Nutrition in Diabetes Mellitus

Clinical assessment

Nutritional assessment is part of overall diabetes management. Includes dietary history (types/amounts of food, meal timing), weight/BMI, waist circumference, eating habits, understanding of diabetes and diet.

Investigations

• Anthropometry: Weight, Height, BMI, Waist Circumference.
• Biochemical: Blood glucose monitoring (SMBG, HbA1c), Lipid profile, Blood pressure.
• Dietary Assessment: Food frequency questionnaire, 24-hour recall, food diary.

Diagnostic criteria

Not applicable - This provides dietary guidance for diagnosed diabetes.

Non-pharmacological management

• Medical Nutrition Therapy (MNT): Individualized plan ideally developed with Dietitian/Nutritionist.
• General Principles (Healthy Eating Plate Model often useful):
• - Regular Meals: Eat 3 balanced meals/day at regular times, avoid skipping.
• - Carbohydrates: Choose high-fibre, low glycaemic index sources (whole grains - brown rice/bread/posho, oats, legumes, starchy vegetables like sweet potato/yam, fruits). Control portion size (~1/4 to 1/3 plate). Limit refined grains, sugary drinks, sweets, pastries.
• - Fats: Limit saturated/trans fats (fatty meats, butter, ghee, processed snacks). Choose unsaturated fats (vegetable oils, avocado, nuts, seeds).
• - Protein: Include lean sources (~1/4 plate) (beans, lentils, peas, fish, poultry without skin, lean meat).
• - Vegetables: Fill half the plate with non-starchy vegetables.
• - Fruits: Include as part of balanced meals/snacks (be mindful of portion size).
• - Salt: Limit intake (<5-6g/day). Reduce added salt, limit processed/salty foods.
• - Alcohol: Moderation only (if allowed, with food).
• - Hydration: Drink plenty of water.
• Weight Management: Aim for gradual weight loss if overweight/obese.
• Physical Activity: Integrate regular exercise (aerobic + resistance).
• Consistency: Consistent timing and amount of food intake, especially carbohydrate, helps stabilize blood glucose, particularly if on insulin or certain oral agents.

Pharmacological treatment

• Dietary management works in conjunction with diabetes medications.
• No specific pharmacological nutritional supplements routinely recommended unless deficiency identified.

Monitoring

Self-monitoring of blood glucose (SMBG) to assess impact of meals. Regular monitoring of HbA1c, lipids, BP, weight/BMI. Review dietary adherence and adjust plan as needed.