Multiple injection regiments :
	Advice snacks will help to attain better blood glucose control, but use self-monitoring to learn what is necessary and desirable
	Advice on flexibility to adjust meal timing and content ( together with insulin doses ) without affecting blood glucose control. But warn about the temptations of extra total calories
Rapid-acting insulin analogue regimens :
	Advice snacks only if self-monitoring suggests a need; check particularly if a high insulin analogue dose is needed to correct hyperglycaemia present pre-prandially

Healthy eating

Advice carbohydrate intake should be higher, and fat intake lower than that of most Europeans, but not different from recommendations for the population in general
	The proposed contribution to energy intake should be :
		Fat : saturated fat <10 %; replace excess saturated fat with monounsaturates, or polyunsaturates ( up to 10 % ), or carbohydrate
		Carbohydrate : around 50-55 %. Use foods containing soluble fibre in a carbohydrate rich diet. Simple sugars need not be rigorously excluded from the diet, but often need to be limited
		Protein : around 15 % or less
Recommend a high intake of fresh fruit and vegetables ( five items a day )

Physical Exercise

	Assessing Blood Glucose Control
	Providing Eating and Drinking Advice
	Physical Exercise
	Using Insulin Effectively
	-	Insulin, injections, and associated education
	-	Insulin dose requirements - general considerations
	-	Rapid-acting insulin analogue regimens
	-	Insulin dose adjustment
	Hypoglycameia Problems
	Managing Arterial Risk Factors and Ischaemic heart Disease