Dietary Information

[84RN]

I work in Home Health and have a new patient with type 2 diabetes, controlled with both diet and some insulin (Novolog Mix 70/30 twice daily).

She also takes Coumadin, so is watching her intake of vit K-rich foods.

Do you know of any sources online that I can use for food guidelines and even some meal plans. The patient is 82 and her daughter is overwhelmed with trying to make the best food choices for her mom. They don't have internet access, so anything I can print and give them is great.

Do most type 2 diabetics count carbs now, and if so, how many for each meal/snack? I'm very familiar with type 1 (2 of my kids have it), so can easily teach carb counting, reading labels, serving sizes.

[mammac5]

Anything in print from the ADA is easy to find and follow...you can probably request booklets from their site or ask any endocrinology practice in your area to share. The family could also attend output diabetes education, which usually is offered at local hospitals.

Generally for females the ADA recommends 30-45 grams of carbs with each meal, which is simple to think of as 3-4 servings. Personally, I believe this is too much CHO for most T2DM folks who need to lose weight, but it falls in line with ADA so is safe for you to recommend.

[Justabitoff]

For an older T2 patient, blood sugar control generally doesn't need to be as strict. You can help make it easier by teaching them carbohydrate exchanges, which is 15 grams each. Usually it helps elderly patients just watch portion control, but it's not precise enough for someone who is on insulin.

[CDEWannaBe]

There's no clear answer. Different people with diabetes find different ways of managing.

With your personal experience it may help her a lot to learn about carb counting so she can make decisions on what to eat or not. The best way for most type 2s to manage is to test after eating to see how different foods or meals impact blood sugar.

Low carb or South Beach type diets have the best impact on blood sugar. There's a dietician/diabetes educator who has a book out called Metabolism Makeover that advocates low carb eating. The cookbook shares the author's views and then has recipes to help people eat low carb. Note that insulin doses usually drop dramatically on low carb diets.

The Metabolism Miracle Cookbook: 175 Delicious Meals that Can Reset Your Metabolism, Melt Away Fat, and Make You Thin and Healthy for Life: Diane Kress: 9780738214252: Amazon.com: Books

Is she having unexplained high or low blood sugars with the 70/30 insulin? It has such terrible peak and duration times and can cause a lot of problems. Has she tried Lantus?

[classicdame, MSN, EdD]

If the patient is able and willing, a dietician consult would be a good thing. Many who work in hospitals do Medical Nutrition Therapy, which is covered by Medicare and other insurance, but not 100% of course. Home Health can arrange for a CDE to come to the patient if the MD presecribes. Otherwise, you are creating some liability on your part. I would not go any further than printing off what is found on the ADA or similar websites. For elderly patients I generally recommend portion control, using the FDA recommendations. Search for "My Plate"