As incidence rates of diabetes and prediabetes rise, nurses will find themselves communicating with this patient population more often. How should education be handled?
A recent report by the Centers for Disease Control and Prevention claims that more than 100 million adults in the United States are living with diabetes or prediabetes, a condition that if not treated often leads to type 2 diabetes. The seventh leading cause of death in the country in 2015, diabetes, despite its severity, can often be managed in part through physical activity regimens and proper dieting (in addition to the use of insulin and other medications, of course), according to the CDC.
As the number of patients living with this disease continues to increase, nurses will continue to find themselves with opportunities to educate people on maintaining healthy eating habits as an adjunct to their ongoing care. This article will share some advice offered by the CDC and other noteworthy organizations. According to CDC officials, there are a number day-to-day triggers for elevating blood sugar that tend to be ignored, including lack of sleep, nose sprays and sunburn. There are also common food and drink culprits, such as artificial sweeteners and coffee/caffeine (with and without sweeteners), processed foods and starches. Additionally, skipping breakfast can increase blood sugar after lunch and dinner are consumed, and dehydration can result in a higher blood sugar concentration, generally speaking. General goals that the CDC suggests to be established for patients include paying special attention to a few key areas: carbohydrates, fats and cholesterol, proteins, vitamins and minerals and alcohol. When it comes to carbs, the most counted should come in the form of fiber, according to the CDC. Examples include whole-grain breads and cereals, dried beans and peas, vegetables and fruits.
Fat-free foods should be considered as much as possible and any fruit juices should be limited to no more than 4 ounces daily. Fatty and high-cholesterol fried foods should be avoided, as should high-fat dairy, butter, margarine and bacon. If nuts are consumed they should be unsalted and limited. Too much protein can lead to kidney disease more quickly, CDC officials warn, and it’s suggested that proteins from plants may be better than those from animals. Small portions of meat, fish or poultry (no more than 3 ounces at a sitting) can be complemented by being mixed with beans, peas, vegetables, fruits, grains, tofu and other soy products. A physician and/or nutritionist should be consulted before vitamin or mineral supplements are introduced, as too high of a dosage may be harmful. Those patients who drink alcohol should be educated to have only one beverage per day and should consult a physician since its consumption can increase the risk of hypoglycemia. Patients should never drink alcohol without eating something at the same time and should not drink alone.
MANAGING MEAL PLANS
According to officials with the American Diabetes Association (ADA), meal-planning education for patients should include instruction on the timing of meals along with how much to eat and which foods to choose. Meal plans should also take into account one’s likes, dislikes and lifestyle and should serve as a guide to help meet any personal weight and blood glucose goals through the following of an “eating pattern,” a term used to describe the foods or groups of foods that a person chooses to eat on a daily basis over time, according to ADA officials. Examples of eating patters include a Mediterranean diet, vegetarian (or vegan), low-carb and low-fat.
The Mediterranean style focuses on mostly plant-based foods and locally grown foods. Mall amounts of dairy are available, (for example, cheese, yogurt, fish and poultry). Olive oil is said to be the main source of fat and red meat is limited. Wine can be consumed in small amounts (1-2 glasses per day) with meals.
The vegetarian eating pattern is also based on plant foods and meat substitutes with little or no animal products. Rich in vitamins, minerals and fiber, this diet is also lower in saturated fat and cholesterol, according to the ADA. Within the vegetarian patterns are vegan, which calls for the avoidance of all meat, poultry, fish and seafood, eggs, and dairy products; lacto-vegetarian, which calls for no meat, poultry, eggs, fish or seafood; lacto-ovo vegetarian, which is similar to the lacto-vegetarian pattern but includes dairy products and eggs; low-carbohydrate, which focuses on non-starchy vegetables such as broccoli, green beans, kale, salad greens and protein foods like meat, poultry, fish, shellfish, eggs, cheese, nuts and seeds, fats (oils, butter, olives and avocado); and low-fat eating, which includes vegetables, fruits, starches, lean protein (such as chicken and turkey without the skin, fish and low-fat dairy products). According to the ADA, this eating pattern has been shown to improve heart health when overall calorie intake is reduced and weight loss occurs.
SAFE PRACTICES & FOODS TO AVOID
According to clinicians who specialize in the treatment of diabetes at the Mayo Clinic, a number of dietary do’s and don’ts can be implemented into a patient’s diet to help them manage the disease process. For starters, patients should be encouraged to eat three mails daily at regular, consistent times in an effort to assist the body in effectively using the insulin it produces or receives through medication.
Recommended foods include “healthy” carbohydrates, foods that are high in fiber, “good” fats and certain types of fish considered to be “heart healthy,” such as cod, tuna, halibut, salmon, mackerel, sardines and bluefish. Cod, tuna and halibut are said to have less total fat, saturated fat and cholesterol than the likes of meat and poultry. Additionally, tuna, as well as salmon, mackerel, sardines and bluefish are high in omega-3 fatty acids, which promote heart health by lowering triglycerides. Fish can serve as a substitute for high-fat meats and it’s recommended that patients be advised to eat those of the heart-healthy variety at least twice per week. However, patients should avoid fried fish and fish types that contain high levels of mercury, including tilefish, swordfish and king mackerel. Other foods to avoid include high-fat dairy products and animal proteins, such as beef, hot dogs, sausage and bacon.
Processed snacks, baked goods, shortening and stick margarines contained trans fats, or trans-fatty acids, which raise LDL (i.e. “bad”) cholesterol and lowers HDL (i.e. “good”) cholesterol. Common sources of cholesterol include high-fat dairy products and high-fat animal proteins, egg yolks, liver and other organ meats. Mayo clinic recommendations suggest having patients aim for no more than 200 mg of cholesterol daily, as well as less than 2,300 mg of sodium per day. (This number shrinks to less than 1,500 mg daily for those living with hypertension.)
The healthiest of carbohydrates include fruits, vegetables, whole grains, legumes and low-fat dairy. Good sources of dietary fiber include vegetables, fruits, nuts, legumes, whole-wheat flour and wheat bran. “Good” fats are monounsaturated and polyunsaturated fats that can help lower cholesterol levels and are found in such foods as avocados, almonds, pecans, walnuts, olives, canola oil, olive oil and peanut oils. All of these items are high in calories, however, so they should only be consumed conservatively.
- New CDC report: More Than 100 million Americans Have Diabetes or Prediabetes. Accessed online: www.cdc.gov/media/releases/2017/p0718-diabetes-report.html
- 10 Surprising Things That Can Spike Your Blood Sugar. Accessed online: https://www.cdc.gov/diabetes/library/spotlights/blood-sugar.html
- Living with Diabetes: What’s There to Eat? Accessed online: www.cdc.gov/diabetes/diabetesatwork/pdfs/LivingWithDiabetes.pdf
- Eating Patterns and Meal Planning. Accessed online: www.diabetes.org/food-and-fitness/food/planning-meals/diabetes-meal-plans-and-a-healthy-diet.html?loc=ff-slabnav