Educating Your Patients On Nutrition And Exercise

By Pamela M. Jensen, DPM

Convey The Importance Of Fiber
The ADA gives the following recommendations for people with diabetes:
• Limit fat to 30 percent or less of daily calories.
• Limit saturated fat to 10 percent or less of daily calories.
• Limit protein to 10 to 20 percent of daily calories. For those with initial signs of diabetes-induced kidney disease, restrict protein to 10 percent of daily calories.
• Limit cholesterol to 300 milligrams or less daily.
• Consume about 20 to 35 grams of fiber daily.
Fiber, which includes whole grain products, fruits, vegetables and legumes, plays an important role in glycemic control and weight management. The skins on the fruits and vegetables contain the largest amount of fiber and should also be consumed. Fiber is not broken down by the body and is not metabolized into carbohydrates although it is considered one. Therefore, it can be subtracted from the total carbohydrate consumption of what one is eating.
The average American eats half of the recommended 20 to 35 grams of fiber each day. A diabetic who eats greater than 50 grams of fiber a day is able to control blood sugars far better than those who eat less. In addition, fiber adds bulk and makes you feel full, aiding in weight loss. To avoid constipation, remember to drink six to eight glasses of water per a day.

What Vitamins Can Have An Impact For Your Diabetes Patients?
Well-balanced meals and snacks are important in supplying the majority of one’s nutrients. If the diet is not well rounded, a vitamin supplement is not going to make up for large losses of nutrients. In addition, many foods contain beneficial substances that cannot be obtained by a supplement. A vitamin and mineral supplement with no more than 100 to 150 percent of the daily-recommended value (with at least 20 types of vitamins and minerals listed) is appropriate. It should contain 400 mg of folic acid and 400 IU of vitamin D. Men usually do not need a supplement with iron. Store-brand supplements are as good as name-brand supplements.
Vitamin C and E are antioxidants that neutralize free radicals that damage cell and can lead to diseases like cancer, heart disease and lung disease. Vitamin C levels in diabetics are generally lower due to high blood sugar levels, hampering the uptake of Vitamin C by cells. Vitamin C has known influence in aiding control of blood sugar levels as well as control of cholesterol and triglyceride levels. Recommended daily requirement of vitamin E is 30 IU and there is some evidence that it may play a role in preventing kidney and/or eye damage. However, a large dosage greater than 800 IU increases the risk of stroke in those with high blood pressure and interferes with anticoagulants.

Five Key Tips On Exercise
When giving advice to diabetes patients about exercise, consider the following tips.
• If the patient is 35, he or she may need a stress test.
• Emphasize blood glucose testing before and after exercise. These patients should not exercise if blood glucose is over 250 and there are ketones in their urine. If blood glucose is over 250 but no ketones are present, you should follow these guidelines. Tell type 1 patients not to exercise if their blood glucose is 300 or more. Tell type 2 patients not to exercise if their blood glucose is 400 or more.
• Encourage these patients to always carry a carbohydrate snack.
• Encourage them to drink plenty of fluids.
• Emphasize wearing shoes and equipment that fit well.

Final Thoughts
A well-balanced diet combined with exercise can lower the blood sugar and improve the body’s ability to use glucose. A variety of factors influence how quickly food is digested. Meals with large amounts of fiber and raw foods take longer to digest and reduce the degree of blood sugar elevation. With regular exercise, the amount of insulin needed decreases. In addition, a balanced diet with exercise decreases the risk factors for heart disease, improves the control of high blood pressure, facilitates weight loss, aids in relieving depression and increases energy levels.
In conclusion, educating the patient about a proper well-balanced diet and exercise will empower the patient to control his or her blood sugars without feeling guilty and deprived.

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