Providing Nutritional Advice

Reviewing dietary management

Review dietary management regularly :
		Is healthy eating ( see box ) a normal part of life-style?
		Is calorie intake appropriate to desired body weight?
		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?
		Is money being spent unnecessarily on special 'diabetes' food products?
		Does calorie distribution reflect the patient's life-style and preferences, as well as glucose lowering therapy and regional eating habits?
		Do raised blood pressure or kidney damage suggest a benefit from special recommendations ( protein intake <0.8 g/kg, salt intake <6 g/day, respectively )?
Make recommendations and review eating :
		at diagnosis
		at each consultation if overweight or vascular risk factor control sub-optimal
		formally every other year as a routine, or more often as required
		on beginning insulin therapy
		on request

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

Healthy eating

Advise carbohydrate intake should be higher, and fat intake lower than that of most Europeans, but not different from recommendations for the population in general :
		Saturated fat : <10 % of calories
		Polyunsaturated fat : <10 % of calories
		Carbohydrate : use foods containing soluble fibre in a carbohydrate rich diet
		Simple sugars : need not be rigorously excluded from the diet, but should be limited
		Protein : <15 % of calories
		Monounsaturated fat : use to maintain palatability and balance calorie intake
		Total calories : as required for normal body mass index
		Fresh fruit / vegetables : encouraged as part of meal-time calorie intake
		Alcohol : if desired, as part of total daily calorie intake
	Individualize intake to match needs, preferences and culture

Physical Exercise

Assessing Blood Glucose, Blood Lipid, and Blood Pressure Control

-	Blood glucose control assessment levels
-	Blood lipid control assessment levels
-	Blood pressure control assessment levels

Providing Nutritional Advice

Physical Exercise

Therapy for High Blood Glucose Concentrations

-	Using oral glucose-lowering drugs
-	Insulin therapy in Type 2 diabetes

Therapy for Abnormal Blood Lipid Concentrations

Therapy for Raised Blood Pressure

Managing Arterial Risk Factors